Background: Unlike in developed countries, the clinical effectiveness of diabetes self-management education (DSME) is not well-studied in the African context. Thus, this study sought to determine effects of DSME on clinical outcomes among type 2 diabetic (T2DM) patients in Ethiopia.Methods: Before-and-after controlled study design was employed, with random assignment of 116 T2DM adult patients to a nurse-led DSME group and 104 to a treatment-as-usual (comparison) group. A nurse-led DSME with six sessions supported with illustrative pictures handbooks and fliers was customized to local conditions and delivered by trained nurses over 9 months. Our primary outcome was a change in the proportion of people with target glycated hemoglobin (HbA1c ≤ 7%). We used chi-square test and mixed model analysis.Results: Seventy-eight (67%) and 64 (62%) participants assigned to intervention and comparison, respectively completed the study, and included in the final analysis. Mean HbA1c was significantly reduced by 2.88% within the intervention group and by 2.57% within the comparison group. However, change in the proportion of participants with target HbA1c and end-line mean HbA1c difference between the groups were not significant. Adjusted end-line fasting blood sugar (FBS), systolic blood pressure (SBP), and diastolic blood pressure (DBP) were significantly lower in the intervention group, by 27 ± 9 mg/dL, 12 ± 3, and 8 ± 2 mmHg, respectively.Conclusion: After 9 months of nurse-led DSME, HbA1c was significantly reduced within both groups but there was no significant difference in HbA1c between groups. The intervention also showed some clinically significant effects on blood pressure and FBS.Clinical Trial Registration: ClinicalTrials.gov Identifier: NCT03185689, retrospectively registered on June 14, 2017 on ClinicalTrials.gov. https://clinicaltrials.gov/ct2/show/NCT03185689.

Background The preparedness of newly graduated registered nurses for a demanding work environment and care practices takes form during nursing education. Norwegian nursing education at one university has implemented a selection of basic physical assessment skills (B-PAS) in the nursing curriculum in order to prepare nursing students for a demanding work environment post-graduation. Methods A mixed-method cohort design. We evaluated nursing students’ self-reported use of B-PAS during their clinical rotation using the “Survey of Examination Techniques Performed by Nurses” questionnaire (30 items). In addition, two focus group interviews elicited factors that hinder or facilitate the actual use of B-PAS during clinical rotation. We recruited students from a bachelor’s degree programme for nursing at a Norwegian university. Three hundred and sixty-three of 453 eligible nursing students in the first, second, and third year of the bachelor’s degree programme participated in the study (80%). Results ANOVA showed a significant progression ( p < 0.016) in students’ self-reported use of B-PAS. Auscultation and percussion skills were graded below the median score of 3, which indicates that these skills were less used throughout the programme. The nursing students highlighted contextual factors for their use of B-PAS when in clinical rotation. Preceptors are important gatekeepers for successful implementation, and there is a need for close collaboration between the university and clinical practice. Conclusion Despite the reduced PAS taught in the curricula, there is still a lack of application of such skills in clinical rotations. This study highlights that research should explore how different work environments influence the utilisation of learned skills, and which learning strategies are appropriate or most successful for stimulating clinical reasoning and the extensive use of physical assessment.

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Background Introducing welfare technology in home-based palliative care has been suggested to be beneficial for improving access to health care at home and enhancing patients’ feelings of security and safety. However, little is known about the experiences of municipal health-care professionals using welfare technology in palliative home care. The aim of this study was to explore municipal health-care professionals’ experiences regarding the significant challenges, facilitators, and assessments associated with implementing a technological solution named “remote home care” in palliative home care for patients with cancer. Methods A qualitative, descriptive, exploratory design was used. Data were collected through focus-group interviews and individual semi-structured interviews with interdisciplinary health-care professionals who had experience using remote home care in clinical encounters with cancer patients who were in the palliative phase and living at home. Data were analyzed using qualitative content analysis. Results Three themes were identified: 1) shifting from objective measures to assessing priorities for patients, 2) lack of experience and personal distress regarding cancer inhibits professional care, and 3) prominent organizational challenges undermine the premise of remote home care. Conclusion The results showed that shifting from a disease-focused to a person-centered approach enables health-care professionals to assess patients’ personal priorities. However, health-care professionals’ uncertainty and lack of knowledge and experience, along with organizational issues concerning information-sharing, represent great challenges that have the potential to inhibit professional care. The availability of networks through which difficult issues can be discussed was highlighted as being a fundamental resource for facilitating the provision of care.

Purpose -The aim of the paper is to explore how multiple modes of knowledge play out in the consolidation of nursing procedures in construction of "local universality". The paper seeks to explore processes where nurses negotiate universal procedures that are to become local standards in a hospital. Design/methodology/approach -The paper is based on a case study design. Working group sessions, where the activity was to consolidate different versions of nursing procedures were observed and videotaped. For this paper, transcribed videotaped observations, where tension-laden situations were identified, are subject to interaction analysis. Findings -In the negotiations to construct standards, multiple modes of knowledge play out; personal experience, collective expertise and formalized knowledge. The paper demonstrates the contributions these modes of knowledge make in a process of standardization. This shows that standards, as such, do not stay universal for very long, but are constructed as "local universalities". Research limitations/implications -The study elaborates on discursive negotiations of procedures to illustrate how local universality plays out in processes to constitute standards. It is a limitation because how the local universality plays out in clinical work, or make claims about practice transformation, cannot be described. Originality/value -The paper shows the necessity of confronting standardized procedures through multiple modes of knowledge. The paper exemplifies productive interactions in the construction of local universality, and how professionals account for practice when facing formal and standardized procedures.

Background As many students in higher education are skilled users of mobile technology, mobile learning (mLearning) can be a promising educational strategy to enhance their learning experience. mLearning might also be well suited for nursing students as they navigate between multiple learning contexts in their educational curriculum. As an educational strategy, mLearning may also reduce challenges caused by the theory-practice gap in nursing by supporting skills and knowledge transfer between the university and clinical settings. As the introduction of basic physical assessment skills (B-PASs) into Norwegian bachelor’s degree education in nursing occurred quite recently, there is a lack of competence in supervision and teaching in both university and clinical settings. As such, mLearning appears to be a good strategy to support student B-PAS learning and knowledge transfer across learning contexts. Objective This study aims to explore and elicit the perspectives of students regarding the way in which a selection of digital learning resources supports B-PAS learning and application in clinical rotation, which of the selected digital learning resources are beneficial to include in a suite of mLearning tools, and how the selected digital learning resources could support the transfer of skills and knowledge from the academic to clinical context. Methods We used a longitudinal participatory design approach to co-design a suite of mLearning tools. The co-design processes took place in several workshops (WSs) over a period of 3 months: 2 WSs with first-year students (n=6), 3 WSs with second-year students (n=6), and 3 WSs with third-year students (n=8). The students evaluated several digital learning resources in both academic and clinical contexts. The digital learning resources included digital simulation with virtual patients, massive open online courses, and multimedia learning material. In the co-design WS, the potential and benefits of these digital learning resources for the learning and application of B-PASs were explored. Results The students reported that the digital learning resources stimulated learning in 7 different ways. They also emphasized the importance of including all selected and tested digital learning resources. Moreover, students supported the inclusion of additional learning material, such as multiple-choice tests and written assignments, aimed at providing feedback and contributing to knowledge development. Conclusions The co-design processes and collaboration with the nursing students provided insight into how a suite of mLearning tools may support the learning and application of B-PASs and human bioscience knowledge in clinical rotation. From the students’ perspective, one of the strengths of the suite of mLearning tools was the range of content, as this met a broader range of student learning preferences regarding learning B-PASs. The suite of mLearning tools contributes to and supports skills training and knowledge transfer between multiple learning contexts.

Objective Globally, the number of digital health solutions is increasing, but they are not always designed with access and utilisation for people with impairments in mind. Development efforts have often not included the voice and requirements of people with impairments, who make up 15% of the world’s population, despite the fact that this can help ensure broad access and utilisation. Little attention to and limited inclusion of people with impairments in the development of digital health solutions results in continued and reinforced inequalities in health services provision for people with impairments. This review investigates the needs and barriers of people with impairments related to use of digital health solutions and strategies to foster user participation, access and utilisation of digital health solutions. Methods This scoping review, based on the Joanna Briggs Institute Manual, had five phases: 1) identification of aim and research questions, 2) literature search in five databases (April/May 2020), 3) literature screening based on predetermined inclusion and exclusion criteria, 4) data extraction, and (5) reporting results. Results The literature search resulted in 5968 sources, of which 25 met our inclusion criteria. People with impairments appreciate digital health solutions that are designed to meet their specific impairment-related challenges. The reported needs and barriers related to technological design varied depending on the individuals’ challenges. The literature reported different types of participatory co-design strategies to foster access and utilisation of digital health solutions. Conclusion This scoping review support needs for increased awareness among developers to design solutions that meet people’s needs, contexts and states of health. By applying universal design as a strategy and including people with different types of impairments, starting in the idea creation phase of digital health solutions and throughout the development, developers can design solutions with better accessibility. Digital health solutions that are accessible and usable have a tremendous opportunity to foster health equity and achieve health promotion, prevention and self-care. This in turn can contribute to closing the gap between different population groups, reduce disparities and get the most from available healthcare services.

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