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Aim: To explore barriers and facilitators that influence adherence to evidence‐based guidelines for peripheral intravenous catheter care in different hospital wards. Design: Sequential explanatory mixedmethod study design, with qualitative data used to elaborate on quantitative findings. Method: Data were collected between March 2021 and March 2022 using the previously validated Peripheral Intravenous Catheter mini questionnaire (PIVC‐miniQ) on each ward in a tertiary hospital in Norway. Survey completion was followed by individual interviews with nurses from selected wards. The Pillar Integration Process was used to integrate and analyse the quantitative and qualitative findings. Results: The PIVC‐miniQ screening assessed 566 peripheral intravenous catheters in 448 patients in 41 wards, and we found variation between wards in the quality of care. Based on the quantitative variation, we interviewed 24 nurses on wards with either excellent or not as good quality. The integration of the quantitative and qualitative findings in the study enabled an understanding of factors that influence nurses' adherence to the care of peripheral venous catheters. One main theme and four subthemes emerged. The main finding was that ward culture affects education practice, and this was evident from four subthemes: (1) Deviation from best practice, (2) Gaps in education and clinical training, (3) Quality variation between wards and (4) The importance of supportive leadership. Conclusion: This mixed method study is the first study to explore reasons for variability in peripheral intravenous catheter quality across hospital wards. We found that ward culture was central to catheter quality, with evidence of deviations from best practice correlating with observed catheter complications. Ward culture also impacted nursing education, with the main responsibility for learning peripheral intravenous catheter management left to students' clinical training placements. Addressing this educational gap and fostering supportive leadership, including champions, will likely improve peripheral intravenous catheter care and patient safety. Implications for the Profession and/or Patient Care: Nurses learn good peripheral intravenous catheter care in wards with supportive leaders and champions. This implies that the quality of nursing practice and patient outcomes are situational. Nurses need a strengthened emphasis on peripheral catheter quality in the undergraduate curriculum, and nurse leaders must emphasize the quality of catheter care in their wards. Impact: The study findings impact nurse leaders who must commit to quality and safety outcomes by appointing and supporting local ward champions for promoting peripheral intravenous catheter care. This also impacts nursing education providers, as the emphasis on catheter care must be strengthened in the undergraduate nursing curriculum and continually reinforced in the hospital environment, particularly when guidelines are updated. Reporting Method: The study adhered to the Good Reporting of A Mixed Method Study (GRAMM). Patient or Public Contribution: A patient representative has been involved in planning this study. [ABSTRACT FROM AUTHOR]

Aims and objectives: To identify sources of interruptions and distractions to medicine administration rounds in hospitals. Background: Nurses are frequently interrupted during medicine administration. There is no systematic description of nurses' behaviours and interruptions during administration of medicines to patients. Design: Exploratory nonparticipant observational study. Methods: Three hundred and fifty‐one episodes of medicine administration with 32 nurses from three hospitals in Norway were observed using paper‐based observation grids between December 2013 and March 2014. Results: Nurses were frequently interrupted and distracted, mainly by nurses and other healthcare professionals. One‐third of the nurses interrupted their medicine administration: They prioritised helping patients with direct patient care. When the nurses were interrupted, they left the round and re‐entered the procedure. Even so, they managed to refocus and continue to administer the medicines: Interruptions and disturbances made little difference to most behaviours and actions, possibly because nurses double‐checked more frequently. Some differences were seen in behaviours potentially affecting the safety of the medicine administration, such as leaving medicines at the bedside and not helping patients take their medicines. Some interruptions were avoidable, such as those by other nurses and professionals. Conclusions: This study offers insights into nurses' behaviours and actions when they are interrupted and distracted during medicine administration. The findings highlight a conflict for nurses administering medicines. Nurses are forced to prioritise between two important activities: direct patient care and medicine administration. Management and education providers need to recognise that nurse interrupting each other is a potential threat to patient safety. Relevance to clinical practice: Our data indicate that nurses and other healthcare professionals should be warned not to interrupt colleague administering medicines and managers should ensure other staff are available to respond to patients' immediate needs during medicine rounds. [ABSTRACT FROM AUTHOR]

Aims and objectives To investigate what differences exist in nurses' communications with each other as opposed to their communications with members of other healthcare professions. Background Difficulties have been reported related to the introduction of interdisciplinary collaboration in hospitals even when their efficacy has been demonstrated. Design This paper is a report of a project that was a cross-sectional survey design. Method Nurses and assistant nurses received questionnaires that examined two different components of interdisciplinary collaboration. Using the psychometric method known as Systematizing Person-Group Relations to gather data and for analysis, the method aims to investigate the dominant aspects of the particular work environment by identifying key characteristics of interdisciplinary collaboration. Results The respondents reported significant differences in six of the 12 factors; high scores on caring, acceptance, engagement and empathy characterised communication with members of their own professional group as low scores on the same factors characterised communication with other healthcare professions. Conclusion Findings in this study suggests that nurses behave in a more loyal, accepting and critical manner when communicating with each other than they do when communicating with members of other healthcare professions. Nurses are more influenced by behaviours characterised by assertiveness and resignation in their communication with members of other healthcare professions. The findings indicate that nurse's experience mixed emotions and behaviours that influence their communications with healthcare personnel from other professions. Relevance to clinical practice Nurses often hold key positions on interdisciplinary collaboration; therefore, they must develop the communicative skills required in this position to be able to improve the quality of patient care in hospitals, related to nurses' experiences and skills. [ABSTRACT FROM AUTHOR]

Aim: To explore registered nurses' thinking strategies during the drug administration process in nursing homes. Design: An exploratory qualitative design. Methods: Eight registered nurses, one male and seven female, in five nursing home wards in Mid‐Norway were observed during 15 drug dispensing rounds (175 drug dispensing episodes). Think Aloud sessions with follow‐up individual interviews were conducted. The Think Aloud data were analysed using deductive qualitative content analysis based on Marsha Fonteyn's description of 17 thinking strategies. Interview data were used to clarify missing information and validate the content of Think Aloud data. Results: The registered nurses used all 17 thinking strategies described by Fonteyn, including several variants of each strategy. The three most frequent were 'providing explanations', 'setting priorities' and 'drawing conclusions'. In addition, we found two novel thinking strategies that did not fit into Fonteyn's template, which were labelled 'controlling' and 'interacting'. Among all strategies, 'controlling' was by far the most used, serving as a means for the registered nurses to stay on track and navigate through various interruptions, while also minimising errors during drug dispensing. Conclusion: The study highlights the diverse thinking strategies employed by registered nurses in nursing homes during medication administration. The findings emphasise the multifaceted nature of medication administration and underscore the importance of skilled personnel in ensuring medication safety. Recognising the significance of these findings is crucial for maintaining patient well‐being and upholding medication safety standards in healthcare settings. Relevance to Clinical Practice: Understanding the thinking strategies employed by registered nurses can inform training programmes and enhance the clinical judgements of health care professionals involved in medication administration, ultimately leading to improved patient outcomes and reduced medication errors in practice. Patient or Public Contribution: Patients were involved in this study as recipients of drugs which the nurses distributed during the observations. The patients were involved as a third party and consent to the observations was either given by the patients themselves or relatives in cases where the patient was not competent to consent. No personal information was collected about the patients. Reporting Method: The reporting of this study adhered to the COREQ checklist. [ABSTRACT FROM AUTHOR]

Aims and Objectives: The aim of this study was to investigate the prevalence of post‐traumatic stress symptoms, and to identify possible predictive factors in Norwegian intensive care unit survivors, 6 months after admission to the intensive care unit with COVID‐19. Background: The SARS CoV‐2 virus causing COVID‐19 has spread worldwide since it was declared a pandemic in March 2020. The most severely ill patients have been treated in the intensive care due to acute respiratory failure and also acute respiratory distress syndrome. It is well documented that these severe conditions can lead to complex and long‐lasting symptoms, such as psychological distress, and was, therefore, investigated for the specific COVID‐19 population. Design: Prospective observational study. Methods: Clinical data and patient reported outcome measures were collected by the Norwegian Intensive Care and Pandemic Registry and by the study group 6 months after admission to an intensive care unit. Results: Among 222 COVID‐19 patients admitted to Norwegian intensive care units between 10 March and 6 July 2020, 175 survived. The study sample consisted of 131 patients who responded to at least one patient reported outcome measure at 6 months following admission. The primary outcome was self‐reported post‐traumatic stress symptoms, using the Impact of Event Scale‐6 (n = 89). Of those, 22.5% reported post‐traumatic stress symptoms 6 months after admission. Female gender, younger age and having a high respiratory rate at admission were statistically significant predictive factors for reporting post‐traumatic stress symptoms. Conclusions: The result is in accordance with previously published research with comparable populations, suggesting that for many COVID‐19 survivors psychological distress is a part of the post‐acute sequelae. Results from the present study should be replicated in larger datasets. Relevance to Clinical Practice: This project provides important insight to post‐acute sequelae after COVID‐19 that patients may experience after critical illness. [ABSTRACT FROM AUTHOR]

Aim: To explore and gain a broader understanding of residents' viewpoints and experiences of spiritual care when living in a nursing home. Design: A qualitative hermeneutical interview study inspired by Gadamer's philosophical hermeneutics. Methods: Thirty‐eight individual interviews of 14 male and 24 female residents; of these, 24 had a dementia diagnosis. The setting was one large Norwegian nursing home providing long‐term care. FACIT‐Sp‐12 was used as a guide for the interview, in addition to two open‐ended questions about thriving and spiritual care. Findings: The older residents' voices portray a broad and diverse understanding of spiritual care, and four themes emerged: (1) Spiritual at‐homeness, (2) Spiritual awareness, (3) Philosophy of life and (4) Interconnectedness. Conclusion: Accepting one's life situation in a nursing home can foster a feeling of belonging, leading to feeling more at‐home. Spiritual well‐being, including finding purpose, spiritual awareness and beliefs, was found to be interconnected with spiritual at‐homeness in the nursing home. Implications for the Profession and/or Patient Care: This study provides insights into older nursing home residents' viewpoints on spiritual care, including persons living with dementia. Impact: The study addressed the limited evidence regarding how older residents themselves experience and express spiritual care. Listening to older nursing home residents' voices provides a unique contribution to the research field. As several individuals with dementia contributed to the findings, this study mirrors the current population of residents in nursing homes. The findings may inform healthcare provision and policymakers and impact upon spiritual care in the field of older people nursing and dementia care services. Reporting Method: The COREQ guideline. Patient or Public Contribution: Participation through interviews of nursing home residents. [ABSTRACT FROM AUTHOR]

Aims: To gain a comprehensive understanding of nurses' infection control practices, antibiotics stewardship attitudes and self‐efficacy when caring for patients with multidrug‐resistant bacterial infections in a hospital setting. Background: Multidrug‐resistant bacteria cause a substantial health burden by complicating infections and prolonging hospital stays. Attitudes and self‐efficacy can inform professional behaviour. Nurses' attitudes and self‐efficacy concerning multidrug‐resistant bacteria, infection prevention and control and antibiotic stewardship are vital in keeping patients safe. Design: A descriptive and convergent mixed‐methods design involving quantitative and qualitative approaches was used. Methods: Two hundred and seventeen nurses working in clinical practice at seven different hospital wards (i.e., general medicine, surgical, haematological and oncology) at a Norwegian university hospital were invited to participate. Data were collected in February and March 2020 via two questionnaires: the Multidrug‐Resistant Bacteria Attitude Questionnaire and the General Perceived Self‐Efficacy Scale (n = 131) and four focus group interviews (n = 22). The data were analysed using descriptive statistics and systematic text condensation. Results: Most nurses showed moderate knowledge, adequate behavioural intentions towards infection prevention and antibiotic stewardship, and high self‐efficacy. However, they reported negative emotions towards their knowledge level and negative emotions towards nursing care. The nurses appeared uncertain about their professional influence and role in antibiotic stewardship practices. Organisational and relational challenges and ambivalent perceptions of nurses' role were potential explanations. Conclusion: Nurses report moderate attitudes and high self‐efficacy when caring for patients with multidrug‐resistant bacterial infections. This study suggests that nurses experience organisational and relational factors in their work environment that challenge their attitudes towards infection prevention and control and antibiotic stewardship practices. Measures that strengthen their knowledge and emotional response underpin correct infection prevention and control behaviour. A role clarification is needed for antibiotic stewardship. No Patient or Public Contribution. Relevance to clinical practice: Measures to increase attitudes towards infection prevention and control, antibiotic stewardship and multidrug resistance is recommended. Measures should be taken to overcome organisational challenges. A clarification of the nurses' role in antibiotic stewardship is needed. [ABSTRACT FROM AUTHOR]

Aims and Objectives: To investigate the association between perceived nurse–patient interaction and quality‐of‐life among nursing home residents, adjusted for loneliness, anxiety and depression. Background: Symptoms of anxiety and depression are known to residents of nursing homes along with cognitive impairment, physical inactivity and low quality‐of‐life. Anxiety, depression and loneliness are found detrimental to NH residents' quality‐of‐life. The nurse–patient relationship is important for patient's well‐being, both in terms of illness and symptom management. Design: Cross‐sectional design. Methods: Data were collected in 2017 and 2018 from 188 residents in 27 nursing homes resided in two large urban municipalities in Middle and Western Norway. The inclusion criteria were: (1) local authority's decision of long‐term NH care; (2) residential stay 3 months or longer; (3) informed consent competency recognised by responsible doctor and nurse; (4) capable of being interviewed, and (5) aged 65 years or older. This article is executed in accordance with STROBE statement. Results: Adjusting for age, sex, anxiety, depression and loneliness, perceived nurse–patient interaction was statistically significant to quality‐of‐life. While anxiety and depression showed insignificant estimates, loneliness demonstrated a significant relation with quality‐of‐life. Nurse–patient interaction and loneliness explained together 25% of the variation in quality‐of‐life. Conclusion: This study suggests that loneliness is frequent as well as more detrimental to quality‐of‐life among nursing home residents compared to anxiety and depression. Furthermore, the present results show that the nurse–patient interaction represents an essential health‐promoting resource for Quality‐of‐life in this population. Relevance to clinical practice: Staff nurses need to exercise their awareness of loneliness to meet residents' needs. Nursing educations should provide knowledge about nurse–patient interaction, and students as well as staff nurses in NHs should be trained, for instance by simulation, to use the nurse–patient interaction as a health‐promoting resource. Finally, loneliness represents a bigger challenge than depression and anxiety; accordingly, building nurses that are capable of meeting patients' needs and facilitate care that counteracts loneliness is highly warranted [ABSTRACT FROM AUTHOR]

Aims and Objectives: To explore the longitudinal experiences using an application named remote home care for remote palliative care among patients with cancer living at home. Background: Introducing welfare technology in home‐based care for patients with cancer in the palliative phase is internationally suggested as a measure to remotely support palliative care needs. However, little is known about the experiences of patients utilising welfare technology applications to receive home‐based care from healthcare professionals in a community care context. Although living with cancer in the palliative phase often presents rapidly changing ailments, emotions and challenges with patients' needs changing accordingly, no studies exploring the longitudinal experiences of patients were found. Design: A qualitative study with a longitudinal, exploratory design. Methods: Data were collected through individual interviews with 11 patients over 16 weeks. The data were analysed using qualitative content analysis. The COREQ checklist guided the reporting of the study. Results: Three themes were identified: (1) potential to facilitate self‐governance of life‐limiting illness in daily life, (2) need for interpersonal relationships and connections, and (3) experiences of increased responsibility and unclear utility of the Remote Home Care. Conclusion: The results showed that remote home care facilitated patients' daily routines, symptom control and improved illness‐management at home. Interpersonal relationships with healthcare professionals were considered pivotal for satisfactory follow‐up. Infrastructural glitches regarding data access, information sharing and lack of continuous adjustments of the application represented major challenges, with the potential to impose a burden on patients with cancer in the palliative phase. Relevance to Clinical Practice: By exploring the experiences of patients in palliative care over time as the disease progresses, this study provides constructive insights for the design and development of welfare technology applications and optimal care strategies. Patient or Public Contribution: The remote home care was developed by interdisciplinary healthcare professionals. [ABSTRACT FROM AUTHOR]

Aim and objectives: Describe patients' and family members' perceptions of family support from nurses and other mental healthcare professionals, and quality of care in community mental healthcare service. Further, compare the perceptions of patients and family members. Background: While patients value family involvement, family members feel unprepared and lack the necessary skills to be supportive. Since healthcare professionals predominantly focus on patients, they may fail to understand the complex needs of families. Family perceived support and quality of community mental health care may vary across patients and family members. Design and methods: Cross‐sectional study with patients suffering from mental illness and family members in community mental healthcare services in Norway. Altogether 86 participants, of whom 33 patients and 33 family members had a family relationship—paired samples. Participants filled in the translated version of the Iceland Family Perceived Support Questionnaire (FPSQ‐N) and Quality in Psychiatric Care—Community Out‐Patient (QPC‐COP) and Community Out‐Patient Next of Kin (QPC‐COPNK). STROBE checklist was used. Results: Family members scored family perceived support and quality of community mental health care lower than patients. Family members feel the loss of support. Patient and family members found the Patient—healthcare professionals' relationship to be of high quality, while family members gave low score to being respected and invited to take part in care by nurses and other mental healthcare professionals. Conclusion: Family members' unmet need of support highlights the need for nurses and other community mental healthcare professionals to assess complex family needs and to intervene. Barriers to collaboration exist, and family members need to be respected and invited into community mental health care. Relevance to clinical practice: Contributes knowledge of how to meet the family's needs and provides a basis for further care and treatment development in similar contexts nationally and internationally. [ABSTRACT FROM AUTHOR]

Aims and objectives: The present study aimed to explore patients' experiences of participating in their rehabilitation process in the context of specialised rehabilitation in Norway. Background: The rights of patients to participate in their care and treatment is an ideology that underlines newer international and Norwegian public documents. However, there is a gap between policy statements and clinical practice, and a discrepancy between patients' and professionals' statements about patient participation in rehabilitation. Design: A qualitative approach with a narrative design. Methods: Eleven patients were individually interviewed to tell their stories about the rehabilitation processes. We utilised narrative analysis with a three‐dimensional space narrative structure including temporality, sociality and spatiality. This study followed the COREQ checklist. Results: The analysis identified two throughout plots: 'person‐centred culture' and 'time', and three plots which constructed how the patients participate in change through the rehabilitation process: (a) dependent—'open doors'; (b) motivation from within; and (c) independence—'locked doors'. Conclusions: Patient participation in rehabilitation was dependent on person‐centred cultures in the unit and on different aspects of time. The dialogue and the power balance between the patients and the health personnel changed as the rehabilitation progressed. Motivation for rehabilitation had to come from within patients. The paternalistic ideology did not seem to dominate the specialised rehabilitation unit in the present study. Relevance to clinical practice: This study gives new insight into how patients participate in change in the rehabilitation process. This can be valuable for healthcare professionals and governments. Insight into how the lack of person‐centred focus can harm the rehabilitation process, and a deeper understanding of the meaning of time in the rehabilitation process is essential. These results may provide a stimulus for discussions on how patients might participate in their rehabilitation process. [ABSTRACT FROM AUTHOR]

Aims and Objectives: To describe postoperative handover reporting and tasks in relation to patient condition and situational circumstances, in order to identify facilitators for best practices. Background: High‐quality handovers in postoperative settings are important for patient safety and continuity of care. There is a need to explore handover quality in relation to patient condition and other affecting factors. Design: Observational mixed methods convergent design. Methods: Postoperative patient handovers were observed collecting quantitative (n = 109) and qualitative data (n = 48). Quantitative data were collected using the postoperative handover assessment tool (PoHAT), and a scoring system assessing patient condition. Qualitative data were collected using free‐text field notes and an observational guide. The study adheres to the GRAMMS guideline for reporting mixed methods research. Results: Information omissions in the handovers observed ranged from 1–13 (median 7). Handovers of vitally stable and comfortable patients were associated with more information omissions in the report. A total of 50 handovers (46%) were subjected to interruptions, and checklist compliance was low (13%, n = 14). Thematic analysis of the qualitative data identified three themes: "adaptation of handover," "strategies for information transfer" and "contextual and individual factors." Factors facilitating best practices were related to adaptation of the handover to patient condition and situational circumstances, structured verbal reporting, providing patient assessments and dialogue within the handover team. Conclusions: The variations in items reported and tasks performed during the handovers observed were related to patient conditions, situational circumstances and low checklist compliance. Adaptation of the handover to patient condition and situation, structured reporting, dialogue within the team and patient assessments contributed to quality. Relevance to clinical practice: It is important to acknowledge that handover quality is related to more than transfer of information. The present study has described how factors related to the patient and situation affect handover quality. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

Aims and objectives: To use nursing students to observe hand hygiene adherence in nursing homes and to explore whether the students' reflections after observing hand hygiene practices gives them a deeper understanding of the subject matter. Background: Residents in nursing homes worldwide have low tolerance for healthcare‐associated infections that require antibiotics, and hand hygiene is the single most effective action to reduce infections. Design: Observational study using (a) World Health Organization's (WHO) "Five moments for hand hygiene" validated tool to record indications and adherence and (b) an exploratory study of individual reflection notes from students conducted during and after observations. Methods: From February 12–15, 2018, 26 nursing students in their second semester of a 3‐year bachelor programme participated as observers in five wards in four nursing homes in the Oslo metropolitan area. This study was performed according to the STROBE statement. Results: Hand hygiene was performed for 57.2% of the 2,393 indications observed and recorded. Adherence differed significantly by type of personnel and by location. Four thematic categories emerged from the reflection notes: (a) practical awareness and introspection; (b) visualisation and enhancement of understanding of practice learning; (c) incorrect hand hygiene practices; and (d) stimulation to increase essential knowledge. Conclusion: Hand hygiene adherence was too low to prevent healthcare‐associated infections and to reduce the use of antibiotics. The students' reflection notes indicated more "insight and understanding of the complexity of hand hygiene." We suggest using nursing students in clinical placement as a means of incorporating different interventions as part of their learning skills and become "living reminders" of the importance of hygiene and infection prevention. Relevance for clinical practice: Improving the student's activity about hygiene and infection prevention in clinical placement may help to raise awareness by healthcare workers in nursing homes. [ABSTRACT FROM AUTHOR]

Aims and objectives: (a) To describe and analyse advanced practice nursing students' self‐assessment of their clinical competence and need for further training and (b) to analyse the possible predictive variables in their self‐assessment. Background: The self‐assessment of clinical competence in nursing education is important for identifying professional development and educational needs to improve patient care. Design: A cross‐sectional survey following STROBE guidelines was used. Methods: Ninety‐nine students from three universities/university colleges in Norway participated in the study, and data were collected using a revised version of the Professional Nurse Self‐Assessment Scale II. Descriptive, correlation and regression analyses were performed. Results: The students gave the highest self‐assessment ratings for their clinical competence in taking full responsibility and for their need for further training in medication effects and interactions. Although the students gave themselves low ratings for the use of electronic devices, they assessed their need for further training in this area as average. Clinical work experience as a registered nurse and previous higher education level were not significant predictors of clinical competence nor the need for further training. Conclusion: The findings indicate that self‐assessment is appropriate for students in advanced practice nursing programmes. This study implies that programmes in advanced practice nursing need to familiarise students with the possibilities of information technology. It questions the entry requirement that stipulates that prospective students must have several years of clinical work experience as registered nurses before entering advanced practice nursing programmes. These programmes need to communicate that competencies other than direct clinical practice are also needed for students' future roles. Relevance to clinical practice: The study contributes to the exploration of how students self‐assess own clinical competence and need for further training in advanced practice nursing programmes. Further research should evaluate the development of clinical competence. [ABSTRACT FROM AUTHOR]

Aims and objectives: To examine the association between registered nurses' (referred to as "nurses" for brevity) shifts of 12 hr or more and presence of continuing educational programmes; ability to discuss patient care with other nurses; assignments that foster continuity of care; and patient care information being lost during handovers. Background: The introduction of long shifts (i.e., shifts of 12 hr or more) remains controversial. While there are claims of efficiency, studies have shown long shifts to be associated with adverse effects on quality of care. Efficiency claims are predicated on the assumption that long shifts reduce overlaps between shifts; these overlaps are believed to be unproductive and dangerous. However, there are potentially valuable educational and communication activities that occur during these overlaps. Design: Cross‐sectional survey of 31,627 nurses within 487 hospitals in 12 European countries. Methods: The associations were measured through generalised linear mixed models. The study methods were compliant with the STROBE checklist. Results: When nurses worked shifts of 12 hr or more, they were less likely to report having continuing educational programmes; and time to discuss patient care with other nurses, compared to nurses working 8 hr or less. Nurses working shifts of 12 hr or more were less likely to report assignments that foster continuity of care, albeit the association was not significant. Similarly, working long shifts was associated with reports of patient care information being lost during handovers, although association was not significant. Conclusion: Working shifts of 12 hr or more is associated with reduced educational activities and fewer opportunities to discuss patient care, with potential negative consequences for safe and effective care. Relevance to clinical practice: Implementation of long shifts should be questioned, as reduced opportunity to discuss care or participate in educational activities may jeopardise the quality and safety of care for patients. [ABSTRACT FROM AUTHOR]

Aims and objectives: To describe positively and negatively perceived situations experienced by adults with type 1 diabetes using continuous glucose monitoring and the actions they take to deal with these situations. Background: Real‐time continuous glucose monitoring has been shown to improve glycaemic control and reduce hypoglycaemia. Although many patients with type 1 diabetes report great benefits when using continuous glucose monitoring, a substantial number discontinue using the device. Little is known about the different situations and experiences with the daily use of continuous glucose monitoring that contribute to such differences. Design: A descriptive design based on the critical incident technique was used. The study complied with the Consolidated Criteria for Reporting Qualitative Research (COREQ) (see File S1). Methods: Individual interviews were conducted with a purposive sample of 23 adults with type 1 diabetes, including current and former users of continuous glucose monitoring from four different outpatient clinics. Results: The participants described that they felt that the use of continuous glucose monitoring was a balance between benefits and barriers, and how, through their actions, they tried to adapt their use of continuous glucose monitoring to fit their lifestyles. Various life events affected and altered the balance between benefits and barriers and thus affected their use of continuous glucose monitoring. Conclusions: Continuous glucose monitoring is perceived as an effective and important tool in the self‐management of diabetes type 1. It enables a better everyday life and increased satisfaction with treatment. At the same time, the use of continuous glucose monitoring can be both demanding and challenging. Relevance to clinical practice: Understanding the complex interplay between perceived benefits, treatment burden and adherence to continuous glucose monitoring use is important for nurses engaged in diabetes care. Education and support regarding the use of continuous glucose monitoring must be based on the understanding and perspectives of the patient to alleviate stress and barriers and enhance self‐efficacy. As the use of continuous glucose monitoring can change over time, this must be a continuous process beyond initial training. [ABSTRACT FROM AUTHOR]

Aims and objectives: To describe the variation in public health nurses' perceptions of interprofessional collaboration related to adolescents' mental health problems in secondary schools in Norway. Background: Mental health problems among adolescents account for a large portion of the global burden of disease and affect 10%–20% of adolescents worldwide. Public health nurses in school health services play an important role in disease prevention and promotion of physical and mental health. In order to serve adolescents with regard to mental health problems, public health nurses are dependent on collaboration with other professionals in schools. Design: Qualitative interviews were conducted with 18 public health nurses working in the school health services. Method: A phenomenographic approach was used for interviewing and for analysing the qualitative interviews. This study is presented in line with COREQ's checklist. Result: The analysis resulted in three descriptive categories based on eight identified conceptions. The categories are as follows: "The formal structure has an impact on interprofessional collaboration"; "The public health nurse is an important, but not always self‐evident, partner in interprofessional collaboration"; and "The primary players are the teachers in collaboration." Conclusion: The public health nurses describe that they had limited impact on collaboration and were dependent on both the school principal and the teachers for achieving good collaboration. Teachers have the power to decide whether to collaborate with the public health nurse, and public health nurses regard teachers as the most important collaborative partners. The public health nurses need to make themselves and their competence visible. Relevance to clinical practice: The findings demonstrated that public health nurses are important collaborators, but are not always included in interprofessional collaboration. This knowledge is essential to strengthen public health nurses' roles and presence in schools, which could most certainly benefit adolescents with mental health problems in secondary school. [ABSTRACT FROM AUTHOR]

Aims and objectives: To assess Norwegian advanced geriatric nurses' (AGNs) use of their knowledge and skills, and factors that may influence AGNs' opportunities to use their knowledge and skills to reach their full potential. Background: Despite the need for nurses with advanced knowledge and skill in the care of older adults, the introduction of new advanced nursing roles has been challenging. Countries in the process of establishing advanced roles need to monitor and identify possible implementation issues. Design: A cross‐sectional descriptive survey. Methods: We invited the total population of AGNs in Norway (n = 26) and some of their colleagues (n = 465) to answer an online questionnaire. Twenty‐three (88.5%) of the AGNs and 195 (42.0%) of the invited colleagues completed and submitted the questionnaires. The data were analysed with descriptive statistics. STROBE guidelines were used in reporting this study. Results: Of the AGNs, 16 (69.6%) used their knowledge and skills to their full potential when providing direct care. However, a minority used their knowledge and skills to their full potential when proving indirect care (n = 11, 47.8%), teaching/supervision (n = 11, 47.8%) and coordination (n = 5, 21.8%). A total of 47 (24.1%) colleagues experienced the AGNs' scope of practice as completely clear, and 52 (26.6%) collaborated with the AGNs several times a week. Of the colleagues, 131 (67.2%) considered the AGNs' role and scope of practice contributed positively to a high degree to health service for older adults. Conclusion: The results indicate the need for greater focus on organisational adjustment for the AGNs to utilise their knowledge and skills to their full potential. Relevance to clinical practice: There is a need for greater focus on organisational adjustment to integrate AGNs at the workplace, as complete integration may improve the AGNs' use of their knowledge and skills. [ABSTRACT FROM AUTHOR]

Aims and objectives: To explore children's postsurgical experiences with pain and pain management in the recovery unit. Background: Children's pain is underestimated and undertreated. Untreated pain can cause unnecessary suffering, increased complication risks and may lead to chronic pain. Research exploring children's experiences with postoperative pain and pain management is limited. Design: A qualitative, exploratory study. The study complied with the Consolidated Criteria for Reporting Qualitative Research (COREQ). Methods: Children (N = 20), 8–16 years old, took part in semi‐structured interviews about their experiences with pain and postoperative pain management while they were in a recovery unit. Data were collected at two university hospitals in Norway. Content analysis was used to analyse the data. Results: Three themes emerged from the interviews: "children's experiences of what felt unpleasant and painful," "children's experiences with pain management" and "children's recommendations for future pain management". About half of the children reported moderate to severe pain while in the recovery unit and they did not always tell their nurses when they had pain. They also reported experiencing pain in places other than their surgical wounds and stated that nausea and vomiting felt unpleasant and painful. The children indicated that pain medications and the use of nonpharmacological methods helped them cope with their pain and provided several recommendations about how to improve pain management. Conclusion: Paediatric postoperative pain management remains suboptimal. The children in our study provided useful information about their pain experiences, how to improve pain management and explained why they did not tell their nurses when they were in pain. Relevance to clinical practice: These findings should direct further improvements in paediatric postoperative pain management, such as increased use of pain assessment tools and preparatory information, as well as more appropriate administration of pain medications. [ABSTRACT FROM AUTHOR]

Aims and objectives: To obtain a deeper understanding of the persistent use of telecare for older adults and their family caregivers. Background: Telecare is seen as part of the solution in home care services for ageing in place. Previous studies have shown that telecare is a complex intervention, and there is still a poor understanding of older adults' and their family caregivers' experience with the use of telecare. Design: This study used a qualitative hermeneutic research approach. Method: Interviews were conducted with 18 older adults and follow‐up interviews were conducted with 15 participants after 5–6 months of use. In addition, interviews were conducted with seven close family caregivers. The COREQ checklist was used. Results: The older adults expressed increased safety, security and independence. Although some of them experienced challenges, they continued to use the services. Furthermore, the findings revealed needs that telecare could not cover. Family caregivers reported that telecare eased their concern for a time. However, they felt increased responsibility which led to ambivalent feelings between wanting to comply with the older adults' desire to live at home and the stress and concern this caused. Conclusion: Telecare does improve care offered by home care services. However, it must be considered in the context of assistance and other measures and be provided in response to each individual's specific needs. Family caregivers may benefit from telecare, but telecare may also add to their care burden. Relevance to clinical practice: There is a need for increased knowledge and information about telecare and for follow‐up from home care services. Family caregivers are important for promoting sustainable use, but a support system and better cooperation with home care services is needed. [ABSTRACT FROM AUTHOR]

Aims and objectives: To describe the prevalence of pressure ulcers among middle- and older-aged patients in a general medical hospital in Norway and to describe the associations between pressure ulcers and potential risk factors additional to the Braden risk score. Background: Degrees of mobility, activity, perfusion and skin status are risk factors for development of pressure ulcer. Nurses’ clinical judgements combined with risk assessment tools are effective to detect pressure ulcer risk. Design: Cross-sectional study. Methods: The study was performed as part of a research project conducted between September 2012–May 2014 in a general hospital in the capital of Norway. Registered nurses and nursing students collected data from all eligible patients on 10 days during the students’ clinical practice studies. The Braden scale was used to measure pressure ulcer risk, and skin examinations were performed to classify the skin area as normal or as indicative of pressure ulcer according to the definitions by the National Pressure Ulcer Advisory Panel. Comorbidities were collected by patient’s self-report. This analysis focused on the 255 inpatients at the medical wards ≥52 years of age, most of whom had more than one comorbidity. Results: The prevalence of pressure ulcers was 14.9% in this sample. Higher age, underweight, diabetes and worse Braden scores were factors associated with pressure ulcer, and pressure ulcer was most frequently sited at the sacrum or heel. Conclusion: Adding age, weight and diabetes status to pressure ulcer risk assessment scales may improve identification of patients at risk for pressure ulcers. Relevance to clinical practice: Knowledge about strengths and limitations of risk assessment tools is important for clinical practice. Age, weight and diabetes status should be considered for inclusion in risk assessment tools for pressure ulcers in medical wards. [ABSTRACT FROM AUTHOR]

Aims and objectives To examine whether interprofessional simulation training on management of postpartum haemorrhage enhances self-efficacy and collective efficacy and reduces the blood transfusion rate after birth. Background Postpartum haemorrhage is a leading cause of maternal morbidity and mortality worldwide, although it is preventable in most cases. Interprofessional simulation training might help improve the competence of health professionals dealing with postpartum haemorrhage, and more information is needed to determine its potential. Design Multimethod, quasi-experimental, pre-post intervention design. Methods Interprofessional simulation training on postpartum haemorrhage was implemented for midwives, obstetricians and auxiliary nurses in a university hospital. Training included realistic scenarios and debriefing, and a measurement scale for perceived postpartum haemorrhage-specific self-efficacy, and collective efficacy was developed and implemented. Red blood cell transfusion was used as the dependent variable for improved patient outcome pre-post intervention. Results Self-efficacy and collective efficacy levels were significantly increased after training. The overall red blood cell transfusion rate did not change, but there was a significant reduction in the use of ≥5 units of blood products related to severe bleeding after birth. Conclusion The study contributes to new knowledge on how simulation training through mastery and vicarious experiences, verbal persuasion and psychophysiological state might enhance postpartum haemorrhage-specific self-efficacy and collective efficacy levels and thereby predict team performance. The significant reduction in severe postpartum haemorrhage after training, indicated by reduction in ≥5 units of blood transfusions, corresponds well with the improvement in collective efficacy, and might reflect the emphasis on collective efforts to counteract severe cases of postpartum haemorrhage. Relevance to clinical practice Interprofessional simulation training in teams may contribute to enhanced prevention and management of postpartum haemorrhage, shown by a significant increase in perceived efficacy levels combined with an indicated reduction of severe postpartum haemorrhage after training. [ABSTRACT FROM AUTHOR]

Aims and objectives To examine the relationship between leisure-time physical activity, health-related quality of life and sense of coherence in women after an acute myocardial infarction, and further to investigate whether these aspects were associated with age. Background Physical activity and health-related quality of life are vital aspects for patients after an acute myocardial infarction. Design Cross-sectional. Method All eligible women diagnosed with acute myocardial infarction received a postal questionnaire two to three months after hospital discharge, and 142 women were included. To measure health-related quality of life and sense of coherence, The MacNew Heart disease questionnaire and the Sense of coherence-13 scale was used. Results Respondents reporting at least one type of physical activity had significantly higher health-related quality of life as compared to respondents reporting no kind of physical activity. Respondents reporting physical activity for at least 30 minutes twice a week had significantly higher health-related quality of life scores than respondents being active less than twice a week. A weak association was found between physical activity level and sense of coherence. Reduction in physical activity after the acute myocardial infarction was associated with reduced health-related quality of life and sense of coherence. Sense of coherence was significantly associated with age, as respondents 75 years and older had significantly higher scores than respondents younger than 75 years. Conclusions Physical activity, even at a low level, is significantly associated with increased health-related quality of life and to some extent to sense of coherence. Relevance to clinical practice Tailoring women after an acute myocardial infarction about lifestyle changes must include knowledge about the benefits of leisure-time physical activity, and that even a small amount of activity is associated with a better health-related quality of life. The utmost important assignment is to motivate the women for regular physical activity in their leisure-time. Older women need special attention. [ABSTRACT FROM AUTHOR]

Aims and objectives To explore undocumented migrants' mental healthcare needs and more specifically to explore how undocumented adults living in Norway perceive psychological distress, to gather insight on their living conditions and to explore associated living condition risk factors. Background Undocumented migrants are defined both nationally and internationally as an especially vulnerable group with regard to their health status, living conditions and barriers to access to health care and social welfare. Design An exploratory mixed-methods design using primarily quantitative data with a qualitative component was implemented. Methods Socio-demographic data on 90 undocumented migrants were obtained, and self-report questionnaire on psychological distress was completed, supplemented by qualitative data obtained through interviews. Results The level of psychological distress was extremely high in our group of undocumented migrants. Leaving their home country because of war or persecution, economic strain, homelessness, hunger and having experienced abuse was significantly positively associated with psychological distress. Contrary to what was predicted, having family and work was not significantly associated with the reduction of psychological distress. Additional qualitative data indicate that having family entails great responsibilities and work implies exploitation to such an extent that any potential positive influence this has on mental health, such as a sense of belonging and a reasonable standard of living, is outweighed. Conclusions The high level of psychological distress indicates a need of additional diagnostic evaluation and mental health care. The living conditions were so marginal that their day-to-day existence was threatened. Relevance to clinical practice We recognised a need for an interdisciplinary and dynamic approach to mental health care. Undocumented migrants are in need of a minimum of psychological and material support assuring basic needs such as shelter and appropriate food and access to health care and social welfare. [ABSTRACT FROM AUTHOR]

Aims and objectives To identify what nurses experience as barriers to ensuring adequate nutritional care for the undernourished hospitalized elderly. Background Undernutrition occurs frequently among the hospitalised elderly and can result in a variety of negative consequences if not treated. Nevertheless, undernutrition is often unrecognised and undertreated. Nurses have a great responsibility for nutritional care, as this is part of the patient's basic needs. Exploring nurses' experiences of preventing and treating undernourishment among older patients in hospitals is therefore highly relevant. Design A focus group study was employed based on a hermeneutic phenomenological methodological approach. Methods Four focus group interviews with totally 16 nurses working in one large university hospital in Norway were conducted in spring 2012. The nurses were recruited from seven somatic wards, all with a high proportion of older (≥70 years) inpatients. The data were analysed in the three interpretative contexts: self-understanding, a critical common-sense understanding and a theoretical understanding. Results We identified five themes that reflect barriers the nurses experience in relation to ensuring adequate nutritional care for the undernourished elderly: loneliness in nutritional care, a need for competence in nutritional care, low flexibility in food service practices, system failure in nutritional care and nutritional care is being ignored. Conclusions The results imply that nutritional care at the university hospital has its limits within the hospital structure and organisation, but also regarding the nurses' competence. Moreover, the barriers revealed that the undernourished elderly are not identified and treated properly as stipulated in the recommendations in the national guidelines on the prevention and treatment of undernutrition. Relevance to clinical practice The barriers revealed in this study are valuable when considering improvements to nutritional care practices on hospital wards to enable undernourished older inpatients to be identified and treated properly. [ABSTRACT FROM AUTHOR]

Aims and objectives To investigate the experiences of home care nurses with electronic messaging (e-messaging) and to determine how it influenced their communication with general practitioners. Background Nurses in home care services must collaborate with general practitioners to care for homebound patients. Studies have shown that communication and collaboration are often constrained because they are organised separately and are dispersed. The use of information and communication technology is expected to support communication and to be a tool for increased patient safety and higher-quality care. Design Cross-sectional study with group comparisons Methods The data were collected with a mailed questionnaire that was answered by home care nurses ( n = 425) who had implemented e-messaging and by home care nurses in a comparison group who had not implemented e-messaging ( n = 364). The data were analysed using descriptive analyses, chi-square test, Mann-Whitney U-test and multilevel analysis. Results The home care nurses who used e-messages reported to a greater extent that they had communication procedures with general practitioners compared to what the home care nurses in the comparison group reported. The implementation of e-messaging did not result in timelier communication or differences between the two groups in the use of nonelectronic communication, except for a lower use of faxes in the e-messaging group. However, the home care nurses who used e-messaging reported more frequent contacts with general practitioners. Conclusion The results demonstrate that even if e-messaging was implemented, the home care nurses and the general practitioners continued to use nonelectronic communication methods. Relevance to clinical practice E-messaging did not replace but rather complemented the communication methods and thereby transformed clinical communication and collaboration. This should be considered when planning and implementing new information technology in primary care. [ABSTRACT FROM AUTHOR]

Aims and objectives To assess patients' symptoms, quality of life and satisfaction with information three to four years after radical prostatectomy, radical external beam radiotherapy and postoperative radiotherapy and to analyse differences between treatment groups and the relationship between disease-specific, health-related and overall quality of life and satisfaction with information. Background Radical prostate cancer treatments are associated with changes in quality of life. Differences between patients undergoing different treatments in symptoms and quality of life have been reported, but there are limited long-term data comparing radical prostatectomy with radical external beam radiotherapy and postoperative radiotherapy. Design A cross-sectional survey design was used. Methods The study sample included 143 men treated with radical prostatectomy and/or radical external beam radiotherapy. Quality of life was measured using the 12-item Short Form Health Survey and the 50-item Expanded Prostate Cancer Index Composite Instrument. Questions assessing overall Quality of life and satisfaction with information were included. Descriptive statistics and interference statistical methods were applied to analyse the data. Results Radical external beam radiotherapy was associated with less urinary incontinence and better urinary function. There were no differences between the groups for disease-specific quality of life sum scores. Sexual quality of life was reported very low in all groups. Disease-specific quality of life and health-related quality of life were associated with overall quality of life. Patients having undergone surgery were more satisfied with information, and there was a positive correlation between quality of life and patient satisfaction. Conclusion Pretreatment information and patient education lead to better quality of life and satisfaction. This study indicates a need for structured, pretreatment information and follow-up for all men going through radical prostate cancer treatment. Relevance to clinical practice Long-term quality of life effects should be considered when planning follow-up and information for men after radical prostate cancer treatment. Structured and organised information/education may increase preparedness for symptoms and bother after the treatment, improve symptom management strategies and result in improved quality of life. [ABSTRACT FROM AUTHOR]

Aims and objectives To investigate (1) the extent to which shock anxiety and perceived support from healthcare professionals are related to post-traumatic stress disease ( PTSD) symptoms and (2) the extent to which perceived support from healthcare professionals moderates the relationship between shock anxiety and PTSD symptoms in implantable cardioverter defibrillator recipients. An additional aim was to describe the level of PTSD symptoms and perceptions of support from healthcare professionals. Background Studies examining PTSD symptoms among implantable cardioverter defibrillator recipients are still sparse. In addition, little is known about how perceived support from healthcare professionals is related to PTSD symptoms. Design Cross-sectional survey design. Methods Recipients ( n = 167) with implantable cardioverter defibrillator attending an outpatient device clinic completed questionnaires assessing shock anxiety, PTSD symptoms and perceived support from healthcare professionals. Results The results indicated that between ten and 15% of the recipients experienced moderate to severe symptoms of PTSD. Although a majority perceived constructive support from healthcare professionals, 12% perceived nonconstructive support. Regression analysis demonstrated that shock anxiety and perceived nonconstructive support from healthcare professionals had a statistically significant (p < 0·01) association with PTSD symptoms. Moreover, the results suggest that associations between shock anxiety and PTSD symptoms were significantly (p < 0·01) moderated by perceived nonconstructive support from healthcare professionals. Young age, short time since implantation and secondary prevention indication were also significantly associated with PTSD symptoms. Conclusions The results indicate that nonconstructive support from healthcare professionals can increase the tendency to develop PTSD symptoms, particularly in those who experience shock anxiety. Relevance to clinical practice Healthcare professionals should pay more attention to the way in which they communicate information to the recipients during follow-up visits. Clinically based strategies and interventions targeting shock anxiety and PTSD symptoms should be carried out. [ABSTRACT FROM AUTHOR]

Aims and objectives To develop, empirical test, and validate an instrument measuring patient participation in surgical treatment decision-making from healthcare professionals' perspective. Background Since the advent of New Public Management in many Western countries, patient participation in healthcare decision-making has been considered to be a best practice. A common notion is that well-educated and well-informed public want to choose their own treatments and providers and want to ask questions about the quality of their health services. Design Survey. Methods A self-report-measuring instrument was designed and administered to 620 healthcare professionals. Items were developed, validated and tested by 451 nurses and physicians working in six surgical wards in a University Hospital in Norway. Results A 16-item scale with the following four dimensions was developed: information dissemination, formulation of options, integration of information and control. Factor analysis procedures and reliability testing were performed. A one-way, between-groups analysis of variance was conducted to compare doctors' and nurses' opinions on four dimensions of patient participation in surgical treatment decision-making. Conclusions This article shows that patient participation in surgical treatment decision-making can be measured by a 16-item scale and four distinct dimensions. The analysis demonstrated a reasonable level of construct validity and reliability. Nurses and physicians have a positive attitude towards patient participation overall, but the two groups differ in the extent to which they accept the idea of patient participation in treatment decision-making. Relevance to clinical practice The instrument can be a tool for managers and healthcare professionals in the implementation of patient participation in clinical practice. Data from the instrument can be useful to identify health services being provided and what areas that could strengthen patient participation. [ABSTRACT FROM AUTHOR]

Aims and objectives. Hypothesised that sociodemographic factors and illness variables would be associated with mortality and that emotional and social loneliness measured using the Social Provisions Scale would influence mortality among nursing homes residents with cancer. Background. Studies are lacking on how emotional and social loneliness influence mortality among cognitively intact older people in nursing homes with and without a diagnosis of cancer. Design. A cross-sectional design was used at baseline with a five-year follow-up of mortality. Methods. A cohort of 227 cognitively intact (Clinical Dementia Rating scale score ≤0·5) older residents (60 with cancer and 167 without) from 30 nursing homes were followed from 2004-2005 to 2010. Data were collected by face-to-face interview. Sociodemographic variables and medical diagnoses were obtained from the records. Results. Survival did not differ significantly between residents with and without cancer. After adjustment for sociodemographic and illness variables, increasing age, higher education and comorbidity were associated with mortality. In the final model from a backward selection procedure, attachment (emotional loneliness) was associated with mortality. Conclusions. Independent of a cancer diagnosis or not, emotional loneliness, age, education and comorbidity influenced mortality among nursing homes residents without cognitive impairment. Relevance to clinical practice. Nurses should pay attention to emotional loneliness among nursing homes residents independent of cancer and especially give attention to the importance to have a close confidant who provides emotional support. [ABSTRACT FROM AUTHOR]

Aims and objectives. To examine (1) the relationships between job satisfaction and task- and relationship-oriented leadership and (2) the direct and moderating effects on job satisfaction of three ward-level factors: workload, use of teams and staff stability. Background. Job satisfaction in nursing homes is vital to meeting the challenges related to recruitment and turnover. Design. Cross-sectional design. Method. A multilevel analysis approach was used to recognise a hierarchal structure of determined factors and to capture variation in job satisfaction at the individual and ward level. A questionnaire was sent to 444 registered nurses, auxiliary nurses and unskilled nursing assistants. Structured interviews were administered to 40 ward managers and 13 directors, and 900 hours of field observations was conducted in 40 nursing home wards throughout Norway. Results. We found a significant relationship between job satisfaction and task-oriented and relationship-oriented leadership styles, with a stronger effect for task orientation. The effect of the two leadership styles varied significantly across wards. Furthermore, staff stability had both a significant positive direct effect and a moderating effect on job satisfaction, whereas the two other ward-level predictors yielded no significant contributions. Conclusion. The relatively stronger effect of task-oriented leadership on job satisfaction, particularly in wards with low staff stability, is in contrast to most previous studies and suggests that there may be specific conditions in nursing homes that favour the use of this leadership style. The varying effect of both leadership styles indicates that staff in different nursing home wards could benefit from the use of different leadership styles. Relevance to clinical practice. The study highlights the importance of using different leadership behaviour and the importance of high staff stability to ensure job satisfaction among nursing home personnel. [ABSTRACT FROM AUTHOR]

Aim. The aim is to study the health-related quality of life in a school sample of children and adolescents aged 8-18 years and to examine the relationship between health-related quality of life and the following variables; age, gender, perceived pain, body image, body mass index and bullying. Background. The study of health-related quality of life in children and adolescents have received little attention compared with adults in health care research and still little is known about the associations between health-related quality of life and other variables. Design. A cross-sectional design was chosen. Method. We measured the health-related quality of life using the generic questionnaire KIDSCREEN-10. We administered the KIDSCREEN 52-item, and the 10 items were selected from this according to the KIDSCREEN manual. Multilevel regression models were used to evaluate the associations between health-related quality of life and the independent variables. Results. The sample included 1066 children and adolescents, 576 girls and 490 boys, with a response rate of 74%. The results show that body mass index was not significant associated with health-related quality of life in full model. However, in addition to age, being bullied, pain and body image were significant associated with health-related quality of life. Of these predictors, body image has the strongest impact in terms of explained variance in health-related quality of life. Conclusion. The subjective sense of satisfaction or dissatisfaction with one's body, perceived body image, is a powerful predictor of health-related quality of life. Relevance to clinical practice. Knowledge about predictors of health-related quality of life is especially important for public health nurses. Health promotion and intervention programmes that aim to strengthen psychosocial well-being, especially those that strengthen body image, should be developed for both genders. [ABSTRACT FROM AUTHOR]

Aim. To explore depressive symptoms among nursing home residents without cognitive impairment and the relationship between their depressive symptoms and dependence on activities of daily living, comorbidity and sociodemographic variables. Background. Depression has become a major health care concern among older people, but depression and its association with functioning in activities of daily living among nursing home residents without cognitive impairment has previously not been studied in Norway. Design. A cross-sectional comparative design. Methods. The sample comprised older residents (age 65-102 years; n = 227) from 30 nursing homes with at least six months of residence. All nursing home residents had a Clinical Dementia Rating scale score ≤0·5 and were capable of conversation. Scores on the Geriatric Depression Scale (15 items) and demographic variables were collected during face-to-face interviews. The activities of daily living were assessed using the Katz Index based on nurses' observation, and medical diagnoses were obtained from the patient records. Pearson's chi-square test and ordinal logistic regression were used to identify possible associations between activities of daily living and depression. Results. After adjustment for age, sex, marital status, length of stay per year and education, more dependence on activities of daily living was associated with depression [odds ratio (OR): 1·18; 95% confidence interval (CI): 1·04-1·37; p = 0·02]. Higher age was associated with less depression (OR: 0·64; 95% CI: 0·43-0·94; p = 0·02), that is, the odds of depression declined by 36% for each 10-year increase in age. Conclusions. Our results suggest that depression symptoms are a major health problem among nursing home residents without cognitive impairment and that younger residents are more prone to having depressive symptoms. Relevance to clinical practice. Nursing home staff should communicate with and observe residents closely for signs of depression, especially younger residents with high dependence on activities of daily living. In addition, formal screening of all residents for depression using an instrument that is sensitive to older people is recommended. [ABSTRACT FROM AUTHOR]