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A Systematic Review of Intuition—A Way of Knowing in Clinical Nursing?

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Open Journal of Nursing 2016年第5期6卷 412-425页

作者： Anne Lise Holm elisabeth severinsson Department of Health Science Stord/Haugesund University College Stord Norway Centre for Women’s Family and Child Health Faculty of Health Sciences University College of Southeast Norway Kongsberg Norway

The aim of this systematic review was to illuminate intuition in clinical nursing. Frequently described as a defining characteristic of professional expertise, intuition is gaining acceptance as a legitimate form of knowledge in clinical nursing. A total of 352 abstracts were read and eight quantitative studies included. A thematic analysis was performed to one main theme, two themes, and four sub-themes emerged. The main theme was: Sensing an unconscious and conscious state of mind, and the two themes were: A sudden emotional awareness and reflection, and arousal of conscious thought processes. The first theme included two sub-themes: Sensing spiritual connections with patients and experiencing physical sensations;worrying and reassuring feelings. The second theme comprised two sub-themes: Willingness to act on personal, interpersonal, and clinical experiences;the influence of maturity and social support in clinical decision-making. An implication for clinical nursing was the need to develop sensitivity as a key to understanding the patient’s illness. In conclusion, leadership and management could facilitate discussions about intuition as a legitimate method of processing information and making decisions about patient care.

关键词： Clinical Nursing Conscious Emotional Awareness Knowledge Unconscious

How Can Manual Rotation Reduce Vacuum, Forceps and Caesarean Deliveries?—A Review of the Evidence

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Open Journal of Nursing 2017年第1期7卷 68-85页

作者： Cathrine Os elisabeth severinsson The Centre for Women’s Family & Child Health Department of Nursing and Health Sciences Faculty of Health and Social Sciences University College of Southeast-Norway Kongsberg Norway Oslo University Hospital Ullev&aringl Oslo Norway

The aim of this review was to investigate whether manual rotation can be used to reduce vacuum, forceps and caesarean deliveries in women with occiput posterior or occiput transverse positions from 7 cm dilation in labour. A search strategy was developed and relevant papers published between 1946 and January 2015 were identified from electronic databases. Key search terms used were manual and digital rotation, labour presentation, obstetric labour complications, occiput posterior and version foetal. The search revealed 330 papers. A short list of 33 publications of possible relevance was compiled and assessed using the following criteria: primary studies on the effectiveness of manual rotation performed in women with singleton occiput posterior or occiput transverse presentations published in English or the Scandinavian languages. The quality of the included studies was evaluated by means of the critical appraisal tools for quantitative studies. Seven studies were included in the thematic analysis. The results varied but the main finding was that in order to decrease vacuum, forceps and caesarean deliveries by means of manual rotation, it is essential that the procedure is successful. The success rate of manual rotation is dependent on the experience of the healthcare professionals who perform the rotation procedure rather than the technique employed. Predictors of successful manual rotation were used after engagement of the foetal head, at full dilatation and prophylactic use before failure to progress in labour. In conclusion, although the results vary, there is a consensus in all the studies that manual rotation is worth considering and that it can contribute to decreasing vacuum, forceps and caesarean deliveries. The implications for practice are that successful manual rotation can reduce caesarean delivery and increase spontaneous vaginal delivery, but experience is necessary to perform successful rotations. Because there are no risk factors associated with man

关键词： Literature Review Midwifery Manual and Digital Rotation Labour Presentation Occiput Posterior

Mapping Psychosocial Risk and Protective Factors in Suicidal Older Persons—A Systematic Review

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Open Journal of Nursing 2015年第3期5卷 260-275页

作者： Anne Lise Holm elisabeth severinsson Department of Health Science Stord/Haugesund University College Haugesund Norway Centre for Women’s Family and Child Health Faculty of Health Sciences Buskerud and Vestfold University College Drammen Norway

Social disconnectedness in combination with depression, somatic disease, stigma, social exclusion and functional impairment has been described as a major risk factor for suicide in old age. However, protective factors have not been focused on in the same way. The aim was to identify psychosocial risk and protective factors in suicidal older persons. A systematic review was performed in Academic Search Premier (34), Ovid Medline (0), PsycInfo (0), PubMed (66), CINAHL (3) and ProQuest (1078) for the period May - September, 2014. Results: Twelve studies were included in the final analysis. Psychosocial risk factors were categorized under four themes: Being a burden to others increases depression and hopelessness, the struggle due to poor social integration, the strain of physical illness and old age and Negative aspects of religious activity. A total of four protective factors emerged: a sense of belonging, maintaining social dignity, satisfaction with relationships and feeling useful and positive aspects of religious activity. In conclusion, the context of a suicidal older person in a home healthcare service may create a “vulnerable psychosocial state” in which she/he is confronted by stressful psychosocial life events including physical illness and social network changes. The fact that protective factors are solely related to social factors needs to be taken into account in future prevention studies.

关键词： Older Protective Factors Psychosocial Risk Factors Suicide

Patients’ Role in Their Own Safety—A Systematic Review of Patient Involvement in Safety

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Open Journal of Nursing 2015年第7期5卷 642-653页

作者： elisabeth severinsson Anne Lise Holm Centre for Women’s Family and Child Health Faculty of Health Sciences Buskerud & Vestfold University College Kongsberg Norway Department of Health Science Stord/Haugesund University College Stord Norway

It is necessary to evaluate progress in the area of patient safety. However, although there has been an increase in number of quality and safety related studies have increased, the topics of patient involvement and patient safety are not automatically linked. The aim of this systematic review was to identify and evaluate the evidence contributed by studies of patient involvement in the provision of safe care. Inclusion criteria were studies undertaken to promote involvement in safety, covering patients’ attitudes, unsafe and safe care, risk reduction and handover practices during discharge from hospital to primary care. The results revealed three themes: satisfaction with and need for knowledge about healthcare and the health system, sharing responsibility and accountability for safety and the need to overcome language barriers to prevent harm and error. In conclusion, there is an increased focus on the role of the patient in the provision of safe care. Existing evidence is related to medication rather than patients’ capability and willingness to be involved. It is recommended that patient participation in the provision of safe care should be explored in relation to phenomena such as trust, responsibility, shared decision-making and powerlessness. It is also important to investigate the patient’s role with respect to patient rights.

关键词： Patient Involvement Patient Safety Systematic Review

Evaluating Improvement in the Care of Depressed Elderly Patients: An Empirical Approach to the WHO Patient Safety Model

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Open Journal of Nursing 2015年第5期5卷 397-406页

Depression among the elderly is a public health issue. This paper demonstrates the value of patient safety research for future strategies in this area. The aim of the present study was to analyse the relationship between the World Health Organization (WHO) Patient Safety (PS) Model and empirical research on depressed elderly patients’ experiences of quality and safe care. The research question was: Which patients’ experiences could be linked to quality and safe care as recommended by the WHO? We adopted an implementation approach as the starting point for this interdisciplinary project. A total of 29 individual narrative-based, in-depth interviews were performed to explore patients’ experiences and two healthcare teams participated in the focus group interviews. Interpretation of the results revealed that the 23 components of the PS model were linked to elderly patients’ experiences of quality and that safe care was not achieved. There was evidence of low quality and lack of safe care due to psychological distress, stress and fatigue, the absence of involvement in decision-making, misdiagnosis, sleep problems as a result of harm from medical error and a poor physical state. Patients’ experiences of loneliness gave rise to suicidal thoughts. In conclusion, quality improvement is necessary in all components of the WHO PS model. We recommend structural, process and outcome improvements, more specifically: active involvement, shared decision-making and increased self-management.

关键词： Chronic Care Management Implementation Patient Safety Model WHO

Implementation Strategies for Improving the Care of Depressed Elderly Persons—Summary of an International Workshop

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Open Journal of Nursing 2014年第11期4卷 715-723页

作者： elisabeth severinsson Anne Lise Holm Centre for Women’s Family and Child Health Faculty of Health Sciences Buskerud & Vestfold University College Kongsberg Norway

The aim of the study was to identify the most important research priorities as well as future strategies for promoting and implementing evidence-based care of depressed elderly persons. An interdisciplinary workshop was organized using a focus group format and the transcript of the discussion was interpreted by means of the qualitative content analysis. The most important research priorities for improving the care of depressed elderly persons, implementation levels, theoretical approaches as well as possible outcomes were analysed on individual consumer, healthcare system, and policy level. A wide range of theories and methods are necessary to identify and explain implementation processes and results. Qualitative and quantitative methodologies in combination with knowledge synthesis were discussed. In addition, the need to summarize the literature in terms of specific issues was emphasized. In conclusion, the implementation strategies for improving the care of depressed elderly persons should be addressed on three levels: individual consumer, healthcare system and policy. Although some aspects of the implementation model may need to be enhanced, the fact that it includes conditions on individual level, i.e. self-management support, is of importance. The expansion and maintenance of evidence-based care generate potential for change in mental healthcare, thus improving outcomes for individual elderly patients. Areas that require further research are organization, cost and leadership. The use of mixed methods could strengthen future studies. Implementation researchers need a broad repertoire in order to plan and perform evidence-based research. To improve practice, implementation strategies should be developed in clinical and community guidelines.

关键词： Implementation Research Depression Elderly Professional Guidelines Workshop

Evaluation Nursing Students’ Views of Improved Competence Development after Clinical Supervision: An Educative Approach to the WHO Patient Safety Model

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Open Journal of Nursing 2015年第8期5卷 725-734页

作者： Anne Lyberg Kirsten Eika Amsrud elisabeth severinsson Centre for Women’s Family and Child Health Faculty of Health Sciences Buskerud & Vestfold University College Kongsberg Norway

Bachelor of Science Nursing (BSN) students’ education comprises both theories and practical aspects. Access to resources is required for the development of a professional identity, which includes gaining technical knowledge and receiving feedback, guidance as well as social and emotional support from clinical supervisors. The aim of this study was to evaluate BSN students’ views of professional development after clinical supervision (CS) during their undergraduate education. An additional aim was to illuminate how competence development was related to the WHO Patient Safety Educational Model. A cross-sectional study was conducted, in which CS was measured as part of a survey completed by a sample of nursing students after their clinical placement at two time-points, namely 2012 and 2013. Statistical descriptive and inferential analyses were used and differences in the responses between Time 1 and Time 2 compared. The benefit of CS for nursing students’ competence development revealed a positive significant relationship between students’ Interpersonal skills and the factor Improved care/skills. There were differences in terms of variables related to the Importance value of CS and Professional skills. The results can be used to inform undergraduate nursing education leaders, teachers and practice partners on individual, group and organisational level in order to enhance patient safety and highlight the importance of CS for BSN students’ professional development.

关键词： Clinical Supervision Nursing Students Patient Safety

Lost in a Nameless Chaos—Women’s Experiences of Postpartum Depression: A Meta-Ethnographic Study

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Open Journal of Nursing 2017年第8期7卷 962-977页

作者： Bente Dahl Marthe Sandvoll Hermansen elisabeth severinsson The Centre for Women’s Family and Child Health Department of Nursing and Health Faculty of Health and Social Sciences University College of Southeast Norway Kongsberg Norway

Postpartum depression is a common complication related to childbearing with an estimated prevalence of 10% - 15%. The aim of the study was to explore and synthesize qualitative empirical studies published between 2005 and 2016 that describe women’s experiences of postpartum depression. Ten qualitative studies describing different perspectives on women’s experiences of postpartum depression were summarized and synthesized using Noblit and Hare’s 7-step meta-ethnographical method. Four central metaphors described women’s experiences of postpartum depression: Feeling trapped by reality, Experiencing a nameless chaos, Struggling to find a way out and Being seen as a normal but suffering person. The findings resulted in the following synthesis: The women expected the transition to motherhood to be a joyous experience. Instead, they found it painful, lonely and experienced losing themselves in a nameless chaos. Motherhood is challenged when women experience losing themselves due to depression rather than building a new identity as a mother. Such a situation causes chaos, shame, anxiety and isolation. When seeking professional help, it is essential that the woman is encountered with empathy and professional knowledge, rather than a pat on the back and an underestimation of her problems.

关键词： Postpartum Depression Experience Meta-Ethnography Qualitative

The Use and Misuse of Mobile Phones in the Maternity Ward—A Threat to Patient Safety?

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Open Journal of Nursing 2017年第6期7卷 707-719页

作者： Bente Dahl Sandra Akenes-Carlsen elisabeth severinsson Centre for Women’s Family&Child HealthDepartment of Nursing and Health SciencesFaculty of Health and Social SciencesUniversity College of Southeast NorwayKongsbergNorway Obstetric Unit Department of Obstetrics/Gynecology and PediatricsOstfold Hospital TrustGralumNorway

An important task for the midwife is following up mother-child interaction to facilitate mother-infant attachment. The aim of this study was to explore midwives’ perceptions of parents’ use of mobile phones in the maternity ward. The research question was: Is the use of mobile phones in the maternity ward a threat to patient safety? Two focus group interviews exploring midwives’ perceptions (n = 10) of parent’ use of mobile phones during and after the birth were conducted in January 2016. Systematic text condensation was used to analyse the data, revealing three themes pertaining to safety concerns: Interrupted communication due to parents’ excessive use of mobile phones during labour and postnatally, Unsafe care caused by lack of attention to the newborn baby’s signals as a result of being disturbed by the mobile phone and Unsafe care because of parents interrupting their conversation with the midwife by answering the mobile, acting in a disrespectful manner and failing to pay attention. The midwives’ descriptions of parents’ use of mobile phones in the maternity ward included reflections on mobile phone usage as a permanent phenomenon. They were concerned that parents’ use of mobile phones in the maternity ward could negatively affect the attachment process and considered that it interrupted their work. In conclusion, there is a need for increased awareness of parents’ use of mobile phones in the maternity ward. Further research is required to gain greater insight into the consequences of mobile phone use in order to promote patient safety by ensuring effective communication between parents and midwives. In addition, research is needed to explore the safety discourse, clinical risks and/or health problems involved in the development of infant-parent attachment in newborn babies.

关键词： Communication Focus Group Interviews Infant-Parent Attachment Midwife Maternity Care Mobile Phone Patient Safety