Psychometric testing of the Norwegian version of the questionnaire, student satisfaction and self-confidence in learning, used in simulation.

Simulation is increasingly being used as an approach to learning in nurse education. There is a need for frameworks and valid evaluation tools to help guide educators in implementing the method. The questionnaire, Student Satisfaction and Self-Confidence in Learning, which consists of two subscales, has been developed by the National League for Nursing in the US for evaluating simulation used in nurse education. The aim of the present study was to test the questionnaire, Student Satisfaction and Self-Confidence in Learning, for psychometric properties in a Norwegian nurse education context. A sample consisting of 130 nursing students participated in a simulation situation, and 123 responded. When the questionnaire was tested in its entirety, psychometric testing conducted with a principal component analysis did not reveal a stable factor solution. The two subscales were then tested separately. The analysis for Satisfaction with Current Learning suggested a one-component solution, thereby explaining 62.8% of the variance, and the internal reliability was 0.84. With regard to Self-Confidence in Learning, no stable solution was achieved, and an alpha value of 0.64 was shown. To further validate the questionnaire, Student Satisfaction and Self-Confidence in Learning, more studies by various nursing programmes in different cultural contexts are recommended.

Swedish nurses' perceptions of influencers on patient advocacy: a phenomenographic study.

BACKGROUND: A limited number of studies have shown that patient advocacy can be influenced by both facilitators and barriers which can encourage and discourage nurses to act as patient advocates. OBJECTIVE: This study's aim was to describe Swedish nurses' perceptions of influencers on patient advocacy. RESEARCH DESIGN AND CONTEXT: Interviews with 18 registered nurses from different Swedish clinical contexts were analysed using the phenomenographic method. ETHICAL CONSIDERATIONS: Ethical revisions were made in accordance with national legislation and guidelines by committees for research ethics at Karlstad University. FINDINGS: Three levels of hierarchically related influencers on patient advocacy were found in the descriptive categories. The fundamental influencer, the nurse's character traits, was described in the perceptions that advocacy is influenced by nurse's having a moral compass, having control over the care situation, being protective and feeling secure as a nurse. The second most vital influencer, the nurse's bond with the patient, was expressed in the perceptions of knowing the patient and feeling empathy for the patient. The third level of influencers, the organisational conditions, was described in the perceptions that the organisational structures and organisational culture influence patient advocacy. DISCUSSION: The results correspond with findings from earlier research but add an understanding that influencers on patient advocacy exist at three hierarchically related levels. CONCLUSION: The nurse's character traits are the fundamental influencer to patient advocacy, but in order to be comfortable and secure when advocating for patients, nurses also need to be familiar with both the patient and the situation. A supposition could be that all influencers interact, which needs to be further addressed in future studies.

Individual and organisational factors influencing registered nurses' attitudes towards patient advocacy in Swedish community health care of elders.

AIM: The aim of this study was to describe and explore individual and organisational factors potentially influencing registered nurses' (RNs) attitudes towards patient advocacy. METHODS AND SAMPLE: In a quantitative cross-sectional study, data were collected from 226 RNs in community health care of elders. A questionnaire was used to measure a number of factors including attitudes towards patient advocacy, nursing competence, personality traits, individual preferences regarding the quality of health care and working climate. A multiple regression analysis was performed. RESULTS: The results showed that individual factors of nursing competence and individual preferences of the quality of health care, as well as organisational factors of the working climate, explained 26.2% of the variance in the RNs' attitudes towards patient advocacy. CONCLUSIONS: Although the mentioned individual factors may be intertwined, the conclusion is that both individual and organisational factors influenced RNs' attitudes towards patient advocacy. The results do not verify that nursing experience, workplace experience, educational level or personality traits influence the RNs' attitudes towards patient advocacy. The proportion of explained variance indicates that additional factors also influence attitudes towards patient advocacy, and more research is needed to shed further light on these factors.

Caring for patients at high speed.

AIM: The aim of this article is to explore whether ambulance clinicians in Sweden perceive their working environment to be safe. METHOD: Twenty four ambulance nurses and nine paramedics at five ambulance stations in urban and rural areas of Sweden were interviewed. FINDINGS: After transcripts of the interviews had been analysed, nine issues that affect how participants perceive the safety of patient care in ambulances emerged: planning before departure; use of safety belts; driving at high speeds; patient first, safety second; equipment design and placement; noise; driving styles; presence of relatives; documentation. CONCLUSION: Ambulance personnel should have greater involvement in the design of ambulance care spaces and drivers should be given more regular training.

Swedish registered nurses' and nurse managers' attitudes towards patient advocacy in community care of older patients.

AIM: To describe and compare registered nurses' (RNs) and nurse managers' (NMs) attitudes towards patient advocacy in the community care of older patients. BACKGROUND: RNs may act as patients' advocates in the care of older patients. NMs should support patient advocacy in order to make the best care available to patients. METHOD: A modified Attitudes towards Patient Advocacy Scale was used to collect data from 207 RNs and 23 NMs in the Swedish community care of older patients. The response rate was 52%. Descriptive and inferential statistics were used. RESULTS: Both RNs and NMs showed positive attitudes towards patient advocacy. They were more positive towards patient advocacy for patients unable to help themselves than for competent patients. CONCLUSIONS: This study showed that RNs and NMs did not differ in their attitudes towards patient advocacy. This result is consistent with the idea of giving the neediest and vulnerable patients greater care. IMPLICATIONS FOR NURSING MANAGEMENT: It is important for NMs to clarify their own and RNs attitudes towards patient advocacy as disparities may affect cooperation between the groups. Any effects on cooperation may, by extension, affect the quality of care.

The psycho-social dimension of pain and health-related quality of life in the oldest old.

BACKGROUND: Chronic pain has an impact on the physical and social functioning of older people which in turn may worsen their health-related quality of life. Research with focus on prolonged extensive pain in the most elderly and how pain may interfere with their life situation is scarce. AIMS: The aims were to describe and investigate pain from a multidimensional point of view (duration, location, psycho-social) and health-related quality of life as well as to compare sex and age groups in people aged 80 years and over. METHODS: In this cross-sectional study, a total of 225 of 282 people responded to a questionnaire consisting of two instruments and background questions. The psycho-social dimension of pain was measured using the Multidimensional Pain Inventory-Swedish language version (MPI-S) with five scales: Pain Severity, Interference, Life Control, Affective Distress and Social Support. Health-related quality of life was measured using the Short Form Health Survey-12 (SF-12). RESULTS: Median duration of pain was 9.0 years, and the mean number of pain locations was 2.04. The MPI-S scale Interference with a negative orientation had the highest mean score, while the mean score for Social Support was the highest for the scales with a positive orientation. The duration of pain was significantly greater for women, and those aged 80-85 years had higher pain severity than those aged≥86. Participants with a lower health-related quality of life experienced significantly more severe pain, were more troubled with pain and had less control of their life. CONCLUSIONS: Older people with prolonged pain suffered from a low health-related quality of life. Pain interfered with their lives and contributed to diminished control in their daily lives. Nurses are essential for the identification and prevention of pain and should be aware of how pain affects older people's physical, mental and social health.

Nursing students' concerns about end of life in California, Norway, and Sweden.

AIM: To investigate concerns about dying for newly admitted nursing students from California, Norway, and Sweden. METHOD: A total of 389 undergraduate nursing students who had just started their nursing programme participated. Data was collected with a questionnaire that included two instruments-the Concerns about Dying instrument and the Sense of Coherence instrument-and background questions. The data was analysed using statistical and content analysis. RESULTS: There were statistically significant differences between the three groups of students in terms of their age, their experience in health care, whether they had previously attended a dying patient, the age at which they first encountered the death of a loved one, and their concerns about dying. Two main categories emerged from the analysis of the open questions: 'attending to dying and grieving persons' and 'thinking about one's own death'. CONCLUSION: The study provides important insights into the concerns that newly admitted students bring to the nursing programme.

Time saved with high speed driving of ambulances.

Transportation with road ambulances is increasing because of a concentration of hospitals to larger units, with high quality in the acute care of the patients. The concentration implies longer distances to receiving units, which increases the transportation time. The purpose of the present study was to investigate the time difference in ambulance transportation with high speed emergency driving, compared to non-emergency driving in normal traffic pace. Data was collected from 30 emergency high speed ambulance transportations in urban and rural areas. These transportations were then repeated experimentally with an ambulance driving at normal traffic pace. The average speed and duration for the emergency transportations were shorter than for the experimental driving, both in urban and rural areas. The mean time saved was 2.9 min (urban areas) and 8.9 min (rural areas). Regardless of the patient's clinical status or need of care the emergency transportations were carried out in higher speed than the experimental driving. However, patients with life threatening conditions were not included in this study. Procedures and methods should be developed to identify the patients for which fast transportation has clinical relevance to the outcomes.

Tensions related to implementation of postgraduate degree projects in specialist nursing education.

In conjunction with the introduction of the Bologna process in Sweden, specialist nursing education programmes were moved up to the second cycle of higher education with the opportunity to take a one-year master's degree, which also meant that students would undertake a degree project carrying 15 ECTS. The purpose of this study was to examine the introduction of postgraduate degree projects on the second-cycle level into Swedish specialist nursing programmes in accordance with the Bologna process. Five universities were involved and the study design took the form of action research. Problem formulation, planning, evaluation and follow-up with reflection led to new actions over a period of 2 1/2 years. Through a review of local curriculum documents, the implementation of a postgraduate degree project was monitored and these reviews, together with field notes, were analysed by means of constant comparative analysis. The results revealed a variety of tensions that arose when postgraduate degree projects were introduced, taking the form of differing views on the relationship between research, clinical development, specific professional objectives and academic objectives. These tensions were reflected in six areas of change. In summary, it can be noted that implementation of the postgraduate degree projects highlighted tensions related to basic views of learning.

Transportation with hospital beds.

Transporting patients in hospital beds is a common task in acute hospital wards. The aim of the study was to explore the influence of different bed wheel arrangements on the effort and difficulties experienced by personnel when transporting patients. Four test beds were used and tested in four common transport situations. Nineteen registered and enrolled nurses participated in the tests. The perception of effort was rated on Borg's category ratio scale, CR-10 and the perceived level of difficulty on the visual analogue scale. ANOVA and Bonferroni post hoc multiple comparisons were conducted to measure which pairs of beds differed significantly. The results show that the wheel arrangements of the beds have a major influence on the effort and difficulties perceived by the personnel. Standard small diameter castor wheels made the bed easier to manoeuvre in limited spaces, while larger wheels on fixed axles made the beds more comfortable to handle during long distance transportation.