The findings have implications for the planning of care and indicate that further research is required to improve assessment, treatment and follow-up procedures. Adequate pain treatment seems still to be a challenge. Anorexia, fatigue as well as dyspnoea are all symptoms that need further focus.
Comprehensive palliative care programs are often implemented on a community level, and to evaluate such interventions, randomization by cluster (community) may be the only feasible method. In trials randomizing individual subjects, the importance of proper concealment has been stressed. In cluster randomized trials, however, concealment of individual patient allocation is often impossible. The following risk of selection bias has been given little attention. In the present study, comparing palliative care to conventional care, community health care districts were defined as clusters and randomized. The patients' treatment assignment was determined by the allocation of the cluster in which they resided, and hence predictable by their address. A biased selection based on practical considerations related to patients' diagnoses and hospital departments was suspected. To explore this, cancer diagnoses were grouped according to local tradition for sharing of treatment responsibility among hospital departments. A significant difference between trial arms in distribution of these groups was revealed and strongly supported our suspicion. The finding carries an important message to future researchers: when using cluster randomization, any evidence of selection bias should be carefully checked and reported.
The national clinical final examination (NCFE) plays an important role in order to measure the level of knowledge and performance of nursing students. Our findings indicate that the design of the NCFE is beneficial for the students' clinical reasoning and problem solution in the caring situation. The aim of this study was to investigate the experiences of the NCFE from lecturers who corrected the written part examination. A further aim was to study the lectures and the RN during observation in the bedside part of the examination. The NCFE is divided into two parts: a theoretical (written) part and a practical (bedside) part. In nursing education it is essential to assess nursing competencies for the future professional role such as the assessment of clinical competence that has become central to evaluate what outcomes are assessed. In addition, it provides a valuable approach to measure the level of knowledge and performance of nursing students. Future development of the NCFE is necessary regarding the degree to which the examination meets learning objectives and educational results.
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