Simulation-based training and assessment of non-technical skills in the Norwegian Helicopter Emergency Medical Services: a cross-sectional survey.

BACKGROUND: Human error and deficient non-technical skills (NTSs) among providers of ALS in helicopter emergency medical services (HEMS) is a threat to patient and operational safety. Skills can be improved through simulation-based training and assessment. OBJECTIVE: To document the current level of simulation-based training and assessment of seven generic NTSs in crew members in the Norwegian HEMS. METHODS: A cross-sectional survey, either electronic or paper-based, of all 207 physicians, HEMS crew members (HCMs) and pilots working in the civilian Norwegian HEMS (11 bases), between 8 May and 25 July 2012. RESULTS: The response rate was 82% (n=193). A large proportion of each of the professional groups lacked simulation-based training and assessment of their NTSs. Compared with pilots and HCMs, physicians undergo statistically significantly less frequent simulation-based training and assessment of their NTSs. Fifty out of 82 (61%) physicians were on call for more than 72 consecutive hours on a regular basis. Of these, 79% did not have any training in coping with fatigue. In contrast, 72 out of 73 (99%) pilots and HCMs were on call for more than 3 days in a row. Of these, 54% did not have any training in coping with fatigue. CONCLUSIONS: Our study indicates a lack of simulation-based training and assessment. Pilots and HCMs train and are assessed more frequently than physicians. All professional groups are on call for extended hours, but receive limited training in how to cope with fatigue.

Narratives of breathlessness in chronic obstructive pulmonary disease.

AIMS AND OBJECTIVES: To explore patient perceptions of chronic obstructive pulmonary disease exacerbation and the patients' experiences of their relations with health personnel during care and treatment. BACKGROUND: Patients suffering from acute exacerbation of chronic obstructive pulmonary disease often experience life-threatening situations and undergo noninvasive positive-pressure ventilation via bi-level positive airway pressure in a hospital setting. Theory on trust, which often overlaps with the issue of power, can shed light on patient's experiences during an acute exacerbation. DESIGN: Narrative research design was chosen. METHODS: Ten in-depth qualitative interviews (n = 10) were conducted with patients who had been admitted to two intensive care units in Western Norway during the autumn of 2009 and the spring of 2010. Narrative analysis and theories on trust and power were used to analyse the interviews. RESULTS: Because of their breathlessness, the patients perceived that they were completely dependent on others during the acute phase. Some stated that they had experienced an altered perception of reality and had not understood how serious their situation was. Although the patients trusted the health personnel in helping them breathe, they also told stories about care deficiencies and situations in which they felt neglected. CONCLUSIONS: This study shows that patients with an acute exacerbation of chronic obstructive pulmonary disease often feel wholly dependent on health personnel during the exacerbation and, as a result, experience extreme vulnerability. RELEVANCE TO CLINICAL PRACTICE: The findings give nurses insight into building trust and a good relationship between patient and caregiver during an acute exacerbation of chronic obstructive lung disease.

Intensive care unit nurses' perceptions of patient participation in the acute phase of chronic obstructive pulmonary disease exacerbation: an interview study.

AIM: To report a study conducted to explore intensive care unit nurses' perceptions of patient participation in the acute phase of chronic obstructive pulmonary disease exacerbation. BACKGROUND: An acute exacerbation is a life-threatening situation, which patients often consider to be extremely frightening. Healthcare personnel exercise considerable power in this situation, which challenges general professional notions of patient participation. DESIGN: Critical discourse analysis. METHODS: In the autumn of 2009, three focus group interviews with experienced intensive care nurses were conducted at two hospitals in western Norway. Two groups had six participants each, and one group had five (N = 17). The transcribed interviews were analysed by means of critical discourse analysis. FINDINGS: The intensive care nurses said that an exacerbation is often an extreme situation in which healthcare personnel are exercising a high degree of control and power over patients. Patient participation during exacerbation often takes the form of non-involvement. The participating nurses attached great importance to taking a sensitive approach when meeting patients. The nurses experienced challenging ethical dilemmas. CONCLUSION: This study shows that patient participation should not be understood in universal terms, but rather in relation to a specific setting and the interactions that occur in this setting. Healthcare personnel must develop skill, understanding, and competence to meet these challenging ethical dilemmas. A collaborative inter-professional approach between physicians and nurses is needed to meet the patients' demand for involvement.

Norwegian midwives' perception of the labour admission test.

OBJECTIVE: To explore what information and knowledge the labour admission test is perceived to provide and what meaning the test carries in the daily work of practising midwives. DESIGN: In-depth interviews transcribed verbatim and analysed using the grounded theory technique. SETTING: Four different labour wards in Norway. PARTICIPANTS: A theoretical sample of 12 practising midwives. FINDINGS: The core category "experiencing contradictions" was identified during the analyses, indicating that the midwives found conflicting interests within themselves, or between themselves and others when using the labour admission test. They experienced contradictions between professional identity and the increasing use of technology, between feeling safe and feeling unsafe and between having power and being powerless. KEY CONCLUSIONS: The labour admission traces could be difficult to interpret, especially for newly qualified midwives. Some midwives thought that a labour admission trace could protect them in case of litigation. The hierarchy of power in the labour ward influences the use and interpretation of the labour admission test. Some midwives felt their professional identity threatened and that midwives in general are losing their traditional skills because of the increasing use of obstetric technology. IMPLICATIONS FOR PRACTICE: The findings of the present study should be taken into consideration when changing practice to not routinely perform the labour admission test. There is also a need for further research on what effect the increasing use of obstetric technology has on traditional midwifery skills.

Swedish upper secondary school pupils' sense of coherence, coping resources and aggressiveness in relation to educational track and performance.

The health of an individual depends on how well he or she can handle various stressors in his or her environment. One vulnerable period occurs during the transition from child to adult. The overall aim of this research project was to determine whether differences in the ability to deal with stress are related to various health indicators, aggression, and school marks during primary and upper secondary school. Data were collected class-wise and 253 Swedish upper secondary school pupils participated. Three well-established questionnaires [Sense of Coherence (SOC), Coping Resources Inventory (CRI) and Aggression Questionnaire (AQ)] were used. In addition, blood pressure, teacher evaluation and school marks were collected. Some demographic data such as gender, age and type of study programme were also collected. Both SOC and Coping Resources Inventory correlated significantly positively with many of the primary and upper secondary marks, while the AQ had significantly negative correlations with the mark. Females obtained higher values than males in Coping Resources Inventory, but lower in SOC and AQ.

Negative memories of childhood and current drug use.

Data on drug abuse and memories of the childhood were collected through a self-report questionnaire from a group of current drug users and a group of non-using controls. Both samples were unidentified as groups by the society and were identified by the researchers throw snowball sampling. Earlier results of an unstable childhood and a poor social situation from studies that used other sampling methods were replicated. The drug users had an earlier nicotine and alcohol debut, and perceived themselves as unloved, physically abused children that were afraid of their parents during childhood. In addition, depression, suicide attempts and convictions were more common among the drug users.