Top-level managers’ and politicians’ worries about future care for older people with complex and acute illnesses - a Nordic study

Successful ability to stay at home - an interview study exploring multiple diagnosed older persons and their relatives' experiences

BACKGROUND

Society places increased demands on regions and municipalities to jointly carry out activities for multi-diagnosed older persons with extensive coordination needs. Interprofessional collaboration is reported as an important success factor for the overall health care of this group of patients. This project focuses on older persons with multiple diagnoses and their relatives' own experiences of what is most important for safety and security in their homes. The aim of the study was: to illuminate the meaning of success for the ability to stay at home as experienced by older persons with multiple diagnoses and their relatives.

METHODS

The project had a descriptive explorative design with a phenomenological hermeneutic approach based on analysis of 14 in-depth interviews with older people and their relatives.

FINDINGS

Own resources were identified such as belief in the future, spiritual belief, social network, having loved ones and pets. Technical aids were seen as helpful resources, working as indoor and outdoor security safeguards. These resources included having good telephone contact with social and professional networks as well as other forms of personal equipment such as a personal alarm. The professional network was a resource, acting as support when the patient's own abilities were not sufficient. Finally, having personnel who had the time and interest to listen was seen as crucial to experience safety.

CONCLUSIONS

The main reason for being able to continue homecare was the person's self-care system, their personal, social, and technical resources. Professional care development should anchor team work to the patient's own system of self and informal care.

Emergency nurses' and physicians' perceptions and self-assessed competence in providing care to older patients

AIM

This study examined emergency nurses' and physicians' perceptions and self-assessed competence in caring for older patients.

METHODS

Data were analyzed using a mixed methods approach and quantitative data were supplemented with qualitative responses. There were 451 nurses and physicians working at the two examined emergency departments, with 125 of them responding to the survey; the response rate was 27.7 %.

RESULTS

Physicians and nurses felt that acutely ill older patients are a responsibility of emergency services. Nurses were more critical than physicians (p = 0.000) of the failure to recognize older patients as a special group at the emergency department. Over half (51.8 %) of the physicians and 29.0 % of the nurses (p = 0.027) felt that older patients' special needs had been considered during facility planning. Nurses and physicians described the problems related to multimorbidity and aging relatively similarly. Both expressed a need for more knowledge in geriatrics and gerontology.

CONCLUSION

Future facility planning and care processes at the emergency department should better consider the specific needs of older patients. The results also emphasize a need to more effectively prioritize competence and educational needs of emergency staff and recognize caring for older patients as a specific competence area in the emergency department.

Revealing a gap in the clinical competence of nursing staff in nursing homes: a cross-sectional study with the Ms. Olsen test

BACKGROUND

Nursing staff, caring for frail older people in long-term care, needs to have a certain level of clinical competence to identify diseases at an early stage and to assess and provide good nursing care. In Finland, nursing care is based on evidence-based and high-quality nursing care. However, earlier inspections by the National Supervisory Authority for Welfare and Health showed many discrepancies between the nursing staff's clinical competence and adequate and continuous education.

AIM

This study aimed to explore nursing staff, i.e. the clinical competence and decision-making skills of registered and practical nurses in nursing homes for older people in Finland and to analyse the association between nurses' clinical competence and fundamental background factors.

METHODS

We conducted a cross-sectional study of 337 participants in 50 nursing homes in the western part of Finland, between December 2020 and January 2021. The instrument used was the validated Ms. Olsen test, an extraction of NOP-CET. Statistical analyses were conducted with descriptive statistics and correlations and a cut-off for clinical competence.

RESULTS

This study with the Ms. Olsen test revealed that only one-fourth of the RNs and a third of the PNs passed the clinical competence test. In the self-evaluation, almost all participants evaluated themselves with good clinical competence. The Finnish Current Care Guidelines were used on a daily basis by 7.4% and weekly by 30%. Significant correlation was found between Swedish as a working language and mother tongue and the score for clinical competence.

CONCLUSION

The clinical competence test, the Ms. Olsen test, was used in Finland for the first time to evaluate the nursing staffs´ clinical competence in nursing homes. We found gaps in the clinical competence in Finnish nursing homes, both for PNs and RNs. The result differed remarkably from their self-assessments and the staff did not use the national nursing guidelines as required to develop their nursing skills and knowledge. Gaps in the clinical competence have been identified and can be used to develop targeted continuous education.

Bibliometric Analysis on Geriatric Nursing Research in Web of Science (1900-2020)

Objective

Aging is a growing public health concern for people, organizations, and governments. The current study was undertaken to provide insights into the global research output on geriatric nursing.

Methods

A bibliometric study was implemented using the WoS database for the period from 1900 to 2020. Various tools and measures were used to analyze and visualized.

Results

The search strategy found 4923 papers. The oldest paper was written by Beverly C. Andre in 1953. As team size increases, so does the number of citations. The USA was the active country and the highest number of coauthors. New York University was an active institution. Stig Karlsson was the most active author in Geriatric Nursing with 28 articles from Sweden, followed by Koen Milisen and Sandman, with 26 articles each from Sweden and Belgium. The most frequent words in this field were depression, malnutrition, education, Alzheimer's disease, and dementia. The latest research themes in this field were COVID-19, interprofessional locomotive syndrome, emergency nursing, and public health. The most influential papers were specified. Journal of the American Geriatrics Society was the most active journal.

Conclusions

Geriatric nursing is a rooted field and has received special attention in the last decade. Policymakers, especially in developing countries, should pay attention to geriatric nursing as a specialty of nursing to solve aging issues they would face considering the increasing elderly population.

Supportive and Palliative Care Indicators Tool prognostic value in older hospitalised patients: a prospective multicentre study

BACKGROUND

An increasing number of older patients are hospitalised. Prognostic uncertainty causes hospital doctors to be reluctant to make the switch from cure to care. The Supportive and Palliative Care Indicators Tool (SPICT) has not been validated for prognostication in an older hospitalised population.

AIM

To validate SPICT as a prognostic tool for risk of dying within one year in older hospitalised patients.

DESIGN

Prospective multicentre study. Premorbid SPICT and 1-year survival and survival time were assessed.

SETTING/PARTICIPANTS

Patients 75 years and older admitted at acute geriatric (n=209) and cardiology units (CUs) (n=249) of four hospitals.

RESULTS

In total, 59.3% (124/209) was SPICT identified on acute geriatric vs 40.6% (101/249) on CUs (p<0.001). SPICT-identified patients in CUs reported more functional needs and more symptoms compared to SPICT non-identified patients. On acute geriatric units, SPICT-identified patients reported more functional needs only.The HR of dying was 2.9 (95% CI 1.1 to 8.7) in SPICT-identified versus non-identified after adjustment for hospital strata, age, gender and did not differ between units. One-year mortality was 24% and 22%, respectively, on acute geriatric versus CUs (p=0.488). Pooled average sensitivity, specificity and partial area under the curve differed significantly between acute geriatric and CUs (p<0.001), respectively, 0.82 (95%CI 0.66 to 0.91), 0.49 (95%CI 0.40 to 0.58) and 0.82 in geriatric vs 0.69 (95% CI 0.42 to 0.87), 0.66 (95% CI 0.55 to 0.77) and 0.65 in CUs.

CONCLUSIONS

SPICT may be used as a tool to identify older hospitalised patients at risk of dying within 1 year and who may benefit from a palliative care approach including advance care planning. The prognostic accuracy of SPICT is better in older patients admitted at the acute geriatric versus the CU.

Associations between symptoms of pain, insomnia and depression, and frailty in older adults: A cross-sectional analysis of a cohort study

BACKGROUND

Frailty is prevalent in older adults and has adverse effects on multiple health outcomes. Pain, insomnia, and depressive symptoms are commonly seen and treatable symptoms in older adults and are associated with frailty. However, it is unknown whether these symptoms are independently associated with frailty and how they interact with each other creating a greater impact on frailty than individual symptoms. It is important to understand these associations for nurses to provide high-quality patient-centered care for older adults with frailty.

OBJECTIVES

To determine independent associations of pain, insomnia, and depressive symptoms with frailty and examine their synergistic impact on frailty among older adults.

DESIGN

A cross-sectional analysis of a cohort study.

SETTING

Communities in the United States.

PARTICIPANTS

Community-dwelling older adults from the National Health and Aging Trend Study (N = 7,609), a nationally representative survey of Medicare Beneficiaries in the United States.

METHODS

Frailty status was determined by five criteria of the Physical Frailty Phenotype: exhaustion, low physical activity, weakness, slowness, and shrinking. Pain was determined by self-reports of bothersome pain in the last month. Insomnia included self-reports of difficulty initiating sleep and difficulty maintaining sleep. Depressive symptom was assessed by the Patient Health Questionnaire-2. Logistic regression models were used adjusting for sociodemographic, health-related and behavioral covariates.

RESULTS

The sample was mainly under 80 years old (72%), female (57%), and non-Hispanic White (81%). Approximately 53% experienced bothersome pain, 11% had difficulty initiating sleep, 6% had difficulty maintaining sleep, and 15% had depressive symptom; 46% were pre-frail and 14% were frail. Independent associations with pre-frailty and frailty were found in pain (odds ratio [OR]: 1.81, 95% CI: 1.60, 2.04), difficulty initiating sleep (OR: 1.23, 95% CI: 1.04, 1.46) and depressive symptom (OR: 2.29, 95% CI: 1.85, 2.84). Interaction terms between pain and depressive symptom (OR: 1.87, 95% CI: 1.14, 3.07), and between difficulty initiating sleep and depressive symptom (OR: 2.66, 95% CI: 1.15, 6.13) were significant, suggesting a synergistic impact on pre-frailty and frailty.

CONCLUSIONS

Pain, difficulty initiating sleep, and depressive symptoms are independent risk factors of frailty and may have a synergistic impact on frailty. Interventions should be developed to address these symptoms to reduce the adverse effects of frailty.

Reconciling economic concepts and person-centred care of the older person with cognitive impairment in the acute care setting

Person-centred care is a relatively new orthodoxy being implemented by modern hospitals across developed nations. Research demonstrating the merits of this style of care for improving patient outcomes, staff morale and organizational efficiency is only just beginning to emerge. In contrast, a significant body of literature exists showing that attainment of person-centred care in the acute care sector particularly, remains largely aspirational, especially for older people with cognitive impairment. In previous articles, we argued that nurses work constantly to reconcile prevailing constructions of time, space, relationships, the body and ethics, to meet expectations that the care they provide is person-centred. In this article, we explore key concepts of neo-liberal thought which forms an important back-story to the articles. Economic concepts, "efficiency" and "freedom" are examined to illustrate how nurses work to reconcile both the repressive and productive effects of economic power. We conclude the article by proposing a new research agenda aimed at building a more nuanced understanding of the messy actualities of nursing practice under the influences of neo-liberalism, that illuminates the compromises and adaptations nurses have had to make in response to economic power.

Introducing Nurse Practitioners Into Norwegian Primary Healthcare-Experiences and Learning

BACKGROUND AND PURPOSE

Nurse practitioners (NPs) are well established internationally, and Norway is now in the first phase of implementing their role. The aim of this study was to describe the reflections of nurse leaders and general practitioners (GPs) on the establishment of the new NP role in primary healthcare.

METHODS

This study was qualitative and longitudinal. Written reports and audio recordings from 11 meetings with nurse leaders and GPs during 3 years in 3 municipalities were analyzed by a thematic analysis.

RESULTS

Four themes were identified: the need for enhanced clinical competence among registered nurses, the need for reorganization of advanced practice, the need for negotiating professional barriers, and demanding economic situations. Nurse leaders and GPs were generally positive toward NPs, but they had difficulty in clarifying their roles and how to organize them in the existing work models. This was due to economic pressures, different needs in departments, and shift work. Nurse leaders and GPs agreed that NPs should not replace physicians but perform the tasks of advanced practice nursing in a more expert way. Nurse leaders also wanted NPs to be a resource for registered nurses. It was important to gain trust in the new role not only of GPs but also of registered nurses.

IMPLICATIONS FOR PRACTICE

It is extremely important that an implementation group is proactive in finding a suitable model for the implementation process. Clarification of the roles, tasks, and responsibilities of NPs at an early implementation stage could make the process easier.

'Thinking outside the box': advanced geriatric nursing in primary health care in Scandinavia

Background

Older people are frequent users of primary health care (PHC) services. PHC services have been critiqued, mainly regarding limited accessibility and continuity of care. In many countries, investment in nurse practitioners (NPs) has been one strategy to improve PHC services. In the North of Europe, the NP role is still in its infancy. The aim of this study was to explore the feasibility of introducing geriatric nurse practitioners (GNPs) in PHC in Scandinavia, from multiprofessional and older persons’ perspectives.

Methods

The study had a qualitative design, including 25 semi-structured interviews with nurses, nurse leaders, physicians, politicians and older persons from several communities in Scandinavia. The material was analysed by means of qualitative content analysis.

Results

The results highlight current challenges in health services for the older population, i.e. comorbid older patients with complex care needs aging in place, lack of competent staff, and organisational challenges. The results present an envisioned GNP scope of practice in health services for the older population, including bringing advanced competence closer to the patient, an autonomous role including task-shifting, and a linking role. The results also present factors influencing implementation of the GNP role, i.e. GNP competence level, unclear role and scope of practice, and openness to reorganisation.

Conclusions

The results indicate that it is feasible to implement the GNP role in primary health care in Scandinavia. Notwithstanding, there are factors influencing implementation of the GNP role that should be considered.

Electronic supplementary material

The online version of this article (10.1186/s12912-019-0350-2) contains supplementary material, which is available to authorized users.

Nurse competence in the interface between primary and tertiary healthcare services

AIMS

(a) To explore nurses' self-assessed competence and perceived need for more training in primary and tertiary healthcare services; and (b) to investigate the factors associated with these issues.

DESIGN

Quantitative, cross-sectional, descriptive.

METHODS

The ProffNurseSAS, the Job Satisfaction Scale and socio-demographics were used. A convenient sampling method was used to invite registered nurses from 23 primary (N = 104) and tertiary care wards (N = 26).

RESULTS

Five significant differences in self-assessed competence were identified, with none regarding the perceived need for more training between nurses working in primary versus tertiary health care. Nurses in primary health care had longer experience, and a larger proportion had continuing education. Nevertheless, this was not associated with either self-assessed competence or the perceived need for more training. Years of experience, training or reported job satisfaction was not associated with the items on the ProffNurseSAS.

CONCLUSION

Findings indicate that nurses' competence is same in primary and tertiary healthcare settings. Moreover, the findings of this research highlight areas that need further improvement and emphasis from both leaders and educational institutions when they attempt to ensure nurses' competence.

'Best fit' caring skills of an interprofessional team in short-term goal-directed reablement: older adults' perceptions

This paper reports a study conducted to illuminate older adults' perceptions of multiproffesional team's caring skills as success factors for health support in short-term goal-directed reablement. The fact that older adults are given perquisites to live in their own homes puts great demands on the professional care given them at home. An option offered could be short-term goal-directed reablement delivered by an interprofessional team. This means after periods in hospitals to strengthen their multidimensional health, older adults' reablement processes are supported to return to their daily life as soon as possible. Crucial in making these intentions a reality seems to be identifying the professional's approach that works as success factors for health support in the reablement process. A descriptive qualitative design with a phenomenographic approach based on interviews with 23 older persons who had received short-term goal-directed reablement at home after a period at hospital was used. The study was approved by an ethical board. The analysis revealed four major referential aspects of multiproffesional team's caring skills as success factors for health-support in short-term goal-directed reablement: a motivating caregiver, a positive atmosphere-creating caregiver, a human fellowship-oriented caregiver and a caregiver that goes beyond the expected. In this study, all caring skills in the continuum are perceived as positively loaded necessities in different situations during the reablement process. Caring skills as success factors are initially shown at a practical level, such as how the professional caregivers encourage and motivate the older persons in different training situations. At a deeper level, the caregivers open their hearts and have the capacity to go beyond the expected in the professional caregiver-patient relationship. The multiproffesional team's best fit caring skills during the home reablement process need to be addressed as evidence base in the area of elderly home care.

The role of advanced geriatric nurses in Norway: A descriptive exploratory study

BACKGROUND

Care of older adults in the community is becoming increasingly complex. However, nursing staff often has insufficient knowledge and skills to adequately address the needs of frail older adults. There is therefore a need for nurses with advanced qualifications. To meet this need, advanced geriatric nursing has been introduced in Norway.

AIMS AND OBJECTIVES

This study aimed to describe the experiences of nurses with their new role as advanced geriatric nurses in care of older adults and to determine what strategies the nurses considered important in the development of their new role.

DESIGN

This study applied a descriptive, exploratory design.

METHODS

In-depth interviews were conducted with 21 nurses who had undergone an educational programme to become advanced geriatric nurses in Norway in 2016. Content analysis was used to analyse the data.

FINDINGS

The participants described a complex and extensive nursing role, which they related to a new understanding of the patients, relatives and the system in which they worked. This new gaze had developed based on a combination of their new knowledge, their skills, experiences and professional interests. The opportunities to use their role depended on their workplace conditions. They related to contextual challenges at their workplace in different ways to optimise the use of their new gaze.

CONCLUSIONS

Common for all participants was a broader and deeper understanding of the patient's health and life situation, which guided participants' actions. The key issue in developing the new role was developing effective strategies to foster role integration.

IMPLICATIONS FOR PRACTICE

Advanced geriatric nurses should collaborate with their managers to create a role that takes advantage of their knowledge and skills, as well as collaborate with colleagues to enhance understanding of utilisation of their role.

Postgraduate nurses' self-assessment of clinical competence and need for further training. A European cross-sectional survey

BACKGROUND

Nursing practice requires application of knowledge, skills and values in various combinations and has undergone substantial changes the last decades. An increased focus on inter-professional collaboration and possible new and more independent roles for nurses are described. A variety of programs have been developed in order to educate registered nurses (RN) to meet the changes and demands in health and nursing care throughout the world.

AIM

The aims were to 1) describe nurses' self-assessment of clinical competence and need for further training, and 2) explore possible differences between nurses in specialist vs master's programs.

METHODS

A cross-sectional survey design was applied. 97 nurses in postgraduate programs from five countries responded (response rate 45%). A revised version of the Professional Nurse Self-Assessment Scale of clinical core competencies (PROFFNurseSASII) was used for data collection. Independent student t-test and regression analyses were carried out.

RESULTS

The respondents rated their competence highest in taking full responsibility, cooperation with other health professionals and in acting ethically. Items where they considered themselves needing further training most were competence on medications, interaction and side effects and differential diagnoses. For all items, nurses in master's programs rated their competence higher than nurses in the specialist programs. Nurses in specialist programs rated their need for more training for all items higher than nurses in master's degree programs, and for 47 out of the 50 items these differences were statistically significant.

CONCLUSION

Even though the nurses rated their competence high for important competence aspects such as taking responsibility and cooperation with other health professionals, it is worrying that their need for further training was highest for effects and interaction of various types of medications. Further studies are needed to conclude if and how master's education improves patient outcome.

Advanced nurse practitioners in municipal healthcare as a way to meet the growing healthcare needs of the frail elderly: a qualitative interview study with managers, doctors and specialist nurses

Background

The number of frail elderly people with complex nursing and medical care needs is increasing, and consequently, the healthcare burden. The implementation of Advanced Nurse Practitioners globally has been shown to make healthcare more effective and increase patient safety, continuity of care and access to care. In Sweden, research about Advanced Nurse Practitioners is limited. Thus, this study aimed to investigate the opinions of managers, doctors and nurses in primary care and municipal healthcare about the role of ANPs in municipal healthcare as a way to meet the increasing healthcare needs of the frail elderly.

Methods

Managers, doctors and specialist nurses in primary care and municipal healthcare adopted a qualitative, descriptive design through 12 semi-structured interviews. The data were analysed using content analysis.

Results

The participants expressed both opportunities as well as challenges with Advanced Nurse Practitioners in municipal healthcare. This role considered to satisfy frail elderly people’s healthcare needs and making the healthcare more effective as the doctors would have more time for other patients. The challenges mainly consist of doubts from the managers whether the nurses would be motivated to pursue further education to become an Advanced Nurse Practitioner if the role becomes a reality. The doctors were unsure if the nurses would consider taking the responsibility the role would imply.

Conclusions

Advanced Nurse Practitioner is considered to be a valuable resource not only for the frail elderly but also for the nurses in the municipal healthcare and for the doctors in primary care as they probably would make healthcare more effective. They might be a way to meet the increasing healthcare needs of frail elderly, however there are also challenges to overcome before they can become a reality in a Swedish healthcare context. Consequently, this role deserves further investigation.

Electronic supplementary material

The online version of this article (10.1186/s12912-017-0258-7) contains supplementary material, which is available to authorized users.

Supportive care for older people with frailty in hospital: An integrative review

BACKGROUND

Growing numbers of older people living with frailty and chronic health conditions are being referred to hospitals with acute care needs. Supportive care is a potentially highly relevant and clinically important approach which could bridge the practice gap between curative models of care and palliative care. However, future interventions need to be informed and underpinned by existing knowledge of supportive care.

AIM

To identify and build upon existing theories and evidence about supportive care, specifically in relation to the hospital care of older people with frailty, to inform future interventions and their evaluation.

DESIGN

An integrative review was used to identify and integrate theory and evidence. Electronic databases (Cochrane Medline, EMBASE and CIHAHL) were searched using the key term 'supportive care'. Screening identified studies employing qualitative and/or quantitative methods published between January 1990 and December 2015. Citation searches, reference checking and searches of the grey literature were also undertaken.

DATA SOURCES

Literature searches identified 2733 articles. After screening, and applying eligibility criteria based on relevance to the research question, studies were subject to methodological quality appraisal. Findings from included articles (n=52) were integrated using synthesis of themes.

RESULTS

Relevant evidence was identified across different research literatures, on clinical conditions and contexts. Seven distinct themes of the synthesis were identified, these were: Ensuring fundamental aspects of care are met, Communicating and connecting with the patient, Carer and family engagement, Building up a picture of the person and their circumstances, Decisions and advice about best care for the person, Enabling self-help and connection to wider support, and Supporting patients through transitions in care. A tentative integrative model of supportive care for frail older people is developed from the findings.

CONCLUSION

The findings and model developed here will inform future interventions and can help staff and hospital managers to develop appropriate strategies, staff training and resource allocation models to improve the quality of health care for older people.

Home healthcare nurses’ experiences of being on stand by as a first responder in a ‘While Waiting For the Ambulance’ assignment

The aim of the study is to describe experiences of the ‘While Waiting for the Ambulance’ (WWFA) assignment, as described by home healthcare nurses (HHCNs). Since the early 1990s, municipal resources in Sweden, preferably firefighters, have been dispatched on WWFA. In order to further assist the local residents on an island in the southwest of Sweden, HHCNs have recently begun accompanying firefighters on WWFA. A reflective lifeworld approach was used for data analysis including in-depth interviews with eight HHCNs. When WWFA was established, the HHCNs experienced lack of clarity in where their responsibilities start and end. A split role is described, and there is a paradox in that the responders are meant to collaborate toward saving lives, when the assignment itself has a lack of collaborative structure. Ethical dilemmas and inner emotional worries led to the nurses expressing a need for support before, during and after WWFA.

The Professional Nurse Self-Assessment Scale: Psychometric testing in Norwegian long term and home care contexts

BACKGROUND

Nurses' clinical competence is vital to ensure safe and high quality care, and the continuous assessment of nurses' clinical competence is of major concern. A validated instrument for the self-assessment of nurses' clinical competence at different educational levels across specialties and countries is lacking. The aim of this study was to test the reliability and construct validity of the new Professional Nurse Self-Assessment Scale (ProffNurse SAS) questionnaire in long term and home care contexts in Norway. The questionnaire is based on the Nordic Advanced Practice Nursing model, in which the nurse-patient relationship is central.

METHODS

The study has a cross-sectional survey design. A purposive sample of 357 registered nurses who worked in long term and home care contexts in two geographical regions encompassing eight municipalities and three counties was included. The respondents completed the 74-item ProffNurse SAS questionnaire and demographic background data was collected. Data collection was conducted in two phases: first region autumn 2011 and second region spring 2012. Exploratory factor analyses (EFA) were used to test the psychometric properties of the questionnaire and included the following steps: assessment of the factorality of the data, factor extraction by Principal Component Analysis (PCA), oblimin (oblique) factor rotation, and interpretation. Cronbach's alpha was used to estimate the internal consistency.

RESULTS

The PCA revealed a six-component structure, reducing the number of items in the questionnaire from 74 to 51. Based on the content of the highest-loading items, the six components were named: Direct Clinical Practice, Professional Development, Ethical Decision-Making, Clinical Leadership, Cooperation and Consultation, and Critical Thinking. The Cronbach's alpha values ranged from 0.940 (highest; Direct Clinical Practice) to 0.737 (lowest; Critical Thinking), leading to the estimation that the ProffNurse SAS is reliable.

CONCLUSIONS

The six components support the study's theoretical framework. The ProffNurse SAS showed acceptable reliability and construct validity and may therefore be a promising instrument for the assessment of practicing nurses' clinical competence. However, we recommend further psychometric testing in other countries and contexts and the inclusion of larger samples of nurses at various levels of education, particularly master's level APNs.

The competence gap in community care: Imbalance between expected and actual nursing staff competence

Research that examines nursing staff competence that is necessary in order to provide safe community care is called for. This literature review examines Norwegian policy documents and international research with the aim to assess whether there is a match between expected and actual nursing staff competence in community care. Twelve policy documents and ten research articles were included in the review, of which key themes were identified. The Norwegian government expects a wide range of competence ranging from specific tasks in medical management to adhering to safe practice and care guidelines. Major discrepancies were identified between the advanced competence expected in policy documents and the actual competence as described by the research literature, which was mainly concerned with assistance with activities of daily living, medical knowledge, and personal abilities. There is a general lack of opportunities for competence development in the sector, implying that a general development of nursing staff competence is a pressing need in community care.

Meanings over time of working as a nurse in elderly care

Background:

Although registered nurses (RNs) play a central role in the care of older persons, their work in elderly care has historically been described as “low status” in nursing. This is especially problematic due to the global issue of RN turnover, but there is still little evidence of how to change this trend. Better understanding is needed of the reasons why RNs work in elderly care, as well as knowledge of whether these reasons have changed over time.

Aim:

The aim was to explore the meaning of working in elderly care, over time, from the perspective of RNs.

Method:

We interviewed thirteen RNs working in nursing homes, six of them in 2000 and the remaining seven in 2012, and analysed the resulting data using Interpretive Description.

Results:

The results show similarities and differences over time in the RNs’ reasoning about the meaning of their work with older persons, from a focus on obstacles to a view of opportunities.

Conclusion:

An RN’s intention to continue working in elderly care might be based on their beliefs; their view of older people, and their experiences of being able to influence the care. Managing this knowledge could be an essential factor in reversing the historical trend of RN work in elderly care being seen as low status, and the increasing turnover in such nurses. Our results could stimulate reflection on daily care and beliefs about caring for older persons.