Dag Hofoss

Patient safety culture concerns leader and staff interaction, attitudes, routines, awareness and practices that impinge on the risk of patient-adverse events. Due to their complex multiple diseases, nursing home patients are at particularly high risk of adverse events. Studies have found an association between patient safety culture and the risk of adverse events. This study aimed to investigate safety attitudes among healthcare providers in Norwegian nursing homes, using the Safety Attitudes Questionnaire – Ambulatory Version (SAQ-AV). We studied whether variations in safety attitudes were related to professional background, age, work experience and mother tongue. In February 2016, 463 healthcare providers working in five nursing homes in Tønsberg, Norway, were invited to answer the SAQ-AV, translated and adapted to the Norwegian nursing home setting. Previous validation of the Norwegian SAQ-AV for nursing homes identified five patient safety factors: teamwork climate, safety climate, job satisfaction, working conditions and stress recognition. SPSS v.22 was used for statistical analysis, which included estimations of mean values, standard deviations and multiple linear regressions. P-values <0.05 were considered to be significant. Out of the 463 employees invited, 288 (62.2%) answered the questionnaire. Response rates varied between 56.9% and 72.2% across the five nursing homes. In multiple linear regression analysis, we found that increasing age and job position among the healthcare providers were associated with significantly increased mean scores for the patient safety factors teamwork climate, safety climate, job satisfaction and working conditions. Not being a Norwegian native speaker was associated with a significantly higher mean score for job satisfaction and a significantly lower mean score for stress recognition. Neither professional background nor work experience were significantly associated with mean scores for any patient safety factor. Patient safety factor scores in nursing homes were poorer than previously found in Norwegian general practices, but similar to findings in out-of-hours primary care clinics. Patient safety culture assessment may help nursing home leaders to initiate targeted quality improvement interventions. Further research should investigate associations between patient safety culture and the occurrence of adverse events in nursing homes.

Several tools have been developed to measure safety attitudes of health care providers, out of which the Safety Attitudes Questionnaire (SAQ) is regarded as one of the most appropriate ones. In 2007, it was adapted to outpatient (primary health care) settings and in 2014 it was tested in out-of-hours health care settings in Norway. The purpose of this study was to translate the English version of the SAQ-Ambulatory Version (SAQ-AV) to Slovenian language; to test its reliability; and to explore its factor structure. This was a cross-sectional study that took place in Slovenian out-of-hours primary care clinics in March-May 2015 as a part of an international study entitled Patient Safety Culture in European Out-of-hours services. The questionnaire consisted of the Slovenian version of the SAQ-AV. The link to the questionnaire was emailed to health care workers in the out-of-hours clinics. A total of 438 participants were invited. We performed exploratory factor analysis. Out of 438 invited participants, 250 answered the questionnaire (response rate 57.1%). Exploratory factor analysis put forward five factors: 1) Perceptions of management, 2) Job satisfaction, 3) Safety climate, 4) Teamwork climate, and 5) Communication. Cronbach’s alpha of the whole SAQ-AV was 0.922. Cronbach’s alpha of the five factors ranged from 0.587 to 0.791. Mean total score of the SAQ-AV was 56.6 ± 16.0 points. The factor with the highest average score was Teamwork climate and the factor with the lowest average was Job satisfaction. Based on the results in our study, we cannot state that the SAQ-AV is a reliable tool for measuring safety culture in the Slovenian out-of-hours care setting. Our study also showed that there might be other safety culture factors in out-of-hours care not recognised before. We therefore recommend larger studies aiming to identify an alternative factor structure.

A diagnosis of neuroendocrine tumors (NET) provides challenges to patients and clinicians due to physical side effects of and mental response to treatment resulting in increased perceived stress. General self-efficacy, social support and cancer-related stress are key factors in coping. Thus, knowledge of these factors may be of value in improving health-related quality of life (HRQoL). The aim of the study was to examine the relationships between general self-efficacy, social support, cancer-related stress and HRQoL in patients with NET using a path model. 196 Norwegian patients living with NET were enrolled in this cross-sectional study. Inclusion criteria were: patients with tumors restricted to the GI tract; ability to speak and write Norwegian; over 18 years of age; undergoing medical treatment for NET. Measures used in the study were background characteristics, Health-related Quality of Life (SF-36), the Impact of Event Scale (IES), General Self-efficacy and the Interpersonal Support Evaluation List (ISEL). Relationships between sociodemographic variables, general self-efficacy, social support, cancer-related stress and mental and physical components scores were tested by path analysis with AMOS 22 using maximum standard likelihood estimation. The sample consisted of 50.5 % women and the average age was 65 years and the median disease duration was 4 years. Sociodemographic variables of gender, education and whether the patient lived alone or with someone were unrelated (directly or indirectly) to HRQoL. Age was directly and negatively correlated with physical HRQoL, general self-efficacy and social support in a well-fitting path model. General self-efficacy modified the negative effects of age on physical HRQoL. Physical and mental HRQoL were not associated with cancer-related stress. Higher social support was related to less stress. Intervening to improve general self-efficacy and social support for patients with NET may improve their HRQoL.

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. 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. 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. 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.

Patient safety culture is how leader and staff interaction, attitudes, routines and practices protect patients from adverse events in healthcare. The Safety Attitudes Questionnaire is the most widely used instrument to measure safety attitudes among health care providers. The instrument may identify possible weaknesses in clinical settings, and motivate and guide quality improvement interventions and reductions in medical errors. The Safety Attitudes Questionnaire – Ambulatory Version was developed for measuring safety culture in the primary care setting. The original version includes six major patient safety factors: Teamwork climate, Safety climate, Job satisfaction, Perceptions of management, Working conditions and Stress recognition. We describe the results of a validation study using the Norwegian translation of the questionnaire in the primary care setting, and present the psychometric properties of this version.

Background: There is universal agreement that higher mortality goes with lower income. Opinions differ on causality: the association may reflect the damaging effect of poverty on health and survival chances. Conversely, it may reflect selection/reverse causation: low income indicates health problems, and from health problems follow a higher risk of dying. Methods: We studied all deaths in Norway (111 504) during the 10-year period 1994–2003 among persons aged 25–66 years in 1993 (2 261 076). For each year, age-standardized mortality rates were calculated for each 1993 income decile for men and women separately. Income was calculated as family size-adjusted income after taxes but including cash welfare transfers. If the selection theory was correct, one would expect to see the excess mortality in the lower income fractiles decline as the bad risks, over-represented among the poorer, died away. Results: Large income decile variations in mortality remained at the end of the 10-year period: after 10 years, the age-standardized mortality rate for men and women was still much higher in the lower income deciles. Conclusion: As the excess mortality in the poorer income deciles was not much reduced during the 10-year period, excess mortality among persons in bad health in the lower income deciles does not explain the income inequality in mortality in our data set.

The early post-discharge period is a vulnerable time for older patients with complex care requirements. This paper identifies factors predicting a self-reported successful post-discharge outcome for patients aged 80 years and over by exploring factors related to the discharge process, the provision of formal home-care services, informal care and characteristics of the patients. The study reports results from survey interviews with patients admitted from home to 14 hospitals in Norway and later discharged home. Logistic regression analysis was performed to assess the impact of a number of factors on the likelihood that the patients would report that they managed well after discharge. The odds of managing well after discharge were more than four times higher (OR=4.75, p=0.022) for patients reporting that someone was present at homecoming than for those who came home to an empty house. Patients who reported receiving adequate help from the municipality had an odds four times (OR=4.18, p=0.006) higher of reporting that everything went well after discharge than those who stated the help was inadequate. Having someone at home upon return from hospital and having adequate formal home-care services are significantly associated with patient-reported success in managing well.

To capture the differences in female and male patients' hospital experiences, this article discusses the gendered nature of 699 free-text comments given in a survey of patient satisfaction at a Norwegian university hospital. The comments were analysed both quantitatively and qualitatively, and the impressions gained through the comments were then to a smaller extent compared with the patients' multiple choice questionnaire ticking. Female responders added free-text comments to their multiple-choice responses more often than male responders did. Male and female patients also drew attention to different aspects of what it was like to be hospitalized, and male and female patients also expressed themselves differently. The voices of the patients were mainly the voices of contextualizing experiences, reflecting differences in male and female patient's experiences and in the meaning the patients attached to their experiences. The rather clear gender differences in our data emphasizes the need for a gender-sensitive approach in the encounters between staff and patients as well as in the design of patient satisfaction research.