The extraordinary makes the ordinary visible - nursing students' experiences of their learning in clinical practice during COVID-19: a qualitative study.

BACKGROUND: The COVID-19 crisis had a significant impact on health care and nursing education as a large part of it is carried out in clinical practice. However, it is not known how the learning situations during the pandemic affected students' learning. To deepen the understanding of students' learning, learning theories within a constructive paradigm is used as a framework for this study. The purpose of the study was to explore nursing students´ perceptions of their learning in clinical practice during COVID-19. METHODS: In this interpretative qualitative study, seven focus group discussions were conducted with 21 nursing students at different stages of the nursing programme, all of whom performed clinical practice during the outbreak of COVID-19. The analysis of the discussions was performed with interpretative content analysis related to theoretical assumptions about learning. RESULTS: The learning situation was characterised by chaos and confusion affecting both the students' opportunities to learn and what they learned. Despite the uncertainty the students appreciated having experienced this unique situation, which contributed to valuable learning. Things otherwise taken for granted or not encountered before became visible. The learning processes were characterised by complexity and challenges that hindered or stimulated learning. It depended on the student's approach and the management of the clinical education. Concerns about one´s own and relatives' health, and not being able to finish studies, also affected learning. The students learned about important measures during a pandemic regarding hygiene, care organisation, communication, and the multifaceted role of the nurse. CONCLUSION: Unpredictable situations such as a pandemic can lead to unique learning since "the extraordinary makes the ordinary visible". The students learned things additional to the formal learning outcomes, and the experiences strengthened their will to become nurses. Challenges due to a crisis can become important driving forces for learning, if not experienced as overwhelming. Some students felt they received space for own initiatives and responsibility while others felt lost and abandoned. Preparing for a crisis means preparing for an unknown future. Students therefore need to experience dilemmas and uncertain situations and reflect in a safe environment.

Symptom management strategies used by older community-dwelling people with multimorbidity and a high symptom burden - a qualitative study.

BACKGROUND: Older community-dwelling people with multimorbidity are often not only vulnerable, but also suffer from several conditions that could produce a multiplicity of symptoms. This results in a high symptom burden and a reduced health-related quality of life. Even though these individuals often have frequent contact with healthcare providers they are expected to manage both appropriate disease control and symptoms by themselves or with the support of caregivers. The aim of this study was therefore to describe the symptom management strategies used by older community-dwelling people with multimorbidity and a high symptom burden. METHOD: A qualitative descriptive design using face-to-face interviews with 20 community-dwelling older people with multimorbidity, a high healthcare consumption and a high symptom burden. People ≥75 years, who had been hospitalized ≥3 times during the previous year, ≥ 3 diagnoses in their medical records and lived at home were included. The participants were between 79 and 89 years old. Data were analysed using content analyses. RESULT: Two main strategy categories were found: active symptom management and passive symptom management. The active strategies include the subcategories; to plan, to distract, to get assistance and to use facilitating techniques. An active strategy meant that participants took matters in their own hands, they could often describe the source of the symptoms and they felt that they had the power to do something to ease their symptoms. A passive symptom management strategy includes the subcategories to give in and to endure. These subcategories often reflected an inability to describe the source of the symptoms as well as the experience of having no alternative other than passively waiting it out. CONCLUSIONS: These findings show that older people with multimorbidity and a high symptom burden employ various symptom management strategies on daily basis. They had adopted appropriate strategies based on their own experience and knowledge. Healthcare professionals might facilitate daily life for older people with multimorbidity by providing guidance on active management strategies with focus on patient's own experience and preferences.

Spouse-related factors associated with quality of recovery of patients after hip or knee replacement - a Nordic perspective.

BACKGROUND: Today's shorter hospital stays mean that patients may need support from informal caregivers during their recovery period. The responsibility for providing this support shifts from the healthcare staff to their family members fairly early in the recovery process. Spousal caregivers are considered to be the primary caregivers as their relationship with the patient is more interdependent than that of other family members or caregivers. OBJECTIVES: The aim was to describe spouse-related factors that were associated with patients' quality of recovery on discharge from hospital after elective hip or knee replacement. DESIGN: The design was prospective, descriptive and comparative, with two measurements, before arthroplasty and on discharge. SETTINGS: Two Finnish, three Icelandic and two Swedish university or community hospitals. PARTICIPANTS: The sample consisted of spouses and patients. The inclusion criteria were as follows: age ≥18 years, ability to complete the questionnaires, and ability to understand Finnish/Icelandic/Swedish. The patients were asked to identify one family member. Spouses were those defining themselves as a wife, husband or cohabiting partner. Out of 463 spouses, 306 (66%) were included. The mean age of the included spouses was 64 years and 54% of them were females. METHODS: Self-reported instruments were used on expected and received knowledge, access to knowledge, emotional state and quality of recovery. RESULTS: If the spouses were or had been employed in healthcare or the social services, their partner had greater quality of recovery (p = 0.006). Spouses experiencing negative emotions had partners who experienced lower quality of recovery (p <0.001). Spouses who felt that nurses had enough time for them (p = 0.044) and explained matters concerning their family members' care and treatment (p = 0.011) had partners who experienced greater quality of recovery. CONCLUSIONS: Spouses' emotional state played an important role in the patients' quality of recovery (QoR), with uncertainty and depressive state as the main predictors. The importance of nurses explaining matters sufficiently to spouses was emphasized, while spouses' fulfilment of knowledge expectations was not associated with patients' recovery.

Fulfilment of knowledge expectations among family members of patients undergoing arthroplasty: a European perspective.

In the recovery process of arthroplasty patients, their family members play an important role due to short hospital stay and increased age of patients. Family members need to have knowledge to be able to support the patient. The aim of this study was to explore expected and received knowledge in family members of arthroplasty patients and describe the relationships between the differences in received and expected knowledge and background factors, country, information and control preferences and access to knowledge. The study was conducted in six European countries (Cyprus, Greece, Finland, Iceland, Spain and Sweden). The study design was cross-cultural, prospective and comparative with two measurement points: pre-operative and at discharge from hospital. Knowledge Expectations of significant other-scale and Krantz Health Opinion Survey were used before surgery and Received Knowledge of significant other-scale and Access to Knowledge at discharge. Patients undergoing elective hip or knee arthroplasty in seventeen hospitals were asked to identify one family member. The sample size was decided by power calculation. A total of 615 participants answered the questionnaires at both measurements. Family members perceived to receive less knowledge than they expected to have, most unfulfilled knowledge expectations were in the financial, social and experiential dimensions of knowledge. Seventy-four per cent of participants had unfulfilled knowledge expectations. Increased access to information from healthcare providers decreased the difference between received and expected knowledge. Compared to family members in southern Europe, those in the Nordic countries had more unfulfilled knowledge expectations and less access to information from healthcare providers. The evidence from this study highlights the need to involve the family members in the educational approach.