This PhD study shows the complexity of the nursing service in MipAC (municipal in-patient acute care). It highlights the implications for nursing competence and focuses the areas that represent a potential for improvement in some of the units.
Torunn Kitty Vatnøy
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.
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.
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?
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.
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.
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.
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 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.
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)
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:
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