No abstract

Background: Over the past 20 years, the organisation of specialist health services in Norway has developed from a system with many hospitals with a broad range of functions and expertise into a hierarchy with specialist expertise concentrated in a small number of hospitals. This reorganisation of healthcare has meant new challenges for ICU nurses. The professional practice of ICU nurses is governed by legislation on responsible treatment, care and support. Responsible ICU nursing requires appropriate competencies for the challenges of the individual ICU. The aim of this study is to shed light on nursing challenges and competence requirements by interpreting the experiences of five intensive care nurses from their work in a level 1 ICU (the lowest level). Design and method: Qualitative design with individual semi-structured interviews. Sample: Strategic. Five experienced ICU nurses from a level 1 unit. Analysis: Systematic text condensation. The findings revealed themes and subthemes. Theme: experienced competence, sub-themes: being experienced, taking responsibility, need for further development. Theme: experienced professional and systemic challenges, sub-themes: unclear expectations, unpredictable situations, individual and system. Conclusion: A lack of congruence was experienced between the challenges of reality and the responsibilities described. There was an uneven level of competence among both nurses and doctors in the ICU. ICU nurses had considerable responsibility for ensuring sound practices in their unit. They experienced a close relationship between competence, well-being, professional self-confidence, quality and patient safety. There was a particular need for training and competence development to help nurses prepare for and deal with unpredictable situations.

Some patients in nursing homes require extra attention to enable staff to detect and manage deterioration at an early stage. Nursing skills are vital to make systematic observations and assessments of a patient’s condition. It is challenging for nurses in nursing homes to make professional decisions without being able to consult other nurses. To improve the quality and safety of health care for patients and their relatives, the focus must be on working to ensure patient safety in nursing homes. Simulation-based learning can be one way to increase reflection on patient safety and develop health professionals’ knowledge, skills and attitudes, while protecting patients from unnecessary risks. Simulation-based learning as a method in medical education offers activities that mimic a clinical environment, where students can practice procedures and decision-making and where their critical thinking can be enhanced through role-play, videos or simulators. While simulation often takes place in a simulation center, in situ simulation refers to a learning activity that takes place in participants’ everyday work environment where they actually provide patient care. In this chapter, we aim to describe nurses’ experiences of in situ simulation and their subsequent reflections on patient safety in nursing homes. Data were collected from two focus groups with 5–6 nurses per group. The transcribed material was analyzed using qualitative content analysis, and two categories were identified that described the nurses’ experiences: “to doubt oneself” and “being dependent on others”.