Forskningsartikler

Introduction: Alcohol use remains a leading cause of excess mortality and morbidity worldwide, and identifying and following up harmful alcohol use represents a key component of alcohol harm reduction policies. This article explores health professionals’ experiences implementing these policies in a Norwegian hospital.

Aim: To explore health professionals’ views and experiences of systematic screening and tailored follow-up of harmful and hazardous alcohol use in a Norwegian hospital.

Methods: We conducted semi-structured interviews with 13 specialty registrars and nurses working in the emergency department and observation ward of a hospital in Oslo, Norway. Interviews were carried out between May and December 2022, coded using NVivo v.14 and analyzed thematically.

Results: We identified three themes: (i) standardized and clinical assessment, referring to tensions between standardized and clinical alcohol risk assessment; (ii) formal and informal treatment guidelines, encompassing the informal patient care practices enacted in the emergency department and on the wards, and; (iii) training delivery and barriers to implementation, referring to the training penetration rate and identified need for “clear and simple” alcohol treatment guidelines.

Conclusion: This study highlights tensions between alcohol-related harm and alcohol-related norms as these pertain to screening and following up harmful and hazardous alcohol use in a Norwegian hospital. Results suggest training should focus on zero alcohol recommendations, the use of assessment tools, the acceptability of screening to patients and “clear and simple” patient follow-up procedures.

Thomas Tjelta, Stig Tore Bogstrand, Anners Lerdal, Linda Elise Couëssurel Wüsthoff, Hilde Marie Erøy Edvardsen & Aud Johannessen

Samandrag
Hensikt: Å undersøkje fysioterapeutar sine erfaringar med å rekruttere, lære opp og rettleie frivillige instruktørar som skal ha ansvar for å leie Sterk og stødig-treningsgrupper som ein del av kommunen sitt fallførebyggande tilbod til heimebuande eldre.

Metode: Fire individuelle djupneintervju med fysioterapeutar tilsett i ulike kommunar vart analysert med systematisk tekstkondensering.

Funn: Fem tema vart funne: (1) Ei naturleg rolle som skapar variasjon i arbeidskvardagen, (2) Rekruttering – ei ny rolle, (3) Frivillige som brubyggjarar for kunnskapsformidling, (4) Kontinuerleg rettleiing for å sikre riktig dosering og (5) Sterk og stødig for målgruppa?

Studien syner at opplærings- og rettleiingsrolla i Sterk og stødig vart opplevd som naturleg, og prega av tryggheit, kompetanse og ei positiv haldning til å arbeide førebyggande med målgruppa. Frivillige instruktørar fungerte som kunnskapsformidlarar om trening og fallførebygging til gruppedeltakarane. Å rekruttere eigna frivillige instruktørar var essensielt for både treningseffekt og drift av tilbodet, men var også ressurskrevjande for fysioterapeutane. Synet på å inkludere deltakarar utanfor målgruppa varierte.

Konklusjon: Fysioterapeutane opplever at arbeidsoppgåver knytt til Sterk og stødig integrerast naturleg inn i eiga rolle. Trass krevjande rekrutteringsarbeid, vert samarbeidet med frivillige gruppeinstruktørar ein viktig ressurs i det fallførebyggande arbeidet. Å finne gode løysingar knytte til rekrutteringsarbeid er sentralt.

Ane Brekke, Bård Erik Bogen, Ingebjørg Kyrdalen & Lill Anette Juvik

Abstract

Aim
This study explores nurses’ experience and reflections on the use of advance care planning (ACP) for older adult patients in home care services.
Method
The study employs an explorative qualitative design. Five focus groups with 21 nurses in home care services were conducted and analyzed using content analysis.
Results
Three main categories were identified; 1) limited experience with the use of ACP, 2) reflections on systematic use of ACP and 3) prerequisites for successful ACP conversations. The participants revealed limited experience with ACP but recognized that such conversations could provide important clarifications for patient and family caregiver support. The use of ACP needs to be individually tailored, involving family caregivers, and being conducted in collaboration with a physician. The need for open conversations initiated by the patient or family caregivers should be addressed. For successful implementation, competence building, a planned process, and support from management are essential.
Conclusion
ACP could be beneficial in the follow-up of older, chronically ill patients living at home, but should not substitute the need for individualized spontaneous conversations.

Beth Helen Tomren Løken & Anne Marie Mork Rokstad

Abstract:

Objective: What are the core capabilities physiotherapists need to deliver quality care when working with people with dementia and their families/caregivers?

Design: A three-round modified e-Delphi study.

Participants: Panel members were physiotherapists experienced in working with people with dementia and/or educating and/or researching in the dementia field.

Methods: A steering group (16 international physiotherapists and a consumer) developed a draft framework including 129 core capabilities across 5 domains for panel members to rate their appropriateness for inclusion as a core capability to provide high quality care to people with dementia and their caregivers/families. The RAND/UCLA method was used to assess consensus.

Results: Thirty-five physiotherapists from 11 countries participated in Round 1, 31 (89%) in Round 2 and 28 (80% of Round 1) in Round 3. All core capabilities were rated appropriate for inclusion in each round. Panel members recommended wording refinements across the rounds and suggested 51 core capabilities for consideration. Three rounds were needed to reach consensus, resulting in 137 core capabilities rated appropriate for inclusion across 5 domains: 1) Knowledge and understanding, n = 36; 2) Assessment, n = 39; 3) Management, interventions and prevention n = 40; 4) Communication, therapeutic relationship and person-centred care, n = 17; and 5) Physiotherapists self-management and improvement, n = 5.

Conclusions: This e-Delphi study outlines the core capabilities physiotherapists need to provide high quality care to people with dementia and their families/caregivers. These core capabilities can be used by physiotherapists to help identify knowledge/skill gaps, as well as by educators to improve their training of undergraduate and postgraduate students, and clinicians.

Morag E Taylor, Karen Sverdrup, Julie Ries, Erik Rosendahl, Gro Gujord Tangen, Elisabeth Telenius, Katherine Lawler, Keith Hill, Annika Toots, Hans Hobbelen, Vanina Dal Bello-Haas, Abi Hall, Susan W Hunter, Victoria A Goodwin, Julie Whitney, Michele L Callisaya