Nursing Competence in Norwegian Municipal in-patient Acute Care. Professional Accountability, Environment, and Leadership

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Torunn Kitty Vatnøy of the Faculty of Health and Sport Sciences at the University of Agder has submitted her thesis entitled «Nursing Competence in Norwegian Municipal in-patient Acute Care. Professional Accountability, Environment, and Leadership» and will defend the thesis for the PhD-degree Monday 28 November 2022. 

She has followed the PhD programme at the Faculty of Health and Sport Sciences.

Summary of the thesis by Torunn Kitty Vatnøy:

Nursing Competence in Norwegian Municipal in-patient Acute Care. Professional Accountability, Environment, and Leadership

Changes from the introduction of the Coordination Reform in Norway have induced an increase in the need for highly qualified nursing staff in the primary health care service.

An important initiative of the reform is the municipal in-patient acute care (MipAC) service, which is a 24-hour care or observation health services provide at municipal level.

Different organisation

The MipAC is expected to deliver safe quality care and may entail many patient and societal benefits.

However, the service establishment and organisation differ per municipality, putting the service quality into question.

Older and vulnerable patients constitute the largest group of patients under the MipAC service.

The benefits of well-educated nursing staff to care for vulnerable older people are broadly recognised. However, requirements for nursing competence are sparsely defined in governmental documents, and knowledge of nursing competence in the services is lacking.

Therefore, this PhD project aimed to explore and describe aspects of nursing competence in the MipAC service and answer the question: What is the necessary nursing competence in MipAC, and how is it facilitated, maintained, and enhanced?

Three sub-studies

The project consists of three sub-studies, presented in the three papers included in the thesis.

In Study 1 critical aspects of nursing competence in MipAC were explored through a qualitative research design. The study revealed a need for advanced competence and a professional and supportive environment and leaders (Paper 1).

For sub-studies 2 and 3, a survey, partly based on findings from the first study, was conducted and distributed to first-line managers at all MipAC in Norway.  The purpose of the survey was both to get an overview of the nursing competence in the country's MipAC (Paper 2), and to explore the leadership style of first-line managers and the impact it has on nursing competence in the units (Paper 3).

Study 2, which included 207 MipAC (91,6% of MipAC in Norway), revealed a generally low proportion of registered nurses (RNs) holding advanced competence.

A great variation in nursing competence was also found in which MipAC in long-term units had a lower proportion of RNs in the unit, compared to MipAC in short-term units and in MipAC.

The study also revealed that Northern and Central Norway had a lower proportion of RNs compared to MipAC in South, East and West-Norway.

Study 3 showed that the first-line managers' leadership style was predominantly relational, but that they also showed a high degree of task-oriented leadership style.

We also found a positive correlation between relational leadership style and team culture, while there was no association between leadership style and competence planning in MipAC.

The study also showed that having professional development nurse employed was important for competence planning in the units.

Findings

This PhD study shows the complexity of the nursing service in MipAC. It highlights the implications for nursing competence and focuses the areas that represent a potential for improvement in some of the units.

Sufficient professional nurses and advanced nursing competence in the staff, a supportive environment and management, seem to be important for the competence of the services.

Relational leadership style that supports a team-oriented organizational culture and having a professional development nurse employed to support first-line managers in planning and developing nursing competence also appears to be important.

Disputation facts:

The trial lecture and the public defence will take place in Auditorium C2 040, Campus Grimstad and online via the Zoom conferencing app - registration link below.

Dean, Professor Anders Johan Wickstrøm Andersen, Faculty of Health and Sport Sciences, University of  Agder,  will chair the disputation.

The trial lecture Monday 28 November at 10:15 hours

Public defence Monday 28 November at 12:30 hours

 

Given topic for trial lecture: «Quality of care in municipal health and care services: dilemmas and paradoxes in balancing expectations and capabilities»

Thesis Title: «Nursing Competence in Norwegian Municipal in-patient Acute Care. Professional Accountability, Environment, and Leadership»

Search for the thesis in AURA - Agder University Research Archive, a digital archive of scientific papers, theses and dissertations from the academic staff and students at the University of Agder.

The thesis is available here:

PhD thesis Torunn Kitty Vatnøy 14.06.22

  

The Candidate: Torunn Kitty Vatnøy (1962, Gulen) Nurse from Haukeland sykepleierhøgskole, (Haukeland Nursing College) Bergen (1988) and Intensive Care Nurse from Høgskolen i Agder (Agder University College) (1997). Masters degree in Health Informatics from Høgskolen i Agder (Agder University College) and Aalborg University, Denmark (2005). Work experience as a Nurse, Intensive Care Nurse and Professional development nurse for several years at Alta Infirmery and Sørlandet Hospital. Experience from this work was an important inspiration for the theme in the doctoral work. The doctoral project are tied up to Senter for omsorgsforskning, Sør (Centre for Care Research, South). From 2010 she is working as Associate Professor at the Department of Health and Nursing Sciences, University of Agder.

Opponents:

First opponent: Professor Aud Uhlen Obstfelder, Centre for Care Research, Department of health sciences, Norwegian University of Science and Technology - NTNU in Gjøvik

Second opponent: Senior Researcher / Associate Professor Palle Bager, Department of Clinical Medicine - Hepatology and Gastroenterology, Aarhus University, Denmark

Professor Kristin Haraldstad, Department of Health and Nursing Sciences, Faculty of Health and Sport Sciences, University of  Agder,  is appointed as the administrator for the assessment committee.

Supervisors in the doctoral work were Professor Emerita Bjørg Dale, Department of Health and Nursing Sciences, University of  Agder (main supervisor). Professor Tor-Ivar Karlsen, Department of Psychososial Health, University of Agder and Associate Professor Marianne Sundlisæter Skinner, Centre for Care Research, Department of Health Sciences, Norwegian University of Science and Technology - NTNU in Gjøvik (co-supervisors)

What to do as an online audience member:

The disputation is open to the public, but to follow the trial lecture and the public defence digitally, transmitted via the Zoom conferencing app, you have to register as an audience member on this link:

https://uiano.zoom.us/meeting/register/u5Ypcu6sqTkoE91d31EqDsFoMvhSLR7L9MS9

A Zoom-link will be returned to you. (Here are introductions for how to use Zoom: support.zoom.us if you cannot join by clicking on the link.)

We ask online audience members to join the virtual trial lecture at 10:05 at the earliest and the public defense at 12:20 at the earliest. After these times, you can leave and rejoin the meeting at any time. Further, we ask online audience members to turn off their microphone and camera and keep them turned off throughout the event. You do this at the bottom left of the image when in Zoom. We recommend you use ‘Speaker view’. You select that at the top right corner of the video window when in Zoom.

Opponent ex auditorio:

The chair invites members of the public to pose questions ex auditorio in the introduction to the public defense. Deadline is during the break between the two opponents. The person asking questions should have read the thesis. For online audience the Contact Persons e-mail are available in the chat function during the Public Defense, and questions ex auditorio can be submitted to Eli Margareth Andås on e-mail eli.andas@uia.no.