Marit Kirkevold

• Bragstad, Line Kildal; Bronken, Berit Arnesveen; Sveen, Unni; Hjelle, Ellen Gabrielsen; Kitzmüller, Gabriele; Martinsen, Randi; Kvigne, Kari Johanne; Mangset, Margrete & Kirkevold, Marit (2019). Implementation fidelity in a complex intervention promoting psychosocial well-being following stroke: An explanatory sequential mixed methods study. BMC Medical Research Methodology.  ISSN 1471-2288.  19(59) . doi: 10.1186/s12874-019-0694-z Fulltekst i vitenarkiv. Vis sammendrag

  Background: Evaluation of complex interventions should include a process evaluation to give evaluators, researchers, and policy makers greater confidence in the outcomes reported from RCTs. Implementation fidelity can be part of a process evaluation and refers to the degree to which an intervention is delivered according to protocol. The aim of this implementation fidelity study was to evaluate to what extent a dialogue-based psychosocial intervention was delivered according to protocol. A modified conceptual framework for implementation fidelity was used to guide the analysis. Methods: This study has an explanatory, sequential two-phase mixed methods design. Quantitative process data were collected longitudinally along with data collection in the RCT. Qualitative process data were collected after the last data collection point of the RCT. Descriptive statistical analyses were conducted to describe the sample, the intervention trajectories, and the adherence measures. A scoring system to clarify quantitative measurement of the levels of implementation was constructed. The qualitative data sources were analyzed separately with a theory-driven content analysis using categories of adherence and potential moderating factors identified in the conceptual framework of implementation fidelity. The quantitative adherence results were extended with the results from the qualitative analysis to assess which potential moderators may have influenced implementation fidelity and in what way. Results: The results show that the core components of the intervention were delivered although the intervention trajectories were individualized. Based on the composite score of adherence, results show that 80.1% of the interventions in the RCT were implemented with high fidelity. Although it is challenging to assess the importance of each of the moderating factors in relation to the other factors and to their influence on the adherence measures, participant responsiveness, comprehensiveness of policy description, context, and recruitment appeared to be the most prominent moderating factors of implementation fidelity in this study. Conclusions: This evaluation of implementation fidelity and the discussion of what constitutes high fidelity implementation of this intervention are crucial in understanding the factors influencing the trial outcome. The study also highlights important methodological considerations for researchers planning process evaluations and studies of implementation fidelity. Trial registration: ClinicalTrials.gov, NCT02338869; registered 10/04/2014. Keywords: Process evaluation, Implementation fidelity, Stroke, Psychosocial intervention, Mixed methods

• Fjose, Marianne; Eilertsen, Grethe; Kirkevold, Marit & Grov, Ellen Karine (2019). Caregiver reactions and social provisions among family members caring for home-dwelling patients with cancer in the palliative phase: A cross-sectional study.. Clinical Nursing Studies.  ISSN 2324-7940.  7(4) . doi: DOI: 10.5430/cns.v7n4p1 Fulltekst i vitenarkiv.
• Haltbakk, Johannes; Graue, Marit; Harris, Janet; Kirkevold, Marit; Dunning, Trisha & Sigurdardottir, Árún K. (2019). Integrative review: Patient safety among older people with diabetes in home care services. Journal of Advanced Nursing.  ISSN 0309-2402.  75(11), s 2449- 2460 . doi: 10.1111/jan.13993
• Harris, Janet; Haltbakk, Johannes; Dunning, Trisha; Austrheim, Gunhild; Kirkevold, Marit; Johnson, Maxine & Graue, Marit (2019). How patient and community involvement in diabetes research influences health outcomes: A realist review. Health Expectations.  ISSN 1369-6513.  22(5), s 907- 920 . doi: 10.1111/hex.12935
• Henni, Silje Havrevold; Kirkevold, Marit; Antypas, Konstantinos & Foss, Christina (2019). The integration of new nurse practitioners into care of older adults: A survey study. Journal of Clinical Nursing.  ISSN 0962-1067.  28(15-16), s 2911- 2923 . doi: 10.1111/jocn.14889
• Hjelle, Ellen Gabrielsen; Bragstad, Line Kildal; Kirkevold, Marit; Zucknick, Manuela; Bronken, Berit Arnesveen; Martinsen, Randi; Kvigne, Kari Johanne; Kitzmüller, Gabriele; Mangset, Margrete; Thommessen, Bente & Sveen, Unni (2019). Effect of a dialogue-based intervention on psychosocial well-being 6 months after stroke in Norway: A randomized controlled trial. Journal of Rehabilitation Medicine.  ISSN 1650-1977.  51(8), s 557- 565 . doi: 10.2340/16501977-2585 Fulltekst i vitenarkiv. Vis sammendrag

  Abstract Objective: To evaluate the effect of a dialogue-based intervention on psychosocial well-being 6 months after stroke. Design: Multicentre, prospective, randomized controlled trial. Subjects: Adults (aged ≥ 18 years) who had their first or recurrent stroke within the last month, were medically stable, had sufficient cognitive functioning to participate and understood and spoke Norwegian. Methods: A total of 322 participants were randomly assigned to the intervention (n = 166) or control (n = 156) group. Participants in the intervention group received up to 8 individual sessions aimed at supporting the coping and life skills of stroke survivors in addition to usual care. The primary outcome was the proportion of participants with normal mood measured by the General Health Questionnaire-28 (GHQ-28). The secondary outcomes included health-related quality of life (Stroke and Aphasia Quality of Life Scale; SAQOL-39g), depression (Yale-Brown single-item questionnaire; Yale) and sense of coherence (SOC-13). Results: After controlling for the baseline values, no significant benefit was found in the intervention group over the control group (odds ratio (OR): 0.898: 95% confidence interval (95% CI): 0.54-1.50, p = 0.680) 6 months post-stroke. Conclusion: Psychosocial well-being improved during the first 6 months after stroke in both arms of the trial, but no statistically significant benefit of the dialogue-based intervention was found compared with usual care. Lay Abstract The aim of this study was to evaluate the effect of a dialogue-based intervention on psychosocial well-being 6 months after stroke. A total of 322 participants were assigned to an intervention (= 166) or control (= 156) group. Participants in the intervention group received up to 8 individual sessions aimed at supporting the coping and life skills of stroke survivors in addition to usual care. Psychosocial well-being improved during the first 6 months after the stroke in both arms of the trial. However, no benefit of the dialogue-based intervention was found compared with usual care.

• Hjelle, Ellen Gabrielsen; Bragstad, Line Kildal; Zucknick, Manuela; Kirkevold, Marit; Thommessen, Bente & Sveen, Unni (2019). The General Health Questionnaire-28 (GHQ-28) as an outcome measurement in a randomized controlled trial in a Norwegian stroke population. BMC Psychology.  ISSN 2050-7283.  7(18) . doi: 10.1186/s40359-019-0293-0 Fulltekst i vitenarkiv.
• Kitzmüller, Gabriele; Mangset, Margrete; Evju, Anne Svelstad; Angel, Sanne; Aadal, Lena; Martinsen, Randi; Bronken, Berit Arnesveen; Kvigne, Kari Johanne; Bragstad, Line Kildal; Hjelle, Ellen Gabrielsen; Sveen, Unni & Kirkevold, Marit (2019). Finding the way forward : the lived experience of people with stroke after participation in a complex psychosocial intervention. Qualitative Health Research.  ISSN 1049-7323.  29(12), s 1711- 1724 . doi: 10.1177/1049732319833366 Fulltekst i vitenarkiv. Vis sammendrag

  Stroke patients’ well-being is threatened after stroke. A psychosocial intervention was developed for Norwegian stroke patients living in the community. Eight individual sessions between people with stroke and a trained health care professional were conducted 1 to 6 months post-stroke with one group of participants and 6 to 12 months post-stroke with another group. Subsequently, 19 of these stroke patients were interviewed to gain an in-depth understanding of their lived experience of the influence of the intervention on their adjustment process. Interview texts were analyzed using Ricoeur’s interpretation theory. Two participants did not personally find the intervention useful. The remaining participants greatly appreciated dialogues with the empathetic intervention personnel, feeling free to discuss their fears and worries. The intervention raised these participants’ awareness of their needs and resources. They were guided to resume their everyday life and adopt a future-oriented attitude. The intervention facilitated their meaning-making endeavors and post-stroke adjustment.

• Lood, Qarin; Kirkevold, Marit; Sjögren, Karin; Bergland, Ådel; Sandman, Per-Olof & Edvardsson, David (2019). Associations between person-centred climate and perceived quality of care in nursing homes: a cross-sectional study of relatives' experiences.. Journal of Advanced Nursing.  ISSN 0309-2402.  s 1- 9 . doi: 10.1111/jan.14011 Vis sammendrag

  AIMS: To explore the extent to which a more person-centred climate could explain the variation in quality of care, as rated by relatives to nursing home residents in three countries. DESIGN: A cross-sectional, correlational, anonymous questionnaire study. METHODS: Questionnaires were administered to 346 relatives to residents in six nursing homes in Australia, Norway and Sweden between April - June 2016. A total of 178 relatives agreed to participate. Data were analysed using descriptive statistics and hierarchical multiple regression. RESULTS: The results showed that the relatives' experiences of a more person-centred climate was associated with higher ratings of the quality of care. A person-centred climate of safety had the strongest unique association with the quality of care, explaining 14% of the variance in quality of care. In addition, the results indicated that the relatives in general were satisfied the quality of care and that children to the residents rated the quality of care higher than partners or other relatives. CONCLUSION: This study advances the understanding of the relationship between person-centredness in nursing homes and quality of care, showing that person-centred climate aspects of safety and hospitality have a significant role in the quality of care as perceived by relatives. IMPACT: Person-centredness in nursing homes is often mentioned as a quality of care indicator, but the empirical evidence for this suggestion is limited. This study expanded the evidence-base for person-centredness as a significant aspect of relatives' experiences of the quality of care in nursing homes. This article is protected by copyright. All rights reserved.

• Næss, Gro; Wyller, Torgeir Bruun & Kirkevold, Marit (2019). Structured follow-up of frail home-dwelling older people in primary health care: Is there a special need, and could a checklist be of any benefit? A qualitative study of experiences from registered nurses and their leaders. Journal of Multidisciplinary Healthcare.  ISSN 1178-2390.  12, s 675- 690 . doi: 10.2147/JMDH.S212283 Fulltekst i vitenarkiv. Vis sammendrag

  Aim: To identify experiences and opinions about the need for a structured follow-up and to identify potential benefits and barriers to the use of a checklist (Sub Acute Functional decline in the Older people [SAFE]) when caring for frail home-dwelling older people. Background: The complexity of older peoples’ health situation requires more coordinated health care across health care levels and a better structured follow-up than is currently being offered, especially in the transitional phase between hospital discharge and primary care, but also in more stable phases at home. Design: This was a qualitative study using focus group interviews. Methods: Data were collected during six focus group interviews in three districts in a municipality. Nineteen registered nurses (RNs) and seventeen leaders responsible for the follow-up of frail home-dwelling older people participated. Participants were representatives of the RNs in homecare and their leaders. Results: Our results highlight that although most RNs and their leaders saw a number of significant benefits to conducting a structured assessment and follow-up of frail older people home care recipients, a number of barriers made this difficult to realize on a daily basis. Conclusion: There is no common perception that a structured follow-up of frail homedwelling older people in primary health care is an important and contributing factor to better quality of health care. Despite this, most RNs and leaders found that the use of a structured checklist such as SAFE was a benefit to achieving a structured follow-up of the frail older people. We identified several factors of importance to whether a structured follow-up with a checklist is conducted in home care.

• Renolen, Åste; Hjaelmhult, Esther; Høye, Sevald; Danbolt, Lars Johan & Kirkevold, Marit (2019). Creating room for evidence-based practice: Leader behavior in hospital wards. Research in Nursing and Health.  ISSN 0160-6891.  43(1), s 1- 13 . doi: 10.1002/nur.21981 Vis sammendrag

  Abstract The integration (routinizing and sustaining) of evidence-based practice (EBP) into hospital management is a key element for improving patient safety and ensuring better patient outcomes. Hospital managers and clinical leaders play crucial roles in this integration. Interactions between leaders and integration context influence the improvement's quality, but leader-based actions that are effective for improving nursing practice remain unclear. The relationship between leaders could also either hinder or enable this implementation process. The aim of this study was to generate a theory about patterns of leader behavior that leaders are engaged in when attempting to integrate EBP in a clinical setting. We used a classic grounded theory methodology to generate a substantive EBP theory. In this study, through participant observation, we observed 63 nurses (15 specialist, 39 registered, and 9 assistant nurses). From these, five ward leaders (two head nurses, one assistant head nurse, and two teaching nurses) participated in individual interviews, and 18 clinical nurses participated in four focus groups. "Creating room for EBP" emerged as a theory for explaining the way in which the leaders attempted to resolve their main concern: How to achieve EBP treatment and care with tight resources and without overextending the nurses. Creating room for EBP encompasses a process of interactions, including positioning for, executing, and interpreting responses to EBP.

• Renolen, Åste; Hjaelmhult, Esther; Høye, Sevald; Danbolt, Lars Johan & Kirkevold, Marit (2019). Evidence‐based practice integration in hospital wards—The complexities and challenges in achieving evidence‐based practice in clinical nursing. Nursing Open.  ISSN 2054-1058.  6(3), s 815- 823 . doi: 10.1002/nop2.259 Fulltekst i vitenarkiv. Vis sammendrag

  Abstract: Aim: Exploring the processes involved in two different strategies to integrate evidence‐based practice into nursing practice. Design: Classical grounded theory methodology was used. Methods: Data were collected through 90 hr of observation and 4 focus groups among clinical nurses in two different hospital wards. Results: We identified a multidimensional evidence‐based practice integration framework that illuminates the complexities involved in the integration process. The dimensions were approaches to evidence‐based practice, positions of evidence‐based practice and levels of evidence‐based practice. The interactions between the dimensions gave five combinations; an explicit evidence‐based practice performed as a parallel to daily work at the systems level, an implicit evidence‐based practice integrated into daily work at the systems level, an explicit evidence‐based practice integrated into daily work at the individual level, an explicit evidence‐based practice integrated into daily work at the systems level and an implicit evidence‐based practice integrated into daily work at the individual level.

• Skogestad, Ingrid Johansen; Kirkevold, Marit; Indredavik, Bent; Gay, Caryl & Lerdal, Anners Vetle (2019). Lack of content overlap and essential dimensions – A review of measures used for post-stroke fatigue. Journal of Psychosomatic Research.  ISSN 0022-3999.  124 . doi: 10.1016/j.jpsychores.2019.109759 Fulltekst i vitenarkiv.
• Vassbø, Tove Karin; Kirkevold, Marit; Edvardsson, David; Sjögren, Karin; Lood, Qarin & Bergland, Ådel (2019). The meaning of working in a person-centred way in nursing homes: a phenomenological-hermeneutical study. BMC Nursing.  ISSN 1472-6955.  18:45, s 1- 8 . doi: 10.1186/s12912-019-0372-9 Fulltekst i vitenarkiv. Vis sammendrag

  Background The present study aims to illuminate the meaning of working in a person-centred way as experienced by staff in nursing homes. Insights into what working in a person-centred way mean for nursing home staff may contribute to a more comprehensive understanding of what gives staff satisfaction in their work and support further development of person-centred care approach in nursing homes. Methods Interviews with 29 health care personnel who had participated in a one-year intervention focusing on person-centred care and thriving in three nursing homes in Australia, Norway and Sweden were performed, and a phenomenological-hermeneutical method was used to explore staffs’ lived experiences of working in a person-centred way in nursing homes. Results For nursing home staff, working in a person-centred way meant that they were able to meet individual resident’s needs and expressed preferences in close family-like relationships, understanding the residents’ rhythms and preferences as the basis of the daily work plans and being able to do ‘the little extra’ for residents. Also, working in a person-centred way meant meeting shared goals by working towards a collective practice in collaborative teams. As a whole, the staffs’ lived experiences of working in a person-centred way in nursing homes was interpreted to mean thriving at work as a psychological state in which individuals experience both a sense of vitality and learning. Conclusions Working in a person-centred way means staff thriving at work in nursing homes. The results further indicate that delivering care by only focusing on routines and practical tasks and not on residents’ preferences and well-being would inhibit thriving among nursing staff, leading to the potential for dissatisfaction with work.

• Fjose, Marianne; Eilertsen, Grethe; Kirkevold, Marit & Grov, Ellen Karine (2018). “Non-palliative care” – a qualitative study of older cancer patients’ and their family members’ experiences with the health care system. BMC Health Services Research.  ISSN 1472-6963.  18(745), s 1- 12 . doi: 10.1186/s12913-018-3548-1 Fulltekst i vitenarkiv.
• Geard, Anne; Kirkevold, Marit; Løvstad, Marianne & Schanke, Anne-Kristine (2018). Exploring narratives of resilience among seven males living with spinal cord injury: A qualitative study. BMC Psychology.  ISSN 2050-7283.  6(1) . doi: 10.1186/s40359-017-0211-2 Fulltekst i vitenarkiv.
• Goyal, Alka Rani; Bergh, Sverre; Engedal, Knut; Kirkevold, Marit & Kirkevold, Øyvind (2018). The course of anxiety in persons with dementia in Norwegian nursing homes: A 12-month follow-up study. Journal of Affective Disorders.  ISSN 0165-0327.  235, s 117- 123 . doi: 10.1016/j.jad.2018.04.015
• Goyal, Alka Rani; Bergh, Sverre; Engedal, Knut; Kirkevold, Marit & Kirkevold, Øyvind (2018). Trajectories of quality of life and their association with anxiety in people with dementia in nursing homes: A 12-month follow-up study. PLOS ONE.  ISSN 1932-6203.  13:e0203773(9), s 1- 14 . doi: 10.1371/journal.pone.0203773 Fulltekst i vitenarkiv.
• Henni, Silje Havrevold; Kirkevold, Marit; Antypas, Konstantinos & Foss, Christina (2018). The role of advanced geriatric nurses in Norway: A descriptive exploratory study. International Journal of Older People Nursing.  ISSN 1748-3735.  13(3) . doi: 10.1111/opn.12188 Fulltekst i vitenarkiv.
• Kirkevold, Marit (2018). Teaching nursing homes: the Norwegian experience 20 years on. Journal of Research in Nursing.  ISSN 1744-9871.  23(2-3), s 254- 264 . doi: 10.1177/1744987118756478 Fulltekst i vitenarkiv.
• Kirkevold, Marit; Bragstad, Line Kildal; Bronken, Berit Arnesveen; Kvigne, Kari Johanne; Martinsen, Randi; Hjelle, Ellen Gabrielsen; Kitzmüller, Gabriele; Mangset, Margrete; Angel, Sanne; Aadal, Lena; Eriksen, Siren; Wyller, Torgeir Bruun & Sveen, Unni (2018). Promoting psychosocial well-being following stroke: study protocol for a randomized, controlled trial. BMC Psychology.  ISSN 2050-7283.  6(12) . doi: 10.1186/s40359-018-0223-6 Fulltekst i vitenarkiv. Vis sammendrag

  Background: Stroke is a major public health threat globally. Psychosocial well-being may be affected following stroke. Depressive symptoms, anxiety, general psychological distress and social isolation are prevalent. Approximately one third report depressive symptoms and 20% report anxiety during the first months or years after the stroke. Psychosocial difficulties may impact significantly on long-term functioning and quality of life, reduce the effects of rehabilitation services and lead to higher mortality rates. The aim of the study is to evaluate the effect of a previously developed and feasibility tested dialogue-based psychosocial intervention aimed at promoting psychosocial well-being and coping following stroke among stroke survivors with and without aphasia. Methods: The study will be conducted as a multicenter, randomized, single blind controlled trial with one intervention and one control arm. It will include a total of 330 stroke survivors randomly allocated into either an intervention group (dialogue-based intervention to promote psychosocial well-being) or a control group (usual care). Participants in the intervention group will receive eight individual sessions of supported dialogues in their homes during the first six months following an acute stroke. The primary outcome measure will be psychosocial well-being measured by the General Health Questionnaire (GHQ). Secondary outcome measures will be quality of life (SAQoL), sense of coherence (SOC), and depression (Yale). Process evaluation will be conducted in a longitudinal mixed methods study by individual qualitative interviews with 15–20 participants in the intervention and control groups, focus group interviews with the intervention personnel and data collectors, and a comprehensive analysis of implementation fidelity. Discussion: The intervention described in this study protocol is based on thorough development and feasibility work, guided by the UK medical research council framework for developing and testing complex interventions. It combines classical effectiveness evaluation with a thorough process evaluation. The results from this study may inform the development of further trials aimed at promoting psychosocial well-being following stroke as well as inform the psychosocial follow up of stroke patients living at home

• Kolltveit, Beate-Christin Hope; Thorne, Sally; Graue, Marit; Gjengedal, Eva; Iversen, Marjolein M. & Kirkevold, Marit (2018). Telemedicine follow-up facilitates more comprehensive diabetes foot ulcer care : a qualitative study in home based and specialist health care. Journal of Clinical Nursing.  ISSN 0962-1067.  27(5/6), s e1134- e1145 . doi: 10.1111/jocn.14193 Vis sammendrag

  Aims and objectives: To investigate the application of a telemedicine intervention in diabetes foot ulcer care, and its implications for the healthcare professionals in the clinical field. Background: Contextual factors are found to be important when applying technology in health care and applying telemedicine in home‐based care has been identified as particularly complex. Design and methods: We conducted field observations and individual interviews among healthcare professionals in home‐based care and specialist health care in a diabetes foot care telemedicine RCT (Clin.Trial.gov: NCT01710774) during 2016. This study was guided by Interpretive Description, an inductive qualitative methodology. Results: Overall, we identified unequal possibilities for applying telemedicine in diabetes foot ulcer care within the hospital and home care contexts. Different circumstances and possibilities in home‐based care made the application of telemedicine as intended more difficult. The healthcare professionals in both care contexts perceived the application of telemedicine to facilitate a more comprehensive approach towards the patients, but with different possibilities to enact it. Conclusions: Application of telemedicine in home‐based care was more challenging than in the outpatient clinic setting. Introducing more updated equipment and minor structural adjustments in consultation time and resources could make the use of telemedicine in home‐based care more robust. Relevance to clinical practice: Application of telemedicine in diabetes foot ulcer follow‐up may enhance the nursing staff's ability to conduct comprehensive assessment and care of the foot ulcer as well as the patient's total situation. Access to adequate equipment and time, particularly in home‐based care, is necessary to capitalise on this new technology.

• Løvstad, Marianne; Solbrække, Kari Nyheim; Kirkevold, Marit; Geard, Anne; Hauger, Solveig Lægreid & Schanke, Anne-Kristine (2018). “It gets better. It can´t be worse than what we have been through.” Family accounts of the minimally conscious state. Brain Injury.  ISSN 0269-9052.  s 1- 11 . doi: 10.1080/02699052.2018.1539244
• Mousing, Camilla A.; Timm, Helle; Kirkevold, Marit & Lomborg, Kirsten (2018). Receiving home care and communicating about COPD-related concerns and palliative care : a qualitative study of the patient perspectives. Nordisk sygeplejeforskning.  ISSN 1892-2678.  8(2), s 107- 121 . doi: 10.18261/issn.1892-2686-2018-02-03
• Mousing, Camilla A.; Timm, Helle; Lomborg, Kirsten & Kirkevold, Marit (2018). Barriers to palliative care in people with chronic obstructive pulmonary disease in home care: A qualitative study of the perspective of professional caregivers. Journal of Clinical Nursing.  ISSN 0962-1067.  27(3-4), s 650- 660 . doi: 10.1111/jocn.13973
• Renolen, Åste; Høye, Sevald; Hjaelmhult, Esther; Danbolt, Lars Johan & Kirkevold, Marit (2018). “Keeping on track” − Hospital nurses’ struggles with maintaining workflow while seeking to integrate evidence-based practice into their daily work: A grounded theory study. International Journal of Nursing Studies.  ISSN 0020-7489.  77, s 179- 188 . doi: 10.1016/j.ijnurstu.2017.09.006 Fulltekst i vitenarkiv. Vis sammendrag

  Background Evidence-based practice is considered a foundation for the provision of quality care and one way to integrate scientific knowledge into clinical problem-solving. Despite the extensive amount of research that has been conducted to evaluate evidence-based practice implementation and research utilization, these practices have not been sufficiently incorporated into nursing practice. Thus, additional research regarding the challenges clinical nurses face when integrating evidence-based practice into their daily work and the manner in which these challenges are approached is needed. Objectives The aim of this study was to generate a theory about the general patterns of behaviour that are discovered when clinical nurses attempt to integrate evidence-based practice into their daily work. Design We used Glaser’s classical grounded theory methodology to generate a substantive theory. Settings The study was conducted in two different medical wards in a large Norwegian hospital. In one ward, nurses and nursing assistants were developing and implementing new evidence-based procedures, and in the other ward, evidence-based huddle boards for risk assessment were being implemented. Participants A total of 54 registered nurses and 9 assistant nurses were observed during their patient care and daily activities. Of these individuals, thirteen registered nurses and five assistant nurses participated in focus groups. These participants were selected through theoretical sampling. Methods Data were collected during 90 hours of observation and 4 focus groups conducted from 2014 to 2015. Each focus group session included four to five participants and lasted between 55 and 65 minutes. Data collection and analysis were performed concurrently, and the data were analysed using the constant comparative method. Results “Keeping on track” emerged as an explanatory theory for the processes through which the nurses handled their main concern: the risk of losing the workflow. The following three strategies were used by nurses when attempting to integrate evidence-based practices into their daily work: “task juggling”, “pausing for considering” and “struggling along with quality improvement”. Conclusions The “keeping on track” theory contributes to the body of knowledge regarding clinical nurses’ experiences with evidence-based practice integration. The nurses endeavoured to minimize workflow interruptions to avoid decreasing the quality of patient care provided, and evidence-based practices were seen as a consideration that was outside of their ordinary work

• Røe, Cecilie; Kirkevold, Marit; Andelic, Nada; Søberg, Helene L.; Sveen, Unni; Bautz-Holter, Erik; Jahnsen, Reidun Birgitta; Van Walsem, Marleen Regina; Bragstad, Line Kildal; Hjelle, Ellen Gabrielsen; Klevberg, Gunvor Lilleholt; Oretorp, Per; Habberstad, Andreas Hanssønn; Hagfors, Jon; Væhle, Randi; Engen, Grace & Gutenbrunner, Christoph (2018). The challenges of describing rehabilitation services: A discussion paper. Journal of Rehabilitation Medicine.  ISSN 1650-1977.  50, s 151- 158 . doi: 10.2340/16501977-2299 Fulltekst i vitenarkiv. Vis sammendrag

  Objectives: To apply the Classi cation of Service Or- ganization in Rehabilitation (ICSO-R) classi cation of services to different target groups, include the user perspective, identify missing categories, and propose standardized descriptors for the categories from a Norwegian perspective. Design: Expert-based consensus conferences with user involvement. Subjects: Health professionals, stakeholders and users. Methods: Participants were divided into 5 panels, which applied the ICSO-R to describe the habilitation and rehabilitation services provided to children with cerebral palsy and people with Huntington’s disease, acquired brain injuries (traumatic brain injuries and stroke) and painful musculoskeletal conditions. Ba- sed on the Problem/Population, Intervention, Com- parison, Outcome (PICO) framework, the services were described according to the ICSO-R. Missing ca- tegories were identi ed. Results: The ICSO-R was found to be feasible and applicable for describing a variety of services pro- vided to different target groups in Norway, but the user perspective was lacking, categories were missing, and a need for standardized description of the categories was identi ed. Conclusion: The present work supports the need to produce an updated version of the ICSO-R and to en- courage national and international discussion of the framework. The ICSO-R has the potential to become a tool for the standardized assessment of rehabilita- tion services. For such purposes, more standardized descriptions of subcategories are necessary.

• Vassbø, Tove Karin; Kirkevold, Marit; Edvardsson, David; Sjögren, Karin; Lood, Qarin; Sandman, PO & Bergland, Ådel (2018). Associations between job satisfaction, person-centredness and ethically difficult situations in nursing homes—a cross-sectional study. Journal of Advanced Nursing.  ISSN 0309-2402.  75(5), s 1- 10 . doi: 10.1111/jan.13890 Vis sammendrag

  Aim To explore the associations between job satisfaction and perceived person‐centredness and ethically difficult situations among staff in nursing homes (NHs). Background Previous studies have indicated that person‐centredness and few ethically difficult situations can contribute positively to NH staff's job satisfaction. However, empirical evidence of these associations is lacking. Design Cross‐sectional survey design. Method Nursing home staff (N = 341) in six NHs in Australia, Norway, and Sweden completed the questionnaire measuring job satisfaction, person‐centredness, and ethically difficult situations. Data were collected between April – June 2016. Univariate analysis was used to describe the sample, one‐way analysis of variance examined differences between variables. Bivariate correlation tested the relationships between variables and hierarchical multiple regression explored the extent to which person‐centredness and ethically difficult situations could explain job satisfaction among staff. Results After controlling for socio‐demographic variables in a regression model, three variables of person‐centredness and “ethically difficult situations” were significantly associated with job satisfaction. A “climate of community” contributed the most, followed by the “amount of organizational and environmental support,” “a climate of everydayness,” and few “ethically difficult situations.” Conclusion The results support the theoretical foundation and previous findings suggesting that establishing NHs organizations based on person‐centredness will increase staff job satisfaction. However, this is a cross‐sectional study and the causality may go in both directions and should be further explored.

• Bendixen, Bente; Kirkevold, Marit; Graue, Marit & Haltbakk, Johannes (2017). Experiences of being a family member to an older person with diabetes receiving home care services. Scandinavian Journal of Caring Sciences.  ISSN 0283-9318.  32(2), s 805- 814 . doi: 10.1111/scs.12511
• Edvardsson, David; Sjögren, Karin; Lood, Qarin; Bergland, Ådel; Kirkevold, Marit & Sandman, Per-Olof (2017). A person-centred and thriving-promoting intervention in nursing homes - study protocol for the U-Age nursing home multi-centre, non-equivalent controlled group before-after trial. BMC Geriatrics.  ISSN 1471-2318.  17 . doi: 10.1186/s12877-016-0404-1 Fulltekst i vitenarkiv. Vis sammendrag

  Background The literature suggests that person-centred care can contribute to quality of life and wellbeing of nursing home residents, relatives and staff. However, there is sparse research evidence on how person-centred care can be operationalised and implemented in practice, and the extent to which it may promote wellbeing and satisfaction. Therefore, the U-Age nursing home study was initiated to deepen the understanding of how to integrate person-centred care into daily practice and to explore the effects and meanings of this. Methods The study aims to evaluate effects and meanings of a person-centred and thriving-promoting intervention in nursing homes through a multi-centre, non-equivalent controlled group before-after trial design. Three nursing homes across three international sites have been allocated to a person-centred and thriving-promoting intervention group, and three nursing homes have been allocated to an inert control group. Staff at intervention sites will participate in a 12-month interactive educational programme that operationalises thriving-promoting and person-centred care three dimensions: 1) Doing a little extra, 2) Developing a caring environment, and 3) Assessing and meeting highly prioritised psychosocial needs. A pedagogical framework will guide the intervention. The primary study endpoints are; residents’ thriving, relatives’ satisfaction with care and staff job satisfaction. Secondary endpoints are; resident, relative and staff experiences of the caring environment, relatives’ experience of visiting their relative and the nursing home, as well as staff stress of conscience and perceived person-centredness of care. Data on study endpoints will be collected pre-intervention, post-intervention, and at a six-month follow up. Interviews will be conducted with relatives and staff to explore experiences and meanings of the intervention. Discussion The study is expected to provide evidence that can inform further research, policy and practice development on if and how person-centred care may improve wellbeing, thriving and satisfaction for people who reside in, visit or work in nursing homes. The combination of quantitative and qualitative data will illuminate the operationalisation, effects and meaning of person-centred and thriving-promoting care. Trial registration The trial was registered at ClinicalTrials.gov March 19, 2016, identifier NCT02714452. Keywords Person-centred care Thriving Residential aged care Long-term care Residents Relatives Staff Job satisfaction Satisfaction with care Intervention studies

• Goyal, Alka Rani; Bergh, Sverre; Engedal, Knut; Kirkevold, Marit & Kirkevold, Øyvind (2017). Anxiety, Anxiety Symptoms, and Their Correlates in Persons with Dementia in Norwegian Nursing Homes: A Cause for Concern. Dementia and Geriatric Cognitive Disorders.  ISSN 1420-8008.  43(5-6), s 294- 305 . doi: 10.1159/000471796 Vis sammendrag

  Background/Aims: Little is known about anxiety and its associations among persons with dementia in nursing homes. This study aims to examine anxiety, anxiety symptoms, and their correlates in persons with dementia in Norwegian nursing homes. Methods: In all, 298 participants with dementia ≥65 years old from 17 nursing homes were assessed with a validated Norwegian version of the Rating Anxiety in Dementia scale (RAID-N). Associations between anxiety (RAID-N score) and demographic and clinical characteristics were analyzed with linear regression models. Results: Anxiety, according to a cutoff of ≥12 on the RAID-N, was found in 34.2% (n = 102) of the participants. Irritability (59.7%) and restlessness (53.0%) were the most frequent anxiety symptoms. The participants' general physical health, a wide range of neuropsychiatric symptoms, and anxiolytic use were significant correlates of higher RAID-N scores. Conclusion: Knowledge about anxiety, anxiety symptoms, and their correlates may enhance early detection of anxiety and planning of necessary treatment and proactive measures among this population residing in nursing homes.

• Goyal, Alka Rani; Bergh, Sverre; Engedal, Knut; Kirkevold, Marit & Kirkevold, Øyvind (2017). Norwegian version of the rating anxiety in dementia scale (RAID-N): a validity and reliability study. Aging & Mental Health.  ISSN 1360-7863.  21(12), s 1256- 1261 . doi: 10.1080/13607863.2016.1220921 Vis sammendrag

  Objectives: Dementia-specific anxiety scales in the Norwegian language are lacking; the aim of this study was to investigate the validity and inter-rater reliability of a Norwegian version of the Rating Anxiety in Dementia (RAID-N) scale. Method: The validity of the RAID-N was tested in a sample of 101 patients with dementia from seven Norwegian nursing homes. One psychogeriatrician (n = 50) or a physician with long experience with nursing home patients (n = 51) ‘blind’ to the RAID-N score diagnosed anxiety according to DSM-5 criteria of generalised anxiety disorder (GAD). A receiver operating characteristic (ROC) analysis assessed the best cut-off point for the RAID-N, and the area under the curve (AUC) was calculated. Inter-rater reliability was tested in a subgroup of 53 patients by intraclass correlation (ICC) and Cohen's kappa. Results: Twenty-eight of 101 (27.7%) met the GAD criteria. The mean RAID-N score for patients with GAD was 16.1 (SD 6.3) and without GAD, 8.8 (SD 6.5) (p < 0.001). A cut-off score of ≥12 on the RAID-N gave a sensitivity of 82.1%, specificity of 70.0%, and 73.3% accuracy in identifying clinically significant GAD in patients with dementia. Inter-rater reliability on overall RAID-N items was good (ICC = 0.82), Cohen's kappa was 0.58 for total RAID-N score, with satisfactory internal consistency (Cronbach's alpha = 0.81). Conclusion: The RAID-N has fairly good validity and inter-rater reliability, and could be useful to assess GAD in patients with dementia. Further studies should investigate the optimal RAID-N cut-off score in different settings.

• Grape, Hedda; Solbrække, Kari Nyheim; Kirkevold, Marit & Mengshoel, Anne Marit (2017). Tiredness and fatigue during processes of illness and recovery: A qualitative study of women recovered from fibromyalgia syndrome. Physiotherapy Theory and Practice.  ISSN 0959-3985.  33(1), s 31- 40 . doi: 10.1080/09593985.2016.1247933 Vis sammendrag

  Fibromyalgia syndrome (FMS), a chronic musculoskeletal pain condition, is often accompanied by fatigue. In this study, inspired by narrative approaches to health and illness, we explore how women who have regained their health after FMS describe tiredness along a storyline from before they fell ill, through their illness, recovery process, and present-day health. The data derive from qualitative interviews with eight Norwegian women who previously suffered from FMS but who no longer had the condition at the time of interview. We undertook a narrative analysis to understand the complexity of the stories about tiredness and fatigue and on this basis identified a storyline based on four sub-narratives: 1) Alarming but ignored tiredness (before illness); 2) paralyzing fatigue (during illness); 3) making sense of fatigue (recovery process); and 4) integrating tiredness into life (today). The findings highlight participants’ different understandings and meanings of tiredness and fatigue and the ways in which these link past, present, and future. Significantly, a clear distinction between tiredness and fatigue was not always found. Overall, the storyline that emerges from the narratives is about balancing tiredness/fatigue with everyday life, and how this unfolds in different ways across the span of FMS, from falling ill to recovering and regaining health.

• Kolltveit, Beate-Christin Hope; Gjengedal, Eva; Graue, Marit; Iversen, Marjolein M.; Thorne, Sally & Kirkevold, Marit (2017). Conditions for success in introducing telemedicine in diabetes foot care : a qualitative inquiry. BMC Nursing.  ISSN 1472-6955.  16(2), s 1- 10 . doi: 10.1186/s12912-017-0201-y Fulltekst i vitenarkiv. Vis sammendrag

  Abstract Background The uptake of various telehealth technologies to deliver health care services at a distance is expanding; however more knowledge is needed to help understand vital components for success in using telehealth in different work settings. This study was part of a larger trial designed to investigate the effect of an interactive telemedicine platform. The platform consisted of a web based ulcer record linked to a mobile phone to provide care for people with diabetic foot ulcers in outpatient clinics in specialist hospital care in collaboration with primary health care. The aim of this qualitative study was to identify perceptions of health care professionals in different working settings with respect to facilitators to engagement and participation in the application of telemedicine. Methods Ten focus groups were conducted with health care professionals and leaders in Western Norway between January 2014 and June 2015 using Interpretive Description, an applied qualitative research strategy. Results Four key conditions for success in using telemedicine as a new technology in diabetes foot care were identified: technology and training that were user-friendly; having a telemedicine champion in the work setting; the support of committed and responsible leaders; and effective communication channels at the organizational level. Conclusions Successful larger scale implementation of telemedicine must involve consideration of complex contextual and organizational factors associated with different work settings. This form of new care technology in diabetes foot care often involves health care professionals working across different settings with different management systems and organizational cultures. Therefore, attention to the distinct needs of each staff group seems an essential condition for effective implementation. Keywords: telehealth, telemedicine, health care Professionals, diabetic foot ulcer, focus groups interviews, interpretive description

• Mjørud, Marit; Engedal, Knut; Røsvik, Janne-Kathrin & Kirkevold, Marit (2017). Living with dementia in a nursing home, as described by persons with dementia: a phenomenological hermeneutic study. BMC Health Services Research.  ISSN 1472-6963.  17(93) . doi: 10.1186/s12913-017-2053-2 Fulltekst i vitenarkiv.
• Nyborg, Ingrid; Danbolt, Lars Johan & Kirkevold, Marit (2017). Few opportunities to influence decisions regarding the care and treatment of an older hospitalized family member: A qualitative study among family members. BMC Health Services Research.  ISSN 1472-6963.  17(619) . doi: 10.1186/s12913-017-2563-y Fulltekst i vitenarkiv. Vis sammendrag

  Background The drive towards patient involvement in health services has been increasingly promoted. The World Health Organisation emphasizes the family’s perspective in comprehensive care. Internationally there is an increased emphasis on what patients and their family tell about the hospital experiences. However, current literature does not adequately address the question of participation experiences among relatives of older hospitalized family members. There is a paucity of research with a generational perspective on relatives’ opportunities to exert influence. The aim of the study was to explore relatives’ experiences of opportunities to participate in decisions about the care and treatment of older hospitalized family members and whether there are different experiences of influence to the relatives’ age. Methods This was an explorative study applying individual qualitative interviews. The interviews were analysed following hermeneutic methodological principles. Two Norwegian geriatric wards participated: one at a university hospital and one at a local hospital. Twelve participants, six women and six men, were purposively selected. The relatives were aged from 36 to 88 (mean age 62) and were spouses, children and/or children-in-law of patients. Results The relatives’ experienced opportunities to exert influence were distributed along a continuum ranging from older relatives being reactive waiting for an initiative from health professionals, to younger adults being proactive securing influence. Older “invisible” carers appeared to go unnoticed by the health professionals, establishing few opportunities to influence decisions. The middle-aged relatives also experienced limited influence, but participated when the hospital needed it. However, limited participation seemed to have less impact on their lives than in the older relatives. Middle-aged relatives and younger adults identified strategies in which visibility was the key to increasing the odds of gaining participation. The exceptional case seemed to be some older carers’ experiences of influencing decisions with the help of professionals. Conclusions Our findings suggest that experiences of influence were limited regardless of age. However, the results indicated that participation among relatives decrease with age while vulnerability for not having influence seemed to increase with age. The problem of patient choice most clearly manifested among the older carers, which might indicate that the relatives’ age sets terms for opportunities to participate.

• Nyborg, Ingrid; Danbolt, Lars Johan & Kirkevold, Marit (2017). User participation is a family matter: A multiple case study of the experiences of older, hospitalised people and their relatives. Journal of Clinical Nursing.  ISSN 0962-1067.  26(23-24), s 4353- 4363 . doi: 10.1111/jocn.13765 Vis sammendrag

  AIMS AND OBJECTIVES: The purpose of this multiple case study was to compare and contrast older people’s and their relatives’ experiences of participation in decision-making processes regarding the planning of everyday life after discharge from hospital. BACKGROUND: Internationally, patient involvement in health services is established to benefit patient health and to improve quality of the services. The literature shows that at hospital discharge, older people would benefit from better communication and more active participation of relatives in the discharge planning. Little research has been carried out on the experiences of patients and relatives as a family in this context, and even less has investigated their participation. DESIGN: This study used a qualitative design with a comparative multicase approach. Participants were recruited from two hospitals in Norway using a purposive sampling strategy. METHODS: Semi-structured interviews were conducted with five patients and with six of their relatives. RESULTS: Three patterns of experiences were identified: contradicting experiences; consistent experiences of nonpreferred participation; similar, but separate experiences of user participation. CONCLUSIONS: User participation in the planning of everyday life following discharge appeared to be random and limited for both patients and their relatives, and conflicting for the families as a whole. The decision-making processes seemed to be limited to the hospital context and did not include the broader context of everyday life following discharge. RELEVANCE TO CLINICAL PRACTICE: The results underscore the importance of taking a family perspective when caring for older people. Family meetings might be a useful tool to ensure systematic assessment and integration of the perspectives of both older people and their family in the planning of follow-up care. KEYWORDS case study research, decision-making, family, hospital, older people, patient participation, relative

• Næss, Gro; Kirkevold, Marit; Hammer, Wenche; Straand, Jørund & Wyller, Torgeir Bruun (2017). Nursing care needs and services utilised by home-dwelling elderly with complex health problems: Observational study. BMC Health Services Research.  ISSN 1472-6963.  17(1) . doi: 10.1186/s12913-017-2600-x
• Stormorken, Eva; Jason, Leonard A & Kirkevold, Marit (2017). Factors impacting the illness trajectory of post-infectious fatigue syndrome: A qualitative study of adults' experiences. BMC Public Health.  ISSN 1471-2458.  17(1) . doi: 10.1186/s12889-017-4968-2
• Stormorken, Eva; Jason, Leonard A & Kirkevold, Marit (2017). From good health to illness with post-infectious fatigue syndrome: a qualitative study of adults? experiences of the illness trajectory. BMC Family Practice.  ISSN 1471-2296.  18(1), s 1- 15 . doi: 10.1186/s12875-017-0614-4
• Bing-Jonsson, Pia Cecilie; Hofoss, Dag; Kirkevold, Marit; Bjørk, Ida Torunn & Foss, Christina (2016). Sufficient competence in community elderly care? Results from a competence measurement of nursing staff. BMC Nursing.  ISSN 1472-6955.  15 . doi: 10.1186/s12912-016-0124-z Vis sammendrag

  Background Multi-morbidity, poly-pharmacy and cognitive impairment leave many old patients in a frail condition with a high risk of adverse outcomes if proper health care is not provided. Knowledge about available competence is necessary to evaluate whether we are able to offer equitable and balanced health care to older persons with acute and/or complex health care needs. This study investigates the sufficiency of nursing staff competence in Norwegian community elderly care. Methods We conducted a cross-sectional survey of 1016 nursing staff in nursing homes and home care services with the instrument “Nursing Older People – Competence Evaluation Tool”. Statistical analyses were ANOVA and multiple regression. Results We found that nursing staff have competence in all areas measured, but that the level of competence was insufficient in the areas nursing measures, advanced procedures, and nursing documentation. Nursing staff in nursing homes scored higher than staff in home care services, and older nursing staff scored lower than younger nursing staff. Conclusions A reason for the relatively low influence of education and training on competence could be the diffuse roles that nursing staff have in community elderly care, implying that they have poor standards against which to judge their own competence. Clearer role descriptions for all groups of nursing staff are recommended as well as general competence development in geriatric nursing care.

• Edvardsson, David; Backman, Annica; Bergland, Ådel; Björk, Sabine; Bölenius, Karin; Kirkevold, Marit; Lindkvist, Marie; Lood, Quarin; Lämås, Kristina; Lövheim, Hugo; Sandman, Per-Olof; Sjögren, Karin; Sköldunger, Anders; Wimo, Anders & Winblad, Bengt (2016). The Umeå ageing and health research programme (U-Age): Exploring person-centred care and health-promoting living conditions for an ageing population. Nordic journal of nursing research.  ISSN 2057-1585.  36(3), s 168- 174 . doi: 10.1177/2057158516645705 Vis sammendrag

  The aim of this article is to describe the Umeå ageing and health research programme that explores person-centred care and health-promoting living conditions for an ageing population in Sweden, and to place this research programme in a national and international context of available research evidence and trends in aged care policy and practice. Contemporary trends in aged care policy includes facilitating ageing in place and providing person-centred care across home and aged care settings, despite limited evidence on how person-centred care can be operationalised in home care services and sheltered housing accommodation for older people. The Umeå ageing and health research programme consists of four research projects employing controlled, cross-sectional and longitudinal designs across ageing in place, sheltered housing, and nursing homes. The research programme is expected to provide translational knowledge on the structure, content and outcomes of person-centred care and health-promoting living conditions in home care, sheltered housing models, and nursing homes for older people and people with dementia.

• Fjose, Marianne; Eilertsen, Grethe; Kirkevold, Marit & Grov, Ellen Karine (2016). A Valuable but Demanding Time, Family Life During Advanced Cancer in an Elderly Family Member. Advances in Nursing Science.  ISSN 0161-9268.  39(4), s 358- 373 . doi: 10.1097/ANS.0000000000000145
• Gonzalez, Marianne Thorsen & Kirkevold, Marit (2016). Design Characteristics of Sensory Gardens in Norwegian Nursing Homes: A Cross-Sectional E-Mail Survey. Journal of Housing for the Elderly.  ISSN 0276-3893.  30(2), s 141- 155 . doi: 10.1080/02763893.2016.1162252
• Iversen, Marjolein M.; Espehaug, Birgitte; Hausken, Marie Fjelde; Graue, Marit; Østbye, Truls; Skeie, Svein; Cooper, John; Tell, Grethe Seppola; Günther, Bodo Erhardt; Dale, Håvard; Smith-Strøm, Hilde; Kolltveit, Beate-christin Hope; Kirkevold, Marit & Rokne, Berit (2016). Telemedicine Versus Standard Follow-Up Care for Diabetes-Related Foot Ulcers: Protocol for a Cluster Randomized Controlled Noninferiority Trial (DiaFOTo). JMIR Research Protocols.  ISSN 1929-0748.  5(3) . doi: 10.2196/resprot.5646 Fulltekst i vitenarkiv.
• Kolltveit, Beate-Christin Hope; Gjengedal, Eva; Graue, Marit; Iversen, Marjolein M.; Thorne, Sally & Kirkevold, Marit (2016). Telemedicine in diabetes foot care delivery : health care professionals’ experience. BMC Health Services Research.  ISSN 1472-6963.  16:134, s 1- 8 . doi: 10.1186/s12913-016-1377-7 Fulltekst i vitenarkiv. Vis sammendrag

  Background: Introducing new technology in health care is inevitably a challenge. More knowledge is needed to better plan future telemedicine interventions. Our aim was therefore to explore health care professionals’ experience in the initial phase of introducing telemedicine technology in caring for people with diabetic foot ulcers. Methods: Our methodological strategy was Interpretive Description. Data were collected between 2014 and 2015 using focus groups (n = 10). Participants from home-based care, primary care and outpatient hospital clinics were recruited from the intervention arm of an ongoing cluster randomized controlled trial (RCT) (Clinicaltrials.gov: NCT01710774). Most were nurses (n = 29), but the sample also included one nurse assistant, podiatrists (n = 2) and physicians (n = 2). Results: The participants reported experiencing meaningful changes to their practice arising from telemedicine, especially associated with increased wound assessment knowledge and skills and improved documentation quality. They also experienced more streamlined communication between primary health care and specialist health care. Despite obstacles associated with finding the documentation process time consuming, the participants’ attitudes to telemedicine were overwhelmingly positive and their general enthusiasm for the innovation was high. Conclusions: Our findings indicate that using a telemedicine intervention enabled the participating health care professionals to approach their patients with diabetic foot ulcer with more knowledge, better wound assessment skills and heightened confidence. Furthermore, it streamlined the communication between health care levels and helped seeing the patients in a more holistic way. Keywords: telemedicine, diabetic foot ulcer, focus groups, interpretive description, health care professionals

• Nyborg, Ingrid; Kvigne, Kari; Danbolt, Lars Johan & Kirkevold, Marit (2016). Ambiguous participation in older hospitalized patients: gaining influence through active and passive approaches - a qualitative study. BMC Nursing.  ISSN 1472-6955.  15(50) . doi: 10.1186/S12912-016-0171-5 Fulltekst i vitenarkiv. Vis sammendrag

  Background: Patient participation is required by law in Norway and in several western countries. Current participation ideology is based on individualism, which may conflict with the older generation’s commonly held values of solidarity and community. Hence, different values and ideologies may come in conflict when older patients receive treatment and rehabilitation in geriatric wards. Participation is a guiding principle in rehabilitation. Criteria for admission of older patients to geriatric wards are complex health problems, acute illness and/or acute physical and/or cognitive functional failure. The ideal is an active and engaged patient. The aim of the study was to describe the difficulties experienced by older patients on acute geriatric wards when involving themselves with their own treatment and care. Methods: In this qualitative study older patients were interviewed during hospitalization in geriatric wards and asked to tell about their experiences with participation. Data analysis was conducted using a phenomenological hermeneutic method. Results: The patients experienced difficulties in participating in decisions and care. They linked their difficulties to their own diminishing capabilities, and cited the ward’s busy schedule as a reason for abstaining from participation. However, despite their reservations, they did participate in decisions in different ways. Their participatory practices appeared ambiguous and they employed various strategies to put themselves in a position of influence. The most important of these involved their relatives. The patients delegated to family the tasks of seeking, receiving and giving information to the nurses and the staff, and, to some extent, for the dialogues with hospital staff about their needs and plan of care. The family appeared to accept the responsibility willingly. Conclusions: The patients addressed their difficulties by authorizing family members to act and participate on their behalf. This underlines the family’s important role in patient participation and the role that nurses and other staff must play in collaborating with the patient and their family to facilitate participation independently of the patients’ performances of participation.

• Smebye, Kari Lislerud; Kirkevold, Marit & Engedal, Knut (2016). Ethical dilemmas concerning autonomy when persons with dementia wish to live at home: A qualitative, hermeneutic study. BMC Health Services Research.  ISSN 1472-6963.  16(21) . doi: 10.1186/s12913-015-1217-1 Vis sammendrag

  Background Caring for people with dementia living in their own homes is a challenging care issue that raises ethical dilemmas of how to balance autonomy with their safety and well-being. The theoretical framework for this study consisted of the concepts of autonomy, beneficence, non-maleficence, paternalism and from the ethics of care. The aim of this study was to explore ethical dilemmas concerning autonomy that were identified when persons with dementia wished to live at home. Methods This Norwegian study had a qualitative, hermeneutic design and was based on nine cases. Each case consisted of of a triad: the person with dementia, the family carer and the professional caregiver. Inclusion criteria for the persons with dementia were: (1) 67 years or older (2) diagnosed with dementia (3) Clinical Dementia Rating score 2 i.e. dementia of moderate degree (4) able to communicate verbally and (5) expressed a wish to live at home. The family carers and professional caregivers registered in the patients’ records were included in the study. An interview guide was used in interviews with family carers and professional caregivers. Field notes were written after participant observation of interactions between persons with dementia and professional caregivers during morning care or activities at a day care centre. By means of deductive analysis, autonomy-related ethical dilemmas were identified. The final interpretation was based on perspectives from the theoretical framework. Results The analysis revealed three main ethical dilemmas: When the autonomy of the person with dementia conflicted with (1) the family carer’s and professional caregiver’s need to prevent harm (non-maleficence) (2) the beneficence of family carers and professional caregivers (3) the autonomy of the family carer. Conclusions In order to remain living in their own homes, people with dementia accepted their dependence on others in order to uphold their actual autonomy and live in accordance with their identified values. Paternalism could be justified in light of beneficence and non-maleficence and within an ethics of care.

• Smith-Strøm, Hilde; Iversen, Marjolein M.; Graue, Marit; Skeie, Svein & Kirkevold, Marit (2016). An integrated wound-care pathway, supported by telemedicine, and competent wound management—Essential in follow-up care of adults with diabetic foot ulcers. International Journal of Medical Informatics.  ISSN 1386-5056.  94, s 59- 66 . doi: 10.1016/j.ijmedinf.2016.06.020
• Zoffmann, Vibeke; Hörnsten, Åsa; Storbækken, Solveig; Graue, Marit; Rasmussen, Bodil; Wahl, Astrid Klopstad & Kirkevold, Marit (2016). Translating person-centered care into practice: A comparative analysis of motivational interviewing, illness-integration support, and guided self-determination. Patient Education and Counseling.  ISSN 0738-3991.  99(3), s 400- 407 . doi: 10.1016/j.pec.2015.10.015
• Bergland, Ådel; Hofoss, Dag; Kirkevold, Marit; Vassbø, Tove Karin & Edvardsson, David (2015). Person-centred ward climate as experienced by mentally lucid residents in long-term care facilities. Journal of Clinical Nursing.  ISSN 0962-1067.  24(3-4), s 406- 414 . doi: 10.1111/jocn.12614 Vis sammendrag

  Aims and objectives To assess the content validity and reliability of the Person-centred Climate Questionnaire-Patient version in long-term care facilities, to describe residents' perceptions of the extent to which their ward climate was person-centred and to explore whether person-centredness was associated with facility and resident characteristics, such as facility and ward size, having a sensory garden and having a primary caregiver. Background The importance of the physical environment to persons with dementia has been investigated. However, research is lacking regarding the extent to which mentally lucid residents experience their physical and psycho-social ward climate as person-centred and the factors influencing their experience. Design Cross-sectional survey design. Methods The Person-centred Climate Questionnaire–Patient version was translated into Norwegian with forward and backward translation. The content validity index for scales was assessed. The Person-centred Climate Questionnaire –Patient version was completed by 145 mentally lucid residents in 17 Norwegian long-term care facilities. Reliability was assessed by Cronbach's α and item–total correlations. Test–retest reliability was assessed by paired samples t-test and Spearman's correlation. To explore differences based on facility and resident characteristics, independent-samples t-test and one-way anova were used. Results The content validity index for scales was satisfactory. The Person-centred Climate Questionnaire–Patient version was internally consistent and had satisfactory test–retest reliability. The climate was experienced as highly person-centred. No significant differences were found, except that residents in larger facilities experienced the climate as more person-centred in relation to everyday activities (subscale 2) than residents in smaller facilities. Conclusion The Norwegian version of the Person-centred Climate Questionnaire–Patient version can be regarded as reliable in a long-term care facility context. Perceived degree of person-centredness was not associated with facility or resident characteristics, such as the number of residents, having a sensory garden or knowing that one has a primary caregiver.

• Bergland, Ådel; Kirkevold, Marit; Sandman, Per-Olof; Hofoss, Dag & Edvardsson, David (2015). The Thriving of Older People Assessment Scale: validity and reliability assessments. Journal of Advanced Nursing.  ISSN 0309-2402.  71(4), s 942- 951 . doi: 10.1111/jan.12593 Vis sammendrag

  Aim. To explore construct validity and reliability of the Thriving of Older People Assessment Scale. Background. The concept of thriving emphasizes person–environment interaction in relation to well-being. The Thriving of Older People Assessment Scale has been developed and evaluated as a self-report and proxy scale based on the theory of thriving. Design. Cross-sectional survey design. Method. The Thriving of Older People Assessment Scale was completed by a sample of 259 residents, 146 family members and 52 staff from 13 long-term care facilities in Norway and Sweden. Data were collected between April 2010–December 2011. Exploratory factor analysis was applied to explore construct validity in terms of factor structure and dimensionality of the 32-item scale in relation to the thriving theory. Reliability was explored through internal consistency estimation using Cronbach’s alpha and through homogeneity evaluation using corrected item-total correlations. Results. Exploratory factor analysis resulted in five factors (subscales) that corresponded meaningfully with the thriving theory and were labelled 1: Resident’ attitudes towards being in long-term care; 2: Quality of care and caregivers; 3: Resident engagement and peer relationships; 4: Keeping in touch with people and places; and 5: Quality of the physical environment. The scale had satisfactory internal consistency and homogeneity estimates. Conclusion. The 32-item Thriving of Older People Assessment Scale can be regarded as construct valid and reliable. Its factor structure corresponded logically to the thriving theory and its factors showed satisfactory internal consistency and homogeneity. Nevertheless, the TOPAS would benefit from further testing in other populations and contexts. Keywords: instrument development, long-term care, long-term care facilities, nursing, psychometrics, thriving

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• Bragstad, Line Kildal; Bronken, Berit Arnesveen; Sveen, Unni; Hjelle, Ellen Gabrielsen; Kitzmüller, Gabriele; Martinsen, Randi; Kvigne, Kari Johanne; Mangset, Margrete & Kirkevold, Marit (2019). Implementation fidelity in an RCT evaluating psychosocial well-being following stroke: an explanatory sequential mixed methods study.
• Bragstad, Line Kildal; Hjelle, Ellen Gabrielsen; Sveen, Unni; Bronken, Berit Arnesveen; Martinsen, Randi; Kvigne, Kari Johanne; Kitzmüller, Gabriele; Mangset, Margrete & Kirkevold, Marit (2019). Interpreting neutral results in an intervention aimed at promoting psychosocial well-being following stroke: A process evaluation.
• de Lange, Thomas & Kirkevold, Marit (2019). Kollegaveiledning: Hvordan gjøre oss selv og hverandre bedre som veiledere?.
• Hjelle, Ellen Gabrielsen; Bragstad, Line Kildal; Kirkevold, Marit; Zucknick, Manuela; Bronken, Berit Arnesveen; Martinsen, Randi; Kvigne, Kari Johanne; Kitzmüller, Gabriele; Mangset, Margrete; Thommessen, Bente & Sveen, Unni (2019). The effect of a psychosocial intervention on well-being 6 months after stroke – a multicentre prospective randomized controlled trial.
• Hjelle, Ellen Gabrielsen Hjelle; Bragstad, Line Kildal; Kirkevold, Marit; Zucknick, Manuela; Bronken, Berit Arnesveen; Martinsen, Randi; Kvigne, Kari Johanne; Kitzmüller, Gabriele; Mangset, Margrete; Thommessen, Bente & Sveen, Unni (2019). The complexities of an intervention to promote psychosocial well-being after stroke: Implications for trial outcome.
• Kirkevold, Marit; Mathisen, Lars; Hellesø, Ragnhild; Kvangarsnes, Marit; Bergland, Ådel; Kapstad, Heidi & Førsund, Linn Hege (2019). Spesialistsykepleiere skal møte udekkede behov. Dagens medisin.  ISSN 1501-4290. Vis sammendrag

  Allmennsykepleiere skal møte udekkede behov og styrke de kommunale helse- og omsorgtjenestene - ikke erstatte leger. Det er ikke grunn til å tro at introduksjon av allmennsykepleiere går ut over legers oppgaver, funksjon og næringsgrunnlag

• Mangset, Margrete; Kitzmüller, Gabriele; Evju, Anne Svelstad; Angel, Sanne; Aadal, Lena; Martinsen, Randi; Bronken, Berit Arnesveen; Kvigne, Kari Johanne; Bragstad, Line Kildal; Hjelle, Ellen Gabrielsen; Sveen, Unni & Kirkevold, Marit (2019). The influence of the assessment interviews on the control group participants in a complex psychosocial intervention study after stroke.
• Martinsen, Randi; Kitzmüller, Gabriele; Mangset, Margrete; Bronken, Berit Arnesveen; Evju, Anne Svelstad; Kvigne, Kari Johanne; Bragstad, Line Kildal; Hjelle, Ellen Gabrielsen; Sveen, Unni & Kirkevold, Marit (2019). Helsepersonells erfaringer med å gjennomføre psykososial støtte til personer med hjerneslag.
• Sjögren, Karin; Lood, Qarin; Bergland, Ådel; Vassbø, Tove Karin; Kirkevold, Marit & Edvardsson, David (2019). An international person-centred and thriving promoting intervention in nursing homes.
• Björklöf, Guro Hanevold; Kirkevold, Marit; Engedal, Knut; Selbæk, Geir & Helvik, Anne-Sofie (2018). Fastlåst i en skrustikke. Mestringsprosessen ved depresjon i eldre år. BestPractice Psykiatri/Nevrologi/Geriatri.  (34)
• Bragstad, Line Kildal; Bronken, Berit Arnesveen; Sveen, Unni; Hjelle, Ellen Gabrielsen; Kitzmüller, Gabriele; Martinsen, Randi; Kvigne, Kari Johanne; Mangset, Margrete & Kirkevold, Marit (2018). Implementation fidelity in a complex intervention promoting psychosocial well-being following stroke: an explanatory sequential mixed methods study. Part One..
• Bronken, Berit Arnesveen; Bragstad, Line Kildal; Sveen, Unni; Hjelle, Ellen Gabrielsen; Kitzmüller, Gabriele; Martinsen, Randi; Kvigne, Kari Johanne; Mangset, Margrete & Kirkevold, Marit (2018). Implementation fidelity in a complex intervention promoting psychosocial well-being following stroke: an explanatory sequential mixed methods study. Part Two..
• Eik, Hedda; Solbrække, Kari Nyheim; Kirkevold, Marit & Mengshoel, Anne Marit (2018). Å gjennvinne et akseptabelt liv- tilfriskningsprosesser fra fibromyalgi.
• Halvorsen, Kjell H.; Goodman, Claire; Achterberg, Wilco; Gordon, Adam; Kirkevold, Marit; Rosstad, Tove & Husebø, Bettina (2018). Experiences from how interdisciplinary network initiatives enhance care home research.
• Kitzmüller, Gabriele; Mangset, Margrete; Evju, Anne Svelstad; Angel, Sanne; Aadal, Lene; Martinsen, Randi; Bronken, Berit Arnesveen; Kvigne, Kari Johanne; Bragstad, Line Kildal; Hjelle, Ellen Gabrielsen; Sveen, Unni & Kirkevold, Marit (2018). To find oneself - The lived experience of persons with stroke after participation in a complex psychosocial intervention.
• Kolltveit, Beate-Christin Hope; Kirkevold, Marit; Graue, Marit; Gjengedal, Eva; Iversen, Marjolein M. & Thorne, Sally (2018). Healthcare professionals`experience in using telemedicine in diabetes foot care delivery..
• Kolltveit, Beate-Christin Hope; Kirkevold, Marit; Graue, Marit; Gjengedal, Eva; Iversen, Marjolein M. & Thorne, Sally (2018). Telemedicine in diabetes foot care delivery: Healthcare professionals`experiences..
• Kolltveit, Beate-Christin Hope; Kirkevold, Marit; Graue, Marit; Gjengedal, Eva; Iversen, Marjolein M. & Thorne, Sally (2018). Telemedisinsk oppfølging i diabetes fotsår behandling: helsepersonell sine erfaringer..
• Martinsen, Randi; Kirkevold, Marit; Mangset, Margrete; Kitzmüller, Gabriele; Bronken, Berit Arnesveen; Bragstad, Line Kildal; Hjelle, Ellen Gabrielsen; Sveen, Unni; Evju, Anne Svelstad & Kvigne, Kari Johanne (2018). Nurses’ and occupational therapists’ experiences of their roles in supporting stroke survivors during rehabilitation.
• Rahman, Muhammad Aziz; McDonald, Ewan; Edvardsson, Kristina; Pascoe, Liz; Lood, Qarin; Jokwiro, Yangama; Bergland, Ådel; Vassbø, Tove Karin; Kirkevold, Marit; Sandman, Per-Olof; Sjögren, Karin & Edvardsson, David (2018). Psychometric analyses of the English version Person-Centered Climate Questionnare-Family (OCQ-F).
• Renolen, Åste; Hjälmhult, Esther; Høye, Sevald; Danbolt, Lars Johan & Kirkevold, Marit (2018). Leadership strategies in the integration of evidence-based practice in hospital wards.
• Sjögren, Karin; Bergland, Ådel; Lood, Qarin; Vassbø, Tove Karin; Kirkevold, Marit; Sandman, Per-Olof & Edvardsson, David (2018). Resident Thriving in Nursing Homes – a cross-country comparison.
• Bragstad, Line Kildal; Bronken, Berit Arnesveen; Hjelle, Ellen Gabrielsen; Sveen, Unni; Martinsen, Randi; Kitzmüller, Gabriele; Kvigne, Kari; Mangset, Margrete & Kirkevold, Marit (2017). Promoting psychosocial wellbeing following stroke: Evaluating implementation fidelity in a multi-center RCT – a quantitative study of intervention adherence.
• Bragstad, Line Kildal; Hjelle, Ellen Gabrielsen; Sveen, Unni; Bronken, Berit Arnesveen; Martinsen, Randi; Kvigne, Kari Johanne; Kitzmüller, Gabriele; Mangset, Margrete & Kirkevold, Marit (2017). Guidet egenbeslutning for å fremme psykososial helse etter hjerneslag. En samtalebasert intervensjon.
• Bragstad, Line Kildal; Hjelle, Ellen Gabrielsen; Sveen, Unni; Bronken, Berit Arnesveen; Martinsen, Randi; Kvigne, Kari; Kitzmüller, Gabriele; Mangset, Margrete & Kirkevold, Marit (2017). Guidet egenbeslutning for å fremme psykososial helse etter hjerneslag. Ergoterapeuten.  ISSN 0800-3475.  60(6), s 31- 33
• Bronken, Berit Arnesveen; Bragstad, Line Kildal; Martinsen, Randi; Kitzmüller, Gabriele; Mangset, Margrete; Hjelle, Ellen Gabrielsen; Kvigne, Kari & Kirkevold, Marit (2017). Promoting psychosocial well-being following stroke: Facilitating implementation of a complex intervention in primary Healthcare..
• Fjose, Marianne; Grov, Ellen Karine; Eilertsen, Grethe & Kirkevold, Marit (2017). Hvordan opplever eldre kreftpasienter i palliativ fase og nærmeste familiemedlemmer oppfølgingen fra helsetjenesten.
• Fjose, Marianne; Grov, Ellen Karine; Eilertsen, Grethe & Kirkevold, Marit (2017). Hvordan oppleves den palliative helsetjenesten for eldre kreftpasienter og deres nærmeste familie?.
• Goyal, Alka Rani; Bergh, Sverre; Engedal, Knut; Kirkevold, Marit & Kirkevold, Øyvind (2017). The course of anxiety in persons with dementia in Norwegian nursing homes: A 12 months follow-up study.
• Hjelle, Ellen Gabrielsen; Bragstad, Line Kildal; Kirkevold, Marit; Bronken, Berit Arnesveen; Martinsen, Randi; Kvigne, Kari Johanne; Kitzmüller, Gabriele; Mangset, Margrete; Thommessen, Bente & Sveen, Unni (2017). Promoting Psychosocial well-being following stroke.
• Hjelle, Ellen Gabrielsen; Bragstad, Line Kildal; Kirkevold, Marit; Bronken, Berit Arnesveen; Martinsen, Randi; Kvigne, Kari Johanne; Kitzmüller, Gabriele; Mangset, Margrete; Thommessen, Bente & Sveen, Unni (2017). Psykososial helse etter hjerneslag - en kontrollert, randomisert multisenter studie.
• Kitzmüller, Gabriele; Mangset, Margrete; Evju, Anne Svelstad; Angel, Sanne; Aadal, Lena; Kvigne, Kari Johanne; Bronken, Berit Arnesveen; Martinsen, Randi; Bragstad, Line Kildal; Hjelle, Ellen Gabrielsen; Sveen, Unni & Kirkevold, Marit (2017). Promoting psychosocial well-being following stroke: Stroke patients' experiences of participating in a complex psychosocial intervention.
• Kolltveit, Beate-Christin Hope & Kirkevold, Marit (2017). Telemedicine follow-up in diabetes foot ulcer care: Essential conditions and contextual factors from the perspective of health care professionals.
• Martinsen, Randi; Kitzmüller, Gabriele; Mangset, Margrete; Evju, Anne Svelstad; Bronken, Berit Arnesveen; Bragstad, Line Kildal; Kvigne, Kari; Hjelle, Ellen Gabrielsen; Sveen, Unni & Kirkevold, Marit (2017). Promoting psychosocial wellbeing following stroke: Nurses' and occupational therapists' experiences of delivering an individualized dialogue-based intervention to support stroke survivors the first six months following stroke.
• Smebye, Kari Lislerud; Kirkevold, Marit & Engedal, Knut (2017). Decision Making in Dementia Care. A qualitative study..
• Renolen, Åste; Høye, Sevald; Hjälmhult, Esther; Danbolt, Lars Johan & Kirkevold, Marit (2016). Kunnskapsbasert praksis og sykepleieres utfordringer med å ta i bruk ny forskningskunnskap i klinisk praksis.
• Bragstad, Line Kildal; Hjelle, Ellen Gabrielsen; Sveen, Unni & Kirkevold, Marit (2016). Evaluating complex interventions: Methodological challenges of assessing intervention fidelity in a randomized controlled trial targeting psychosocial wellbeing following stroke.
• Bragstad, Line Kildal; Kirkevold, Marit & Foss, Christina (2016). De uunnværlige mellomledd. Pårørendes deltagelse under og etter utskrivning fra sykehus.
• Fjose, Marianne; Eilertsen, Grethe; Kirkevold, Marit & Grov, Ellen Karine (2016). I grenseland - familielivets utfordringer når et eldre familiemedlem har kreft i palliativ fase.
• Gonzalez, Marianne Thorsen & Kirkevold, Marit (2016). Sansehage som som miljøbehandling for personer med dmens, I: Signe Tretteteig (red.),  Demensboka. Lærebok for helse- og omsorgspersonell.  Forlaget Aldring og helse.  ISBN 978-82-8061-260-1.  Kapittel 20.  s 367 - 375
• Haltbakk, Johannes; Graue, Marit; Sigurdardottir, Árún K.; Harris, Janet; Dunning, Trisha & Kirkevold, Marit (2016). Sikkerhetsrisiko og uheldige hendelser I hjemmesykepleiens diabetesomsorg - En integrative review.
• Hjelle, Ellen Gabrielsen; Bragstad, Line Kildal; Kirkevold, Marit; Bronken, Berit Arnesveen; Martinsen, Randi; Kvigne, Kari; Kitzmüller, Gabriele; Eriksen, Siren; Mangset, Margrete & Sveen, Unni (2016). Promoting psychosocial well-being following stroke: A randomized, single blind, controlled trial.
• Kolltveit, Beate-Christin Hope; Gjengedal, Eva; Graue, Marit; Iversen, Marjolein M.; Thorne, Sally & Kirkevold, Marit (2016). Health care professionals` perspectives on the introduction of telemedicine.
• Kolltveit, Beate-Christin Hope; Gjengedal, Eva; Graue, Marit; Iversen, Marjolein M.; Thorne, Sally & Kirkevold, Marit (2016). Improving quality in documentation and communication between health care professionals when adopting telemedicine in diabetes foot care delivery..
• Kolltveit, Beate-Christin Hope; Gjengedal, Eva; Graue, Marit; Iversen, Marjolein M.; Thorne, Sally & Kirkevold, Marit (2016). Interpretive Description as a strategy in the study of the health care professionals`experiences in using telemedicine in diabetes foot care..
• Mjørud, Marit; Engedal, Knut; Røsvik, Janne-Kathrin & Kirkevold, Marit (2016). Living with dementia in a nursing home, as described by persons with dementia.
• Sjögren, Karin; Bergland, Ådel; Lood, Qarin; Kirkevold, Marit; Sandman, Per-Olof & Edvardsson, David (2016). A person-centred and thriving-promoting intervention in nursing homes.
• Smith-Strøm, Hilde; Iversen, Marjolein M.; Graue, Marit; Rokne, Berit & Kirkevold, Marit (2016). A qualitative study among patients with diabetes foot ulcers randomized to a telemedicine versus traditional follow- up health care intervention.

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