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Background: Norwegian Psychomotor Physiotherapy (NPMP) is an established treatment approach mainly applied to patients with long-lasting musculoskeletal pain. The research in the field of NPMP is gradually expanding. The aim of this study was therefore to conduct a systematic search of the published literature for empirical studies in the field, to chart the characteristics and methodologies used and uncover gaps in the research field. Methods: A scoping review methodology was chosen. Results: A total of 93 full text research articles were analysed. The analysis identified primarily articles with a quantitative approach concerning development and standardisation of the NPMP body examination into scales. The qualitative studies concerned different experiences from the body examination and the treatment approach from the patients’ and/or the physiotherapists’ perspectives. Conclusion: The literature in the field is limited but has slowly expanded during the last 20 years. More research is generally needed to further develop and expand the treatment approach.

Purpose: In the treatment of patients with long-lasting musculoskeletal pain, the challenge is to identify causal and sustaining factors and targeted treatment in order to improve function. Norwegian Psychomotor Physiotherapy (NPMP) is an approach often applied to patients with such pain. Long-term NPMP processes from the patients’ perspective have been studied and discussed in the light of phenomenology of the body. The study purpose was to explore what kind of changes patients with long-lasting musculoskeletal pain experience during NPMP and further transfer into daily life context. Methods: A phenomenological, descriptive, and retrospective design was applied. Two focus-group interviews were conducted with 11 patients receiving such treatment. The interviews were audiotaped, transcribed, and analysed inspired by Giorgi’s phenomenological methodology. Results: The analysis resulted in an overarching structure: “To develop embodied ownership of oneself over time”, and two themes describing the essence of change that the patients experienced: (1) “To get an embodied grip on oneself through treatment”; (2) “To give oneself space in daily life”. Conclusions: Enhanced embodied self-perception involving a sense of embodied ownership and agency seemed to be important both to be aware of own bodily needs and to transfer changes from treatment into daily life.

Cognitive deficits experienced by older adults with dementia limit use of wearable devices (necklaces or bracelets) that summon assistance after the older adult falls. To use these wearable devices, older adults must choose to wear them, remember how to use them, and be conscious after falling. Devices such as the Smart Carpet substitute pre-programmed or automatic functions for functions requiring deliberation and decision. After development of a Smart Carpet prototype, 11 volunteers participated in tests to measure sensitivity of sensors embedded in the Smart Carpet. The embedded sensors were not perceptible to the volunteers as they walked across the Smart Carpet and successfully detected gait characteristics. Findings confirmed the feasibility of fall detection. Measurements obtained of gait characteristics will be used in development of more advanced versions of the Smart Carpet. [ABSTRACT FROM AUTHOR]

The Quality Improvement Program for Missouri (QIPMO), a state school of nursing project to improve quality of care and resident outcomes in nursing homes, has a special focus to help nursing homes identified as 'at risk' for quality concerns. In fiscal year 2006, 92 of 492 Medicaid-certified facilities were identified as 'at risk' using quality indicators (QIs) derived from Minimum Data Set (MDS) data. Sixty of the 92 facilities accepted offered on-site clinical consultations by gerontological expert nurses with graduate nursing education. Content of consultations include quality improvement, MDS, care planning, evidence-based practice, and effective teamwork. The 60 'at-risk' facilities improved scores 4%-41% for 5 QIs: pressure ulcers (overall and high risk), weight loss, bedfast residents, and falls; other facilities in the state did not. Estimated cost savings (based on prior cost research) for 444 residents who avoided developing these clinical problems in participating 'at-risk' facilities was more than $1.5 million for fiscal year 2006. These are similar to estimated savings of $1.6 million for fiscal year 2005 when 439 residents in 'at-risk' facilities avoided clinical problems. Estimated savings exceed the total program cost by more than $1 million annually. QI improvements demonstrate the clinical effectiveness of on-site clinical consultation by gerontological expert nurses with graduate nursing education. [ABSTRACT FROM AUTHOR]

The purpose of this exploratory qualitative study was to identify behaviors that contribute to the decision to discharge the resident with dementia from an assisted living facility to a skilled nursing facility. Administrators of 14 assisted living facilities in Missouri were interviewed. The administrators were asked to describe occasions when residents with dementia were discharged. The findings of the study were based on analysis of the audiotapes of the interviews. According to the administrators, resident behaviors that influenced discharge decisions included behaviors indicating progression of dementia, behaviors indicating the need for more assistance with activities of daily living, incontinence, wandering, behaviors that did not meet the facility's expectations, behaviors reflecting changes in physical condition, and aggressive behaviors. These findings have implications for the role of nurses in assisted living facilities and for further research. [ABSTRACT FROM AUTHOR]

Social work counsellors, exposed to hardships of clients’ lives, might, over time, experience strain as bodily reactions of muscle tension and pain. Within the framework of improving professional practice, the aim was to explore meanings attached to moving and breathing by studying the influence of supervision, encompassing experiences and reflections on bodily exercises, and reflection on challenging professional experiences. Action research of interdisciplinary supervision for seven counsellors, based on observations, field notes, reflection notes, and a focus group interview, was carried out. Data were analysed across participants within sessions and over time to compare meaning variations. The counsellors’ change of experiences were identified as phases: What is in it for me, not knowing what to perceive, attention as basis for knowing how to move, experiencing and creating connections, and knowing oneself better. Adjusted to change of experiences, supervisors encouraged counsellors to give attention to, become aware of, and relieve and explore muscle tension and breathing restrictions to contexts of meaning. Supervision based on movement opened access to personal learning. Supervision as approaches of movements and reflections contributed to increased self-knowledge in professional social work practices. Based on ability to perceive and relieve muscle tension and flow of breathing, the approach might be a potential for professionals to handle challenging situations. The findings, related to the lived body, encompass appearances of new meanings and new uses to experiences of muscular tension and flow of breathing.

The aim of the study was to explore how third year social educator students reflect in writing on challenging practice-based experiences of communication, and how they experience the writing process. Based on selected and analyzed research material of students’ texts of reflective writing and texts of comments on reflective writing, following findings emerged: I) Experiences of reflective writing included the themes a) to learn to reflect and to become conscious of lived experiences, and b) to improve reflection on connections between experienced relationships and theoretical concepts. II) Reflecting on participation in challenging relationships in specific contexts of communication: a) the relationship of a student and a service receiver with learning disabilities preparing crossing a road, and b) the relationship between a student, a colleague and a patient with stroke, ordering food in a restaurant. Use of reflective writing facilitates self-consciousness, professional reflection and action.

This study is grounded in a phenomenological lifeworld perspective. It aims at providing rich descriptions of lived experience of the process of losing weight after obesity surgery. Two women participated in in-depth interviews four times each during the first postoperative year. Based on the women's experiences, a meaning structure—the ambivalence of losing weight after obesity surgery—was identified across the women's processes of change. This consisted of five core themes: movement and activity—freedom but new demands and old restraints; eating habits and digestion—the complexity of change; appearance—smaller, but looser; social relations—stability and change; and being oneself—vulnerability and self-assurance. These core themes changed over time in terms of dominance. The experience of ambivalence is discussed according to a phenomenological perspective of the body as lived experience.

Introduction: The article explores how narrative knowledge can facilitate change from being detached from to be in touch with the body, based on a study of long-term Norwegian psychomotor physiotherapy for patients with chronic muscular pain. Main part: Mattingly’s concept «emergent narrative» was applied to identify how ongoing treatment situations can emerge as potential moments of change. «Emergent narratives» indicate knowledge of the process of becoming in touch with the body. Retrospective narratives seemed to grasp experiences that indicated if/how development of symptoms was intervowen in daily life activities, as well as experiences of change of movements and breath over time. Conclusion: The study indicated that emergent narratives point to potential moments of change and seem to be a useful supplement in physiotherapy.

I artikkelen redegjør jeg for valg av engelskvariant i skolefaget engelsk i Norge, fra Skoleloven av 1936, da engelsk ble innført som fag i den obligatoriske folkeskolen, og fram til i dag. Skolefagets læreplaner utgjør her kildene til kunnskap om engelskvariant som modell for elevenes egen læring av uttale, elevenes forståelse av ulike uttalevarianter og opprinnelseslandet til kulturelementer representert. Analysen viser at først i 1987 ble de to hovedvariantene av engelsk uttale, britisk engelsk og amerikansk engelsk, formelt likestilt. Denne læreplanen hadde videre som målsetting at elevene skulle lytte til uttalevarianter også fra verden utenfor Storbritannia og USA og lære å akseptere dem som likeverdige. I den påfølgende planen fra 1997 skulle elevene også lære å skille mellom ulike uttalevarianter. Både 1987- og 1997-planen refererer til engelsk som internasjonalt språk, men først i læreplanen fra 2006 konkretiseres dette blant annet ved at elevene skal få innsikt i hvordan språket brukes som internasjonalt kommunikasjonsmiddel. Kulturkomponenten i skolefaget blir ikke studert per se i artikkelen, men trekkes inn i den grad den kan forstås som en drivkraft for valg av språkvariant. I en ramme rundt artikkelens hovedmålsetting skiller jeg blant annet mellom hovedtyper brukere av engelsk, og jeg diskuterer den internasjonale debatten i samtiden om å gjøre engelsk som lingua franca til modell for fremmedspråkopplæringen men viser samtidig til undersøkelser av holdninger og meninger hos norske elever og lærere som påviser at den innfødte talers modell fortsatt står sterkest.

This article investigates the concept ‘fluency’ from different perspectives. When fluency is an aim in teaching, a thorough comprehension of the concept among teachers is a prerequisite for appropriate planning of instruction, including the choice of appropriate classroom activities. When fluency is an assessment criterion, it is even more important that examiners have a shared perception of the concept. The present article starts by presenting common perceptions of the concept and goes on to explore some of the current research. Next, it provides a historical overview of the place of fluency in teaching theory and explains some of the preconditions for the inclusion of this concept among teaching objectives and assessment criteria. It will also, as an illustration, give an outline of the position of the concept over time in the Norwegian school system on the basis of an analysis of the relevant syllabuses. Finally, the article explicates the notion of language use as a complex cognitive skill and explores current method¬ological ideas about teaching towards fluency.

Background: Device activation typically occurs four weeks post cochlear implant surgery. Emerging evidence suggests earlier activation is feasible and beneficial, giving patients quicker access to sound and rehabilitation., Objectives: Assess current literature for effects of early cochlear implant activation., Methods: Electronic searches of Medline/PubMed, AMED, EMBASE, CINAHL and the Cochrane Library following PRISMA guidelines. Studies investigating any aspect of early activation were included for review., Results: From 15 studies, 625 patients received early activation, compared with 243 patients in the control groups. Early activation was considered as within 7 days post-operatively with 12 studies reporting within 1 day post-operatively, compared with standard activation of 9-46 days post-operatively in the control group. Some studies indicated earlier low levels of impedance in the early activation group. Magnet strength adjustment or off-ear processor wear was often recommended within the early activation cohort. Complication rates were low in both groups. Early activation improved patient satisfaction and anxiety levels without detriment to speech recognition or rehabilitation., Conclusion: Early cochlear implant activation is feasible and allows patients with no contraindications, earlier access to auditory perception and rehabilitation and reduces anxiety linked to delay in activation. Further evidence is required to monitor long-term effects of early activation.

Improvements in health care are slow, in part because doctors and nurses lack skills in quality improvement, patient safety, and interprofessional teamwork. This article reports on the Retooling for Quality and Safety initiative of the Josiah Macy Jr. Foundation and the Institute for Healthcare Improvement, which sought to integrate improvement and patient safety into medical and nursing school curricula. In one academic year, 2009-10, the initiative supported new learning activities (87 percent of which were interprofessional, involving both medical and nursing students) in classrooms, simulation centers, and clinical care settings that involved 1,374 student encounters at six universities. The work generated insights-described in this article-into which learning goals require interprofessional education; how to create clinically based improvement learning for all students; and how to demonstrate the effects on students' behavior, organizational practice, and benefits to patients. A commonly encountered limiting factor for the programs was the lack of a critical mass of clinically based faculty members who were ready to teach about the improvement of care. What's more, the paucity of robust evaluation strategies for such programs suggests a future research agenda that deserves to be funded.

Our team has developed a technological innovation that detects changes in health status that indicate impending acute illness or exacerbation of chronic illness before usual assessment methods or self-reports of illness. We successfully used this information in a 1-year prospective study to alert health care providers so they could readily assess the situation and initiate early treatment to improve functional independence. Intervention participants showed significant improvements (as compared with the control group) for the Short Physical Performance Battery gait speed score at Quarter 3 (p = 0.03), hand grip-left at Quarter 2 (p = 0.02), hand grip-right at Quarter 4 (p = 0.05), and the GAITRite functional ambulation profile score at Quarter 2 (p = 0.05). Technological methods such as these could be widely adopted in older adult housing, long-term care settings, and in private homes where older adults wish to remain independent for as long as possible., (Copyright 2012, SLACK Incorporated.)

Background: The effectiveness of clinical information systems to improve nursing and patient outcomes depends on human factors, including system usability, organizational workflow, and user satisfaction., Objective: The aim of this study was to examine to what extent residents, family members, and clinicians find a sensor data interface used to monitor elder activity levels usable and useful in an independent living setting., Methods: Three independent expert reviewers conducted an initial heuristic evaluation. Subsequently, 20 end users (5 residents, 5 family members, 5 registered nurses, and 5 physicians) participated in the evaluation. During the evaluation, each participant was asked to complete three scenarios taken from three residents. Morae recorder software was used to capture data during the user interactions., Results: The heuristic evaluation resulted in 26 recommendations for interface improvement; these were classified under the headings content, aesthetic appeal, navigation, and architecture, which were derived from heuristic results. Total time for elderly residents to complete scenarios was much greater than for other users. Family members spent more time than clinicians but less time than residents did to complete scenarios. Elder residents and family members had difficulty interpreting clinical data and graphs, experienced information overload, and did not understand terminology. All users found the sensor data interface useful for identifying changing resident activities., Discussion: Older adult users have special needs that should be addressed when designing clinical interfaces for them, especially information as important as health information. Evaluating human factors during user interactions with clinical information systems should be a requirement before implementation.

Technology offers potential solutions to the pending crisis of healthcare for older adults, while healthcare workers are in short supply. Technology can enable remote monitoring of individuals and early detection of potential problems, so that early interventions can help older adults remain as healthy and independent as possible. Research is under way with passive monitoring technology in senior housing that is finding patterns in the data that can enhance nurse care coordination through early illness detection. With early detection, interventions can be more effective and reduce hospitalization and other healthcare expenses. Case studies are presented, and implications are discussed.

As in acute care, use of health information technology in long-term care holds promise for increased efficiency, better accuracy, reduced costs, and improved outcomes. A comprehensive electronic health record (EHR), which encompasses all health care measures that clinicians want to use-both standard health care assessments and those acquired through emerging technology-is the key to improved, efficient clinical decision making. New technologies using sensors to passively monitor older adults at home are being developed and are commercially available. However, integrating the clinical information systems with passive monitoring data so that clinical decision making is enhanced and patient records are complete is challenging. Researchers at the University of Missouri (MU) are developing a comprehensive EHR to: (a) enhance nursing care coordination at TigerPlace, independent senior housing that helps residents age in place; (b) integrate clinical data and data from new technology; and (c) advance technology and clinical research., (Copyright 2010, SLACK Incorporated.)

In response to the Institute of Medicine challenge to improve patient safety and quality of care, an office directing patient safety/quality of care at an academic medical center and faculty from health professions schools collaborated on design, delivery, and evaluation of an interprofessional student curriculum on patient safety, quality, and teamwork. Annually for 6 years, second-year medical students, senior baccalaureate nursing students, second-year masters in health administration students, and junior baccalaureate respiratory therapy students participated. A pre-/postsurvey assessing students' attitudes about quality, safety, and teamwork was developed and modified to reflect course revisions. Survey items were grouped into 1 of the 6 subscales: human fallibility, disclosure, teamwork/communication, error reporting, systems of care, and curricular time spent with other professionals. At pretest, there were significant professional group differences in all the 6 subscales. At completion, differences in 4 subscales were resolved with the exception of human fallibility (P < .001) and curricular time spent together (P < .001). Interprofessional exercises within our curriculum mediated most differences among student groups. As more interprofessional curricular experiences are designed, examining baseline group differences is essential to optimize learning outcomes.

This article provides results of an expert review of data displays for a sensor system used to monitor functional abilities in older adults. The research took place at TigerPlace, an assisted living facility where the sensor system is currently being evaluated. A checklist of 16 heuristic criteria was used to evaluate the sensor data displays, with consideration to the users of the system: residents, their families, and health care providers. Results of this expert review indicate that flexibility and efficiency of use, help and documentation, navigation, and skills were not well developed in the sensor data displays. Conversely, sensor data displays were rated highly for their aesthetic value and the ample visual contrast on the main display components. Through the use of a sensor system, new ways of detecting functional decline in elderly residents of assisted living facilities can be accomplished.

Field test results are reported for the Observable Indicators of Nursing Home Care Quality Instrument-Assisted Living Version, an instrument designed to measure the quality of care in assisted living facilities after a brief 30-minute walk-through. The OIQ-AL was tested in 207 assisted-living facilities in two states using classical test theory, generalizability theory, and exploratory factor analysis. The 34-item scale has a coherent six-factor structure that conceptually describes the multidimensional concept of care quality in assisted living. The six factors can be logically clustered into process (Homelike and Caring, 21 items) and structure (Access and Choice; Lighting; Plants and Pets; Outdoor Spaces) subscales and for a total quality score. Classical test theory results indicate most subscales and the total quality score from the OIQ-AL have acceptable interrater, test-retest, and strong internal consistency reliabilities. Generalizability theory analyses reveal that dependability of scores from the instrument are strong, particularly by including a second observer who conducts a site visit and independently completes an instrument, or by a single observer conducting two site visits and completing instruments during each visit. Scoring guidelines based on the total sample of observations (N = 358) help guide those who want to use the measure to interpret both subscale and total scores. Content validity was supported by two expert panels of people experienced in the assisted-living field, and a content validity index calculated for the first version of the scale is high (3.43 on a four-point scale). The OIQ-AL gives reliable and valid scores for researchers, and may be useful for consumers, providers, and others interested in measuring quality of care in assisted-living facilities.

We have placed a network of sensors in a residential home for the elderly who are aging in place. Restlessness data is displayed as graph of event counts detected by sensors over some time interval, typically a day. This data is related to the actual activities as recorded by the resident. We show two cases of elderly individuals. In both cases the individuals underwent surgery. The restlessness indicators showed changes in patterns that were related to those events. Analyzing the data even at this level we gain increased confidence that technology will be a welcome addition as the population ages and require increasing care.

The faculty at the University of Missouri-Columbia Sinclair School of Nursing (MUSSON) developed and implemented a gerontological nursing care course, with support from the Health Resources and Services Administration, the American Association of Colleges of Nursing, and the John A. Hartford Foundation. The course, with both didactic and clinical components, was mandatory for all students in the baccalaureate program. The course drew on two resources unique to the MUSSON: Senior Care, the school's home care agency, and TigerPlace, a retirement community closely linked to the school. Goals of the course were to increase knowledge of gerontology and gerontological nursing and to promote more positive student attitudes toward older adults. Evaluation of six semesters of pretest and posttest data found that knowledge increased although attitudes toward older adults did not become more positive. However, despite the lack of quantifiable improvement in attitudes, some students wrote positive comments on end-of-semester course evaluations about experiences and interactions with older adults during the course.

"Smart homes" are defined as residences equipped with sensors and other advanced technology applications that enhance residents' independence and can be used for aging in place. The objective of this study is to determine design specifications for smart residences as defined by professional groups involved both in care delivery to senior citizens and development of devices and technologies to support aging. We assessed the importance of specific devices and sensors and their advantages and disadvantages as perceived by the interdisciplinary expert team. This work lays the ground for the implementation of smart home residencies and confirms that only an interdisciplinary design approach can address all the technical, clinical and human factors related challenges associated with home-based technologies that support aging. Our findings indicate that the use of adaptive technology that can be installed in the home environment has the potential to not only support but also empower individual senior users.

This study aim is to explore the perceptions of seniors in regard to "smart home" technology aiming to improve their quality of life and/or monitor their health status. A total of 15 older adults participated in three focus groups. Participants had a positive attitude towards these technologies and identified application areas such as emergency help, detection of falls, monitoring of physiological parameters. Concerns were expressed about privacy and the need for tailored training.

Minimum Data Set data from 15,977 residents were analyzed to investigate the reasons older adults were admitted to skilled nursing facilities from assisted living facilities. Residents admitted from assisted living facilities, private homes, hospitals, and hospitals with previous assisted living facility residence were compared. Findings suggest that residents admitted from assisted living facilities are more likely to be older, to have diagnoses of dementia and depression, and to be placed in Alzheimer's special care units.

Wandering is a commonly observed behavior among older adults with Alzheimer's disease (AD) and other types of dementia. When wandering around becomes wandering away, older adults with dementia are at high risk of injury. This exploratory, qualitative study described the circumstances, environmental risks, and injuries sustained in 62 elopements from long-term care facilities by elderly residents with dementia. Content analysis of the reports of the elopements identified patterns that included: 1) a lack of effective precautions to prevent elopement when residents had indicated an intent to elope, had repeatedly attempted to elope, or had a history of elopement; 2) a lack of awareness by the staff of resident location; and 3) ineffective use of alarm devices intended to alert staff to elopement attempts.

The last decade has seen a substantial growth in the development of residential care facilities (assisted living facilities). Evaluation of the quality of care in this service delivery sector has been hampered by the lack of a consensus definition of quality and the lack of reliable instruments to measure quality. Founded on extensive research on nursing home care quality, a field test of the Residential Care Facility Version of the Observable Indicators of Nursing Home Care Quality Instrument was conducted in 35 residential care facilities in Missouri. Content validity of the 34 items was rated by 4 expert raters as 3.4 on a 4-point scale of relevance. Test-retest was 0.94, interrater reliability was 0.73, and internal consistency was 0.90 for the total scale, indicating excellent results for initial field-testing. A focus group confirmed the 5 dimensions of quality of care measured by the instrument as important in residential care settings.

Purpose: We describe the development of a statewide strategy to improve resident outcomes in nursing facilities, and we present some evaluative data from this strategy., Design and Methods: Key components of the strategy include (a) a partnership between the state agency responsible for the nursing home survey and certification and the school of nursing in an academic health sciences center; and (b) on-site clinical expert technical assistance and support to facilities throughout the state., Results: The partnership has resulted in state agency staff having information from analyses about resident needs and outcomes in the state and facilities having access to the quarterly electronic "Show-Me Quality Indicator Report." On-site clinical expert technical assistance is now used widely across the state, with 569 site visits conducted in 286 different facilities to help them interpret their quality indicator (QI) reports and implement quality improvement programs; statewide improvements in QI scores have been measured in several key QIs., Implications: Other states should consider building partnerships with schools of nursing in an academic health sciences center. Programs using on-site clinical consultation can facilitate improving quality of care in nursing facilities.

Background: The purpose of this article is to highlight the substantive changes and enhancements between the 4th edition and new 5th edition of the so that modifications and enhancements are more easily incorporated into the reader's writing and editing practice., Approach: The 4th and new 5th editions of the were compared and substantive changes are presented., Results: The following text style requirements are addressed: (a) use of parentheses to enclose statistical values, (b) use of italics, and (c) presentation of statistical data. Reference citation style changes include: (a) use of italics instead of underlining, (b) use of et al., and (c) use of the hanging indent. With the explosion of electronic media use, guidelines for documenting these sources are reviewed. Appropriate use of adverbs and research subject descriptors, submission of manuscripts on disks or files, responsibilities of corresponding authors, and converting the dissertation into a journal article are addressed., Discussion: This information should assist the reader to quickly and accurately focus upon the enhancements and changes in the recently released 5th edition. Hopefully these changes will easily be incorporated into the readers' editing responsibilities, manuscripts, and subsequent publications.

This article describes potentially disastrous outcomes associated with failure to determine when nasally inserted feeding tubes are improperly positioned. It also presents information that is important for risk managers to consider when developing protocols for testing placement of newly inserted feeding tubes.