Team experiences of the root cause analysis process after a sentinel event: a qualitative case study.

BACKGROUND: Root cause analysis (RCA) is a systematic approach, typically involving several stages, used in healthcare to identify the underlying causes of a medical error or sentinel event. This study focuses on how members of a Norwegian RCA team experience aspects of an RCA process and whether it complies with the Norwegian RCA method. METHOD: Based on a sentinel event in which a child died unexpectedly during childbirth in a Norwegian hospital in 2021, the following research questions are addressed: 1. What was the RCA team's experience of the RCA process? 2. Was there compliance with the Norwegian RCA method in this case? A case study was chosen out of the desire to understand complex social phenomena and to allow in-depth focus on a case. RESULTS: The result covered three main themes. The first theme related to the hospital's management system and aspects of the case that made it challenging to follow all recommendations in the Norwegian RCA guidelines. The second theme encompassed external and internal assessment. The RCA team was composed of members with methodological and medical expertise. However, the police's involvement in the case made it complex for the team to carry out the process. The third and final theme covered intrapersonal challenges RCA team members faced. Team members experienced various challenges during the RCA process, including being neutral, dealing with role-related challenges, grappling with ambivalence, and managing the additional time burden and resource constraints. As anticipated in the RCA guidelines, the team's ability to remain neutral was tested. CONCLUSION: The findings of this study can help stakeholders better comprehend how an inter-professional RCA teamwork intervention can affect a healthcare organization and enhance the teamwork experience of healthcare staff while facilitating improvements in work processes and patient safety. Additionally, these results can guide stakeholders in creating, executing, utilizing, and educating others about RCA processes.

Home-like care: Collaboration between parents and nurses in everyday situations when children are hospitalized.

When children are hospitalized, parents and nurses need to collaborate. This study aims to investigate how parents and nurses experience collaborating and sharing responsibilities and tasks when providing home-like care for hospitalized children in everyday situations. This qualitative study used a hermeneutic phenomenological approach with observations and interviews and was conducted in a general medical pediatric unit. Twelve parents of eleven hospitalized children between the ages of 1 and 6 years with various medical diagnoses and seventeen nurses who cared for those children participated in the study. Parents and nurses collaborated and shared responsibilities and tasks to provide home-like care for hospitalized children in everyday situations by making mealtimes seem familiar, maintaining customary sleeping patterns, adapting washing and dressing routines, and facilitating play and activity. Parents and nurses collaborated to maintain a familiar rhythm in an unfamiliar environment to enhance the children's well-being. The nurses' degree of involvement in the children's everyday situations varied from little to moderate to strong, with parents assuming the main responsibilities. Nurses' involvement in children's everyday situations was variable, depending on the complexity of the situations.

Experiences after international clinical placement as nursing students in a paediatric ward.

AIM: The aim of this study is to investigate nurses' experiences after participating in an international clinical placement programme as nursing students while staying for one to three weeks in a paediatric ward. BACKGROUND: Student mobilisation is expected to increase the quality of education. Hence, offering international clinical placement programme in low- and high-income countries is a commonly used learning activity in bachelor programmes in nursing. Many studies have mainly examined the general experiences gained from international clinical placement programme but have not specifically focussed on the setting of paediatric wards in hospitals. Nursing students are required to acquire knowledge of paediatric nursing with children as patients. DESIGN AND METHOD: In this qualitative study, a hermeneutic, phenomenological approach was adopted. Data were collected through individual interviews with eight nurses after they participated in an international clinical placement programme as nursing students in a paediatric ward. RESULTS: Meetings with children's destinies as patients were overwhelming, being an observer provided insights into and an overview of paediatric nursing, access to the resources required for treating children is limited, nurses had a different role and parents had an extended caring role. CONCLUSION: All participants gained knowledge of children as patients at a hospital and also gained knowledge of the parents' and nurses' roles and the treatment methods of various diseases that are relevant to paediatric nursing. This helped provide them with the cultural knowledge, awareness and sensitivity required, given the contrasting situation at their home country.

Nurses benefit from international clinical placement as nurse students: A qualitative study.

BACKGROUND: A goal of studying abroad is increased cultural knowledge as well as strengthening the participants' disposition for active participation in society and in future careers. Empirical studies have shown a positive impact on nursing students', but little is known about the effects of international clinical placement on professional nursing. The aim was to investigate nurses' experiences after participating in international clinical placement as students, and how the stay influences their future career as professional nurses. DESIGN: Qualitative design, and a hermeneutic phenomenological approach. METHODS: Individual semi-structured interviews were conducted with a sample of eight nurses who had participated in an international clinical placement as nursing students and worked for at least two years as nurses. The participants were students at one University College in Norway. The data analysis method was inspired by Max van Manen's thematic analysis. RESULTS: The international clinical placement promoted personal and professional development of importance to professional nursing practice. The informants benefited from increased global and cultural awareness and noted that mastering the emotional challenges during the placement strengthen their ability to manage demanding situations in nursing work. The students evaluated guided reflection before, during and after the stay to contributing to learning outcome. CONCLUSION: The potential for increased global and cultural competence and personal and professional development is high in international clinical placements. If the opportunity is taken, the participants' future careers can be affected in a way that benefits patients and colleagues. We recommend that educators and supervisors of students on international clinical placements should facilitate guided reflection to the participating students.

Children's Co-Determination During Challenging Procedures: Nurses and Parents Experiences of Caring Under Short-Term Hospital Stays in Norway.

BACKGROUND: Medical and clinical procedures can cause varying levels of discomfort to children. PURPOSE: This study is to deepen the understanding of the lived experiences of parents and nurses related to challenging medical and clinical procedures performed on children during short-term hospital stays. DESIGN AND METHODS: This qualitative study, which comprises part of a larger study, adopted a hermeneutic phenomenological approach. The data were obtained through a combination of in-depth interviews and observations of twelve parents of eleven children and seventeen nurses. A narrative re-analysis was conducted of four challenging medical and clinical procedures. Four stories were written and subsequently analyzed as one narrative that represents the findings. RESULTS: The form of nurses' and parents' care for the children ranged from encouraging the children's consent and receptiveness to the procedures, to coercion. The analysis indicates that promoting the children's co-determination and participation in the procedures encouraged their consent and receptiveness and facilitated a successful outcome. In contrast, an absence of efforts to involve the children in the procedures contributed to the need for coercion to be employed by parents and nurses. Moreover, parental influence and the responsibilities of nurses had an impact on children's co-determination and participation. CONCLUSIONS: Preparing parents and children before and during a procedure was important to minimize the degree of coercion of the children. PRACTICE IMPLICATIONS: The findings of this study are relevant to clinical practice because they suggest preparing parents and children before and during a procedure situation.

Finding ways to carry on: stories of vulnerability in chronic illness.

Purpose: In this study, we explore the lived experiences of chronic illness in four groups of patients; children with asthma, adolescents with diabetes, young adults with depression, and adult patients with chronic, obstructive pulmonary disease (COPD). Persons living with chronic illness are often designated as vulnerable. This study builds on the assumption that being vulnerable belongs to being human, and that vulnerability also might entail strength and possibilities for growth. Methods: A narrative analysis was undertaken to illuminate how experiences of vulnerability were narrated across the four patient groups, presenting four individual stories, one from each of the patient groups. Results/conclusion: The stories illuminate how living with a chronic illness implies differing capabilities and capacities dependent on the specific condition. At the same time the stories point to how various abilities and challenges in living with chronic illness can be alleviated or seen as resources. Considered together, the stories underscore how ´finding ways to carry on´ in chronic illness requires interpretational work. By calling upon resources among significant others, in the surroundings and in oneself, the narrator can find ways of interpreting living with chronic illness that might open towards a hopeful future.

Parents' and nurses' ideal collaboration in treatment-centered and home-like care of hospitalized preschool children - a qualitative study.

BACKGROUND: The hospitalization of children requires collaboration between parents and nurses in partnerships. This study examines parents' and nurses' experiences of ideal collaboration in treatment-centered and home-like care of hospitalized preschool children. METHODS: This qualitative study is part of a larger study of 12 parents and 17 nurses who were responsible for 11 hospitalized children. Data collection took place at a Norwegian general paediatric unit, and the data were gathered from observations of and qualitative interviews with the parents and nurses. The analysis was conducted in six steps, in alignment with Braun and Clarke. RESULTS: Two essential themes emerged from the analysis. (1) Treatment-centered care focuses on the following tasks in building relationships - gaining trust, securing - gaining voluntariness, distracting and comforting, and securing and gaining voluntariness. The purpose of treatment-centered care is to perform diagnostic procedures and offer treatment. (2) Home-like care, the purpose of which is to manage a child's everyday situations in an unfamiliar environment, focuses on the following tasks: making familiar meals, maintaining normal sleeping patterns, adjusting to washing and dressing in new situations, and normalizing the time in between. From this pattern, we chose two narratives that capture the essence of ideal collaboration between parents and nurses. CONCLUSION: The ideal collaboration between nurses and parents is characterized by flexibility and reciprocity, and is based on verbal and action dialogues. In treatment-centered care, parent-nurse collaboration was successful in its flow and dynamic, securing the children's best interests. Meanwhile, the achievement of the children's best interest within home-like care varied according to the level of collaboration, which in turn was related to the complexity of the children's everyday situations.

Exclusion and inclusion of parents of hospitalized children in Norway in the period 1877-2017.

BACKGROUND: Today, Norwegian parents have the right to stay with their children when they are in hospital. This right is relatively new. The purpose of this article is to examine the nursing profession's ideas on how parents should be included/excluded when their children are in hospital, and to examine the social and ideological conditions that made the nursing profession's ideas on inclusion/exclusion practices possible. METHODS: The analyses are done in the tradition of the French philosopher Michel Foucault's writings on how different kinds of knowledge have been used to discipline citizens. Such studies include analyses of descriptive and normative material and analyses of the ideological and social conditions that made the practices possible. The analyses are based on Norwegian textbooks on nursing. RESULTS: Parents are rarely mentioned in Norwegian nursing textbooks from the period 1877-1940, and they are not present in photos from hospitals. The exclusion of parents may be due to the absence of welfare services and the fear of parents transmitting diseases from the hospitals to the general population.The first Norwegian nursing textbook that argued for the importance of letting parents visit their children in hospital was published in 1941. In 1968, nursing textbooks started to argue for parents' participation in the care. Since 1987, nursing textbooks have advocated full parental participation. The inclusion of parents was in accordance with humanistic ideology. The inclusion of parents occurred in a period of great nursing shortage. In this situation, it would have been of interest to entrust as much as possible of the nurse's work to the family. CONCLUSIONS: Our conclusion is that ideas break through when they are in line with social conditions. From 1877 to 1940 social and economic conditions made it difficult for parents to be with their children in hospital, and hygiene ideology/theory contributed to legitimization of the exclusion of the parents in the care. During the period 1941-2017 it has been economically advantageous for the hospitals that parents care for their children. Ideas on the vulnerable child and self-help ideology have contributed to legitimization of the inclusion of the parents.

Vulnerability in health care--reflections on encounters in every day practice.

Vulnerability is a human condition and as such a constant human experience. However, patients and professional health care providers may be regarded as more vulnerable than people who do not suffer or witness suffering on a regular basis. Acquiring a deeper understanding of vulnerability would thus be of crucial importance for health care providers. This article takes as its point of departure Derek Sellman's and Havi Carel's discussion on vulnerability in this journal. Through different examples from the authors' research focusing on the interaction between health professionals and patients, existential, contextual, and relational dimensions of vulnerability are illuminated and discussed. Two main strategies in the professionals' interactions with patients are described. The strategy that aims at understanding the patients or families from the professional's own personal perspective oftentimes ends in excess attention to the professional's own reactions, thereby impairing the ability to help. The other strategy attempts to understand the patients or families from the patients' or families' own perspective. This latter strategy seems to make vulnerability bearable or even transform it into strength. Being sensitive to the vulnerability of the other may be a key to acting ethically.