85. Clancy A, Svensson T. ‘Faced’ with responsibility: Levinasian ethics and the challenges of responsibility in Norwegian public health nursing. NURS PHILOS 2007;8(3):158-66.
Abstract: This paper is concerned with aspects of responsibility in Norwegian public health nursing. Pub-
lic health nursing is an expansive profession with diffuse boundaries. The Norwegian public health nurse does not perform ‘hands on’ nursing, but focuses on the prevention of illness, injury, or disability, and the promotion of health. What is the essence of ethical responsibility in public health nursing? The aim of this article is to explore the phenomenon based on the ethics of responsibility as reflected upon by the phi- losopher Emanuel Levinas (1906-1995). From an ethical point of view, responsibility is about our duty to- wards the Other, a duty we have not always chosen, are prepared for, or can fully explain; but it is never- theless a demand we have to live with. Interviews with five experienced Norwegian nurses provide the empirical base for reflection and interpretation. The nurses share stories from their practice. In interpreting the nurses’ stories, the following themes emerge: personal responsibility; boundaries; temporality; worry, fear, and uncertainty; and a sense of satisfaction. As the themes are developed further, it becomes ap- parent that, despite their diversity, they are all interrelated aspects of ethical responsibility. Responsibility for the Other cannot be avoided, ignored, or transferred. The nurses’ responsibility is personal and infi- nite. Levinasian ethics can help nurses understand the importance of accepting that being a responsive carer can involve not only contentment in the predictable, but also the fear, worry, and uncertainty of the unpredictable
86. Eriksen W. Practice area and work demands in nurses’ aides: a cross-sectional study. BMC Public Health 2006;6:97.
could give us a better understanding of the factors that influence the working conditions in the health ser- vices, and could help identify specific work-related challenges and problems in the different practice ar- eas. In turn, this may help politicians, and healthcare administrators and managers to develop healthy work units. The aim of this study was to find out how nurses’ aides’ perception of demands and control at work vary with the practice area in which the aides are working. METHODS: In 1999, 12,000 nurses’ aides were drawn randomly from the member list of the Norwegian Union of Health–and Social Workers, and were mailed a questionnaire. 7478 (62.3 %) filled in the questionnaire. The sample of the present study comprised the 6485 nurses’ aides who were not on leave. Respondents working in one practice area were compared with respondents not working in this area (all together). Because of multiple com- parisons, 0.01 was chosen as statistical significance level. RESULTS: Total quantitative work demands were highest in somatic hospital departments, nursing homes, and community nurse units. Physical de- mands were highest in somatic hospital departments and nursing homes. Level of positive challenges was highest in hospital departments and community nurses units, and lowest in nursing homes and homes or apartment units for the aged. Exposure to role conflicts was most frequent in nursing homes, homes or apartment units for the aged, and community nurse units. Exposure to threats and violence was most frequent in psychiatric departments, nursing homes, and institutions for mentally handicapped. Con- trol of work pace was highest in psychiatric departments and institutions for mentally handicapped, and was lowest in somatic hospital departments and nursing homes. Participation in decisions at work was highest in psychiatric departments and community nurse units, and was lowest in somatic hospital de- partments and nursing homes. CONCLUSION: The demands and control experienced by Norwegian nurses’ aides at work vary strongly with the practice area. Preventive workplace interventions should be tailored each area
87. Kjos BO, Botten G, Romoren TI. Quality improvement in a publicly provided long-term care system: the case of Norway. Int J Qual Health Care 2008;20(6):433-8.
Abstract: OBJECTIVE: To explore the extent to which quality improvement activities are implemented in
the Norwegian long-term care system for older people, and to determine if variations in the extent and scope of quality improvement activities are associated with the characteristics of the first-line care lead- ers, the sector or the size of the municipality. DESIGN: A cross-sectional telephone survey supplemented with information from public records and official municipal websites. Data were organized according to six total quality management components, and a sum score was developed to measure quality improvement. Variations in the extent of quality improvement activities were analysed using multivariate analysis. SET- TING: Thirty-two Norwegian municipalities stratified according to region and population size. PARTICI- PANTS: Sixty-four first-line leaders in nursing homes and home-based care. MAIN OUTCOME MEAS- URE: A sum score has been used as a measure of quality improvement activities. RESULTS: The unit’s quality improvement activities varied by quality improvement components and by municipality. The tech- nical component that requires training in tools and techniques was low; the general components as ‘leader’s involvement’ and ‘employee participation’ were more common. The size of the populations of the municipalities showed a significant independent association with the scope of quality activities. CON- CLUSIONS: The six quality improvement components varied from high to extremely low, and the large municipalities had more quality activities than small- or medium-sized municipalities
88. Laerum F, Eik-Nes S, Fonnebo V, Heilo A, Johnsen R, Stray-Pedersen B, et al. Use of ultrasonography in the primary health care setting. 2001. (SMM-Report 4/2001.)
Abstract: RECORD STATUS: This is a bibliographic record of a published health technology assess-
ment from a member of INAHTA. No evaluation of the quality of this assessment has been made for the HTA database
AUTHOR’S OBJECTIVES: To assess the available evidence on the use of ultrasonography in the primary health care settting
TYPE OF INTERVENTION: Diagnosis
STUDY SELECTION – STUDY DESIGNS: Systematic review
AUTHOR’S CONCLUSION: - Ultrasound has in recent years become much more available. High quality apparatus are becoming cheaper and smaller which means that diagnostic ultrasound can be more widely used in primary health care. – Ultrasound has the potential of becoming an integrated support function during the clinical patient examination. However, the report shows that there is very limited documentation about the diagnostic validity and clinical benefit from using diagnostic ultrasound in primary health care. – There is an abundance of literature regarding the use of diagnostic ultrasound in specialist health services (incl. hospitals), but the literature lacks documentation on diagnostic and therapeutic consequences com- pared to alternatives. The transfer value is uncertain regarding experiences from the specialist health ser- vices to the primary health care service. – The present study raises questions about the use of diagnostic ultrasound in primary health care regarding: - use of ultrasound in a population where the prevalence of a disease is low – problems concerning false positive and false negative findings related to ultrasound ex- aminations – consequences experienced by the specialist health services (due to an increase in referrals because of false positive ultrasound examinations and uncertain results, or fewer referrals) – The result of the examination depends very much on the education and experience of the examiner – If general practi- tioners are to use ultrasound in their practice, it is essential to look into: - basic medical education – fur- ther education in general medical practice – certification procedures (accreditation) and documented con- tinued learning (re-certification) – The use of ultrasound in primary health care services will entail in- creased costs, depending on the number of general practitioners who use the method. The cost- effectiveness is not known. – There is a need for clinical studies based on general practice which can say something about the diagnostic value and clinical effect (including the cost-effectiveness) of ultrasonogra- phy use
89. Pedersen R, Nortvedt P, Nordhaug M, Slettebo A, Grothe KH, Kirkevold M, et al. In quest of justice? Clinical prioritisation in healthcare for the aged. J Med Ethics 2008;34(4):230-5.
Abstract: BACKGROUND: A fair distribution of healthcare services for older patients is an important
challenge, but qualitative research exploring clinicians’ consideration in daily clinical prioritisation in healthcare services for the aged is scarce. OBJECTIVES: To explore what kind of criteria, values, and
other relevant considerations are important in clinical prioritisations in healthcare services for older pa- tients. DESIGN: A semi-structured interview-guide was used to interview 45 clinicians working with older patients. The interviews were analysed qualitatively using hermeneutical content analysis and template organising style. PARTICIPANTS: 20 physicians and 25 nurses working in public hospitals and nursing homes in different parts of Norway. RESULTS AND INTERPRETATIONS: Important dilemmas relate to under-provision of community care and comprehensive approaches, and over-utilisation of certain spe- cialised services. Overt ageism is generally not reported, but the healthcare services for the aged seem to be inadequate due to more subtle processes, for example, dominating considerations and ideals and op- erating conditions that do not pay sufficient attention to older patients’ needs and considerations of jus- tice. Clinical prioritisations are described as being dominated by adapting traditional biomedical ap- proaches to the operating conditions. Many of the clinicians indicate that there is a potential for improving end of life decisions and for reducing exaggerated use of life-prolonging treatment and hospitalisations. CONCLUSION: The interviews in this study indicate that considerations of justice and patients’ perspec- tives should be given more attention to strike a balance between specialised medical approaches and more general and comprehensive approaches in healthcare services for older patients
90. Pros C, Kjellberg A. Supervision in occupational therapy regarding rehabilitation of elderly people in Swe- den. Scand J Occup Ther 2008;15(4):221-9.
Abstract: The aim of this study was to investigate occupational therapists’ supervision of healthcare
workers regarding rehabilitation of elderly people in Swedish municipal elderly care. Data were collected through a self-report questionnaire developed for this study. In total, 238 occupational therapists working with supervision of healthcare workers in the field of municipal elderly care participated in the study. Data were analysed using descriptive statistics. For supervising healthcare workers, the participants rated highly the importance of cooperation and communication. Many of the participants considered both the time available for one supervision session and the number of supervision sessions to be insufficient. The result also demonstrated that the participants supervised healthcare workers more frequently in P-ADL than in I-ADL. A majority of the participants supervised other groups of people in addition to healthcare workers. The lack of research work in supervision specific to occupational therapy indicates a need for more studies in this area
91. Ribu E, Haram R, Rustoen T. Observations of nurses’ treatment of leg and foot ulcers in community health care. J Wound Ostomy Continence Nurs 2003;30(6):342-50.
Abstract: OBJECTIVE: The aim of the study was to obtain knowledge about leg and foot ulcer care per-
formed by nurses in community health care. DESIGN: This is a descriptive observational study. SETTIN- GAND SUBJECTS: The sample consisted of Norwegian home care nurses (n = 31), student nurses (n = 30), and patients with leg and foot ulcers (n = 32). Thirty-five ulcer treatments were observed in the pa- tients’ homes. METHODS: A structured observation form with space for additional notes and assess- ments was used. Photographs were taken of the ulcers. Information on background variables for patients and nurses was collected, and descriptive and interpretive analyses were performed. Nursing students made the observations. RESULTS: In 16 situations the patients had no ulcer diagnosis, and most of the patients (79.9%) had other serious chronic diseases. The home care nurses were uncertain about their assessment of the ulcers, and the treatment principles were not always current; for example, dry dress- ings and normal saline were used for cleansing. Twenty-eight different dressing combinations were used on the 35 ulcers. Compression was used on undiagnosed ulcers, sometimes incorrectly. Hand-washing routines were poor, and the treatment was often poorly documented. Poor working conditions were also observed, such as bad lighting in the room. The majority of the ulcer treatments lasted 20 to 30 minutes. CONCLUSION: The study identifies areas where leg and foot ulcer treatment by home care nurses can be improved with respect to technique and documentation.
92. Rustoen T, Begnum S. Quality of life in women with breast cancer: a review of the literature and implica- tions for nursing practice. Cancer Nurs 2000;23(6):416-21.
Abstract: This article discusses the gap between an ever-increasing interest in research on the quality of
life in patients with breast cancer and the lack of impact this research has had in the actual care of these women. A critical review of the literature is used to answer the question of how much can be accepted as established knowledge despite the often methodologically weak studies and contradictory results. Defi- ciency in research studies is no rationale for not improving nursing care in areas wherein there is an ex- pressed need for support and assistance. Nurses are in contact with patients who have breast cancer at all stages of the disease and treatment, because they meet the women in the hospital, at the outpatient clinic, and in their homes. They play an important role in meeting the needs of these women. Ways of im- proving nursing practice at the different stages of the illness, from the pretreatment phase to posttreat- ment follow-up assessment, are discussed, and concrete suggestions made. This article addresses the women’s need both for adequate information and for social and emotional support. [References: 47]
93. Salvesen RS, Mostad U, Aadahl P. Care for children with tracheostomy. Tidsskr Nor Laegeforen 2005;125(7):907-9.
Abstract: Background. Modern technology has improved the quality of life for children with tracheostomy
and home ventilators. Material and methods. A <<home ventilator team>> at St. Olav University Hospital was responsible for 18 children with tracheostomy over a period of 2.5 years. The team serves as a link between different health care providers. A new educational programme for health care providers and par- ents is described. Results and Interpretation. Children with tracheostomy constitute a small, but profes- sionally challenging group with a variety of health-related problems. In Norway it is not quite clear who is responsible for the care of these patients
94. Sellaeg WF. Handlingsplanen for eldreomsorgen: De gode hensiktene. Aldring og Livslöp 2002;19(1):14- 6
95. Simonsen I. Ritualisering i forbindelse med dödsfall på sykehjem. Omsorg: Nordisk Tidsskrift for Palliativ Medisin 2007;24(1):51-5
96. Thorsen IL. Elektronisk pasientjournal i sykehjem - hva skall vi bruke? Utposten 2005;34(6):22-5
97. Thyli B, Athlin E, Hedelin B. Challenges in community health nursing of old migrant patients in Norway: an exploratory study. Int J Older People Nursing 2007;2/1):45-51.
Abstract: Research in Norway on nurse managers’ perceptions of community nurse care of older people
from ethnic minorities. Questionnaires were completed by managers about the extent and content of care and cultural assessment provided. Barriers to good culturally sensitive care were identified including lan- guage differences, the involvement of families and lack of multicultural competence in nurses. 33 refs
98. Tveiten S, Ellefsen B, Severinsson E. Conducting client supervision in community health care. Int J Nurs Pract 2005;11(2):68-76.
Abstract: The aim of the present study was to examine registered public health nurses’ views and re-
ported actions related to client supervision in community health care. Transcript-based, qualitative and in- terpretative content analysis was used to analyse the findings from six focus group interviews. The main findings represented the following themes: the components of the assessment basis related to choosing supervision as an intervention strategy, the strategies related to conducting supervision and the meaning of supervision as an intentional act. In conclusion, the registered public health nurses’ reported model for conducting supervision seems to correspond with principles in the new strategies for health promotion ini- tiated by the World Health Organization. Further research is needed to explore what the nurses really do when conducting supervision in order to provide extended knowledge about their model
99. Tveiten S, Severinsson E. Client supervision: meaning and experiences from the perspective of Norwe- gian public health nurses. Nurs Health Sci 2004;6(4):279-86.
Abstract: The aim of the present study was to examine the meaning and experiences of client supervi-
sion from the perspective of Norwegian public health nurses. The World Health Organization (WHO) states that new intervention strategies to improve public health are necessary. Supervision represents such a strategy. Three focus groups were interviewed twice. The data were analyzed by qualitative con- tent analysis. The findings revealed three themes: (i) the meaning of the umbrella term client supervision; informing, teaching, giving advice and ensuring the quality of supervision; (ii) factors influencing supervi- sion; the public health nurses’ available time and competence and the clients’ ability to be supervised; and (iii) events and content representing the complexity of conducting supervision. In conclusion, the width of the concept, the influencing factors and the complexity claim that public health nurses have com- petence to supervise
100. Tveiten S. Evaluation of the concept of supervision related to public health nurses in Norway. J Nurs Manag 2005;13(1):13-21.
Abstract: AIM: The aim of the study is to clarify the concept of supervision by means of concept analy-
sis, in order to evaluate the concept’s application to the practise of public health nurses. BACKGROUND: According to the World Health Organization, a change in strategies for improving public health is neces- sary. This change demands new strategies. There exists little research concerning intervention strategies in public health. The concept of supervision is well used, but neither well-defined nor well described, ei- ther within the nursing discipline or across disciplinary boundaries. METHODS: The method is a review of literature. Twenty scientific papers covering the years 1996-2001 are analysed, using a concept-analysis methodology. FINDINGS: Supervision can be defined as a formal, pedagogical, relational enabling proc- ess, related to professional competence. Relationship and dialogue are central aspects. Supervision is based on theory and humanistic values, has a normative, formative and restorative function. The supervi- sor’s competence is of great importance. Supervision has unclear boundaries with concepts such as psy- chotherapy, consultation and counselling. CONCLUSION: The concept of supervision as described in the selected papers is applicable to public health nurses’ supervision of clients, with adaptation caused by the contextual variation of the relationship. Related to clients, supervision can be defined as a formal, peda- gogical, relational enabling process with the purpose to strengthen resources, enhance assertiveness and improve independence and coping. It is necessary that registered public health nurses have the compe-