Expanding the non-technical skills vocabulary of operating room nurses: a qualitative study.

BACKGROUND: Operating room nurses have specialised technical and non-technical skills and are essential members of the surgical team. The profession's dependency of tacit knowledge has made their non-technical skills difficult to access for researchers, thus, creating limitations in the identification of the non-technical skills of operating room nurses. Non-technical skills are categorised in the crew resource management framework, and previously, non-technical skills of operating room nurses have been identified within the scope of the framework. The purpose of this study is to explore operating room nurses' descriptions of their practices in search for non-technical skills not included in the crew resource management framework. METHODS: This study has a qualitative design. An expert panel of experienced operating room nurses (N = 96) in Norway provided qualitative descriptions of their practice in a Delphi survey. The data were analysed in an inductive thematic analysis. This study was conducted and reported in line with Standards for Reporting Qualitative Research (SRQR). RESULTS: The inductive thematic analysis developed two themes, 'Ethical competence' and 'Professional accountability', that encompass operating room nurses' novel descriptions of their non-technical skills. The participants take pride in having the patients' best interest as their main objective even if this may threaten their position in the team. CONCLUSIONS: This study has identified novel non-technical skills that are not described in the crew resource management framework. These findings will contribute to the development of a new behavioural marker system for the non-technical skills of operating room nurses. This system will facilitate verbalisation of tacit knowledge and contribute to an increased knowledge about the operating room nursing profession.

How nursing care is expressed among nurse anaesthetists in the perioperative context: A meta-ethnographic synthesis.

AIM: To develop a conceptual framework describing nursing care from the anaesthesia nurse's perspective in the perioperative context. BACKGROUND: Surgical patients find themselves in a vulnerable situation in need of advanced treatment and care. Nurse anaesthetists have a central role in reducing harm and enhance patient safety, in which person-centred care has been identified as a key component. However, they are challenged by productivity and efficiency demands leading to a potential risk to patient safety. DESIGN: Noblit and Hare's interpretative meta-ethnography, directed by the eMERGe reporting guidance. METHODS: A comprehensive systematic search of nine databases without year limitation. Fifteen studies published between 2002 and 2021 were found eligible for inclusion. Quality appraisal was performed using the Joanna Briggs Institute Qualitative Assessment and Review Instrument. RESULTS: Four themes were identified: being vigilant to keep safe from harm, strengthening patients' confidence, expressing courage to act and speak up, and endorsing team collaboration to achieve best practice. The themes were synthesised into the metaphor, 'Continuously assessing and acting according to the patients' needs in a holistic perspective'. A conceptual framework was developed, illustrating the interconnection between the different nursing expressions, as the nurse anaesthetists seek to care for the patient as a whole person. CONCLUSIONS: Nurse anaesthetists aim to deliver holistic nursing care. Nursing care is expressed at two levels, foregrounding and backgrounding anaesthetic nursing, in line with the philosophy of person-centred care. Nursing care in anaesthesia is a matter of how and why it is performed, expressed in attitudes toward the recipients of care. RELEVANCE TO CLINICAL PRACTICE: The framework may be used to inform educational programs and clinical practice in nurse anaesthesia and to promote person-centred care as a shared value across all levels involved in perioperative patient care. NO PATIENT OR PUBLIC CONTRIBUTION: Data were retrieved from already published literature.

Reduction in omission events after implementing a Rapid Response System: a mortality review in a department of gastrointestinal surgery.

BACKGROUND: Hospitals worldwide have implemented Rapid Response Systems (RRS) to facilitate early recognition and prompt response by trained personnel to deteriorating patients. A key concept of this system is that it should prevent 'events of omission', including failure to monitor patients' vital signs, delayed detection, and treatment of deterioration and delayed transfer to an intensive care unit. Time matters when a patient deteriorates, and several in-hospital challenges may prevent the RRS from functioning adequately. Therefore, we must understand and address barriers for timely and adequate responses in cases of patient deterioration. Thus, this study aimed to investigate whether implementing (2012) and developing (2016) an RRS was associated with an overall temporal improvement and to identify needs for further improvement by studying; patient monitoring, omission event occurrences, documentation of limitation of medical treatment, unexpected death, and in-hospital- and 30-day mortality rates. METHODS: We performed an interprofessional mortality review to study the trajectory of the last hospital stay of patients dying in the study wards in three time periods (P1, P2, P3) from 2010 to 2019. We used non-parametric tests to test for differences between the periods. We also studied overall temporal trends in in-hospital- and 30-day mortality rates. RESULTS: Fewer patients experienced omission events (P1: 40%, P2: 20%, P3: 11%, P = 0.01). The number of documented complete vital sign sets, median (Q1,Q3) P1: 0 (0,0), P2: 2 (1,2), P3: 4 (3,5), P = 0.01) and intensive care consultations in the wards ( P1: 12%, P2: 30%, P3: 33%, P = 0.007) increased. Limitations of medical treatment were documented earlier (median days from admission were P1: 8, P2: 8, P3: 3, P = 0.01). In-hospital and 30-day mortality rates decreased during this decade (rate ratios 0.95 (95% CI: 0.92-0.98) and 0.97 (95% CI: 0.95-0.99)). CONCLUSION: The RRS implementation and development during the last decade was associated with reduced omission events, earlier documentation of limitation of medical treatments, and a temporal reduction in the in-hospital- and 30-day mortality rates in the study wards. The mortality review is a suitable method to evaluate an RRS and provide a foundation for further improvement. TRIAL REGISTRATION: Retrospectively registered.

Expanding the theoretical understanding in Advanced Practice Nursing: Framing the future.

AIM: We aimed to discuss the importance of the integration of nursing theories in advanced nursing to meet future demands. BACKGROUND: Nursing studies reporting a lack of professional care have increased in recent years and indicate a global complex socioecological problem. The lack of a clear theoretical understanding in education, research and practice makes Advanced Practice Nursing invisible and vulnerable. DESIGN: A theoretical paper was selected to stimulate vital reflexion and debate about the importance of theory integration. METHODS: The selection of nursing theories represents the position of some theorists based on our experiences with national and international research and personal leadership in a master's degree program. IMPLICATIONS FOR NURSES: For nurses to continue to make a difference in the lives of their patients, practitioners, and researchers need to practice and expand theoretical understanding within their fields. This would enable them to be visible and at the forefront of the wider changes in health care owing to their central position and connection to health organizations. CONCLUSION: Nursing theories are essential to the continuing evolution of the discipline of nursing. Postgraduate programs in nursing and research must be encouraged to use and further develop nursing theories to facilitate the advancement of nursing care in education, research, and practice.

We Are Not There Yet: A Qualitative System Probing Study of a Hospital Rapid Response System.

OBJECTIVES: The capability of a hospital's rapid response system (RRS) depends on various factors to reduce in-hospital cardiac arrests and mortality. Through system probing, this qualitative study targeted a more comprehensive understanding of how healthcare professionals manage the complexities of RRS in daily practice as well as identifying its challenges. METHODS: We observed RRS through in situ simulations in 2 wards and conducted the debriefings as focus group interviews. By arranging a separate focus group interview, we included the perspectives of intensive care unit personnel. RESULTS: Healthcare professionals appreciated the standardized use of the National Early Warning Score, when combined with clinical knowledge and experience, structured communication, and interprofessional collaboration. However, we identified salient challenges in RRS, for example, unwanted variation in recognition competence, and inconsistent routines in education and documentation. Furthermore, we found that a lack of interprofessional trust, different understandings of RRS protocol, and signs of low psychological safety in the wards disrupted collaboration. To help remedy identified challenges, healthcare professionals requested shared arenas for learning, such as in situ simulation training. CONCLUSIONS: Through system probing, we described the inner workings of RRS and revealed the challenges that require more attention. Healthcare professionals depend on structured RRS education, training, and resources to operate such a system. In this study, they request interventions like in situ simulation training as an interprofessional educational arena to improve patient care. This is a relevant field for further research. The Consolidated Criteria for Reporting Qualitative Studies Checklist was followed to ensure rigor in the study.

A Delphi study identifying operating room nurses' non-technical skills.

AIM: To identify the non-technical skills of operating room nurses. This is the first empirical study that includes scrub and circulating operating room nurses. DESIGN: A three-round modified online Delphi technique was used for this study. METHODS: Eligible participants (n = 106) with a minimum of 2 years of operating room nursing experience were selected for the expert panel by self-recruitment from a population (N = 1640) of operating room nurses. Data were collected through online surveys, based on crew recourse management theory, between April and September 2020. Descriptive statistics analysis was used for the quantitative data, and deductive thematic analysis for the qualitative data. Consensus was determined using stability between the survey rounds. RESULTS: A consensus was obtained to maintain the non-technical skills categories of situation awareness, leadership, decision-making, communication and teamwork. The qualitative data revealed several novel non-technical skills, including independent decision-making and leadership skills. CONCLUSION: The non-technical skills of operating room nurses are more extensive than previously identified. This study has contributed to a verbalization of the tacit knowledge and skills of the operating room nurses. In addition, a list of non-technical skills that should be included in the education of operating room nurses to ensure patient safety in the operating room has been prepared. IMPACT: This study addresses the lack of research on the non-technical skills of operating room nurses. When exploring the non-technical skills of scrub and circulating nurses, a diversity of novel non-technical skills was uncovered. This research will provide input for the development of a new training, supervision and assessment tool for accelerated development of the non-technical skills of operating room nurses. This contribution to the verbalization of the formerly tacit non-technical skills may facilitate clinical and formal teaching of such skills and may subsequently impact surgery-related patient safety.

The core qualities and competencies of the intensive and critical care nurse, a meta-ethnography.

AIM: To develop a conceptual framework of the core qualities and competencies of the intensive and critical care nurse based on the experiences of intensive care patients, their relatives and the intensive and critical care nurses. DESIGN: Meta-ethnography. DATA SOURCES: A comprehensive, systematic search in seven databases supplemented with hand, citation and reference search. Sources published from 2007 to 2019 were included. REVIEW METHODS: Noblit and Hare's understanding of meta-ethnography and the work of the eMERGE project have directed the synthesis. RESULTS: Nineteen studies were included and synthesized into a conceptual framework. Overarching theme: 'feeling safe and being safe', subtheme: 'creating confidence and motivation' and conceptual categories (CCs): 'technical skills and biophysical knowledge'; 'inter/intra professional teamwork skills'; 'communication skills (with patients and their relatives)'; 'constant and attentive bedside presence'; 'creating participative care'; 'creating confidence through daily care'; 'creating a good atmosphere and having a supportive and encouraging attitude'; and 'building relationship to maintain self-esteem'. CONCLUSION: By including the perspectives of intensive care patients, their relatives and intensive and critical care nurses, the core qualities and competencies comprise elements of both patient safety and the feeling of safety. The framework outlines concepts necessary to ensure person-centred and safe intensive care. Further research should involve each perspective to validate and strengthen the findings. IMPACT: The development of standards and competence guidelines expressing the learning outcomes and qualification of intensive and critical care nurses should be based on input from intensive care patients, their relatives and intensive and critical care nurses. A variety of core qualities and competencies are necessary to create confidence and motivation, and to make the patient feel safe and be safe. This conceptual framework might form a basis for development of a program or assessment tool to facilitate excellence in education and practice in intensive care.

The value of information and support; Experiences among patients with prostate cancer.

AIMS AND OBJECTIVES: To explore and analyse prostate cancer survivors` experiences and critical reflections of information received during their cancer trajectory. BACKGROUND: Prostate cancer is one of the most prevalent cancers in men worldwide. Treatment causes side effects such as urinary incontinence, bowel changes and erection problems influencing sex life and manhood. Cancer pathways are designed to give patients and their relatives a predictable and as stress-free as possible treatment trajectory and minimise waiting time. DESIGN: Qualitative, explorative research design. METHODS: Focus groups with 16 prostate cancer survivors after having participated in an educational programme. The COREQ checklist was followed to ensure rigour in the study. RESULTS: The main theme, 'Help me stay in control', and three subthemes, 'To be met with interest and support, enough knowledge to understand what is happening and a plan to build the new life on', emerged from qualitative analysis and highlighted the participants' need for information and support, specially scheduled at critical times in the treatment trajectory: the diagnostic phase, the treatment phase and the life after treatment. They also highlighted the need for empathy and interest from healthcare professionals and highlighted the need for arenas to discuss vulnerable topics. Contact with peers was perceived as supportive and encouraging. CONCLUSION: Healthcare professionals must support prostate cancer survivors with empathy, interest and information tailored to their needs in three different phases. Continuity in information flow may increase trust and satisfaction among the prostate cancer survivors. RELEVANCE TO CLINICAL PRACTICE: PCa patients' need for information varied at critical times in their treatment trajectory. HCP should meet them with empathy and interest to be able to tailor their need for information and support.

A work system analysis of the medication administration process in a Norwegian nursing home ward.

Nursing home patients often have multiple diagnoses and a high prevalence of polypharmacy and are at risk of experiencing adverse drug events. The study aims to explore the dynamic interactions of stakeholders and work system elements in the medication administration process in a nursing home ward. Data were collected using observations and interviews. A deductive content analysis led to a SEIPS-based process map and an accompanying work system analysis. The study increases knowledge of the complexity of the medication administration process by portraying the dynamic interactions between the major stakeholders in the work system, and the temporal flow of the activities involved. Secondly, it identifies facilitators and barriers in the work system linked to the medication administration process. Most barriers and facilitators are associated with the work system elements - tools & technology, organisation and tasks - and occur early in the medication administration process.

Understanding beneficial self-management support and the meaning of user involvement in lifestyle interventions: a qualitative study from the perspective of healthcare professionals.

BACKGROUND: In light of the high prevalence of overweight and obesity among adults and the subsequent stigmatization and health consequences, there is a need to develop effective interventions to support lifestyle change. The literature supports the key role of healthcare professionals (HPs) in facilitating self-management through lifestyle interventions for those with chronic conditions. However, there is a lack of knowledge about how HPs practice self-management support (SMS) and user involvement for persons afflicted by overweight or obesity in lifestyle interventions in primary care Healthy Life Centres (HLC). The aim of this study was to explore how HPs provide SMS and what user involvement implies for HPs in HLCs. METHODS: An interpretative exploratory design, using qualitative thematic analysis of data from two focus group interviews with ten HPs from eight different HLCs, was conducted. RESULTS: The analysis resulted in one overall theme; A partnership based on ethical awareness, non-judgemental attitude, dialogue and shared responsibility, comprising four interrelated themes: 1) Supporting self-efficacy, self-worth and dignity through an attitude of respect, acknowledgement and generosity, 2) Promoting self-belief and self-perceived health, 3) Collaborating and sharing responsibility, and 4) Being flexible, adjusting and sharing time. CONCLUSION: HPs in HLCs see service users as equal partners in a collaboration based on shared responsibility, acknowledgement and generosity. In order to help, their practice involves a heightened level of ethical awareness, including a non-judgemental attitude and dialogue. HPs in HLCs have something to teach us about ethical acting and helping persons who are struggling with overweight or obesity to change their lifestyle and regain dignity. They seem to see the service users' existential needs and have learned the art of meeting the other in her/his most vulnerable situation i.e., seeking help for a "wrong lifestyle". It may be time to highlight the need for SMS and user involvement to focus on shared responsibility in partnership rather than personal responsibility. More research is required to explore the conditions for such practice.

Trends and recommendations for critical care nursing research in the Nordic countries: Triangulation of review and survey data.

BACKGROUND: Priorities for critical care nursing research have evolved with societal trends and values. In the 1980s priorities were the nursing workforce, in 1990s technical nursing, in 2000s evidence-based nursing and in 2010s symptom management and family-centred care. OBJECTIVES: To identify current trends and future recommendations for critical care nursing research in the Nordic countries. METHODS: We triangulated the results of a literature review and a survey. A review of two selected critical care nursing journals (2016-2017) was conducted using content analysis to identify contemporary published research. A self-administered computerised cross-sectional survey of Nordic critical care nursing researchers (2017) reported current and future areas of research. RESULTS: A review of 156 papers identified research related to the patient (13%), family (12%), nurse (31%), and therapies (44%). Current trends in the survey (n = 76, response rate 65%) included patient and family involvement, nurse performance and education, and evidence-based protocols. The datasets showed similar trends, but aftercare was only present in the survey. Future trends included symptom management, transitions, rehabilitation, and new nursing roles. CONCLUSION: Critical care nursing research is trending toward increased collaboration with patient and family, delineating a shift toward user values. Recommendations include long-term outcomes and impact of nursing.

Patients' Experiences of Participating Actively in Shared Decision-Making in Mental Care.

BACKGROUND: Patients in mental care express a wish for more active participation. Shared decision-making is a way of increasing patient participation. There is lack of research into what the shared decision-making process means and how the patients can participate in and experience it in the context of mental care. OBJECTIVE: To describe patient participation in shared decision-making in the context of indoor mental care. METHOD: A qualitative content analysis of data from in-depth interviews with 16 patients was performed. RESULTS: One main theme was revealed: thriving in relation to participating actively in a complementary ensemble of care, which represented the red thread between 2 themes: having mental space to discover my way forward and being in a position to express my case. CONCLUSION: Patients can participate actively in shared decision-making when the patients' and the mental health-care professionals' joint expertise is applied throughout their mental care. The patients experience thriving when participating actively in a complementary ensemble of care.

Succeeding with rapid response systems - a never-ending process: A systematic review of how health-care professionals perceive facilitators and barriers within the limbs of the RRS.

BACKGROUND: Meta-analyses show that hospital rapid response systems (RRS) are associated with reduced rates of cardiorespiratory arrest and mortality. However, many RRS fail to provide appropriate outcomes. Thus an improved understanding of how to succeed with a RRS is crucial. By understanding the barriers and facilitators within the limbs of a RRS, these can be addressed. OBJECTIVE: To explore the barriers and facilitators within the limbs of a RRS as described by health-care professionals working within the system. METHODS: The electronic databases searched were: EMBASE, MEDLINE, CINAHL, Epistemonikos, Cochrane, PsychInfo and Web of Science. Search terms were related to RRS and their facilitators and barriers. Studies were appraised guided by the CASP tool. Twenty-one qualitative studies were identified and subjected to content analysis. RESULTS: Clear leadership, interprofessional trust and collaboration seems to be crucial for succeeding with a RRS. Clear protocols, feedback, continuous evaluation and interprofessional training were highlighted as facilitators. Reprimanding down the hierarchy, underestimating the importance of call-criteria, alarm fatigue and a lack of integration with other hospital systems were identified as barriers. CONCLUSION: To succeed with a RRS, the keys seem to lie in the administrative and quality improvement limbs. Clear leadership and continuous quality improvement provide the foundation for the continuing collaboration to manage deteriorating patients. Succeeding with a RRS is a never-ending process.

Being in a space of sharing decision-making for dignified mental care.

WHAT IS KNOWN ON THE SUBJECT?: Several studies describe barriers and facilitators for implementing shared decision-making in mental care, yet a deeper understanding of the meaning of shared decision-making in this context is lacking. Shared decision-making is aimed at facilitating patients' active participation in their care. Mental care is intended to empower the patients by increasing their responsibility and self-awareness and helping them to use their own resources. Too much focus on the patients' independence, responsibility and choice may hinder the patients getting the help they need. WHAT THIS PAPER ADDS TO EXISTING KNOWLEDGE?: The meaning of SDM can be understood as a continuous relational process between the patients and MHCPs in search of dignified care. Practising shared decision-making is a challenging process which requires the MHCPs to possess high professional competence. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: Mental healthcare professionals should be conscious of their own role in the asymmetrical power relationship in decision-making and use their professional competence for their patients' benefit. Clinical supervision can be a tool for developing professional competence and is considered important when assisting mental healthcare professionals practising shared decision-making for dignified care. Abstract Introduction Several studies describe barriers and facilitators for implementing shared decision-making in mental care. However, a deeper understanding of the meaning of shared decision-making in this context is lacking. Shared decision-making is aimed at facilitating patients' active participation in their care by placing them at the centre of care. Too much focus on the patients' autonomy may hinder them getting the help they need. A comprehensive understanding of shared decision-making is needed for its implementation. Aim/research question To interpret the meaning of shared decision-making in mental care as perceived by patients and mental healthcare professionals. The research question was: What is the meaning of shared decision-making in mental care? Method A hermeneutic inductive design with a thematic interpretative analysis of data was performed from in-depth interviews with 16 patients and multistage focus group interviews with eight mental healthcare professionals. Results The overall theme being in a space of sharing decision-making for dignified mental care was described by the three themes engaging in a mental room of values and knowledge, relating in a process of awareness and comprehension and responding anchored in acknowledgement. Discussion Balancing the patients' need for assistance with autonomy, while safeguarding their dignity, is a challenging process requiring mental healthcare professionals to possess professional competence. Implications for practice Organized professional development of the carers' professional competence is important to facilitate shared decision-making.

Medication administration in nursing homes: A qualitative study of the nurse role.

AIMS: The objective of this study was to expand the knowledge of the nurse role during medication administration in the context of nursing homes. The following research question guided the study: How can the nurse role during medication administration in nursing homes be described? DESIGN: A QUAL-qual mixed study design was applied. METHODS: Data were collected using partial participant observations and semi-structured interviews of all staff members involved in medication administration. An inductive content analysis was performed. RESULTS: Medication administration is a pervasive process ingrained in the day-to-day activities of providing care to the patients. The nurse role is compensating, flexible and adaptable. There is a dynamic interaction between several contributory factors, those being shifting responsibility, a need for competence, invisible leadership, varying available competence, staff stability and vulnerable shifts.

Healthy Life Centre participants' perceptions of living with overweight or obesity and seeking help for a perceived "wrong" lifestyle - a qualitative interview study.

BACKGROUND: Overweight and obesity are complex conditions, associated with a wide range of serious health issues. In contemporary society, body size is an important part of a person's self-representation. Lifestyle changes are difficult and long-term weight management is associated with a high risk of failure. In primary health care in Norway, lifestyle interventions are offered by Healthy Life Centres (HLCs) to those seeking help with weight management. The aim of this study was to explore HLC participants' experiences of living with overweight or obesity and perceptions of seeking help to change dietary and activity habits. METHOD: This exploratory study employed a qualitative design. Semi-structured in-depth interviews were conducted with 13 participants. Data were transcribed verbatim and analysed using qualitative content analysis. RESULTS: The analysis resulted in one main theme: Searching for dignity, based on two themes: 1) Needing to justify avoidance of personal responsibility and 2) A desire to change. CONCLUSION: Changing dietary and activity habits is difficult as the emotional alternation between shame, guilt and pride influences the ability to assume personal responsibility. A deeper understanding of each participant's perceptions and experiences is important for the ability to tailor and provide a high quality health service. Addressing participants' emotional distress and search for dignity is necessary for enabling dietary and activity change. This should be considered in the future development of HLCs and health promotion interventions in order to educate service users about emotions and the role they play in food consumption and inactivity. Weight stigma at individual and system level as well as responsibility related to dilemmas about "right" or "wrong" lifestyle should be addressed.

Medication administration and interruptions in nursing homes: A qualitative observational study.

AIMS AND OBJECTIVES: To contribute in-depth knowledge of the characteristics of medication administration and interruptions in nursing homes. The following research questions guided the study: How can the medication administration process in nursing homes be described? How can interruptions during the medication administration process in nursing homes be characterized? BACKGROUND: Medication administration is a vital process across healthcare settings, and earlier research in nursing homes is sparse. The medication administration process is prone to interruptions that may lead to adverse drug events. On the other hand, interruptions may also have positive effects on patient safety. DESIGN: A qualitative observational study design was applied. METHODS: Data were collected using partial participant observations. An inductive content analysis was performed. RESULTS: Factors that contributed to the observed complexity of medication administration in nursing homes were the high number of single tasks, varying degree of linearity, the variability of technological solutions, demands regarding documentation and staff's apparent freedom as to how and where to perform medication-related activities. Interruptions during medication administration are prevalent and can be characterised as passive (e.g., alarm and background noises), active (e.g., discussions) or technological interruptions (e.g., use of mobile applications). Most interruptions have negative outcomes, while some have positive outcomes. CONCLUSIONS: A process of normalisation has taken place whereby staff put up with second-rate technological solutions, noise and interruptions when they are performing medication-related tasks. Before seeking to minimise interruptions during the medication administration process, it is important to understand the interconnectivity of the elements using a systems approach. RELEVANCE TO CLINICAL PRACTICE: Staff and management need to be aware of the normalisation of interruptions. Knowledge of the complexity of medication administration may raise awareness and highlight the importance of maintaining and enhancing staff competence.

Evaluating the past to improve the future - A qualitative study of ICU patients' experiences.

BACKGROUND: The recovery period for patients who have been in an intensive care unitis often prolonged and suboptimal. Anxiety, depression and post-traumatic stress disorder are common psychological problems. Intensive care staff offer various types of intensive aftercare. Intensive care follow-up aftercare services are not standard clinical practice in Norway. OBJECTIVE: The overall aim of this study is to investigate how adult patients experience theirintensive care stay their recovery period, and the usefulness of an information pamphlet. METHOD: A qualitative, exploratory research with semi-structured interviews of 29 survivors after discharge from intensive care and three months after discharge from the hospital. RESULTS: Two main themes emerged: "Being on an unreal, strange journey" and "Balancing between who I was and who I am" Patients' recollection of their intensive care stay differed greatly. Continuity of care and the nurse's ability to see and value individual differences was highlighted. The information pamphlet helped intensive care survivors understand that what they went through was normal. CONCLUSIONS: Continuity of care and an individual approach is crucial to meet patients' uniqueness and different coping mechanisms. Intensive care survivors and their families must be included when information material and rehabilitation programs are designed and evaluated.

Mismatched expectations? Experiences of nurses in a low-income country working with visiting nurses from high-income countries.

AIM AND OBJECTIVES: To describe how nurses in a rural hospital in a low-income country experience working with visiting nurses from high-income countries. BACKGROUND: Nurses in low-income countries work with visiting nurses from high-income countries in various health projects. However, there is a paucity of studies examining how nurses in low-income countries experience working with nurses from such different backgrounds. DESIGN: This study is descriptive, explorative and qualitative. METHODS: The data were collected from 10 semi-structured interviews in 2015 and were analysed using qualitative content analysis. The study was conducted with ward nurses in a rural hospital in Tanzania, a sub-Saharan African country characterised as low-income country. FINDINGS: The data analysis revealed two themes related to the local nurses' experiences of working with visiting nurses from high-income countries: (1) To do it our way and (2) Different expectations, benefits and limitations. CONCLUSION: The findings strongly indicate that the local nurses expected foreign nurses to follow the local system and work under supervision. The local nurses appreciated opportunities to learn from working and sharing knowledge with foreign nurses, but simultaneously expressed that the gained knowledge should be adapted and implemented according to their local health system. RELEVANCE TO CLINICAL PRACTICE: The findings can inform nurses, humanitarian organisations, hospitals and universities working in international collaborations.

Complementary knowledge sharing: Experiences of nursing students participating in an educational exchange program between Madagascar and Norway.

AIM AND OBJECTIVES: To describe how Malagasy and Norwegian nursing students experience an educational exchange program in Madagascar. BACKGROUND: Previous studies show that nursing students participating in an educational exchange program enhanced their cultural knowledge and experienced personal growth. However, few studies have described two-way exchange programs, including experiences from both the hosts' and the guest students' perspectives. DESIGN: This study applies a descriptive qualitative design. METHODS: Data were collected in 2015 by means of five semi-structured interviews with Malagasy students and two focus group interview sessions with Norwegian students. They were analysed using qualitative content analysis. The study was conducted in Madagascar. FINDINGS: The data analyses revealed one main theme and two sub-themes related to the Malagasy and Norwegian nursing students' experiences. Main theme: complementary knowledge sharing; sub-themes: (1) learning from each other and (2) challenges of working together. CONCLUSION: The findings indicate that both the Malagasy and Norwegian nursing students experienced the exchange program as valuable and essential in exchanging knowledge. They also highlighted challenges, linked mainly to language barriers and the lack of available resources.