The association between patient characteristics, psychological distress, and coping in the diagnostic phase of prostate cancer - A cross-sectional multicenter study.

PURPOSE: This study aims to investigate the associations between patient characteristics, psychological distress, and coping in the diagnostic phase of prostate cancer. METHODS: A cross-sectional multicentre study was conducted from 2017 to 2019. A total of 250 patients were recruited from three hospitals in western Norway. The patients completed a questionnaire while awaiting their prostate biopsy. Patient characteristics were collected, and the Hospital Anxiety and Depression Scale and the Revised Ways of Coping Checklist were used to measure psychological distress and evaluate coping strategies and primary appraisal, respectively. RESULTS: Approximately 15% and 5% of the patients experienced symptoms of anxiety and depression, respectively. Younger age and poorer self-reported health were associated with higher anxiety levels. Anxiety was associated with all five coping strategies but showed the strongest correlation with wishful thinking. The patients who appraised their situation as a threat experienced more symptoms of both anxiety and depression and used more wishful thinking and avoidance than did the patients who appraised their situation as a challenge or benign. CONCLUSION: A subgroup of patients experiences psychological distress during diagnostic evaluation of prostate cancer. Age, self-reported health, and primary appraisal may contribute to the development of psychological distress. Identification of patient characteristics associated with higher levels of psychological distress may guide nurses in implementing early interventions aimed at supporting beneficial coping and enhancing well-being.

Comparing didactic approaches for practical skills learning in Scandinavian nursing simulation centres: A qualitative comparative study.

AIM: To explore and compare the didactic approaches to practical skills learning at simulation centres in Scandinavian universities and university colleges. BACKGROUND: Academic simulation centres are an important arena for learning practical nursing skills which are essential to ensure competent performance regarding patient safety and quality of care. Knowledge of didactic approaches to enhance learning is essential in promoting the provision and retention of students' practical nursing skills. However, research on didactical approaches to practical nursing skills learning is lacking. DESIGN: A qualitative comparative design was used. METHODS: During November and December 2019, interviews were conducted with a total of 37 simulation centre directors or assistant directors, each of whom possessed in-depth knowledge of practical skills in teaching and learning. They represented bachelor nursing education in Denmark, Norway and Sweden. A qualitative deductive content analysis was conducted. RESULTS: The results revealed all five predetermined didactical components derived from the didactical relationship model. Twenty-two corresponding categories that described a variation in didactic approaches to practical skills learning in Scandinavian nursing simulation centres were identified. The didactical components of Learning process revealed mostly similarities, Setting mostly differences and Assessment showed only differences in didactic approaches. CONCLUSION: Although various didactic approaches were described across the countries, no common approach was found. Nursing educational institutions are encouraged to cooperate in developing a shared understanding of how didactic approaches can enhance practical skills learning. IMPLICATIONS FOR PROFESSION AND/OR PATIENT CARE: Cross-country comparisons of practical nursing skills learning in Scandinavian countries highlight the importance of educator awareness concerning the impact diverse didactic approaches may have on competent performance in nursing education. Competent performance is pivotal for ensuring patient safety and the provision of high-quality care. PATIENT OR PUBLIC CONTRIBUTION: No Patient or Public Contribution. REPORTING METHOD: This study followed the Consolidated Criteria for Reporting Qualitative Research reporting guidelines.

Translation and Psychometric Testing of the Norwegian Version of the "Patients' Perspectives of Surgical Safety Questionnaire".

PURPOSE: To translate the Patients' Perspectives of Surgical Safety (PPSS) questionnaire into Norwegian and to test it for structural validity and internal consistency. DESIGN: This is a methodological study. METHODS: The original 20-item PPSS questionnaire was translated into Norwegian using a model of translation-back translation. We assessed content validity via a pretest with 20 surgical patients. A sample of 218 surgical patients in a university hospital in Norway completed the PPSS questionnaire. Psychometric analysis included item characteristics, and structural validity was evaluated by an exploratory factor analysis. Internal consistency was calculated using Cronbach's alpha. FINDINGS: We successfully translated and adapted the Norwegian PPSS questionnaire. Completion rate was 74%. Missing values were less than 5% and all 20 items had a high skewness (≥15 %) ranging from 52.8% to 95.9%. The exploratory factor analysis yielded two significant factors that explained 45.15% of variance. The Cronbach's alpha for Factor 1 "Team interaction safety" was 0.88 and for Factor 2 "Patient's ID safety", 0.82. Overall, most patients reported a high sense of surgical safety. CONCLUSIONS: The first Norwegian version of the PPSS measuring surgical patients' perception shows promising psychometric properties regarding structural validity and internal consistency. However, future research on PPSS should provide an examination of construct validity, validation and testing in other populations of surgical patients. To improve safety of the surgical trajectory, it is necessary to pay more attention to patients' perceptions of surgical safety.

Men's perception of information and psychological distress in the diagnostic phase of prostate cancer: a comparative mixed methods study.

BACKGROUND: Previous studies indicate that men experience frustration and uncertainty when confronted with an elevated prostate specific antigen (PSA) test and during further diagnostics for prostate cancer. The novel Stockholm3 test is an algorithm-based test that combines plasma protein biomarkers, genetic markers and clinical variables in predicting the risk of PCa. The test was introduced in a western part of Norway as a new tool for detecting prostate cancer. This study aimed to explore and compare men's perception of information and possible experience of distress between a PSA group and a Stockholm3 group during the diagnostic phase of prostate cancer. METHODS: This study is a part of the trailing research evaluating the impact of the change from PSA to Stockholm3. It is a multicenter study using a comparative mixed method design. Data were collected in a PSA group (n = 130) and a Stockholm3 group (n = 120) between 2017 and 2019. Quantitative data were collected using questionnaires and qualitative data were collected using semi-structured interviews (n = 20). The quantitative and qualitative data were analysed and compared separately and then merged in a side-by-side discussion. The study adheres to the GRAMMS guidelines for reporting mixed-methods research. RESULTS: Compared with the PSA group, men in the Stockholm3 group reported that the information from the general practitioners was better. Similarly, men in the Stockholm3 group were more likely to indicate that they had received sufficient information regarding how examinations would be conducted. No differences were found between the groups regarding waiting time and distress. Three themes emerged from the qualitative analysis of the two groups: "Information affects the experience of comprehension", "Stepping into the world of the healthcare system", and "Periodically feelings of distress". CONCLUSION: The Stockholm3 test may facilitate the provision of information to patients. However, some patients in both groups experienced distress and would benefit from more information and additional support from healthcare professionals. Routines that ensure sufficient information from the interdisciplinary healthcare team should be of priority during the diagnostic phase of prostate cancer in order to provide patients with predictability and to avoid unnecessary distress.

Men's perception of information and descriptions of emotional strain in the diagnostic phase of prostate cancer-a qualitative individual interview study.

OBJECTIVE: To explore men`s perception of information and their possible emotional strain in the diagnostic phase of prostate cancer. DESIGN, SETTING, PATIENTS: A qualitative explorative research design was employed. Data were collected from June to November 2017. The study was set at a urological outpatient clinic at a university hospital in Norway. Semi-structured interviews were conducted with ten men who had been examined for prostate cancer. Interviews were analyzed using Systematic Text Condensation (STC). RESULTS: The analysis revealed three themes. The theme 'Different needs and perceptions of information' illustrated that information should be personalized. Despite different information needs, insufficient information about prostate cancer may prevent some men from being involved in decisions. The theme, 'A discovery of not being alone', indicated that a sense of affinity occurs when men realize the commonality of prostate cancer. Some men benefited from other men's experiences and knowledge about prostate cancer. The last theme 'Worries about cancer and mortality' showed that the emotional strain was affected by men's knowledge of cancer and the received information. Men expressed conflicting feelings toward prostate cancer that could be difficult to express. CONCLUSIONS: The findings indicate that men in the diagnostic phase of prostate cancer are not a homogeneous group, but need personalized information. Some men may benefit from other men's experiences and support. Men's emotional strain can affect their communication about prostate cancer, which should be acknowledged. Procedures that identify patients' information needs early on should be an integrated part of the diagnostic phase of prostate cancer.KEY POINTSKnowledge about men's information needs and possible emotional strain in the diagnostic phase of prostate cancer are limited.Men with suspected prostate cancer have different preferences and information needs; however, insufficient information prevents men from participating in decisions.Men experience a sense of affinity with other men affected by prostate cancer, and some men benefit from exchanging experiences.Men consider prostate cancer as a less aggressive type of cancer but may experience emotional strain.

Development and Testing of an Instrument for Summative Assessment of Practical Skill Performance: A Generalizability Theory Approach.

BACKGROUND AND PURPOSE: Many newly graduated nurses lack proficiency in practical skill performance. Presently, nursing students' practical skill is assessed by summative instruments with overarching items. The purpose of this study was to develop a more detailed instrument to use in summative assessment of nursing students' practical skill performance and to assess its psychometric properties. METHODS: A 50-item instrument was developed. Video-recorded performances were rated by experienced clinical supervisors. A multifacet measurement design was developed. Relevant parameters were estimated by generalizability analysis. RESULTS: Findings indicated that error of measurement were mainly caused by raters far more than by items. CONCLUSIONS: The present study suggested that summative assessment in realistic settings may not apply one rater only. Two to three/four raters appear necessary to dependably measure most skills.

Supportive care needs of men with prostate cancer after hospital discharge: multi-stakeholder perspectives.

PURPOSE: This study explored the supportive care needs of men with prostate cancer (PCa) after hospital discharge based on the perceptions of multiple stakeholders. METHODS: Eight semi-structured focus groups and three individual interviews were conducted between September 2019 and January 2020, with 34 participants representing men with PCa, primary and secondary healthcare professionals, and cancer organizations in western Norway. Data was analysed using systematic text condensation. RESULTS: Four categories emerged: 1) men with PCa have many information needs which should be optimally provided throughout the cancer care process; 2) various coordination efforts among stakeholders are needed to support men with PCa during follow-up; 3) supportive care resources supplement the healthcare services but knowledge about them is random; and 4) structured healthcare processes are needed to improve the services offered to men with PCa. Variations were described regarding priority, optimal mode and timeliness of supportive care needs, while alignment was concerned with establishing structures within and between stakeholders to improve patient care and coordination. CONCLUSIONS: Despite alignment among stakeholders' regarding the necessity for standardization of information and coordination practices, the mixed prioritization of supportive care needs of men with PCa indicate the need for additional individualized and adapted measures.

The art of balancing: the facilitator's role in briefing in simulation-based learning from the perspective of nursing students - a qualitative study.

BACKGROUND: Facilitators plays a key role in nursing student's learning when briefing them for simulation scenarios. However, few studies have explored the importance of the facilitator's role in preparing students from the students' perspective. The aim of this study was to explore undergraduate nursing students' perspectives of the facilitator's role in briefing. METHODS: An explorative, qualitative approach was used. Four focus group interviews with a total of 30 nursing students constituted the data source. Data collection took place in December 2017 and in May 2018. The data was analysed using systematic text condensation. RESULTS: Two main categories were identified: "The importance of framing the subsequent scenario" and "The importance of instructing students how to execute nursing actions in the subsequent scenario". The first category consisted of three subcategories: providing predictability, providing emotional support and providing challenges. The second main category also consisted of three subcategories: providing information about medical and technical equipment, providing a demonstration of the monitor and providing a demonstration of the manikin. CONCLUSION: A briefing is more than a general introduction to a simulation scenario, learning objectives, roles, simulation environment and medical equipment. The information provided in a briefing is important for nursing students' understanding of what they will encounter in the simulation scenario and what is being simulated, as well as possibly being a prerequisite for mastery. The facilitator's role in the briefing is complex and requires a high level of educational expertise to balance the diversity of students' learning approaches. Students have to learn how to simulate before the briefing. Therefore, we suggest separating the concepts of prebriefing and presimulation from the concept of briefing, introducing prebriefing and presimulation preparation before briefing, and possibly dividing students into groups based on their learning approach. Such interventions will make it possible for facilitators to balance between students' needs and the time available for briefing. SUPPLEMENTARY INFORMATION: Supplementary information accompanies this paper at 10.1186/s12912-020-00493-z.

Health professionals' perceptions of colorectal cancer patients' treatment burden and their supportive work to ameliorate the burden - a qualitative study.

BACKGROUND: Support is pivotal for patients in managing colorectal cancer treatment, as they might be overwhelmed by the burden of treatment. There is scarce knowledge regarding health professionals' perceptions of colorectal cancer patients' burdens and supportive needs. The study aims to describe health professionals' perspectives on treatment burden among patients receiving curative surgical treatment for colorectal cancer during the hospital stay and how they support patients to ameliorate the burden. METHODS: This study has a descriptive and explorative qualitative design, using semi-structured interviews with nine health professionals recruited from a gastrointestinal-surgery ward at a university hospital in Norway. Data were analysed by using systematic text condensation. RESULTS: Data analysis identified the themes "capturing patients' burdens of colorectal cancer treatment" and "health professionals' support to ameliorate the burden". Patients with colorectal cancer had to face burdens related to a challenging emotional situation, treatment complications and side effects, and an extensive need for information. A trusting patient-carer relationship was therefore perceived as the essence of health professionals' support. Health professionals focused their support on safeguarding patients, motivating patients to self-manage, and involving family and peers as supporters. Patients' journey characteristics and illness severity challenged health professionals' supportive work. CONCLUSION: Support from health professionals includes providing patients emotional support and relevant treatment-related information and motivating patients for early post-surgical mobilisation. Health professionals should be aware of identifying colorectal cancer patients' information needs according to the specific treatment stages, which may ameliorate the burden of colorectal cancer treatment and enable patients to self-manage.

Cross-cultural validation and psychometric testing of the Norwegian version of TeamSTEPPS teamwork attitude questionnaire.

Healthcare professionals' attitudes play a significant role in influencing team behavior, and thereby affect the quality and safety of patient care. Culturally adapted and validated questionnaires may contribute valuable knowledge of professionals' attitudes toward teamwork. The aim of the study was to translate and cross-validate the TeamSTEPPS Teamwork Attitude Questionnaire (T-TAQ) into Norwegian, and to test the questionnaire for psychometric properties among Norwegian healthcare professionals. The T-TAQ, measuring five dimensions of attitude towards teamwork, was translated according to a model of back translation. Healthcare professionals (N = 247) from various hospital settings responded. A Pearson correlation coefficient, confirmatory factor analysis (CFA), test-retest reliability, Cronbach's alpha, and McDonald's omega were conducted. The inter-correlation test of the T-TAQ dimensions ranged from 0.16 to 0.54. The CFA showed a Root Mean Square Error of Approximation of (RMSEA) = 0.061. Test-retest showed Intraclass Correlation Coefficient scores from 0.73 to 0.86, with Cronbach's alpha and McDonald's omega demonstrating values from 0.53 to 0.76 (alpha) and 0.57 to 0.76 (omega) on the five dimensions. The Norwegian version of T-TAQ revealed potential concerning the psychometric property for measuring healthcare professionals' attitudes toward teamwork in hospital settings. Further testing with a sample that is more proportionally composed in terms of an interprofessional mix is therefore proposed.

Psychometric testing of the Norwegian version of the Simulation Design Scale, the Educational Practices Questionnaire and the Student Satisfaction and Self-Confidence in Learning Scale in nursing education.

Introduction: Simulation-based learning is a well-established technique in nursing education. However, there is a need for reliable and validated evaluation tools across both national boundaries and cultural conditions. Such evaluation tools may contribute in identifying areas for improvement in simulation-based learning from the nursing students' perspective. Objectives: The aim of this study was to test three widely used American questionnaires - the Simulation Design Scale, the Educational Practices Questionnaire, and the Student Satisfaction and Self-Confidence in Learning Scale, for psychometric properties among Norwegian undergraduate nursing students. Methods: A descriptive cross-sectional study was conducted at a university simulation center in southern part of Norway. A total of 105 undergraduate nursing students participated, giving a response rate of 77%. An exploratory factor analysis was used to examine construct validity. Cronbach's alpha was applied in order to establish the questionnaires' internal consistency. Results: The exploratory factor analyses displayed the same number of extracted factors as the number of subscales in each of the original American questionnaires. However, the item-factor structure differed from the original item-subscales. The Cronbach's alpha was > 0.7 for all three questionnaires, indicating acceptable internal consistency. Conclusion: Psychometric testing of the Norwegian versions of the three questionnaires, the Simulation Design Scale, the Educational Practices Questionnaire, and the Student Satisfaction and Self-Confidence in Learning Scale, could be used as valid instruments for nursing students to evaluate important aspects of simulation-based learning. This also makes it easier to compare evaluation results of SBL across languages and cultural boundaries. However, to confirm the construct validity of the factors extracted in this study, further multi-site studies are needed to perform a confirmatory factor analysis in a new, large sample.

Actual clinical leadership: a shadowing study of charge nurses and doctors on-call in the emergency department.

BACKGROUND: The provision of safe, high quality healthcare in the Emergency Department (ED) requires frontline healthcare personnel with sufficient competence in clinical leadership. However, healthcare education curriculum infrequently features learning about clinical leadership, and there is an absence of experienced doctors and nurses as role models in EDs for younger and less experienced doctors and nurses. The purpose of this study was to explore the activities performed by clinical leaders and to identify similarities and differences between the activities performed by charge nurses and those performed by doctors on-call in the Emergency Department after completion of a Clinical Leadership course. METHODS: A qualitative exploratory design was chosen. Nine clinical leaders in the ED were shadowed. The data were analyzed using a thematic analysis. RESULTS: The analysis revealed seven themes: receiving an overview of the team and patients and planning the shift; ensuring resources; monitoring and ensuring appropriate patient flow; monitoring and securing information flow; securing patient care and treatment; securing and assuring the quality of diagnosis and treatment of patient; and securing the prioritization of patients. The last two themes were exclusive to doctors on-call, while the theme "securing patient care and treatment" was exclusive to charge nurses. CONCLUSIONS: Charge nurses and doctors on-call perform multitasking and complement each other as clinical leaders in the ED. The findings in this study provide new insights into how clinical leadership is performed by charge nurses and doctors on-call in the ED, but also the similarities and differences that exist in clinical leadership performance between the two professions. Clinical leadership is necessary to the provision of safe, high quality care and treatment for patients with acute health needs, as well as the coordination of healthcare services in the ED. More evaluation studies of this Clinical Leadership course would be valuable.

Status of Nordic research on simulation-based learning in healthcare: an integrative review.

BACKGROUND: Based on common geography, sociopolitics, epidemiology, and healthcare services, the Nordic countries could benefit from increased collaboration and uniformity in the development of simulation-based learning (SBL). To date, only a limited overview exists on the Nordic research literature on SBL and its progress in healthcare education. Therefore, the aim of this study is to fill that gap and suggest directions for future research. METHODS: An integrative review design was used. A search was conducted for relevant research published during the period spanning from 1966 to June 2016. Thirty-seven studies met the inclusion criteria. All included studies were appraised for quality and were analyzed using thematic analysis. RESULTS: The Nordic research literature on SBL in healthcare revealed that Finland has published the greatest number of qualitative studies, and only Sweden and Norway have published randomized control trials. The studies included interprofessional or uniprofessional teams of healthcare professionals and students. An assessment of the research design revealed that most studies used a qualitative or a descriptive design. The five themes that emerged from the thematic analysis comprised technical skills, non-technical skills, user experience, educational aspects, and patient safety. CONCLUSION: This review has identified the research relating to the progress of SBL in the Nordic countries. Most Nordic research on SBL employs a qualitative or a descriptive design. Shortcomings in simulation research in the Nordic countries include a lack of well-designed randomized control trials or robust evidence that supports simulation as an effective educational method. In addition, there is also a shortage of studies focusing on patient safety, the primary care setting, or a combination of specialized and primary care settings. Suggested directions for future research include strengthening the design and methodology of SBL studies, incorporating a cross-country comparison of studies using simulation in the Nordic countries, and studies combining specialized and primary care settings.

Norwegian nursing students' evaluation of vSim® for Nursing.

BACKGROUND: vSim® for Nursing is the first web-based platform linked to the nursing education curriculum. It is an American simulation tool, developed in 2014 through a collaboration between Wolters Kluwer Health, Laerdal Medical and the National League for Nursing. To our knowledge, no studies have evaluated vSim® for Nursing from the nursing students' perspective in Norway. The aim of the study was to evaluate second year Norwegian nursing students' experiences with the virtual clinical simulation scenario in surgical nursing from vSim® for Nursing. METHODS: A descriptive and a convergent mixed method design was utilised. The method comprised a 7-item questionnaire with five open-ended questions. Sixty-five nursing students participated in the study. RESULTS: The majority of Norwegian nursing students evaluated the virtual clinical scenario in surgical nursing from vSim® for Nursing useful, realistic and educational in preparing for clinical placement in surgical care. However, a small portion of the nursing students had trouble understanding and navigating the American vSim® for Nursing program. CONCLUSIONS: Introducing virtual simulation tools into the nursing education encompasses faculty and student preparation, guidance from faculty members during the simulation session and support for students who are facing difficulties with the simulation program.

Cross-cultural validation and psychometric testing of the Norwegian version of the TeamSTEPPS® teamwork perceptions questionnaire.

BACKGROUND: Teamwork is an integrated part of today's specialized and complex healthcare and essential to patient safety, and is considered as a core competency to improve twenty-first century healthcare. Teamwork measurements and evaluations show promising results to promote good team performance, and are recommended for identifying areas for improvement. The validated TeamSTEPPS® Teamwork Perception Questionnaire (T-TPQ) was found suitable for cross-cultural validation and testing in a Norwegian context. T-TPQ is a self-report survey that examines five dimensions of perception of teamwork within healthcare settings. The aim of the study was to translate and cross-validate the T-TPQ into Norwegian, and test the questionnaire for psychometric properties among healthcare personnel. METHODS: The T-TPQ was translated and adapted to a Norwegian context according to a model of a back-translation process. A total of 247 healthcare personnel representing different professionals and hospital settings responded to the questionnaire. A confirmatory factor analysis was carried out to test the factor structure. Cronbach's alpha was used to establish internal consistency, and an Intraclass Correlation Coefficient was used to assess the test - retest reliability. RESULT: A confirmatory factor analysis showed an acceptable fitting model (χ2 (df) 969.46 (546), p < 0.001, Root Mean Square Error of Approximation (RMSEA) = 0.056, Tucker-Lewis Index (TLI) = 0.88, Comparative fit index (CFI) = 0.89, which indicates that each set of the items that was supposed to accompany each teamwork dimension clearly represents that specific construct. The Cronbach's alpha demonstrated acceptable values on the five subscales (0.786-0.844), and test-retest showed a reliability parameter, with Intraclass Correlation Coefficient scores from 0.672 to 0.852. CONCLUSION: The Norwegian version of T-TPQ was considered to be acceptable regarding the validity and reliability for measuring Norwegian individual healthcare personnel's perception of group level teamwork within their unit. However, it needs to be further tested, preferably in a larger sample and in different clinical settings.

"Teamwork in hospitals": a quasi-experimental study protocol applying a human factors approach.

BACKGROUND: Effective teamwork and sufficient communication are critical components essential to patient safety in today's specialized and complex healthcare services. Team training is important for an improved efficiency in inter-professional teamwork within hospitals, however the scientific rigor of studies must be strengthen and more research is required to compare studies across samples, settings and countries. The aims of the study are to translate and validate teamwork questionnaires and investigate healthcare personnel's perception of teamwork in hospitals (Part 1). Further to explore the impact of an inter-professional teamwork intervention in a surgical ward on structure, process and outcome (Part 2). METHODS: To address the aims, a descriptive, and explorative design (Part 1), and a quasi-experimental interventional design will be applied (Part 2). The study will be carried out in five different hospitals (A-E) in three hospital trusts in Norway. Frontline healthcare personnel in Hospitals A and B, from both acute and non-acute departments, will be invited to respond to three Norwegian translated teamwork questionnaires (Part 1). An inter-professional teamwork intervention in line with the TeamSTEPPS recommend Model of Change will be implemented in a surgical ward at Hospital C. All physicians, registered nurses and assistant nurses in the intervention ward and two control wards (Hospitals D and E) will be invited to to survey their perception of teamwork, team decision making, safety culture and attitude towards teamwork before intervention and after six and 12 months. Adult patients admitted to the intervention surgical unit will be invited to survey their perception of quality of care during their hospital stay before intervention and after six and 12 month. Moreover, anonymous patient registry data from local registers and data from patients' medical records will be collected (Part 2). DISCUSSION: This study will help to understand the impact of an inter-professional teamwork intervention in a surgical ward and contribute to promote healthcare personnel's team competences with an opportunity to achieve changes in work processes and patient safety. TRIAL REGISTRATION: Trial registration number (TRN) is ISRCTN13997367. The study was registered retrospectively with registration date 30.05.2017.

Interprofessional trust in emergency department - as experienced by nurses in charge and doctors on call.

AIMS AND OBJECTIVES: The aim of this study was to describe that which characterises interprofessional trust in a Norwegian emergency department, as expressed by nurses in charge and doctors on call. BACKGROUND: Interprofessional trust requires knowledge of and skills in interprofessional collaboration. It also requires established trust in fellow collaborators, as well as in the work environment and in the more comprehensive system in which the work is conducted. Nurses in charge and doctors on call who collaborate in the context of an emergency department do so under changing conditions in terms of staff composition and work load. DESIGN: The study was designed in a qualitative, inductive and sequential manner. METHOD: Data were collected from September-November 2013 through four focus group interviews and was analysed by means of qualitative content analysis. RESULTS: The data revealed two themes that were characteristic of interprofessional trust: 'having relational knowledge' and 'being part of a context'. Together, the themes can be understood as equally important to contextual collaboration. A model of interprofessional trust between an individual level and system level was developed from the results. CONCLUSION: The study indicates that interprofessional trust is a changeable phenomenon that has great impact on the possibility for development at an individual level and at a more abstract system level. RELEVANCE TO CLINICAL PRACTICE: Interprofessional trust can be improved by focusing on trust-building activities between staff at the individual level and between staff and organisation at the system level. Supportive activities such as continuous interprofessional education are suggested as valuable to the development and maintenance of trust.

Impact of clinical leadership in teams' course on quality, efficiency, responsiveness and trust in the emergency department: study protocol of a trailing research study.

INTRODUCTION: Clinical leadership has long been recognised as critical for optimising patient safety, quality of care and interprofessional teamwork in busy and stressful healthcare settings. There is a need to compensate for the absence of the conventional mentor-to-apprentice transfer of clinical leadership knowledge and skills. While young doctors and nurses are increasingly proficient in medical, surgical and technical skills, their training in, and knowledge of clinical leadership skills, is not adequate to meet the demands for these non-technical skills in the emergency department. Thus, the purpose of the paper is to present and discuss the study protocol of clinical leadership in a course for teams that aims to improve quality, efficiency, responsiveness of healthcare services and collegial trust in the emergency department. METHODS AND ANALYSIS: The study employs a trailing research design using multiple quantitative and qualitative methods in the summative (pretest and post-test) and formative evaluation. Quantitative data have been collected from a patient questionnaire, the emergency departments' database and by the observation of team performance. Qualitative data have been collected by shadowing healthcare professionals and through focus group interviews. To ensure trustworthiness in the data analysis, we will apply member checks and analyst triangulation, in addition to providing contextual and sample description to allow for evaluation of transferability of our results to other contexts and groups. ETHICS AND DISSEMINATION: The study is approved by the ethics committee of the western part of Norway and the hospital. The study is based on voluntary participation and informed written consent. Informants can withdraw at any point in time. The results will be disseminated at research conferences, peer review journals and through public presentations to people outside the scientific community.

Quantitative systematic review of multi-professional teamwork and leadership training to optimize patient outcomes in acute hospital settings.

AIM: To evaluate the impact of multi-professional teamwork (MPTW) and leadership training interventions on patient outcomes in acute hospital settings. BACKGROUND: Although investigations of teamwork and leadership training in acute hospital settings indicate that such programs can optimize patient outcomes, evidence-based recommendations on the content, duration and frequency of training programs associated with clinical evidence are still absent. DESIGN: Quantitative systematic review. DATA SOURCES: A search was conducted for relevant papers published during the period from 2000-February 2014. REVIEW METHODS: Twelve studies met the inclusion criteria and were appraised for quality and a risk-of-bias assessment was conducted. The review used a structured approach for literature search, data evaluation, analysis and presentation. A narrative summary was used to report results. RESULTS: Two MPTW and leadership interventions in stroke units have the greatest impact on patient outcomes in acute hospital settings. The interventions' impact on patient outcomes, explored in the ten remaining studies, is associated with great uncertainty due to several alternative explanations of the findings. CONCLUSION: Research designs that test such interventions must be improved before recommendations on the ultimate program can be made. This can be achieved by strengthening the design, methodology and descriptions of interventions and the use of more consistent patient outcomes. Building a safety culture adjacent to implementing teamwork and leadership training interventions is essential for improving patient outcomes.

Simulation in Nursing Education-International Perspectives and Contemporary Scope of Practice.

PURPOSE: This article provides insights and perspectives from four experienced educators about their approaches to developing, delivering, and evaluating impactful simulation learning experiences for undergraduate nurses. A case study format has been used to illustrate the commonalities and differences of where simulation has been positioned within curricula, with examples of specialized clinical domains and others with a more generic focus. The importance of pedagogy in developing and delivering simulations is highlighted in each case study. A range of learning theories appropriate for healthcare simulations are a reminder of the commonalities across theories and that no one theory can account for the engaging and impactful learning that simulation elicits. CLINICAL RELEVANCE: Creating meaningful and robust learning experiences through simulation can benefit students' performance in subsequent clinical practice. The ability to rehearse particular clinical scenarios, which may be difficult to otherwise achieve, assists students in anticipating likely patient trajectories and understanding how to respond to patients, relatives, and others in the healthcare team.