Publications
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Tarberg, Anett Skorpen; Brenne, Bodil Aarmo; Jeppestøl, Kristin; Søvde, Bente Egge & Staats, Katrine
(2026).
Unclear boundaries: Family caregivers’ invisible role in home-based palliative care in Norway: an exploratory analysis of secondary data from two previous studies.
International Journal of Nursing Studies Advances (IJNS Advances).
10.
doi:
10.1016/j.ijnsa.2026.100559.
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Background
The future need for home-based palliative care is expected to increase significantly. Family caregivers play a crucial role in home settings by ensuring continuity of care, participating in decision-making, and providing both emotional and practical support to their family members. Despite guidelines highlighting the importance of their involvement in providing palliative care at home, inadequate support from healthcare professionals often leaves family caregivers feeling overwhelmed and undervalued.
Objective
This study aimed to explore the pivotal role of family caregivers in home-based palliative care to deepen our understanding of their experiences and challenges as they navigate their undefined roles between healthcare professionals and patients.
Design
This study was a qualitative and explorative secondary analysis of data from two prior studies, guided by Gadamer’s hermeneutical approach.
Settings
All interviews took place in the participants’ homes, except for two in public institutions and two at work locations.
Participants
Twenty-four male and female family caregivers (age range, 30–80 years).
Methods
Using purposive sampling, data were collected through individual interviews with family caregivers. Oncology nurses and cancer co-ordinators facilitated the recruitment of participants. Secondary data analyses were conducted using Gadamer’s hermeneutical circle.
Results
Three main themes were identified. First, being lost in an unclear palliative care pathway where the family caregivers described themselves as “pawns” with an overwhelming burden. Second, feeling invisible in the caregiving role reflected how many family caregivers felt unnoticed despite their crucial contribution to patient care. Their well-being and needs were rarely addressed, leaving them struggling with their own emotions. Third, being assigned unclear responsibilities and tasks beyond capacity. These family caregivers felt overwhelmed by their responsibility for their patients, compounded by insufficient information and dialogue, leaving them uncertain about what to expect. Interpreting their patients’ condition without competent assistance led to feelings of insecurity and unpredictability.
Conclusions
To support family caregivers adequately in their ambiguous role within palliative care, healthcare professionals must foster open dialogue, ensure clear communication, and provide consistent support. Family caregivers often face emotional and practical challenges; therefore, their often invisible contributions should be acknowledged through increased involvement in care planning, structured emotional support, and formal recognition. Systematic approaches with transparent care pathways offering guidance to enable family caregivers to understand and manage their perceived responsibilities must be established. Hence, recognizing the significance of family caregivers’ roles and enhancing their health literacy are critical to improving the well-being of both patients and their families.
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Vatnøy, Torunn Kitty; Karlsen, Tor-Ivar; Skinner, Marianne Sundlisæter & Jeppestøl, Kristin
(2025).
Use of scoring tools in municipal in-patient acute care services – a cross-sectional study.
Sykepleien Forskning.
ISSN 1890-2936.
20.
doi:
10.4220/sykepleienf.2025.99692en.
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Background: The clinical assessment and decision-making skills of registered nurses (RNs) face challenges in the encounter with patients with acute care needs referred to municipal in-patient acute care (MIPAC) services. The goal of these services is to provide care for older patients and those with chronic, complex health challenges. The use of decision-making tools is recommended to ensure high-quality treatment. However, knowledge of their practical application is limited.
Objective: We wished to explore the degree to which nurses at MIPAC services in Norway use scoring tools in their clinical decision-making processes for early identification of deteriorating somatic condition, risk of falls and risk of undernutrition.
Method: Cross-sectional study with a questionnaire distributed to 220 first-line managers in all of Norway’s MIPAC units.
Results: A total of 207 first-line managers (91.6 per cent) were included in the study. Some 57 per cent of the units examined used the Early Warning Score (EWS) systematically to identify deteriorating somatic condition at an early stage while 29 per cent of the units did not use this. The sepsis scoring tool recommended when the data were collected was systematically used in 46 per cent of the units, while 32 per cent did not use a sepsis score. The use of these tools was lowest in units in Central and Northern Norway and in MIPAC services co-located with long-stay care units. The scoring tool for identifying fall risk was systematically used in 45 per cent of the units, and the nutritional risk screening tool in 55 per cent of the units, while 34 per cent and 33 per cent respectively did not use the tools. Having a professional development nurse (often referred to in the literature as ‘clinical nurse educator’) attached to the unit was the most important factor in the use of the Early Warning Score and tools to assess nutritional status.
Conclusion: The study reveals that there is a considerable potential for increased use of scoring tools in MIPAC services in Norway. The results indicate that this can be achieved by strengthening clinical management through employing professional development nurses in the units.
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Vatnøy, Torunn Kitty; Karlsen, Tor-Ivar; Skinner, Marianne Sundlisæter & Jeppestøl, Kristin
(2025).
Bruk av skåringsverktøy ved kommunale akutte døgnplasser – en tverrsnittsstudie.
Sykepleien Forskning.
ISSN 1890-2936.
20.
doi:
10.4220/Sykepleienf.2025.99692.
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Bakgrunn: Sykepleieres kliniske vurderings- og beslutningskompetanse utfordres i møte med pasienter som henvises til kommunale akutte døgnplasser med akutt behov for helsehjelp. Denne tjenesten har som mål å ivareta eldre og pasienter med kroniske, komplekse helseutfordringer. For å sikre høy kvalitet i behandlingen anbefales det å benytte beslutningsstøtteverktøy. Kunnskapen om praktisk anvendelse av disse verktøyene er imidlertid begrenset.
Hensikt: Vi ønsket å undersøke i hvilken grad sykepleiere ved kommunale akutte døgnplasser i Norge benytter skåringsverktøy for tidlig påvisning av forverret somatisk tilstand, fallrisiko og risiko for underernæring i sine kliniske beslutningsprosesser.
Metode: Tverrsnittsstudie med et spørreskjema som ble distribuert til 220 førstelinjeledere i alle landets kommunale akutte døgnplasser.
Resultat: Det var 207 førstelinjeledere (91,6 prosent) som ble inkludert i studien. Av de undersøkte enhetene brukte 57 prosent skåringsverktøy systematisk for tidlig identifisering av forverret somatisk tilstand, Early Warning Score, men 29 prosent av enhetene brukte ikke dette. Verktøy for sepsisskår som var anbefalt da dataene ble samlet inn, ble systematisk brukt i 46 prosent av enhetene, mens 32 prosent ikke brukte sepsisskår. Bruken av disse verktøyene var lavest i enheter som var lokalisert i Midt- og Nord-Norge, samt i kommunale akutte døgnplasser som var organisert sammen med langtidsenheter. Skåringsverktøy for å identifisere fallrisiko ble systematisk brukt i 45 prosent av enhetene og for ernæringsstatus i 55 prosent av enhetene, mens henholdsvis 34 prosent og 33 prosent ikke brukte verktøyene. Det å ha en fagutviklingssykepleier tilknyttet enheten var den viktigste faktoren for om Early Warning Score og verktøy for å vurdere ernæringstilstand ble brukt.
Konklusjon: Studien avslører at det er et betydelig potensial for økt bruk av skåringsverktøy i kommunale akutte døgnplasser i Norge. Resultatene indikerer at dette potensialet kan realiseres ved å styrke den faglige ledelsen ved å ansette fagutviklingssykepleiere i enhetene.
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Staats, Katrine; Jeppestøl, Kristin; Søvde, Bente Egge; Brenne, Bodil Aarmo & Tarberg, Anett Skorpen
(2024).
End-of-life care at home: Dignity of family caregivers.
Nursing Ethics.
ISSN 0969-7330.
doi:
10.1177/09697330241241773.
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Background: Healthcare services are increasingly being shifted to home settings for patients nearing end-of-life. Consequently, the burden on family caregivers is significant. Their vulnerable situation remains poorly understood and there is little information available regarding their experiences of dignity. Aim: This study seeks to understand the experiences of family caregivers related to dignity and loss of dignity, aiming to provide a deeper insight into their situation when caring for a home-dwelling family member nearing end-of-life. Research design and participants: This exploratory study consists of a second analysis combining data from two primary studies, including 24 family caregivers of a family member nearing end-of-life, and is founded upon Gadamer’s philosophical hermeneutics. Ethical considerations: Approval was obtained from the Norwegian Agency for Shared Services in Education and Research and was based on voluntary participation, informed consent, and confidentiality. Results: The following three main themes were identified: Having a meaningful existence within the living environment, being seen and valued as a family caregiver in relation with others and suffering in a space of loneliness. These contextual, relational, and existential perspectives were found to be closely interrelated. Conclusion and final considerations: The dignity of family caregivers was closely tied to being seen as unique individuals, not merely caregivers, thereby requiring healthcare professionals (HCPs) to understand their personal needs. This study highlights the emotional distress and loneliness family caregivers feel in their dual role within the healthcare system, thereby calling for HCPs to adopt an attitude of gentleness and recognition to impart dignity-preserving care in homecare practices.
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Jeppestøl, Kristin; Kirkevold, Marit & Bragstad, Line Kildal
(2023).
Early warning scores and trigger recommendations must be used with care in older home nursing care patients: Results from an observational study.
Nursing Open.
10(7),
p. 4737–4746.
doi:
10.1002/nop2.1724.
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Aims To explore modified early warning scores (MEWSs) and deviating vital signs among older home nursing care patients to determine whether the MEWS trigger recommendations were adhered to in cases of where registered nurses (RNs) suspected acute functional decline. Design Prospective observational study with a descriptive, explorative design. Methods Participants were included from April 2018 to February 2019. Demographic, health-related and clinical data were collected over a 3-month period. Results In all, 135 older patients participated. Median MEWS (n = 444) was 1 (interquartile range (IQR) 1–2). Frequently deviating vital signs were respiratory (88.8%) and heart rate (15.3%). Median habitual MEWS (n = 51) was 1 (IQR 0–1). Deviating vital signs were respiratory (72.5%) and heart rate (19.6%). A significant difference between habitual MEWS and MEWS recorded in cases of suspected functional decline was found (p = 0.002). MEWS' trigger recommendations were adhered to in 68.9% of all MEWS measurements.
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Jeppestøl, Kristin; Vitelli, Valeria; Kirkevold, Marit & Bragstad, Line Kildal
(2021).
Factors Associated With Care Trajectory Following Acute Functional Decline in Older Home Nursing Care Patients: A Prospective Observational Study.
Home Health Care Management & Practice.
ISSN 1084-8223.
34(1),
p. 42–51.
doi:
10.1177/10848223211034774.
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Health policies and previous research highlight the importance of early identification and treatment of clinical deterioration in older patients to prevent frailty, higher levels of care, and mortality. This study explores older home nursing care patients’ care trajectories and factors associated with clinical response (type and level of intervention) from the health care services, final level of community care and death within 3 months after an incidence of acute functional decline. This observational study with a prospective, descriptive design includes a sample of 135 older home nursing care patients with acute functional decline. Demographic, health-related, and clinical characteristics were analyzed and prediction models for care trajectories were fitted using Bayesian generalized mixed models. Age ranged from 65 to 100, with a median age of 85. Hospital admission were registered for 13.33% (T1) and 8.77% (T2) of the participants. Nine patients (6.7%) were transferred to a higher level of community care, and 11 patients (8.1%) died. Frequent transitions between levels of care characterized care trajectories for patients experiencing more severe functional decline. Age, living in a private home, and increased Modified Early Warning Scores (MEWS) were associated with level of clinical responses throughout the care trajectory. Living in a private home was associated with the patients’ final level of community care. Female gender, hospital admission, and increased MEWS scores were associated with death. Health care personnel must be vigilant when MEWS scores rise even slightly, as this might be an indication of acute functional decline with possible increased risk of mortality.
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Jeppestøl, Kristin; Kirkevold, Marit & Bragstad, Line Kildal
(2021).
Assessing acute functional decline in older patients in home nursing care settings using the Modified Early Warning Score: A qualitative study of nurses’ and general practitioners’ experiences.
International Journal of Older People Nursing.
ISSN 1748-3735.
p. 1–11.
doi:
10.1111/opn.12416.
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Aims and objectives: The study describes experiences of registered nurses and general practitioners when using the Modified Early Warning Score (MEWS) to assess acute functional decline in older home nursing care patients. Background: Acute functional decline is common among older home nursing care patients; typically characterised by nonspecific symptoms and a mix of manifestations. Early warning score systems for detecting clinical deterioration have been thoroughly evaluated in hospital settings, but few studies have evaluated these systems used with older people in a community care setting. Methods: A descriptive exploratory research design and a qualitative approach. 36 nurses and eight general practitioners were purposively sampled. Data were collected in seven mixed focus groups and analysed using an inductive thematic content analysis in an iterative process that moved between text, codes, categories and themes. The COREQ checklist was used. Results: Two main themes were developed in the analysis. The first theme derived, was that the MEWS along with medical-technical equipment and clinical judgement, was used to support nurses’ and general practitioners’ clinical decisions in assessing older deteriorating patients. The second theme referred to nurses’ and general practitioners’ experiences with several adjustments when using the MEWS with the older patient group and in complying with its trigger recommendations. Conclusion: The use of the MEWS when assessing older patients in home nursing care is potentially useful in supporting clinical reasoning. However, the tool's usefulness is limited because it is not experienced as sufficiently adapted to neither the home nursing care services nor to older patients. Implications for practice: This study increases our knowledge of how the MEWS tool is used in a community care setting and highlights the importance of adjustment of assessment procedures for older persons with acute functional decline.
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Fossum, Mariann; Dalsmo, Ingrid Espegren; Kirkevold, Marit; Jeppestøl, Kristin & Strøm, Benedicte Sørensen
(2026).
Universitetssykehjem kan bli nøkkelen til en styrket eldreomsorg under press.
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KRONIKK: Vi blir flere eldre og omsorgstrengende samtidig med at vi blir færre sykepleiere, helsefagarbeidere og annet helsepersonell. Spørsmålet er derfor hvordan kan vi sikre sårbare eldre gode tjenester også i fremtiden?
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Vatnøy, Torunn Kitty & Jeppestøl, Kristin
(2025).
Ny studie om akutt syke i kommunen: – Livsviktige skåringsverktøy blir altfor lite brukt.
[Journal].
Sykepleien .
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Det finnes livsviktige verktøy helsepersonell på kommunale institusjoner kan bruke, men altfor få bruker dem, advarer forsker.
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Jeppestøl, Kristin
(2023).
Kliniske vurderinger og beslutninger ved akutt funksjonssvikt i hjemmesykepleien- en utfordrende oppgave for sykepleiere og legetjeneste.
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Jeppestøl, Kristin
(2023).
Acute functional decline in older home nursing care patients-
Using the Modified Early Warning Score
to support clinical reasoning and decision-making
in community care. A mixed methods study.
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Jeppestøl, Kristin
(2023).
Forskningsarbeid i Østre Agder - Status i ulike prosjekter med vekt på skrøpelige eldre.
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Jeppestøl, Kristin
(2023).
Tverrsektorielt samarbeid når eldre personer krysser grensene mellom kommunehelsetjenesten og sykehus.
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Tarberg, Anett Skorpen; Alnes, Rigmor Grete Einang; Jeppestøl, Kristin; Flem, Elin Sandnes; Saga, Susan & Andfossen, Nina Beate
(2023).
Kommunane bør sikre seg spesialistane i allmennsjukepleie.
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Tarberg, Anett Skorpen; Alnes, Rigmor Grete Einang; Jeppestøl, Kristin; Flem, Elin Sandnes; Saga, Susan & Andfossen, Nina Beate
(2023).
Framoverlente kommunar sikrar seg spesialistar i allmennsjukepleie.
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Jeppestøl, Kristin; Staats, Katrine; Søvde, Bente Egge; Tarberg, Anett Skorpen & Brenne, Bodil Aarmo
(2023).
Av og til helbrede, ofte lindre – alltid trøste Helsepersonell gjør hver dag vurderinger og tar beslutninger i situasjoner knyttet til pasienter med komplekse og ustabile helsetilstander.
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I denne kronikken belyses utfordringer for leger og sykepleiere i sykehjem, som hver dag vurderer og tar beslutninger i ulike situasjoner knyttet til pasienter med komplekse- og ustabile helsetilstander. Her kan grensen mellom aktiv kurativ behandling og lindrende behandling være utfordrende å definere.
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Tarberg, Anett Skorpen; Alnes, Rigmor Grete Einang; Jeppestøl, Kristin; Flem, Elin Sandnes; Saga, Susan & Andfossen, Nina Beate
(2023).
Kommunar bør sikre seg spesialistane i allmennsjukepleie.
Universitetsavisa.
ISSN 0807-5271.
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Tarberg, Anett Skorpen; Alnes, Rigmor Grete Einang; Jeppestøl, Kristin; Flem, Elin Sandnes; Saga, Susan & Andfossen, Nina Beate
(2023).
Kommunar bør sikre seg spesialistar i allmennsjukepleie.
Tidsskriftet sykepleien.
ISSN 0806-7511.
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Jeppestøl, Kristin
(2022).
Bruk av beslutningsstøtteverktøy hos ledere pasienter i hjemmesykepleien ved akutt funksjonssvikt- resultater fra doktorgradsprosjektet i Østre Agder.
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Hollister, Brooke Ann; Jeppestøl, Kristin; Berg-Utby, Camilla; Abildsnes, Eirik & Hernes, Susanne M S
(2025).
ICOPE-n: Kartlegging av iboende kapasitet.
Senter for omsorgsforskning.
doi:
https:/www.uia.no/om-uia/senter-og-nettverk/sof/forskning/oversetting-og-pilotering-av-icope-i-agder.html.
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I prosjektets første del ønsket vi å utarbeide en norsk versjon av ICOPE gjennom å oversette og tilbakeoversette opprinnelig versjon. Et utkast til norsk versjon er nå utarbeidet (pdf). Dette arbeidet er gjennomført av en tverrfaglig og bredt sammensatt gruppe bestående av: Brooke Hollister, Susanne S. Hernes, Eirik Abildsnes, Camilla Berg-Utby, Bjørnulf Arntsen, Kristin Jeppestøl, Toske-Jan Lindenburger, Lucia Lezeeu Sjaavaag, Olga Espegren, Mikkel Peter Høiberg, Isabel Sebjørnsen, Geir Vegar Berg og Jill-Marit Moholt. Utkastet vil bli tilpasset etter eventuelle tilbakemeldinger fra pilotstudier. Den endelige versjonen av ICOPE-n er publisert og tilgjengelig for bruk. Ved ønske om å ta i bruk ICOPE-n til forskning, ta kontakt med Brooke Hollister. I prosjektets andre del (ViCOPE) ønsker vi å gjennomføre en pilotering av ICOPE-n i Agder.
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Tingvold, Laila; Blix, Bodil Hansen; Fagertun, Anette; Førland, Oddvar; Hollister, Brooke Ann & Hufthammer, Karl Ove
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(2024).
Kartlegging av erfaringer med, og bruken av tildelingskontor i norske kommuner.
Senter for omsorgsforskning.
ISSN 9788283401493.
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Dette oppdraget fra Helsedirektoratet har til hensikt å kartlegge erfaringer med og bruken av tildelingskontor i norske kommuner. Vi vil gjennom oppdraget fremskaffe ny kunnskap om tildelingsprosesser knyttet til helse- og omsorgstjenester. Vår overordnede problemstilling har vært: Hvilke ulike organisatoriske modeller for tildeling av kommunale helse- og omsorgstjenester kan identifiseres, og hvilke logikker og praksiser skiller de ulike modellene fra hverandre? På hvilke måter former de ulike modellene arbeidsmåter som fremmer eller hemmer det å skape trygge, sammenhengende og likeverdige tjenester?
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Published
Apr. 16, 2024 11:30 AM
