Norwegian Nurses Research Articles

Health measures in prediction models for high sickness absence: single-item self-rated health versus multi-item SF-12.

Self-rated health (SRH) has been found to predict sickness absence (SA). The present study investigated the effect of replacing single-item SRH by a multi-item health measure on SA predictions. Longitudinal study of 2059 Norwegian nurses with assessments in three waves each separated by 1 year. Health was measured by single-item SRH and multi-item SF-12 in waves 1 and 2. SA was self-reported in all three waves and high SA was defined as more than or equal to 31 SA days within the last 12 months. Predictions of high SA by a model including age, prior SA and single-item SRH were compared with predictions by a model including age, prior SA and multi-item SF-12. Both models were bootstrapped to correct for over-optimism and prospectively validated for their predictions in a new time frame. 1253 nurses (61%) had complete data for analysis. The SF-12 model predicted the risk of high SA more accurately (χ(2) = 4.294; df = 8) and was more stable over time than the SRH model (model χ(2) = 14.495; df = 8). Both prediction models correctly discriminated between high-risk and low-risk individuals in 73% of the cases at wave 2 and in 71% of the cases at wave 3. The accuracy of predictions increased when single-item SRH was replaced by multi-item SF-12, but the discriminative ability did not improve. Single-item SRH suffices to identify employees at increased risk of high SA.

Nurse Competence Scale – Psychometric testing in a Norwegian context

The aim was to test the construct validity of the Nurse Competence Scale. The Nurse Competence Scale has been used in hospital settings for various purposes in several countries. Despite this, confirmatory factor analyses are scarcely reported. The present study is based on re-analyses of data from 2007 (i.e. psychometric testing) and 593 newly graduated nurses working in various contexts were included. Confirmatory as well as exploratory factor analyses (Principal Component Analysis) were carried out. The original 7-factor model of the Nurse Competence Scale (73 items) was not confirmed. The exploratory factor analyses resulted in a Norwegian Nurse Competence Scale consisting of 46 items in the following competence categories: Planning and delivery of care, Teaching functions, Professional leadership, Research utilization and nursing values and Professional awareness.The results underline the needs for psychometric testing of an instrument after translation processes. The instrument is suitable for describing and comparing nurse competence for various reasons. It may also be helpful in creating competence development programs at an individual as well as at an organizational level. Further studies with a broader sample are recommended.

Towards a more comprehensive definition of shift work tolerance.

The aim of the present study was to define the nature of individual differences in shift work tolerance (SWT). This was investigated by an exploratory factor analysis of scores from a wide range of established instruments designed to measure sleep, sleepiness, fatigue, social functioning, as well as physical and mental health. Data were collected from a representative sample of 1,529 Norwegian nurses engaged in rotating shift work. The analyses yielded two factors that seemed to be especially relevant for SWT, namely “Well-being” and “Physical health”. Both factors were related to several demographic and personality variables. In addition, both factors were related to job satisfaction, social support and negative acts, while Well-being was also related to coping. These results support the construct and concurrent validity of the Well-being and Physical factors of SWT. Our findings represent a step towards answering calls from previous research concerning the establishment of a wider definition of individual differences in SWT.

Night work and symptoms of anxiety and depression among nurses: A longitudinal study

Over the last few decades, night work has been found to be associated with negative somatic consequences; however, there is less knowledge about its impact on mental health. In a sample of 633 Norwegian nurses, we investigated by means of latent growth curve modelling whether different work schedules predicted differences in baseline values of anxiety and depressive symptoms, and trajectories of these over a two-year span. All participants completed the Hospital Anxiety and Depression Scale as part of a larger survey conducted during the winters of 2009, 2010 and 2011. The results revealed that night workers and nurses who changed from day work to night work during the study period did not differ from day workers either in terms of baseline symptoms of anxiety or depression, or in terms of trajectories of these symptoms. However, nurses who changed from night work to day work reported a significant decrease in symptoms of both anxiety and depression over time compared to day workers. Furthermore, supporting previous work, languidity was related to higher anxiety and depression and hardiness to lower levels of those symptoms. Possible mechanisms underlying the results are discussed.

PO-0648 Norwegian – Indian Collaboration Project To Improve Newborn Care

Background Norway India Partnership Initiative (NIPI) is cooperation between the Governments of Norway and India, and has a particular focus on improving newborn health by training health personnel. A former exchange program in Kolkata (2011–2013) reports reduction in neonatal mortality rate and improved newborn care. Aim This project aims to improve the care of sick and premature newborns, in line with international standards, in Rajasthan, India. The exchange of health personnel in north-south collaboration can reduce neonatal morbidity and mortality by improving basic neonatal nursing. Focus areas are KMC, nutrition and breastfeeding, developmental care, hygiene and pain management. The project intends to increase multicultural understanding within newborn health care. Method Exchange of 4 indian and 2 norwegian nurses/year for a 3 year period. Norwegian nurses will stay in JK Lone Hospital, Jaipur for 12 months and indian nurses in Oslo university hospital for 6 months. Focus for Norwegian nurses in Jaipur will be teaching doctors and nurses in evidence based newborn care through bedside training in the NICU. Interact with the indian team of doctors, nurses,and family of the sick newborn, in order to develop an understanding of the culture and society they are working in. Focus for Indian nurses in Oslo will be hands on bedside training in the NICU under surveillance of experienced personell. In depth knowledge of the focus areas. All participants are to convey their experience to their home partners after homecoming through teaching, demonstrations and reports. The goal is sustainable practice change according to evidence based care.

Predictors of shift work disorder among nurses: a longitudinal study

BackgroundShift work is associated with sleep problems and impaired health. The main aim of the present study was to explore predictors of developing shift work disorder (SWD) among Norwegian nurses using a longitudinal design. MethodsA total of 1533 nurses participating in a survey on shift work, sleep and health responded to questionnaires at baseline and at follow-up about two years later. SWD was defined as problems of excessive sleepiness and/or complaints of insomnia related to the work schedule. Results and ConclusionsThere was a significant reduction (p < 0.001) in the prevalence of SWD from baseline to follow-up, from 35.7% to 28.6%. Logistic regression analyses showed significant risks of having SWD at follow-up and the following variables measured at baseline: number of nights worked the last year (OR = 1.01, 95% CI = 1.01–1.02), having SWD (OR = 5.19, 95% CI = 3.74–7.20), composite score on the Epworth Sleepiness Scale (OR = 1.08, 95% CI = 1.04–1.13), use of melatonin (OR = 4.20, 95% CI = 1.33–13.33), use of bright light therapy (OR = 3.10, 95% CI 1.14–8.39), and symptoms of depression measured by the Hospital Anxiety and Depression Scale (OR = 1.07, 95% CI = 1.00–1.14). In addition, leaving night work between baseline and follow-up was associated with a significantly reduced risk of SWD at follow-up (OR = 0.12, 95% CI = 0.07–0.22).

Dispensing emotions: Norwegian community nurses' handling of diversity in a changing organizational context

Since the mid-1990s, public sector health care services in Norway have been restructured, in line with New Public Management ideas. This restructuring has coincided with demographic changes that have led to a more culturally diverse patient population. Both developments have created new challenges for community nurses in managing their work. This qualitative study applies the concept of “emotional labor” to examine nurses' experiences in working with ethnic minority patients in the context of pressures arising from organizational reforms. The analysis sheds light on the nurses' attempts to comply with system-induced efficiency considerations, while catering to the special situation of patients with language barriers and unfamiliar cultural traditions. The article demonstrates how efficiency requirements and time constraints either aggravate the nurses' insecurity in dealing with minority patients or, in some cases, compel them to assume more work responsibilities so as to mitigate the effects of such constraints.

Norwegian nursing and medical students' perception of interprofessional teamwork: a qualitative study.

BackgroundLittle is known about the ways in which nursing and medical students perceive and understand their roles in interprofessional teamwork. A 2010 report by the World Health Organization highlights the importance of students’ understanding of teamwork in healthcare, and their ability to be effective team players. This study aims at describing nursing and medical students’ perceptions of interprofessional teamwork, focusing on experiences and recommendations that can be used to guide future educational efforts.MethodsThe study uses a qualitative research design. Data were collected from four focus group interviews: two homogenous groups (one with medical students, one with nursing students) and two mixed groups (medical and nursing students).ResultsThe results show that traditional patterns of professional role perception still prevail and strongly influence students’ professional attitudes about taking responsibility and sharing responsibility across disciplinary and professional boundaries. It was found that many students had experienced group cultures detrimental to team work. Focusing on clinical training, the study found a substantial variation in perception with regard to the different arenas for interprofessional teamwork, ranging from arenas with collaborative learning to arenas characterized by distrust, confrontation, disrespect and hierarchical structure.ConclusionsThis study underlines the importance of a stronger focus on interprofessional teamwork in health care education, particularly in clinical training. The study results suggest that the daily rounds and pre-visit “huddles,” or alternatively psychiatric wards, offer arenas suitable for interprofessional training, in keeping with the students’ assessments and criteria proposed in previous studies.

Updating and prospective validation of a prognostic model for high sickness absence

To further develop and validate a Dutch prognostic model for high sickness absence (SA). Three-wave longitudinal cohort study of 2,059 Norwegian nurses. The Dutch prognostic model was used to predict high SA among Norwegian nurses at wave 2. Subsequently, the model was updated by adding person-related (age, gender, marital status, children at home, and coping strategies), health-related (BMI, physical activity, smoking, and caffeine and alcohol intake), and work-related (job satisfaction, job demands, decision latitude, social support at work, and both work-to-family and family-to-work spillover) variables. The updated model was then prospectively validated for predictions at wave 3. 1,557 (77 %) nurses had complete data at wave 2 and 1,342 (65 %) at wave 3. The risk of high SA was under-estimated by the Dutch model, but discrimination between high-risk and low-risk nurses was fair after re-calibration to the Norwegian data. Gender, marital status, BMI, physical activity, smoking, alcohol intake, job satisfaction, job demands, decision latitude, support at the workplace, and work-to-family spillover were identified as potential predictors of high SA. However, these predictors did not improve the model's discriminative ability, which remained fair at wave 3. The prognostic model correctly identifies 73 % of Norwegian nurses at risk of high SA, although additional predictors are needed before the model can be used to screen working populations for risk of high SA.

Evaluering av klinisk stige ved intensivseksjonen Rikshospitalet-Norge

Clinical ladders are intended to support skills development for nurses in clinical work. Norwegian Nurses' Organization developed criteria for the clinical specialist in 1995 and Rikshospital implemented a clinical ladder in 1999. The program consists of three modules over five years.

Nurse staffing and education and hospital mortality in nine European countries: a retrospective observational study

Austerity measures and health-system redesign to minimise hospital expenditures risk adversely affecting patient outcomes. The RN4CAST study was designed to inform decision making about nursing, one of the largest components of hospital operating expenses. We aimed to assess whether differences in patient to nurse ratios and nurses' educational qualifications in nine of the 12 RN4CAST countries with similar patient discharge data were associated with variation in hospital mortality after common surgical procedures. For this observational study, we obtained discharge data for 422,730 patients aged 50 years or older who underwent common surgeries in 300 hospitals in nine European countries. Administrative data were coded with a standard protocol (variants of the ninth or tenth versions of the International Classification of Diseases) to estimate 30 day in-hospital mortality by use of risk adjustment measures including age, sex, admission type, 43 dummy variables suggesting surgery type, and 17 dummy variables suggesting comorbidities present at admission. Surveys of 26,516 nurses practising in study hospitals were used to measure nurse staffing and nurse education. We used generalised estimating equations to assess the effects of nursing factors on the likelihood of surgical patients dying within 30 days of admission, before and after adjusting for other hospital and patient characteristics. An increase in a nurses' workload by one patient increased the likelihood of an inpatient dying within 30 days of admission by 7% (odds ratio 1·068, 95% CI 1·031-1·106), and every 10% increase in bachelor's degree nurses was associated with a decrease in this likelihood by 7% (0·929, 0·886-0·973). These associations imply that patients in hospitals in which 60% of nurses had bachelor's degrees and nurses cared for an average of six patients would have almost 30% lower mortality than patients in hospitals in which only 30% of nurses had bachelor's degrees and nurses cared for an average of eight patients. Nurse staffing cuts to save money might adversely affect patient outcomes. An increased emphasis on bachelor's education for nurses could reduce preventable hospital deaths. European Union's Seventh Framework Programme, National Institute of Nursing Research, National Institutes of Health, the Norwegian Nurses Organisation and the Norwegian Knowledge Centre for the Health Services, Swedish Association of Health Professionals, the regional agreement on medical training and clinical research between Stockholm County Council and Karolinska Institutet, Committee for Health and Caring Sciences and Strategic Research Program in Care Sciences at Karolinska Institutet, Spanish Ministry of Science and Innovation.

Offline: The league of youth

Last week was my Norwegian father's 80th birthday and a celebration was held in typically Nordic style in Oslo. Unfortunately, I missed a good deal of the night. One of my father's friends, himself a lively 85 years, slipped and fell. He cut his leg and considerable quantities of blood spilled onto the floor. I found myself in a taxi late in the evening taking him to a nearby Norwegian accident and emergency department. I don't speak Norwegian, so the task ahead seemed daunting. Fortunately, another guest came with us and we managed to negotiate our way through the triage nurse into a room where our friend could be examined. The Norwegian nurses and doctors we saw could not have been kinder. The first nurse quickly cleaned his leg. The second nurse did more of the same. A doctor came. She looked at the wound and probed to see what damage had been done. She ordered an x-ray. No fracture. She thought we might get away without stitches but called a colleague for advice. He recommended stitches. Out came the needle, stitches were sewn, and the leg bandaged. Our friend's trousers were pulled back over the wound (all this activity had been completed with his black tie dinner suit still worn). And he was moved into a wheelchair. The aim now was to stand him up, check he could walk, and then take him home (where he lived alone). Sadly, this optimistic outcome was thwarted. Our patient couldn't stand on his damaged leg, and so the doctor decided to keep him in hospital overnight (which turned out to be 3 nights).

NICU nurses’ ambivalent attitudes in skin-to-skin care practice

This article illuminates the essence of Neonatal Intensive Care Unit (NICU) nurses’ attitudes in skin-to-skin care (SSC) practice for preterm infants and their parents. Health care providers are in a unique position to influence the dynamic between infants and parents, and SSC affects both partners in the dyad. The design is descriptively phenomenological in terms of reflective lifeworld approach. Eighteen Swedish, Danish, and Norwegian nurses from NICUs offering varied possibilities and extents of SSC participated. NICU nurses’ attitudes in SSC practice are ambivalent. The nurses consider the sensory, wellness, and mutuality experiences to be primary and vital and enact SSC as much as possible. But “as much as possible” is a broad and varied concept, and their attitudes are ambivalent in terms of not always facilitating what they consider to be the optimal caring conditions. The source of NICU nurses’ ambivalent attitudes in SSC practice is a complex interplay of beliefs, norms, and evidence, which have a multidisciplinary basis. The ambivalent attitudes are, to a great extent, the result of the need to balance these multidisciplinary concerns. This needs to be acknowledged in considering SSC practice, as well as acknowledging that clinical judgments concerning optimal SSC depend on parents and infants unlimited access to each other, which NICU nurses can influence.

Norwegian Nursing Home—A Care Facility or a Home?

This article focuses on the function of Norwegian nursing homes. A brief history of institutionalisation of older people in Norway is presented. An expressed task for Norwegian nursing homes is active treatment, and even though the “Guarantee of dignity” was implemented from January 2011, there are proofs that the rights of the residents are constantly violated. Another task for Norwegian nursing homes is to be home for the residents. This double function of the nursing home, being both a care facility and a home is discussed, and whether the nursing homes succeed in fulfilling these tasks or not is questioned. It is also questioned if Goffman’s descriptions of total institutions are applicable on nursing homes of today.

Mental and physical health‐related functioning mediates between psychological job demands and sickness absence among nurses

To investigate whether health-related functioning mediates the effect of psychological job demands on sickness absence in nurses. Nurses face high job demands that can have adverse health effects resulting in sickness absence. Prospective cohort study with 1-year follow-up. Data for 2964 Norwegian nurses were collected in the period 2008-2010. At baseline, psychological job demands were measured with the Demand-Control-Support Questionnaire. Health-related functioning was assessed by the Mental Composite Score and the Physical Composite Score of the SF-12 Health Survey (2nd version). Sickness absence (no = 0, yes = 1) was self-reported at 1-year follow-up. Interaction and mediation analyses were conducted stratified by tenure (<1-year, 1-2 years, 3-6 years, >6 years) as a registered nurse. A total of 2180 nurses (74%) with complete data were eligible for analysis. A significant three-way interaction between job demands, control and support was found in newly licensed nurses (tenure <1-year). Baseline psychological job demands were positively associated with sickness absence at 1-year follow-up. This association was substantially weakened when Mental Composite Score and Physical Composite Score were introduced as mediator variables, indicating a partial mediation effect that was particularly pronounced in newly licensed nurses. Psychological job demands did not modify the effect of health-related functioning on sickness absence. Both mental and physical health-related functioning mediated between psychological job demands and sickness absence. Nurse managers should pay attention to health-related functioning, because poor health-related functioning may predict sickness absence, especially in newly licensed nurses.

The meaning of ethically charged encounters and their possible influence on professional identity in Norwegian public health nursing: a phenomenological hermeneutic study

In today's health care, new health reforms focus on market values and demands of efficiency influence health workers' professional practice. Norwegian public health nurses work mainly with healthy populations, but the children, families and young people they meet can be in vulnerable and even dependent situations. Strategies in coping with ethically challenging encounters can be important for the identity of the profession. The aim of the study was to illuminate public health nurses' experiences of being in ethically charged encounters and to reflect upon how these experiences can influence their professional identity. A purposive sample of 23 Norwegian public health nurses with experience ranging from 0.5 to 25 years narrated about their work-related experiences. The interviews were interpreted with a phenomenological hermeneutic method inspired by the philosophy of Paul Ricoeur. Four themes were identified: feeling responsible, being committed, feeling confident and feeling inadequate. These experiences were related to both work and private life and involved an emotional commitment to the well-being of children, young people and families. On the basis of the findings, it can be estimated that PHNs are committed to their work, and defending children's rights is a strong driving force. Responsibility for service users is a deciding factor that can overshadow institutional demands. It seems as if value conflicts mobilised courage which is essential in maintaining moral strength. This is in turn important for a strong professional identity and can have positive implications for the quality of public health nursing work.

352 Night work and risk of hormone receptor-defined breast cancer

ObjectivesIn 2007, the International Agency for Research on Cancer categorised shift-work that involves circadian disruption as probably carcinogenic to humans. oestrogen and progesterone are believed to play a central role...

Contradictory discourses of health promotion and disease prevention in the educational curriculum of Norwegian public health nursing: A critical discourse analysis

Health care is under constant change creating new and demanding tasks for public health nurses. The curriculum for public health nursing students is controlled by governmental directives that decide the structure and content of their education. This paper analyses manifest and latent discourses in the curriculum, in order to reveal underlying governmental principles for how public health nurses should promote health and prevent diseases. A critical discourse analysis of the Norwegian public health nursing curriculum was conducted. The study indicates i) 'a competing biomedical and social-scientific knowledge-discourse', with biomedical knowledge dominating the content of the curriculum; ii) 'a paternalistic meta-discourse', referring to an underlying paternalistic ideology despite a clear focus on user participation; and iii) 'a hegemonic individual discourse'. Even though the curriculum stipulates that public health nurses should work at both an individual and a societal level, there is very little population focus in the text. Recent political documents concerning public health nursing focus more on health promotion, however, this is not sufficiently explicit in the curriculum. The lack of emphasis on social scientific knowledge, and the blurred empowerment and population perspective in the curriculum, can lead to less emphasis on health promotion work in public health nursing education and practice. The curriculum should be revised in order to meet the recent governmental expectations.

Physical and mental fatigue as predictors of sickness absence among Norwegian nurses

We investigated whether fatigue can be used to screen nursing populations for risk of sickness absence. Data were available from a prospective cohort study of 2,059 Norwegian nurses working in hospital care, psychiatric care, and nursing home/home care settings. Physical and mental fatigue were measured at baseline with Chalder's Fatigue Questionnaire (FQ). Self-rated sickness absence at 1-year follow-up was considered high if nurses reported >30 sick days in the past year. Physical fatigue accurately predicted high sickness absence and adequately discriminated between high- and low-risk nurses in nursing home/home care settings. Mental fatigue was not predictive in any setting. The FQ is suitable for screening specific nursing populations for the risk of high sickness absence.

Insomnia, Excessive Sleepiness, Excessive Fatigue, Anxiety, Depression and Shift Work Disorder in Nurses Having Less than 11 Hours in-Between Shifts

Study objectiveTo assess if less than 11 hours off work between work shifts (quick returns) was related to insomnia, sleepiness, fatigue, anxiety, depression and shift work disorder among nurses.MethodsA questionnaire including established instruments measuring insomnia (Bergen Insomnia Scale), sleepiness (Epworth Sleepiness Scale), fatigue (Fatigue Questionnaire), anxiety/depression (Hospital Anxiety and Depression Scale) and shift work disorder was administered. Among the 1990 Norwegian nurses who participated in the study; 264 nurses had no quick returns, 724 had 1–30 quick returns and 892 had more than 30 quick returns during the past year. 110 nurses did not report the number of quick returns during the past year. The prevalence of insomnia, excessive sleepiness, excessive fatigue, anxiety, depression and shift work disorder was calculated within the three groups of nurses. Crude and adjusted logistic regression analyses were performed to assess the relation between quick returns and such complaints.ResultsWe found a significant positive association between quick returns and insomnia, excessive sleepiness, excessive fatigue and shift work disorder. Anxiety and depression were not related to working quick returns.ConclusionsThere is a health hazard associated with quick returns. Further research should aim to investigate if workplace strategies aimed at reducing the number of quick returns may reduce complaints among workers.