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BACKGROUND: Advanced practice nurses (APNs) programs are career-development opportunities significant for nursing workforce retention as well as for the quality of patient care. Inconsistency regarding policy, education, titles, scope of practice, skills and competencies have been identified as major challenges in developing advanced practice nursing in Europe. APN roles and education are under development in the Nordic and Baltic countries. However, there is a lack of information on the current state in this region.OBJECTIVE: The purpose of this paper is to compare APN programs in the Nordic and Baltic countries to identify their commonalities and differences.DESIGN AND METHODS: This descriptive comparative study reviewed seven master's level APN programs in six Nordic and Baltic countries. Data was extracted from the programme by the expert teachers or leaders of the programmes (N = 9). Competencies recommended in the European Tuning Project (ETP) and the International Council of Nurses (ICN) guidelines on advanced practice nursing, were used to evaluate the programs. The same informants provided additional information on the current state of APN education in the country.RESULTS: The admission requirements were similar in the six countries but in two, clinical work experience is an entry requirement. There are two commonly identified APN roles: clinical nurse specialist (CNS) and nurse practitioner (NP). Most of the programs included all the EPT and ICN competencies. The main differences regarded prescribing competencies. All programmes included clinical training, but the methods on how it is implemented varies.CONCLUSION: The findings indicate that APN programs in the Nordic and Baltic countries correspond with the recommendations of the European Tuning Project and ICN guidelines. This is an important message for administrators, policymakers, and politicians, as well as the nursing community, on providing opportunities for APNs to practice to their full potential within each country as well as cross-country.TWEETABLE ABSTRACT: "APN programmes in the Nordic and Baltic countries correspond with international guidelines. Special attention is needed in future on the clinical training of APNs".

Introduction Patient satisfaction is one of the important indicators of quality care. Objective To examine patient ratings of pain management satisfaction before and after introducing a nurse-led management program. Methods A quasi-experimental design with three cross-sectional surveys between October 1, 2016 and June 15, 2017. A total of 845 patients admitted to the four inpatient departments (medicine, surgery, maternity, and gynecology) of Jimma University Medical Centre were invited to participate in the study. A questionnaire adapted from the American Pain Society Patient Outcome Questionnaire, Pain Treatment Satisfaction Scale, and related literature was used for the survey. Data were analyzed using the chi-square test (categorical variables), t-tests for continuous variables, and robust regression to determine the effect of nurse-led management program on patient satisfaction. For all tests, p-values Results Of the 845 patients invited, 782 (92.5%) participated in the surveys—Survey 1: N = 256; Survey 2: N = 259; Survey 3: N = 267. The proportion of patients who perceived that staff responded within 30 min increased from 67.8% in Survey 1 to 71.1% in Survey 2 and 74.2% in Survey 3. On a scale of 1 to 5 (1 = strongly dissatisfied and 5 = strongly satisfied), the overall mean patient satisfaction with pain management was 3.61 (SD 0.80) in Survey 1, 3.81 (SD 0.86) in Survey 2, and 4.10 (SD 0.64) in Survey 3. Moreover, the patients scored significantly higher on all satisfaction items in Survey 2 (B ranged between 0.12 and 0.41) and Survey 3 (B ranged between 0.24 and 0.74) compared to Survey 1. Conclusion The patients’ ratings of their satisfaction and staff nurse responsiveness following the nurse-led pain management program have increased compared to the levels before the intervention. However, further studies, including those with a control group, are warranted to confirm the results.

Marianne Kumlin,1– 3 Geir Vegar Berg,2,4 Kari Kvigne,1 Ragnhild Hellesø3 1Department of Health and Nursing Sciences, Inland Norway University of Applied Sciences Elverum, Elverum, Norway; 2Innlandet Hospital Trust, Lillehammer, Norway; 3Department of Nursing Science, Institute of Health and Society, Faculty of Medicine, University of Oslo, Oslo, Norway; 4Department of Health Sciences, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Gjøvik, NorwayCorrespondence: Marianne Kumlin Tel +47 91594685Email marianne.kumlin@inn.noAim: Today, seamless, person-centered healthcare is emphasized when dealing with elderly patients with comprehensive needs. Studies have uncovered a complex healthcare terrain. Despite a great deal of effort on the part of policy makers and healthcare providers, the work healthcare professionals undertake to develop seamless healthcare is still unclear. Therefore, the aim of this study was to uncover the work that healthcare professionals undertake to achieve coherent and comprehensive healthcare for elderly patients with multiple health problems during their journey through the complex healthcare terrain.Methods: This study has an explorative design with individual interviews. Twenty-five healthcare professionals from primary and specialist care agreed to participate. A thematic analysis method was employed.Results: The analyses revealed three central themes in the healthcare professionals’ work to build coherence in the patients’ care trajectory: Working to manage a patient’s illness trajectory during the course of the patient’s life, working to achieve a comprehensive overall picture, and considering multiple options in a “patchwork” terrain.Conclusion: Healthcare professionals have a common understanding that hospital stays are a short part of the elderly person’s journey in the healthcare system. In the comprehensive work to obtain the overall picture of the illness trajectory within the patient’s life story, healthcare professionals emphasized the importance of working in an interdisciplinary manner. Interprofessional consulting and collaboration should be strengthened to build coherence in the older patient’s complex care trajectory.Keywords: older, care trajectory, complex healthcare, health personnel, interdisciplinary

Aim To uncover the characteristics of nurses' information practice in municipal health care and to address how, when and why various pieces of information are produced, shared and managed. Background Nursing documentation in the electronic patient record has repeatedly been found unsatisfactory. Little is known about how the information practice of nurses in municipal health care actually is borne out. In order to understand why nursing documentation continues to fail at living up to the expected requirements, a better understanding of nurses' information practice is needed. Design A qualitative observational field study. The study complied with the Consolidated Criteria for Reporting Qualitative Research. Methods Empirical data were collected in three Norwegian municipalities through participant observations and individual interviews with 17 registered nurses on regular day shifts. The data were analysed through thematic content analysis. Results Nurses' information practice in municipal health care can be described as complex. The complexity is reflected in four themes that emerged from the data: (1) web of information sources, (2) knowing the patient and information redundancy, (3) asynchronous information practice and (4) compensatory workarounds. Conclusions The complex and asynchronous nature of nurses' information practice affected both how and when information was produced, recorded and shared. When available systems lacked functions the nurses wanted, they created compensatory workarounds. Although electronic patient record was an important part of their information practice, nurses in long-term care often knew their patients well, which meant that a lot of information about the patients was in their heads, and that searching for information in the electronic patient record sometimes seemed redundant. Relevance to clinical practice This study provides contextual knowledge that might be valuable (a) in the further development of information systems tailored to meet nurses' information needs and (b) when studying patient safety in relation to nurses' information practice.

Stephan Ore,1 Elin Olaug Rosvold,2 Ragnhild Hellesø3 1Oppsalhjemmet Nursing Home Norlandia, NO-0982 Oslo, Norway; 2Department of General Practice, Institute of Health and Society, Faculty of Medicine, University of Oslo, NO-0318 Oslo, Norway; 3Department of Nursing Sciences, Institute of Health and Society, Faculty of Medicine, University of Oslo, NO-0318 Oslo, Norway Background: Medication administration and management in nursing homes can occur during all phases of the medication process. The aim of this study was to investigate if an introduction of a systematic use of huddle board led to an increased amount of documentation in the patient record of observations of effects and side effects following a change in medication. Methods: A three-layer intervention approach combining huddle boards, educating the entire staff in medication observation and documentation, and frequent feedback to the staff about the outcome was applied. A standard was set for the expected reporting. Correlation between expected and actual reporting as an average was calculated and the staff received weekly updates on their observation–reporting results. Results: The huddle board became a hub in providing an overview of the expectations of observations. To visualize the impact of the intervention, use of a run chart gave comprehensive information about the extent to which the expected goal of documentation was reached. Four different organizational steps and one individual action in the last step were taken to improve the observation–reporting. The identifying of the nonreporting nurses and individual staff guidance to these nurses resulted in a significant improvement in observation–reporting. The expected goal of 100% average reporting was achieved 6 months after all wards were included in the improvement project. Conclusion: The combination of huddle boards, educating the entire staff in observation and documentation, and frequent feedback to the staff about the outcome proved to be a useful approach in medication safety work in nursing homes. Keywords: patient safety, long-term care, prescribing, huddle board, nursing staff, system-approach, medication-effect documentation

Background Many patients suffer from unrelieved pain in hospital settings. Nurses have a pivotal role in pain management. Hence, a nurse-based pain management programme may influence how hospitalized patients experience pain. In this study we investigated hospitalized patients’ experience of pain before and after the introduction of a two-component nurse-based pain management programme. Methods A quasi-experimental design with a separate sample pretest-posttest approach was conducted on a convenience sample of 845 patients (Survey 1: N = 282; Survey 2: N = 283; Survey 3: N = 280) admitted to the four inpatient units (medical, surgical, maternity, and gynecology) of a university medical center. Data were collected at baseline, before the intervention six weeks after pain management education, and finally immediately after four months of rounding using an interviewer-administered questionnaire adopted from a Brief Pain Inventory and the American Pain Society Patient Outcome Questionnaire. Results All the samples had similar sociocultural backgrounds. The proportion of patients who reported average moderate and severe pain intensity in the last 24 h were 68.8% in Survey 1, 72.8% in Survey 2 and then dropped to 48.53% in Survey 3 whereas those who reported moderate and severe pain intensity at the time of interview were 53.9% in Survey 1, 57.1% in Survey 2 and then dropped to 37.1% in Survey 3. The mean pain interference with the physical and emotional function was generally reduced across the surveys after the introduction of the nurse-based pain management programme. These reductions were statistically significant with p

During the last decades, the work of homecare nurses has been affected by several changes, including an aging population, the decentralization of health care, nursing recruitment crises and the scarcity of public resources. Few scholars have analyzed how these changes have impacted homecare nursing. In this article, we describe and discuss aspects of homecare nurses’ work, with specific focus on nurses “organising work.” We outline three phenomena that are increasingly occurring: (a) homecare nurses are frequently involved in negotiating care level and, consequently, what kind of care the patient will receive; (b) homecare nurses’ clinical practice has become increasingly advanced; and (c) and homecare nurses play an important role in coordinating care among interdependent actors. The article draws on material from participant observation and interviews with homecare nurses in two Norwegian studies. Changes in work practice increase the demand for nurses to be competent and have excellent organizational and collaborative skills. Creative Commons CC BY: This article is distributed under the terms of the Creative Commons Attribution 4.0 License (http://www.creativecommons.org/licenses/by/4.0/) which permits any use, reproduction and distribution of the work without further permission provided the original work is attributed as specified on the SAGE and Open Access pages (https://us.sagepub.com/en-us/nam/open-access-at-sage).

Ragnhild Hellesø,1 Line Melby,1 Solveig Hauge21Department of Nursing Science, Institute of Health and Society, Faculty of Medicine, University of Oslo, Oslo, Norway; 2Faculty of Health and Social Studies, Telemark University College, Porsgrunn, NorwayBackground: From a philosophy of science perspective, the literature has posited that different research approaches influence field studies. Studies addressing interdisciplinary research have focused on the challenges of organizing and running interdisciplinary teams, cultural differences between and within disciplines, and constraints in conducting interdisciplinary research. Studies exploring and discussing the process and outcome of transferring observations to notes from an interdisciplinary point of view are not identified. The aim of this paper is to explore the characteristics of field notes created by researchers representing different disciplines and experiences.Methods: A case study using a modified dynamic observation method was employed. The analyses were initiated by a researcher who had not been involved in the data collection. The field notes were analyzed using three main steps.Results: The structures of both researchers' field notes were characterized by similarities in their descriptions, but the notes' foci and analytical levels differed.Conclusion: The findings contribute new insights concerning the execution of interdisciplinary observational studies. Our findings demonstrate that entering the field with different lenses produced richer and more varied data, providing a broader platform from which to discuss and interpret a study's findings. From a theoretical point of view, the findings enable a more nuanced discussion and a conceptual elaboration regarding how observational approaches should be pursued in future studies. On a practical level, the findings show that even if the researchers agree on what the overall focus in the observations should be, differences can occur in both their focus and analytical level throughout the study.Keywords: field study, observational study, interdisciplinary lenses, interpretation, home care nursing

Aim. To report a concept analysis of telecare. Background. Lately telecare has become a worldwide, modern way of giving care over distance by means of technology. Other concepts, like telemedicine, e-health, and telehealth, focus on the same topic though the boundaries between them seem to be blurred. Data sources. Sources comprise 44 English language research articles retrieved from the database of Medline and Cinahl (1995–October 2011). Design. Literature Review. Method. A principle-based analysis was undertaken through content analysis of the definitions, attributes, preconditions, and outcomes of the concept. Results. The attributes are well described according to the use of technology, caring activity, persons involved, and accessibility. Preconditions and outcomes are well described concerning individual and health political needs and benefits. The concept did not hold its boundaries through theoretical integration with the concept of telemedicine and telehealth. The definition of telecare competes with concepts like home-based e-health, telehomecare, telephonecare, telephone-based psychosocial services, telehealth, and telemedicine. Assessment of the definitions resulted in a suggestion of a new definition: Telecare is the use of information, communication, and monitoring technologies which allow healthcare providers to remotely evaluate health status, give educational intervention, or deliver health and social care to patients in their homes. Conclusion. The logical principle was assessed to be partly immature, whereas the pragmatical and linguistical principles were found to be mature. A new definition is suggested and this has moved the epistemological principle forward to maturity.

Aims and objectives. To explore patients’ perspectives on the significance of informal carers in their information management. Background. Being well informed is considered a prerequisite for the ability of heart failure patients to manage their lives at home. Developing knowledge about the informal caregiver’s role in patient information management is important, that is, accurate information adapted to the individual level of comprehension. Design. A qualitative approach using in-depth semi-structured interviews conducted with patients was used. Methods. Eight women and six men suffering from heart failure and with a mean age of 79·6 were interviewed. Data were collected one week after their discharge. A content analysis was performed. Results. The informal carer’s role in information management from the patient’s perspective represents two different phenomena. The first, information ambivalence, is related to the background of the informal carer. From what patients experienced, the process of information involvement throughout their hospital stay was affected by whether or not their informal carer had a health care background. The second phenomenon, information ambivalence, is related to the relationship between the patient and the informal carer with regard to information management at home. Conclusion. The informal carers were of great importance in the information management process because the patients relied on them so as to be able to devote their energy to managing their daily life. Relevance to clinical practice. Patients should be assessed with regard to their information management problems and to the role of their informal carers in this process.

Aims. The present study explores how community nurses addressed patient care in the EPR and the comprehensiveness of their documentation. Background. The need for comprehensive nursing documentation in home health care is considerable and quality is regarded as a prerequisite for continuity of care. Documentation according to the nursing process is considered to be of good quality due to its logical structure. Nurses in home health care face different challenges than nurses in institutionalised care because of long-term patient situations and a focus on chronic illness rather than acute disease. Design. Retrospective study. Method. The study was performed on a sample of 91 patient records. Data were analysed in three phases: (1) systematising the unstructured text, (2) structuring the text according to the nursing process and (3) assessing the comprehensiveness using a validated instrument. Results. The home care nurses documented patient care chronologically along a time axis rather than using a logical structure according to the nursing process. The documentation reflected today’s overall emphasis on patient participation, as more than 70% of the notes on nursing status were connected to subjective nursing status. Paradoxically, the nurses showed a lack of attention to the patients’ ability to communicate. Only two of 264 documented nursing diagnoses were connected to communication. The comprehensiveness of the documentation, however, was incomplete. Conclusions. Home health care nurses are attentive to patient participation but fail to address patients’ needs with regard to communication. The documentation is incomplete when assessed according to the steps of the nursing process. A question that arises is whether the nursing process may be a limitation for the quality of the nursing documentation. Relevance to clinical practice. The study contributes to identifying areas of improvement in documentation by nurses in home health care.

Aims and objectives: To explore how the use of electronic messages support hospital and community care nurses’ collaboration and communication concerning patients’ admittance to and discharges from hospitals. Background: Nurses in hospitals and in community care play a crucial role in the transfer of patients between the home and the hospital. Several studies have shown that transition situations are challenging due to a lack of communication and information exchange. Information and communication technologies may support nurses’ work in these transition situations. An electronic message system was introduced in Norway to support patient transitions across the health care sector. Design: A descriptive, qualitative interview study was conducted. Methods: One hospital and three adjacent communities were included in the study. We conducted semi-structured interviews with hospital nurses and community care nurses. In total, 41 persons were included in the study. The analysis stemmed from three main topics related to the aims of e-messaging: efficiency, quality and safety. These were further divided into sub-themes. Results: All informants agreed that electronic messaging is more efficient, i.e. less time-consuming than previous means of communication. The shift from predominantly oral communication to writing electronic messages has brought attention to the content of the information exchanged, thereby leading to more conscious communication. Electronic messaging enables improved information security, thereby enhancing patient safety, but this depends on nurses using the system as intended. Conclusion: Nurses consider electronic messaging to be a useful tool for communication and collaboration in patient transitions. Relevance to clinical practice: Patient transitions are demanding situations both for patients and for the nurses who facilitate the transitions. The introduction of information and communication technologies can support nurses’ work in the transition situations, and this is likely to benefit the patients. This is the peer reviewed version of the following article: [Patients in transition – improving hospital–home care collaboration through electronic messaging: providers’ perspectives], which has been published in final form at [http://onlinelibrary.wiley.com/doi/10.1111/jocn.12991/abstract]. This article may be used for non-commercial purposes in accordance with Wiley Terms and Conditions for Self-Archiving.

Aims and objectives To explore the relationship between nurses and caregivers using a web camera and web forum as the communication methods. Background In Norway and other European countries, there is an increased focus on ageing at home, which is aided by technology, as well as formal and informal care. The literature reveals that caregivers endure physical and mental burdens. With computer-mediated communication, such as telecare, it is possible for nurses to provide supportive care to caregivers in their homes. Design An explorative design using qualitative content analysis. Method Six nurses and nine caregivers with residential spouses suffering from stroke or dementia were interviewed two times over a six-month period. Results The nurses responded dynamically to the information they received and helped to empower the individual caregivers and to strengthen the interpersonal relationships between the caregivers. While some participants thought that meeting in a virtual room was close and intimate, others wanted to maintain a certain distance. The participants' altered their roles as the masters and receivers of knowledge and experience; this variation was based on a relationship in which mutual respect for one another and an interest in learning from one another allowed them to work together as partners to demonstrate the system and to follow-up with new caregivers. Conclusions The flexibility of the service allows the possibility of engaging in a close, or to some extent, a more distant relationship, depending on the participants' attitudes towards using this type of service. Relevance to clinical practice Nurses can provide close care, support and information to caregivers who endeavour to master their everyday lives together with their sick spouses. The support seems to help the caregivers cope with their own physical and emotional problems.

There is an expectation that the use of electronic patient records will contribute to continuity of care across organizations for the growing number of elderly and chronically ill people who need continuing nursing care after an episode of hospitalization. This article aims to explore the concept of inter-organizational continuity of care and to address the contribution, expectations and promises associated with the advent of the electronic patient record. A content analysis of the literature concerning concept development provided a model which indicates that inter-organizational continuity is a multidimensional concept, comprising individual and organizational perspectives with qualitative and quantitative properties.

Aims and objectives To investigate the experiences of home care nurses with electronic messaging (e-messaging) and to determine how it influenced their communication with general practitioners. Background Nurses in home care services must collaborate with general practitioners to care for homebound patients. Studies have shown that communication and collaboration are often constrained because they are organised separately and are dispersed. The use of information and communication technology is expected to support communication and to be a tool for increased patient safety and higher-quality care. Design Cross-sectional study with group comparisons Methods The data were collected with a mailed questionnaire that was answered by home care nurses (n = 425) who had implemented e-messaging and by home care nurses in a comparison group who had not implemented e-messaging (n = 364). The data were analysed using descriptive analyses, chi-square test, Mann–Whitney U-test and multilevel analysis. Results The home care nurses who used e-messages reported to a greater extent that they had communication procedures with general practitioners compared to what the home care nurses in the comparison group reported. The implementation of e-messaging did not result in timelier communication or differences between the two groups in the use of nonelectronic communication, except for a lower use of faxes in the e-messaging group. However, the home care nurses who used e-messaging reported more frequent contacts with general practitioners. Conclusion The results demonstrate that even if e-messaging was implemented, the home care nurses and the general practitioners continued to use nonelectronic communication methods. Relevance to clinical practice E-messaging did not replace but rather complemented the communication methods and thereby transformed clinical communication and collaboration. This should be considered when planning and implementing new information technology in primary care.

Norway's regional teaching hospitals are working together on a project to develop an interdisciplinary electronic patient record (EPR). This paper presents the results of a project to develop nursing documentation as part of an integrated EPR to improve the quality and continuity of patient care. The project used a consensus process as a working norm. The most important result is that the five hospitals have agreed on a framework for nursing documentation, and on the main components that need to be implemented in the electronic patient record.

Aims. The aim of this paper is twofold. Firstly, it describes hospital nurses’ general use of the language function in the nursing discharge notes of patients who will require posthospital home health care. Secondly, it addresses the similarities and differences in completeness, structure and content between paper and electronic nursing discharge notes. Background. Previous research has identified gaps in the accuracy and relevance of information communicated between nurses working at different organizational levels. Design and methods. A descriptive design with a text analysis framework was used. Results. The study shows that the text in the nursing discharge notes is information-dense and characterized by technical terms, although the nurses contextualized and individualized the content of the terms to clarify the message. Both similarities and differences were found in range and detail of the information nurses exchanged when they used paper or electronic discharge notes. Conclusions. The use of structured and standardized templates helped nurses improve the completeness, structure and content of the information in the nursing discharge notes. Relevance to clinical practice. Whether paper or electronic documentation is used, the findings in this study highlight the challenges nurses encounter in ensuring continuity of care during patients’ trajectory through the health system. The findings may help clarify the appropriateness of the content and language nurses use in the nursing discharge note as a communication medium. This study may also be helpful to nurses planning to use EPRs, as it illustrates some of the issues which should be clarified before this is implemented.