Marit Kirkevold

• 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
• 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 Vis sammendrag

  Trajectories of quality of life and their association with anxiety in people with dementia in nursing homes: A 12-month follow-up study

• 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; 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. . doi: https://www.tandfonline.com/doi/full/10.1080/02699052.2018.1539244
• 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 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. . doi: 10.1111/jan.13890
• 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
• 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

• Bing-Jonsson, Pia Cecilie; Bjørk, Ida Torunn; Hofoss, Dag; Kirkevold, Marit & Foss, Christina (2015). Competence in advanced older people nursing: Development of 'Nursing older people - Competence evaluation tool'. International Journal of Older People Nursing.  ISSN 1748-3735.  10(1), s 59- 72 . doi: 10.1111/opn.12057
• Bing-Jonsson, Pia Cecilie; Hofoss, Dag; Kirkevold, Marit; Bjørk, Ida Torunn & Foss, Christina (2015). Nursing older people-competence evaluation tool: Development and psychometric evaluation. Journal of Nursing Measurement.  ISSN 1061-3749.  23(1), s 127- 153 . doi: 10.1891/1061-3749.23.1.127
• Björklöf, Guro Hanevold; Kirkevold, Marit; Engedal, Knut; Selbæk, Geir & Helvik, Anne-Sofie (2015). Being stuck in a vice: The process of coping with severe depression in late life. International Journal of Qualitative Studies on Health and Well-being.  ISSN 1748-2623.  10 . doi: 10.3402/qhw.v10.27187 Fulltekst i vitenarkiv. Vis sammendrag

  Articles describing older persons’ experiences of coping with severe depression are, to our knowledge, lacking. This article is methodologically grounded in phenomenological hermeneutics, inspired by Paul Ricoeur, and applies a descriptive design with in-depth interviews for producing the data. We included 18 older persons, 13 women and 5 men, with a mean age of 77.9 years, depressed to a severe or moderate degree, 1–2 weeks after admission to a hospital for treatment of depression. We found the metaphor “being in a vice” to capture the essence of meaning from the participants’ stories, and can be understood as being stuck in an immensely painful existence entirely dominated by depression in late life. This is the first article where coping in older men and women experiencing the most severe phase of depression is explored.

• Eilertsen, Grethe; Ormstad, Heidi Kristin; Kirkevold, Marit; Mengshoel, Anne Marit; Söderberg, Siv & Olsson, Malin (2015). Similarities and differences in the experience of fatigue among People living with fibromyalgia, multiple sclerosis, ankylosing spondylitis and stroke. Journal of Clinical Nursing.  ISSN 0962-1067.  24(13-14), s 2023- 2034 . doi: 10.1111/jocn.12774 Vis sammendrag

  Aims and objectives To elucidate the experience of fatigue across several long-term illnesses, focusing on the similarities and differences. Background Fatigue is common to many long-term illnesses, but it has been studied mainly within the context of a single illness; qualitative studies comparing the experience and its impact on daily life across different long-term illnesses are lacking. Design Qualitative design. Methods A secondary analysis was conducted of five original interview studies involving 95 persons with ankylosing spondylitis, fibromyalgia, multiple sclerosis or stroke. Results Similarities and differences concerning experiences of fatigue were found across the studied long-term illnesses. All patients expressed the perception of having an unfamiliar body. Fatigue was also commonly expressed as unpredictable, uncontrollable and invisible to others. Differences were related to a constant versus a varying condition, a sudden and an uncontrollable sleepiness, a mutual reinforcement with pain and increased stress sensitivity. A lack of energy and a need for sleep and rest were common experiences, as was the impact on social relationships. There were also similarities regarding how the patients managed their daily life. The search for practical solutions and attitude adjustment differed with the fatigue characteristics. All patients felt a lack of understanding and disbelief from others. Conclusion and relevance to clinical practice Fatigue is commonly expressed by patients with long-term illnesses. Variations in experience are related to the type of diagnosis. The disparity between experiences influences how patients managed and adjusted to the conditions of everyday life. The illness-specific characteristics of fatigue warrant increased clinical awareness and may allow professionals to offer adequate information and establish effective methods of managing the condition. The

• Gonzalez, Marianne Thorsen & Kirkevold, Marit (2015). Clinical use of sensory gardens and outdoor environments in norwegian nursing homes: A cross-sectional e-mail survey. Issues in Mental Health Nursing.  ISSN 0161-2840.  36(1), s 35- 43 . doi: 10.3109/01612840.2014.932872
• Grape, Hedda; Solbrække, Kari Nyheim; Kirkevold, Marit & Mengshoel, Anne Marit (2015). Staying Healthy From Fibromyalgia Is Ongoing Hard Work. Qualitative Health Research.  ISSN 1049-7323.  25(5), s 679- 688 . doi: 10.1177/1049732314557333
• Haanes, Gro Gade; Kirkevold, Marit; Hofoss, Dag & Eilertsen, Grethe (2015). Discrepancy between self-assessments and standardised tests of vision and hearing abilities in older people living at home: an ROC curve analysis. Journal of Clinical Nursing.  ISSN 0962-1067.  24(23-24), s 3380- 3388 . doi: 10.1111/jocn.12967 Vis sammendrag

  Aims and objectives To determine whether there is consistency between self-assessments and standardised tests of vision and hearing abilities in older people. Background Home-based detection of vision and hearing impairments in older people are generally based on self-assessments of vision and hearing abilities. Design Cross-sectional descriptive study. Methods Receiver operating characteristic analysis was used to compare self-assessments of vision and hearing abilities with a gold-standard test. The vision and hearing abilities of 93 people aged ≥80 years in the home-care setting were screened with a LogMAR chart, a pure-tone audiometer, and a self-assessment screen. Results Comparison of findings using the cut-off points on the self-assessment scale with those of the gold-standard tests yielded 40 false negatives for vision and 18 false negatives for hearing, indicating that a significant proportion of older people report their vision and hearing abilities as being good when standardised tests indicate that they are not. Alternative cut-off points on the self-assessment scale were tested, but no cut-off point was found to provide a sound basis for identifying vision and hearing impairments. Conclusion The area under the receiver operating characteristic curve for self-assessment of vision was 69%, indicating that the self-assessment questions constituted a poor test. It appears that results from self-assessments cannot be relied upon to accurately identify visual acuity. The area under the receiver operating characteristic curve for the self-assessment of hearing was 73%, which may therefore be considered a “fair” test. However, self-assessment of hearing is still insufficient for detecting hearing impairment. Relevance to clinical practice Vision and hearing abilities are crucially important to managing daily living. In addition to treatments for suppressing the further development of existing diseases, standardised tests could be a good starting point for health prevention and promotion. Nurses should apply standardised tests to detect sensory impairments in older people.

• Haanes, Gro Gade; Kirkevold, Marit; Hofoss, Dag; Horgen, Gunnar & Eilertsen, Grethe (2015). An intervention designed to improve sensory impairments in the elderly and indoor lighting in their homes: an exploratory randomized controlled trial. Journal of Multidisciplinary Healthcare.  ISSN 1178-2390.  8, s 11- 20 . doi: 10.2147/JMDH.S71718 Fulltekst i vitenarkiv. Vis sammendrag

  Background: Vision and hearing impairments in the elderly (aged over 80 years) and poor indoor lighting conditions in a home-care setting are risk factors for functional decline, reduced social participation, withdrawal, and accidents. Objective: We aimed to evaluate the changes in vision, hearing, and lighting conditions in the homes of participants aged over 80 years after implementation of a clinical intervention. Methods: We undertook an exploratory randomized, controlled experimental study of sensory impairments and lighting conditions in the homes of elderly aged over 80 years who received home care. The intervention group (IG) received advice and encouragement to improve their vision, hearing, and indoor lighting conditions in the home, with a 10-week follow-up period. The control group (CG) received their usual care and underwent the same vision and hearing tests but were provided no intervention. Results: Vision and hearing (self-assessed) and tested by Wilcoxon rank-sum test were significantly better (P=0.025 and P=0.008, respectively) in the IG after the intervention and follow-up. The test between the groups showed a significance of P=0.026 for visual acuity and P=0.098 for pure-tone average. The maximum and minimum lighting levels were significantly improved in the IG after the intervention (P=0.002 and P=0.039, respectively) but were unchanged in the CG. Conclusion: Several of the IG participants did not follow all of the advice; however, among those who did, vision, hearing, and lighting conditions were all significantly improved. It appears that modest interventions have great potential for improving vision and hearing. Older patients in the home-care setting cannot be expected to take the necessary action to improve their sensory impairments by themselves. They require close monitoring, help from a specialist, and help to improve the indoor lighting conditions in their homes.

• Harris, Janet; Graue, Marit; Dunning, Trisha; Haltbakk, Johannes; Austrheim, Gunhild Helene; Skille, Nina; Rokne, Berit & Kirkevold, Marit (2015). Involving people with diabetes and the wider community in diabetes research: A realist review protocol. Systematic Reviews.  ISSN 2046-4053.  4:146 . doi: 10.1186/s13643-015-0127-y Fulltekst i vitenarkiv.
• Martinsen, Randi; Kirkevold, Marit & Sveen, Unni (2015). Young and midlife stroke survivors’ experiences with the health services and long-term follow-up needs. Journal of Neuroscience Nursing.  ISSN 0888-0395.  47(1), s 27- 35 . doi: 10.1097/JNN.0000000000000107 Fulltekst i vitenarkiv. Vis sammendrag

  The aim of this qualitative study was to explore young and midlife stroke survivors’ experiences with the health services and to identify long-term follow-up needs. Sixteen participants from two cohorts were interviewed in-depth. The interviews were analyzed applying a hermeneuticYphenomenological analysis. The participants struggled to gain access to follow-up health services. They felt that whether they were systematically followed up was more coincidental than planned. Young and midlife stroke survivors thus appear vulnerable to falling outside the follow-up system. Those participants who received some follow-up care perceived it as untailored to their specific needs. To be considered supportive, the follow-up programs must be in line with their long-term needs, take into account their particular challenges as young and midlife stroke survivors, and be planned in close collaboration with the individual patient. To secure systematic and follow-up health services tailored to the individual, knowledgeable and committed healthcare professionals should play a prominent role within the community health services.

• Stormorken, Eva; Jason, Leonard A & Kirkevold, Marit (2015). Fatigue in adults with post-infectious fatigue syndrome: A qualitative content analysis. BMC Nursing.  ISSN 1472-6955.  14(1) . doi: 10.1186/s12912-015-0115-5
• Aadal, Lene; Kirkevold, Marit & Borg, Tove (2014). Neurorehabilitation analysed through ‘situated learning’ theory :. Scandinavian Journal of Disability Research.  ISSN 1501-7419.  16(4), s 348- 363 . doi: 10.1080/15017419.2013.781956
• Bragstad, Line Kildal; Kirkevold, Marit & Foss, Christina (2014). The indispensable intermediaries: a qualitative study of informal caregivers’ struggle to achieve influence at and after hospital discharge. BMC Health Services Research.  ISSN 1472-6963.  14 . doi: 10.1186/1472-6963-14-331 Fulltekst i vitenarkiv.
• Bragstad, Line Kildal; Kirkevold, Marit; Hofoss, Dag & Foss, Christina (2014). Informal caregivers' participation when older adults in Norway are discharged from the hospital. Health and Social Care in the community.  ISSN 0966-0410.  22(2), s 155- 168 . doi: 10.1111/hsc.12071 Vis sammendrag

  This paper describes the participation of informal caregivers in the discharge process when patients aged 80 and over who were admitted from home to different hospitals in Norway were discharged to long-term community care. Data for this cross-sectional survey were collected through telephone interviews with a consecutive sample of 262 caregivers recruited between October 2007 and May 2009. The Discharge of Elderly Questionnaire was developed by the research team and was designed to elicit data concerning informal caregivers' self-reported perceptions on participation in the discharge process. A descriptive and comparative analysis of Thompson's levels of participation reported by the older generation (spouses and siblings) and the younger generation (adult children and children-in-law, nieces and grandchildren) was undertaken using bivariate cross-tabulations and chi-square tests for association and trend. Analyses showed that the younger generation of caregivers received and provided information to hospital staff to a greater degree than the older generation. Overall, 52% of the informal caregivers reported co-operating with the staff to a high or to some degree. A multivariate logistic regression analysis was used to analyse factors predicting the likelihood of informal caregivers reporting co-operation with hospital staff. The odds of younger generation caregivers reporting co-operation were more than twice as high (OR = 2.121, P = 0.045) as the odds of the older generation. Caregivers of patients with a hearing impairment had higher odds of reporting co-operation (OR = 1.722, P = 0.049) than caregivers of patients with no such impairment. The length of hospital stay, the caregiver's and patient's gender and education level were not significantly associated with caregiver's co-operation. The informal caregivers' experiences with information practices and user participation in hospitals highlight important challenges that must be taken seriously to ensure co-operation between families and hospitals when elderly patients are discharged back to the community.

• Gonzalez, Marianne Thorsen & Kirkevold, Marit (2014). Benefits of sensory garden and horticultural activities in dementia care : a modified scoping review. Journal of Clinical Nursing.  ISSN 0962-1067.  23(19-20), s 2698- 2715 . doi: 10.1111/jocn.12388
• Haanes, Gro Gade; Kirkevold, Marit; Horgen, Gunnar; Hofoss, Dag & Eilertsen, Grethe (2014). Sensory impairments in community health care: a descriptive study of hearing and vision among elderly Norwegians living at home. Journal of Multidisciplinary Healthcare.  ISSN 1178-2390.  (7), s 217- 225 . doi: 10.2147/JMDH.S58461 Fulltekst i vitenarkiv. Vis sammendrag

  Background: Hearing and vision impairments increase with age and are common risk factors for functional decline reduced social participation and withdrawal. Objective: Describe the hearing and vision of home care patients older than 80 years. Methods: Ninety-three older adults (80+ years) receiving home care were screened for hearing and vision in their homes. Data were collected using a HEINE Mini 3000® Otoscope to examine the eardrum and presence of earwax, an Entomed SA201-IV portable pure-tone audiometer to measure the pure-tone average (PTAV), a logarithm of the minimum angle of resolution chart to measure visual acuity (VA), and the Combined Serious Sensory Impairment interview guide. Results: Slight and moderate hearing impairments were found in 41% and 47% of the population, respectively (mean PTAV =40.4 dB for the better ear), and 40% and 56% had impaired and slightly impaired vision, respectively (mean VA =0.45 for the better eye). The participants' self-assessments of hearing and vision were only weakly correlated with PTAV and VA values. The visual function was significantly worse in men than in women (P=0.033). Difficulty in performing instrumental activities of daily living because of hearing and vision impairments was experienced by 17% of the participants, whereas 76% experienced no difficulties. When many people were present, 72% of the participants found it difficult to understand speech. Nearly 30% found it tiring to read, and 41% could not read very small print. Conclusion: The patients’ self-assessments of their hearing and vision did not correlate strongly with their VA and PTAV scores. Asking the elderly about their overall hearing and vision ability is not sufficient for detecting sensory impairment, and asking more specific questions about what they could not hear and see was not an adequate indicator of the patients’ hearing and vision problems. To detect hearing and vision impairments among elderly home care patients, standardized measurements of their hearing and vision are necessary.

• Kirkevold, Marit; Martinsen, Randi; Bronken, Berit Arnesveen & Kvigne, Kari (2014). Promoting psychosocial wellbeing following stroke using narratives and guided self-determination: a feasibility study. BMC Nursing.  ISSN 1472-6955.  2(4) . doi: 10.1186/2050-7283-2-4 Vis sammendrag

  Extensive studies have documented the complex and comprehensive psychosocial consequences of stroke. Psychosocial difficulties significantly affect long-term functioning and quality of life. Many studies have explored psychosocial interventions to prevent or treat psychosocial problems, but most have found modest effects. This study evaluated, from the perspective of adult stroke survivors, (1) the content, structure and process and (2) experienced usefulness of a dialogue-based psychosocial nursing intervention in primary care aimed at promoting psychosocial health and wellbeing. This was part of a feasibility study guided by the UK MRC complex interventions framework. It consisted of dialogue-based encounters with trained health professionals during approximately the first year poststroke. It was tested in two formats; individual or group encounters. Inclusion criteria were: Acute stroke, above 18 y.o., sufficient physical and cognitive functioning to participate. Data were collected immediately before, during and 14 days after the completion of the intervention. Pre- and post-data included medical and demographic data, quality of life, emotional wellbeing, life satisfaction, anxiety and depression. Qualitative interviews focusing on participant experiences were conducted two weeks following the intervention. Log notes taken by the health professionals conducting the intervention and work sheets filled in by participants also comprised data. Data analysis was case-oriented. The structured instruments were analysed regarding completeness of data and indication of changes in outcome variables. The qualitative interviews, log notes and work sheets were analysed using thematic content analysis. Twenty-five stroke survivors (17 men, 8 women), median age 64 (range 33–89), participated. Physical limitations varied from mild to severe. Seven participants had moderate to severe expressive aphasia. The participants found the content and process of the intervention relevant. Both the individual and group formats were found useful. Patients with aphasia reported that there were too few encounters (eight encounters were originally planned). The participants underscored the benefits of being supported through a difficult time, having a chance to tell and (re)create their story and being supported in their attempts to cope with the situation. This study provides initial support for the usefulness of the psychosocial intervention and highlights areas requiring further consideration and development

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• Kirkevold, Marit; Brodtkorb, Kari & Ranhoff, Anette Hylen (2014). Geriatrisk sykepleie. God omsorg til den gamle pasienten. 2.utgave. Gyldendal Akademisk.  ISBN 9788205464490.  560 s.

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• 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..
• 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.
• 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.
• 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.
• Bragstad, Line Kildal; Hjelle, Ellen Gabrielsen; Bronken, Berit Arnesveen; Martinsen, Randi; Kvigne, Kari; Kouwenhoven, Siren Eriksen; Mangset, Margrete; Sveen, Unni; Kitzmüller, Gabriele & Kirkevold, Marit (2015). Psychosocial wellbeing following stroke: A randomized, single blind, controlled trial.
• Bronken, Berit Arnesveen; Kirkevold, Marit; Martinsen, Randi; Wyller, Torgeir Bruun & Kvigne, Kari (2015). Aphasia following Stroke: Promoting psychosocial well-being: A feasibility study.
• Fjose, Marianne; Grov, Ellen Karine; Kirkevold, Marit & Eilertsen, Grethe (2015). SILENT CARE - How families interact and communicate during advanced cancer.
• Graue, Marit; Kirkevold, Marit; Haltbakk, Johannes; Austrheim, Gunhild; Skille, Nina; Rokne, Berit; Dunning, Trisha & Harris, Janet (2015). User involvement in diabetes self-management interventions; reviewing how people with diabetes have been involved as co-researchers in diabetes research.
• Haltbakk, Johannes; Graue, M; Sigurdardottir, Árún K.; Harris, Janet; dunning, trisha & Kirkevold, Marit (2015). Patient safety in diabetes care for patients over 64 years reveiving home care services.
• Kolltveit, Beate-christin Hope; Kirkevold, Marit; Gjengedal, Eva; Graue, Marit & Iversen, Marjolein M. (2015). Health care Professionals`experiences using telemedicine in diabetes foot care. A qualitative study..
• Martinsen, Randi; Bronken, Berit Arnesveen; Kvigne, Kari; Sveen, Unni & Kirkevold, Marit (2015). Work-aged stroke survivors’ short term and long term psychosocial challenges and follow-up needs.
• Smebye, Kari Lislerud; Kirkevold, Marit & Engedal, Knut (2015). Etiske dilemma knyttet til autonomi når personer med demens ønsker å bo hjemme.
• Smith-Strøm, Hilde; Iversen, Marjolein M.; Graue, Marit & Kirkevold, Marit (2015). A qualitative study among patients with diabetes foot ulcers randomized to a telemedicine versus traditional follow- up health care intervention..
• Smith-Strøm, Hilde; Iversen, Marjolein M.; Graue, Marit; Rokne, Berit & Kirkevold, Marit (2015). A qualitative study among patients with diabetes foot ulcers randomized to a telemedicine versus traditional follow- up health care intervention. The 8th Nordic Diabetes PhD and Postdoc.
• Bergland, Ådel; Kirkevold, Marit; Hofoss, Dag; Sandman, Per-Olof & Edvardsson, David (2014). Development of the Thriving of Older People Assessment Scale – How to transform a theory into a valid and reliable scale. Vis sammendrag

  Objective: To develop a scale from a theory of thriving in long-term care and to explore the reliability and construct validity of the Thriving of Older people Assessment Scale (TOPAS). Methods: The theory of thriving involved seven dimensions: two core and five additional dimensions, developed from a qualitative study and literature reviews. Thirty-eight items were developed from the theory, and these were formulated as statements that could be rated from three perspectives resident, family and staff). The TOPAS was completed by a sample of 259 residents, 146 family members and 52 staff from 13 long-term care facilities in Norway and Sweden. Reliability was assessed by weighted kappa, Cronbach’s alpha and item-total correlations. Construct validity was assessed by principal component analysis (PCA). Results: Inter-rater reliability was satisfactory in 32 of 38 items, and thus 6 items were excluded. In the resulting 32-item TOPAS, Cronbach’s alpha was satisfactory (0.95) indicating that items measured the same construct. Homogeneity of the scale was satisfactory as shown by tem-total correlations between 0.48 and 0.70. PCA resulted in a stable factor structure that corresponded logically to the thriving theory. Conclusion: The 32-item TOPAS contributes significantly to the methods literature by including the person-environment interaction when exploring well-being in long-term care environments. The scale can be regarded as construct valid and reliable for resident self report as well as for proxy assessments by family and staff, something which is important in long-term care facilities with a large proportion of persons with dementia diseases.

• Bronken, Berit Arnesveen & Kirkevold, Marit (2014). Generering av kvalitative data blant personer med afasi.
• Bronken, Berit Arnesveen; Kirkevold, Marit; Sveen, Unni; Martinsen, Randi; Kvigne, Kari; Kouwenhoven, Siren Eriksen; Bragstad, Line Kildal & Kitzmüller, Gabriele (2014). Promoting psychosocial well-being following stroke. A randomized, single blind, controlled trial.
• Fjose, Marianne; Grov, Ellen Karine; Kirkevold, Marit & Eilertsen, Grethe (2014). Strong in our companionship-family life's impotances and challenges during advanced cancer.
• Haanes, Gro Gade; Horgen, Gunnar; Kirkevold, Marit & Eilertsen, Liv Grethe (2014). Sensory impairments in community health care.

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