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Background: Since the early 2000s, Healthy Life Centres have been established in Norway to promote physical and mental health. Yet to date, little is known about the efficacy of Healthy Life Centres in promoting health behaviour change and maintenance or the factors that underlie these processes. Accordingly, the aim of the current study was to examine the factors that participants in a Healthy Life Centre perceive as relevant for the initiation and maintenance of lifestyle changes toward more physical activity and consumption of a healthier diet.Method: Participants were purposely recruited from among adherers in a 12-month multi-method research project at a Healthy Life Centre. Individual, semi-structured interviews were conducted with 8 women and 6 men who were between the ages of 20 and 61 years old. Data were analysed using Systematic Text Condensation.Results: Three main themes were derived from this analysis. The first theme focused on the motives behind initiation and maintenance of lifestyle changes along with the importance of a relationally supportive environment to promote perceived competence in pursuing a healthy lifestyle. The second theme focused on strategies for coping with the challenges and potential pitfalls that were associated with various unpleasant experiences and life events. The third theme focused on several specific skills that were helpful to the initiation and maintenance of lifestyle changes.Conclusion: The current study enhanced an understanding of the initiation and maintenance of lifestyle changes, although these processes were not disentangled in participants' experiences. In line with self-determination theory, the results suggested that lifestyle change is more likely to be initiated and maintained when goals are not only achievable but also regulated with autonomous motivation and of intrinsic value. Conversely, lifestyle change is difficult to maintain when motives are external to the self. Further, cognitive and behavioural skills were valuable and necessary in coping with unpleasant emotions. Finally, the critical function of self-regulation skills for making realistic plans and prioritizations in order to balance healthy lifestyle behaviours with the routines of "daily life" while monitoring outcomes was readily apparent. Healthy Life Centres can contribute to these processes in meaningful ways. [ABSTRACT FROM AUTHOR]

• This protocol describes a randomised controlled trial where additional school nurse resources are assigned to work systemically with schools. • The additional school nurse resource should work to improve the school environment and reduce bullying and absence for 5th to 7th grade students. • Approximately 9000 students participate each year from 2018 to 2020 in 107 schools located in 12 Norwegian municipalities. • Academic performance is studied as a secondary outcome. This protocol describes a randomized controlled trial where additional school nurse resources are assigned to work systemically with schools to improve the school environment and reduce bullying among and absence of 5th–7th grade students. Approximately 9000 students will have participated each year from 2018 to 2020 from 107 schools located in 12 Norwegian municipalities. Academic performance is studied as a secondary outcome. [ABSTRACT FROM AUTHOR]

Aims and objectives: To explore chronic heart failure patients' perceptions of the burden related to treatment and self‐care. Background: Living with chronic heart failure entails following a demanding treatment regimen, with daily self‐care, which could make patients vulnerable to experiencing treatment burden. Burden of treatment is defined as the "work" the healthcare system passes on to the patients with respect to self‐care at home, and the impact this has on well‐being and quality of life. However, the burden of treatment is an emergent framework, and further research exploring burden among heart failure patients is required. Design: Qualitative study employing semi‐structured interviews and content analysis. The study complied with the Consolidated Criteria for Reporting Qualitative Research (COREQ). Methods: A sample of 17 heart failure patients recruited from an outpatient clinic in Norway. Interview transcripts were coded in Nvivo 11 and analysed using Malterud's systematic text condensation. Results: Two main themes "emotional challenge" and "troublesome self‐care" emerged from the analysis. The first theme contained the following subthemes: "a new life situation," "monitoring body signals," "difficult transitions" and "feelings of guilt." The second theme consisted of the subthemes "poor care coordination," "lack of information and education" and "troublesome medication." Conclusion: Heart failure treatment constitutes challenges related both to self‐care and to emotional burden. The latter not previously clearly articulated in the concept of burden of treatment. Many patients are struggling emotionally, and this affects their self‐care ability in addition to affecting their well‐being and quality of life. Relevance to Clinical Practice: Nurses are in a strategic position to play a pivotal role in identifying and responding to the emotional burden of treatment in heart failure patients, furthermore to guide and support in discharge planning and in outpatient setting to reduce the patients' emotional distress and fear of failing. [ABSTRACT FROM AUTHOR]

Objective To investigate whether inter-professional simulation training influenced the rate of red blood cell ( RBC) transfusions after birth. Design Two cohorts were compared retrospectively using a pre-post design. Setting Norwegian university hospital with 4800 deliveries annually. Population Women with estimated blood loss >500 mL within 24 h after birth in 2009 and 2011. Methods In 2010, all maternity staff attended a 6-h, scenario-based training on emergency obstetrics including postpartum hemorrhage, using a birthing simulator. The simulation focused on prevention, identification, and treatment of postpartum hemorrhage and on communication and leadership. Debrief immediately after the scenarios involved reflection and self-assessment. Main outcome measures The frequency of women receiving RBC transfusions as a marker for blood loss. Secondary outcome was the frequency of surgical procedures in the management of postpartum hemorrhage. Results In 2009, 111/534 (20.8%) women with estimated blood loss >500 mL after birth received RBC transfusions vs. 67/546 (12.3%) in 2011 ( p < 0.01). The adjusted odds ratio for women receiving RBC transfusions in 2011 vs. 2009 was 0.53 (95% CI 0.38-0.74). Parity, oxytocin augmentation, duration of second stage, episiotomy, operative vaginal delivery, and sphincter injury were included in the final model. The odds ratio was stable in all combinations of possible confounders. We observed a significant reduction in the frequencies of curettage ( p < 0.01) and uterine artery embolizations ( p = 0.01). Conclusion We found a significant reduction in RBC transfusions after birth, which might be associated with mandatory simulation training. A causal link cannot be documented because of complex interactions of several variables. [ABSTRACT FROM AUTHOR]

Aims and objectives To examine whether interprofessional simulation training on management of postpartum haemorrhage enhances self-efficacy and collective efficacy and reduces the blood transfusion rate after birth. Background Postpartum haemorrhage is a leading cause of maternal morbidity and mortality worldwide, although it is preventable in most cases. Interprofessional simulation training might help improve the competence of health professionals dealing with postpartum haemorrhage, and more information is needed to determine its potential. Design Multimethod, quasi-experimental, pre-post intervention design. Methods Interprofessional simulation training on postpartum haemorrhage was implemented for midwives, obstetricians and auxiliary nurses in a university hospital. Training included realistic scenarios and debriefing, and a measurement scale for perceived postpartum haemorrhage-specific self-efficacy, and collective efficacy was developed and implemented. Red blood cell transfusion was used as the dependent variable for improved patient outcome pre-post intervention. Results Self-efficacy and collective efficacy levels were significantly increased after training. The overall red blood cell transfusion rate did not change, but there was a significant reduction in the use of ≥5 units of blood products related to severe bleeding after birth. Conclusion The study contributes to new knowledge on how simulation training through mastery and vicarious experiences, verbal persuasion and psychophysiological state might enhance postpartum haemorrhage-specific self-efficacy and collective efficacy levels and thereby predict team performance. The significant reduction in severe postpartum haemorrhage after training, indicated by reduction in ≥5 units of blood transfusions, corresponds well with the improvement in collective efficacy, and might reflect the emphasis on collective efforts to counteract severe cases of postpartum haemorrhage. Relevance to clinical practice Interprofessional simulation training in teams may contribute to enhanced prevention and management of postpartum haemorrhage, shown by a significant increase in perceived efficacy levels combined with an indicated reduction of severe postpartum haemorrhage after training. [ABSTRACT FROM AUTHOR]

Background: Tanzania has a relatively high maternal mortality ratio of 410 per 100,000 live births. Severe postpartum hemorrhage (PPH) is a major cause of maternal deaths, but in most cases, it is preventable. However, most pregnant women that develop PPH, have no known risk factors. Therefore, preventive measures must be offered to all pregnant women. This study investigated the effects of multi-professional, scenario-based training on the prevention and management of PPH at a Tanzanian zonal consultant hospital. We hypothesized that scenario-based training could contribute to improved competence on PPH-management, which would result in improved team efficiency and patient outcome.Methods: This quasi-experimental, pre-vs. post-interventional study involved on-site multi-professional, scenario-based PPH training, conducted in a two-week period in October 2013 and another 2 weeks in November 2014. Training teams included nurses, midwives, doctors, and medical attendants in the Department of Obstetrics and Gynecology. After technical skill training on the birthing simulator MamaNatalie®, the teams practiced in realistic scenarios on PPH. Each scenario was followed by debriefing and repeated scenario. Afterwards, the group swapped roles and the observers became the participants. To evaluate the effects of training, we measured patient outcomes by determining blood transfusion rates. Patient data were collected by randomly sampling Medical birth registry files from the pre-training and post-training study periods (n = 1667 and 1641 files, respectively). Data were analyzed with the Chi-square test, Mann-Whitney U-test, and binary logistic regression.Results: The random patient samples (n = 3308) showed that, compared to pre-training, post-training patients had a 47% drop in whole blood transfusion rates and significant increases in cesarean section rates, birth weights, and vacuum deliveries. The logistic regression analysis showed that transfusion rates were significantly associated with the time period (pre- vs. post-training), cesarean section, patients tranferred from other hospitals, maternal age, and female genital mutilation and cutting.Conclusions: We found that multi-professional, scenario-based training was associated with a significant, 47% reduction in whole blood transfusion rates. These results suggested that training that included all levels of maternity staff, repeated sessions with realistic scenarios, and debriefing may have contributed to reduced blood transfusion rates in this high-risk maternity setting. [ABSTRACT FROM AUTHOR]