Liv Fegran

Professor Emerita Faculty of Health and Sport Sciences

Email: liv.fegran@uia.no
Phone: +47 38 14 18 94
Mobile phone: +47 99 24 88 32
Office: I2085 (Universitetsveien 25, 4630 Kristiansand, Norway)

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Areas of responsibility

Fegran is a Registered Nurse and hold a MScN and PhD in Nursing Science. In addition to her position at the University of Agder, she has a part time position as research supervisor at the Children’s’ Department at Sørlandet Hospital.

Teaching

Qualitative research methods and systematic reviews on the faculty's masterprograms (ME-427, ME-429 og HSI-413) og Systematic Reviews and Evidence Synthesis on the PhD program in Health Sciences (ME-617).

Research

Fegran is a member of the research group Health and Quality of Life in a Family Perspective (HEIFA) at the Faculty of Health and Sport Sciences. Ongoing research projects are focused on pediatric palliative care, neglect, pain, sleep, psychosocial health and quality of life in children and adolescents, as well as sexual health in cancer survivors from patient, family member, and nursing perspectives. Additionally, she participates in the research group Patient Transfer and Transition (PRANSIT) with collaborators from Denmark and Sweden. PRANSIT focuses on systematic litterature reviews of patient transfers for different groups and in different contexts, within a Transitions Theories perspective. Methodological expertise primarily lies in qualitative research, systematic reviews, feasibility and intervention studies, and several projects incorporate technological solutions (e-health) as a central component.

Research groups

HEIFA - HEalth and quality of life In a Family perspective

Håkstad, Katrine; Hovden, Ewa Alicja Szyszko; Wigen, Tove Irene; Fegran, Liv & Köpp, Unni Mette Stamnes (2026). How physical and sexual abuse impacts oral health: a cross-sectional study from a Norwegian Children’s House. BMC Oral Health. 26. doi: 10.1186/s12903-026-09143-3. Full text in Research Archive Show summary
Although the association between neglect and an increased risk of oral disease is well established, the independent association between physical or sexual abuse and oral health has been less extensively studied. This study explored oral health condition in children suspected of being exposed to physical or sexual abuse by examining the association between abuse type and caries experience and gingival condition. It also assessed whether these associations were modified by age, sex, and ethnicity. This cross-sectional study involved 328 children, aged 1–18 years, who underwent clinical forensic dental examinations at a Norwegian Children’s House (NCH) from 2017 to 2021 (n = 328) due to suspected physical or sexual abuse. Data were collected from forensic dental and medical records at the NCH and included data from extra- and intra-oral examinations accompanied by conversations with the children. Negative binomial and logistic regression were performed for unadjusted, adjusted, and stratified analyses. Data are presented as ratios of means (RMs) and odds ratios (ORs), with 95% confidence intervals (CIs). Sexually abused children had a higher mean number of decayed teeth (DT) (RM 1.99, 95%CI 0.99–4.02) compared with physically abused children. They also more frequently received toothbrushing assistance. When stratifying by sex and ethnicity, the results revealed that sexually abused males had a higher mean number of DT compared with physically abused males (RM 4.23, 95%CI 1.37–13.12). A similar association was observed in sexually abused Ethnic Norwegian children (RM 3.53, 95%CI 1.60–7.82). Gingival condition varied by age. Sexually abused children exhibited better gingival condition before the age of four compared with their physically abused peers, but these conditions deteriorated after the age of thirteen, where the results showed an opposite association. The findings indicated that oral health condition varied according to abuse type, with poorer oral health conditions among sexually abused children than those physically abused. These results, underscore the crucial role of forensic and dental professionals in identifying oral health conditions that may signal possible abuse.
Sjuls, Marianne; Ludvigsen, Mette Spliid; Fegran, Liv & Robstad, Anja Nastasja (2026). Beyond standard care: Fathers’ perspectives on healthcare and related support services when caring for a child with a progressive life-limiting condition—A qualitative study. Palliative Medicine. ISSN 0269-2163. doi: https:/journals.sagepub.com/doi/10.1177/02692163261486220. Full text in Research Archive Show summary
Background: Fathers’ experiences are seldom reflected in paediatric palliative care research, and existing studies predominantly focus on malignant conditions. Less is known about fathers’ experiences with healthcare and related support services when caring for a child with a progressive life-limiting condition. These conditions are often marked by long and unpredictable trajectories and complex care needs. Aim: To gain an in-depth understanding of how fathers experience healthcare and related support services while caring for a child with a progressive life-limiting condition. Design: A qualitative interview study grounded in phenomenological hermeneutics. Setting/participants: Thirteen Norwegian fathers of children aged 1–18 years with a progressive life-limiting condition lasting ≥ 12 months. All children lived at home and received varying levels of respite or in-home care. Results: Through the analysis, we developed three themes: 1) Being David against Goliath—battling the system, 2) Being father to a child too complex for tick-box care and 3) Striving for equal recognition as caregivers. Conclusions: Fathers caring for a child with a progressive life-limiting condition experience fragmented healthcare and welfare services, which place substantial advocacy and coordination burdens on families. More flexible, coordinated and father-inclusive paediatric palliative care pathways are needed to recognise parental expertise and support both parents as equal caregivers.
Håkstad, Katrine; Hovden, Ewa Alicja Szyszko; Wigen, Tove Irene; Fegran, Liv & Köpp, Unni Mette Stamnes (2026). Mapping orofacial signs of child abuse in children referred to a Norwegian Children's House. Child Abuse & Neglect. ISSN 0145-2134. 178. doi: 10.1016/j.chiabu.2026.108167. Full text in Research Archive Show summary
Background Child physical and sexual abuse frequently involves the orofacial region, yet comprehensive forensic mapping of both traumatic and nontraumatic orofacial signs in children referred due to suspected abuse remains limited. Objective To comprehensively map extraoral and intraoral signs in children referred for forensic dental examination due to suspected physical or sexual abuse, describing injury types, anatomical distribution, and nontraumatic oral health findings across abuse types. Methods This retrospective cross-sectional study included 362 children aged 1–18 years referred to a Norwegian Children's House, an interdisciplinary forensic assessment center for children, between 2017 and 2021. Extraoral signs were identified through combined forensic dental and medical records, while intraoral signs were identified through dental examinations. Orofacial signs were classified as traumatic injuries or non-traumatic findings. Analyses were conducted at both case level (presence/absence) and the injury count level (number and anatomical distribution of injuries), stratified by suspected abuse type. Results Intraoral signs were identified in 76.1% of the children, and 45.6% had extraoral signs. Most children were aged 6–11 years (56.1%). Extraoral injuries were more common among children with suspected sexual abuse (40.7%) than among those with suspected physical abuse (34.4%), whereas intraoral injuries were similar (≈19%). Dental trauma accounted for nearly three-quarters of all intraoral injuries and was more frequent among physically abused children. Nontraumatic intraoral findings were common in both groups (∼63%), with poor oral hygiene and untreated caries occurring more often in the physical abuse group. Stress-related findings, such as tooth wear and headache, were slightly more common among children with suspected sexual abuse. Conclusions Children referred for forensic evaluation due to suspected abuse frequently presented with traumatic and nontraumatic orofacial signs. The integration of forensic dental and medical examinations strengthens the identification of head and neck injuries and highlights the pivotal role of dental professionals in multidisciplinary child protection.
Sjuls, Marianne; Fegran, Liv; Ludvigsen, Mette Spliid & Robstad, Anja Nastasja (2025). Fathering a Child With a Progressive Life-Limiting Condition in the Context of Pediatric Palliative Care: A Qualitative Interview Study. Qualitative Health Research. ISSN 1049-7323. doi: https:/journals.sagepub.com/doi/10.1177/10497323251398383. Full text in Research Archive Show summary
Fathers report feeling sidelined and being treated as secondary parents in healthcare settings. Despite their vital caregiving contributions, fathers remain underrepresented in pediatric palliative care research, particularly outside oncological contexts. This qualitative study, using a phenomenological hermeneutical design, explores the lived experiences of Norwegian fathers raising children with progressive life-limiting conditions. Thirteen fathers of children aged 1–18 years participated in in-depth, semi-structured interviews conducted online or in person. All children had received a diagnosis at least 12 months prior, lived at home, and received varying levels of care support. The analysis followed a modified version of Ricoeur’s interpretation theory, as described by Lindseth and Norberg in their three-step phenomenological hermeneutical method, and revealed four themes: (1) “Balancing between grief and relief,” where fathers described emotional ambivalence during the diagnostic phase; (2) “Searching for stability in an unpredictable life,” where fathers often turned to information and peer support to manage uncertainty; (3) “Feeling homebound yet making space for life,” where many felt confined to the home but made deliberate efforts to create meaningful experiences for their children and themselves; and (4) “Juggling between being a dad, caregiver, and breadwinner,” where fathers navigated complex and often conflicting roles. The findings highlight the emotional and practical challenges fathers face and underscore the importance of recognizing their unique support needs. Proactive involvement in care planning, access to pediatric palliative care services, peer networks, and respite opportunities are essential not only for the child’s well-being but also to sustain fathers’ caregiving capacity.
Ludvigsen, Mette Spliid & Fegran, Liv (2025). Med Meleis på en ungeklinik. In Martinsen, Bente; Dreyer, Pia & Norlyk, Annelise (Ed.), Sygeplejens superhelte: Sygeplejeteoretikere der styrker klinisk praksis (2. udg.). Munksgaard Forlag. ISSN 9788702434279. Full text in Research Archive
Paulsen, Anita; Fegran, Liv; Hagen, Milada & Vistad, Ingvild (2025). Self-reported Sexual Health-Related Outcomes in Gynecological Cancer Survivors: Results from a Quasi-experimental Multicenter Intervention Study on Follow-up after Gynecological Cancer Treatment. Cancer Nursing. ISSN 0162-220X. doi: 10.1097/NCC.0000000000001493. Full text in Research Archive Show summary
Background: Gynecological cancer survivors often face sexual health challenges posttreatment, making interventions to address these issues essential. Objective: The aim of this study was to investigate changes in sexual health–related outcomes among gynecological cancer survivors comparing 2 different follow-up models. Methods: This preplanned substudy utilized data from the Lifestyle and Empowerment Techniques in Survivorship of Gynecologic Oncology study. Participants were assigned to either the intervention or control group based on their treatment hospital. The control group received standard follow-up care, whereas the intervention group received shared follow-up care with sexual health communication. Analyses included 686 participants with sexual activity as the primary outcome. Secondary outcomes included feelings of reduced physical attractiveness for all, sexual enjoyment and vaginal dryness (sexually active participants), and reasons for sexual inactivity (sexually inactive participants). Assessments were conducted at the end of treatment and at 6 and 12 months posttreatment. Results: No statistically significant group differences were found in any of the outcomes at 12 months. The intervention group showed a more favorable trend in sexual activity at 6 months, not sustained at 12 months. Both groups experienced an increase in vaginal dryness. The absence of a partner was the most common reason for sexual inactivity. Conclusions: Findings suggest that nurse-led sexual health communication during routine follow-up consultations may have a limited impact on the sexual health–related outcomes measured in this study. Implications for Practice: More intensive and individualized interventions may be necessary for significant improvements in the outcomes of this study.
Marthinsen, Gunhild Nordbø; Helseth, Sølvi; Småstuen, Milada Cvancarova; Bjorvatn, Bjørn & Fegran, Liv (2024). A comparison of sleep, insomnia and health‑related quality of life between mothers and fathers of preterm versus full‑born infants: a longitudinal study from Norway. Sleep Science and Practice (SSP). 8. doi: 10.1186/s41606-024-00103-w. Full text in Research Archive Show summary
Background Poor sleep may negatively affect parents’ health-related quality of life (HRQoL). This longitudinal study aimed to describe and compare sleep, insomnia and HRQoL in mothers and fathers of preterm and full-born infants, and to assess possible associations between sleep, insomnia, and HRQoL from birth up to 12 months in the total sample. Methods A longitudinal study of parents of preterm (n = 25 couples) and full-born (n = 76 couples) infants was conducted. To assess sleep, parents wore wrist actigraphs and filled out sleep diaries for 2 consecutive weeks before responding to a digital questionnaire regarding insomnia symptoms and HRQoL. Actigraphy and sleep diary data were collected at the infant age of 2 months, while questionnaire data on insomnia and HRQoL were collected at the infant ages of 2, 6, and 12 months. Statistical analyses included linear regression and linear mixed models for repeated measures. Results There were no statistically significant differences in total sleep time (actigraphy and sleep diary) between the parent groups (preterm and full-born) at 2 months postpartum. Sleep efficiency was significantly higher for the full-born group. All mothers reported significantly shorter total sleep time and lower sleep efficiency compared to fathers (all p < 0.01). In the whole sample, insomnia incidence at 2 months postpartum was high (> 43.5%), and for mothers, it remained high at 6 and 12 months (> 50%). No significant HRQoL differences were identified between the parent groups over time. Fathers in both groups reported significantly higher physical HRQoL levels compared to mothers (p = 0.04). There were no significant associations between total sleep time or sleep efficiency and HRQoL at 2 months postpartum. Insomnia symptoms were associated with reduced mental and physical HRQoL at all measurement points. Conclusions Sleep efficiency (actigraphy and sleep diary) was significantly higher for the full-born group compared to the preterm group. Mothers (both groups) experienced significantly shorter total sleep time and lower sleep efficiency compared to fathers. The incidences of insomnia symptoms were high at 2 months postpartum for the whole sample and remained high at follow-up for mothers. Fathers (both groups) reported higher physical HRQoL compared to mothers. Insomnia symptoms had a significantly negative impact on parents’ long-term HRQoL.
Robstad, Anja Nastasja & Fegran, Liv (2024). The lived experiences of patients with severe obesity during hospital admissions in Norway: A phenomenological hermeneutic study. Journal of Advanced Nursing. ISSN 0309-2402. 80(11), p. 4665–4675. doi: 10.1111/jan.16109. Full text in Research Archive
Westergren, Per Christer Thomas; Aagaard, Hanne; Hall, Elisabeth O.C.; Ludvigsen, Mette Spliid; Fegran, Liv & Robstad, Anja Nastasja [Show all 7 contributors for this article] (2024). Physical Activity Enforces Well-being or Shame in Children and Adolescents With Asthma: A Meta-ethnography. INQUIRY (INQ). ISSN 0046-9580. 61, p. 1–11. doi: 10.1177/00469580241290086. Full text in Research Archive Show summary
Asthma symptoms and experiences of dyspnea challenge participation in physical activity (PA). Therefore, in-depth understanding of experiences with PA is essential. In this meta-ethnography, we synthesized published qualitative studies of experiences of children and adolescents with asthma that influenced, or limited, participation in PA. We followed Noblit and Hare’s 7 phases of meta-ethnography. We searched relevant databases by December 18, 2023 for published peer-reviewed studies (Medline (OVID), Embase (OVID), PsycINFO (OVID), CINAHL (EBSCHOhost), SPORTDiscus (EBSCHOhost), SocINDEX (EBSCHOhost), and Social Science Citation Index (WoS)) and theses (ProQuest Nursing & Allied Health Source, ProQuest Healthcare Administration Database, and ProQuest Public Health Database). We conducted study selection and assessment of methodological quality and data extraction using Joanna Briggs Institute’s methodology. Sixteen reciprocally related qualitative studies, representing experiences of 238 children and adolescents aged 4 to 18 years were included. We translated primary study concepts and findings into 3 themes covering relationships with others, emotions, and behaviors related to PA participation: (1) feeling related to and connected with friends and family in PA; (2) acquiring and managing new PA and asthma skills; and (3) enjoying PA and experiencing well-being. We also defined 3 themes covering aspects related to PA limitations: (4) feeling misunderstood and penalized in relation to PA; (5) experiencing nervousness, embarrassment, shame, and sadness during PA; and (6) withdrawing from PA due to asthma, environment, and/or socially imposed attitudes. The themes were synthesized into the following lines of argument: children and adolescents with asthma experience that PA enforces empathic/non-empathic relationships, vulnerability, and awareness; PA enhances resilient participation and well-being, or reinforces resignment to isolation and shame. From the outset of either relatedness or being penalized, youngsters with asthma either manage well and experience well-being, or experience shame and withdrawal.
Stea, Tonje Holte; Bertelsen, Thomas Bjerregaard; Fegran, Liv; Sejersted, Ellen; Kleppang, Annette Løvheim & Fyhn, Tonje (2024). Interventions targeting young people not in employment, education or training (NEET) for increased likelihood of return to school or employment—A systematic review. PLOS ONE. 19(6). doi: 10.1371/journal.pone.0306285. Full text in Research Archive Show summary
The present systematic review aims to identify, synthesize, and evaluate evidence of effects from interventions targeting youth not in education, employment, or training (NEET). We searched relevant multidisciplinary databases to identify randomized controlled trials (RCTs) and quasi-randomized re-engagement trials. Primary outcomes were participation in education and employment, and training status. Secondary outcomes included changes in financial status, quality of life and well-being, social functioning, and physical, psychological, and behavioral outcomes. The Joanna Briggs Institute methodology and PRISMA guidelines were applied. Eligible studies were screened, included, and extracted for data. Nine trials were included (eight RCTs and one quasi-experimental study), in which samples ranged from 96 to 7346 participants. Results on primary outcomes showed that five studies found an effect of interventions on employment outcomes, while three studies indicated an effect on education or training. Results on secondary outcomes included effects on mental health, subjective health complaints, drug use, self-esteem, and self-efficacy. Studies with other main outcomes than re-engagement showed an effect of interventions on pass rates for the driving test, independent housing, and increased job-seeking activities. Limitations and future directions are discussed, including the lack of rigorous studies, theoretical underpinnings, and standardized measures for re-engagement outcomes.
Paulsen, Anita; Vistad, Ingvild & Fegran, Liv (2023). Nurse–patient sexual health communication in gynaecological cancer follow-up: A qualitative study from nurses' perspectives. Journal of Advanced Nursing. ISSN 0309-2402. 79(12). doi: 10.1111/jan.15755. Full text in Research Archive Show summary
Aim To explore nurse–patient sexual health communication from the perspectives of nurses trained to address sexual health in gynaecological cancer follow-up. Design A qualitative hermeneutic approach. Methods Individual semi-structured interviews with 10 nurses at five different hospitals in Norway were conducted in March and April 2021. A Gadamerian-inspired research method was used in the analysis. Results Three main themes with six sub-themes were identified. The three main themes were: (1) building relationships through communication, (2) practice makes perfect—the importance of experience and knowledge, and (3) personal attitudes as promoters or inhibiters of sexual health communication. Conclusion This study provides valuable insights into nurse–patient sexual health communication from the perspectives of nurses. The nurses in this study experienced the importance of having a good, respectful nurse–patient relationship as the foundation for sexual health communication. The professional confidence gained through experience and knowledge was emphasized, including the significance of how attitudes and taboos can influence sexual health communication. Impact The main findings of this study indicate that training in sexual health communication and the possibility of addressing sexual health repeatedly give nurses skills and professional confidence to address sexual health in cancer follow-up. Our study indicates that sexual health communication can be achieved in a clinical setting without being overly resource demanding. Our results may also motivate nurses to enhance their knowledge about sexual health in cancer follow-ups.
Eriksen, Alison Axisa; Fegran, Liv; Fredwall, Terje Emil & Larsen, Inger Beate (2023). Patients' negative experiences with health care settings brought to light by formal complaints: A qualitative metasynthesis. Journal of Clinical Nursing (JCN). ISSN 0962-1067. 32(17-18), p. 5816–5835. doi: 10.1111/jocn.16704. Full text in Research Archive Show summary
Introduction: Narratives of negative patient experiences expressed in complaints can help health care professionals reflect on their practices. Aims: To synthesise evidence from qualitative primary studies on patients’ negative experiences with different health care settings and to obtain a detailed picture of what patients find problematic while receiving health care. Design: Metasynthesis inspired by Sandelowski and Barroso. Methods: A protocol was published in the International Prospective Register of Systematic Reviews (PROSPERO). A systematic search was conducted in CINAHL (EBSCOhost), MEDLINE (EBSCOhost), PsycInfo (Ovid) and Scopus, on 20.04.2021. Backward and forward citations of included reports were searched for relevant studies and the search was completed in March 2022. Two researchers independently screened and appraised the included reports. A metasynthesis using reflexive thematic analysis and a metasummary were conducted. Results: Twenty-four reports were included, and four main themes were extracted from the metasynthesis: 1) problems with access to health care services; 2) failure to acquire information about diagnosis, treatment, and the expected patient role; 3) experiencing inappropriate care and bad treatment; and 4) problems with trusting health care service providers. Conclusions: Negative patient experiences impact patients’ physical and psychological health, leading to suffering and hampering patients from involving themselves in their health care. Relevance to clinical practice: Narratives of negative patient experiences aggregated from the findings provide knowledge about what patients need and expect from health care providers. These narratives can help health care professionals reflect on the way they interact with patients and improve their practice. Health care organisations need to prioritize patient participation. Reporting Method: Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed. Patient or Public Contribution: Findings were presented and discussed in a meeting with a reference group representing patients, health care professionals and the public.
Befus, Eva-Grethe; Helseth, Sølvi; Mølland, Eirin; Westergren, Per Christer Thomas; Fegran, Liv & Haraldstad, Kristin (2023). Use of KIDSCREEN health-related quality of life instruments in the general population of children and adolescents: a scoping review. Health and Quality of Life Outcomes. 21. doi: 10.1186/s12955-023-02088-z. Full text in Research Archive Show summary
Purpose Subjectively assessing health related quality of life (HRQoL) in children and adolescents is increasingly important in the public health feld. One valid and widely used generic HRQoL instrument is the KIDSCREEN question‑ naire. The aim of this study was to map all studies using KIDSCREEN instruments in the general population of children and adolescents aged 6–18 years. Methods A scoping review was conducted. The search strategy was formulated according to the Preferred Reporting Items for Systematic Reviews and Scoping Reviews guidelines. The databases Cinahl, socINDEX, Medline, Embase, APA Psychinfo, Scopus, and Eric were searched in October 2021. Results In total, 1365 papers were eligible for screening, 1031 were excluded and 334 reports were read in full. 252 reports were included. KIDSCREEN studies in the general population was predominantly conducted in Europe (n=211). Most studies (n=179) had a cross sectional design, while few experimental studies (n=24) were found. The three KIDSCREEN versions comprising of 10, 27 and 52 items, were equally distributed between studies. The selfreported version (n=225) of the KIDSCREEN instrument was more prevalent than the proxy version, while few studies discussed a cut point. Study contexts refected international trends of public health challenges, commonly including mental- and psychosocial health, physical activity, socioeconomic status, and obesity. Conclusion KIDSCREEN is widely used in cross sectional studies assessing common public health challenges. Experi‑ mental and longitudinal assessments, possibly including relevant cut ofs remain mainly unexplored and are recom‑ mended for future research.
Sjuls, Marianne; Ludvigsen, Mette Spliid; Robstad, Anja Nastasja & Fegran, Liv (2023). Fathers' experiences of living with a child with a progressive life-limiting condition without curative treatment options: A qualitative systematic review. Journal of Advanced Nursing. ISSN 0309-2402. doi: 10.1111/jan.15884. Full text in Research Archive Show summary
Aim: To systematically review and synthesize findings across qualitative primary stud-ies about fathers' experiences of living with a child with a progressive life- limiting condition without curative treatment options (C3 conditions).Design: Systematic review and metasynthesis.Methods: Sandelowski and Barosso's qualitative research methodology guided this review and metasynthesis. A modification of Ricoeur's interpretation theory, de-scribed by Lindseth and Norberg, guided the synthesis of qualitative data. The quality of the studies was evaluated using the Joanna Briggs Institute Checklist for Qualitative Research.Data Sources: A systematic literature search was conducted on 6 May 2022 and up-dated on 19 July 2023 on MEDLINE, CINAHL Plus with Full Text, APA PsycInfo and Scopus. Inclusion criteria were English-written qualitative studies from the year 2000, from which we could extract data on fathers' experiences of living with a child from 0 to 18 years with a progressive life- limiting condition without curative treatment options.Results: Seven reports from Western countries contributed to the review. Through structural analysis, we developed the following themes: ‘Being shattered in the per-ception of fatherhood’, ‘Establishing a new normal’ and ‘Striving to be acknowledged as a part of the caring team’.Conclusion: Fathers had to establish a new normal, and they experienced anticipa-tory mourning, role conflicts and feeling sidelined in healthcare settings when living with a child with a C3 condition. An important issue for further research on paediatric palliative care (PPC) should be to include fathers in the research sample and report separately on fathers' or mothers' experiences instead of parents' experiences.Impact: The findings will be of interest to healthcare personnel and multidisciplinary teams working within PPC, as they give insight into fathers' experiences and suggest interventions to increase healthcare personnel's involvement with fathers, such as telemedicine. Reporting Method: Following EQUATOR guidelines, the study was reported accord-ing to the enhancing transparency in reporting the synthesis of qualitative research (ENTREQ) framework.Patient or Public Contribution: No patient or Public Contribution.
Kristoffersen, Eirunn W.; Haslerud, Lilly; Fegran, Liv; Hustad, Jørn & Haddeland, Kristine (2023). Pasienters erfaringer med anestesisykepleie i pre- og peranestetisk fase – en kvalitativ studie. Nordisk sygeplejeforskning. ISSN 1892-2678. 13(4), p. 1–15. doi: 10.18261/nsf.13.4.4. Full text in Research Archive Show summary
Bakgrunn: Pasienter føler ofte uforutsigbarhet, spenning og engstelse før en operasjon. Å ha kunnskap om pasienters erfaringer med anestesisykepleie er vesentlig for at pasienter skal oppleve god behandling. Mål: Hensikten med studien var å få innsikt i pasienters erfaringer med anestesisykepleie i pre- og peranestetisk fase. Metode: Det ble gjennomført individuelle intervju med ni pasienter innlagt på to ulike sykehus. Dataene ble analysert basert på Graneheim og Lundman’s tekstanalyse og COREQ-sjekkliste for kvalitative studier er benyttet. Resultat: Tre hovedtema ble identifisert. Pasientene opplevde: (1) Ulike behov for støtte og trygghet på vei inn i en ukjent verden, (2) Ulike erfaringer av tid og tidspress, og (3) Personlig og faglig kompetanse hos anestesisykepleierne. Konklusjon: Rollen som anestesisykepleier krever kompetanse utover kunnskap og teknisk mestring av ferdigheter, for å ivareta kvalitet og pasientsikkerhet. Funnene gir et viktig innblikk i pasienters erfaringer og kan bidra til å øke kvaliteten på pasientbehandling i pre- og peranestetisk fase.
Audulv, Åsa; Westergren, Per Christer Thomas; Ludvigsen, Mette Spliid; Pedersen, Mona Kyndi; Fegran, Liv & Hall, Elisabeth O. C. [Show all 9 contributors for this article] (2023). Time and change: a typology for presenting research findings in qualitative longitudinal research. BMC Medical Research Methodology. 23(1). doi: 10.1186/s12874-023-02105-1. Full text in Research Archive Show summary
Background: Qualitative longitudinal research (QLR) is an emerging methodology used in health research. The method literature states that the change in a phenomenon through time should be the focus of any QLR study, but in empirical studies, the analysis of changes through time is often poorly described, and the emphasis on time/change in the findings varies greatly. This inconsistency might depend on limitations in the existing method literature in terms of describing how QLR studies can present findings. The aim of this study was to develop and describe a typology of alternative approaches for integrating time and/or change in QLR findings. Methods: In this method study, we used an adapted scoping review design. Articles were identified using EBSCOhost. In total, methods and results sections from 299 QLR articles in the field of health research were analyzed with inspiration from content analysis. Results: We constructed a typology of three types and seven subtypes. The types were based on the underlying structural principles of how time/change was presented: Type A) Findings have a low utilization of longitudinal data, Type B) Findings are structured according to chronological time, and Type C) Findings focus on changes through time. These types differed in 1) the way the main focus was on time, change or neither; 2) the level of interpretation in the findings; and 3) how theoretical understandings of time/change were articulated in the articles. Each type encompassed two or three subtypes that represented distinct approaches to the aim and results presentation of QLR findings. Conclusions: This method study is the first to describe a coherent and comprehensive typology of alternative approaches for integrating time/change into QLR findings in health research. By providing examples of various subtypes that can be used for results presentations, it can help researchers make informed decisions suitable to their research intent.
Paulsen, Anita; Vistad, Ingvild & Fegran, Liv (2023). Gynecological cancer survivors' experiences with sexual health communication in nurse-led follow-up consultations. Acta Obstetricia et Gynecologica Scandinavica. ISSN 0001-6349. p. 1–10. doi: 10.1111/aogs.14749. Full text in Research Archive Show summary
Introduction Gynecological cancer and its treatment may cause sexual difficulties in terms of physical and psychosocial health. Considering the essential role that nurses play in cancer care, they are well positioned to be ideal providers for addressing sexual health concerns in the follow-up phase of gynecological cancer. The aim of this study was to gain in-depth knowledge of how gynecological cancer survivors experience sexual health communication in nurse-led follow-up consultations. Material and methods Using a qualitative hermeneutic approach, we conducted individual semi-structured interviews with 17 women from five different hospitals in Norway between April 4, 2022, and June 2, 2022. The women participated in a large intervention study on cancer follow-up that included sexual health as one of several topics addressed by trained nurses in three consultations in the first year of follow-up. A five-stage Gadamerian-inspired research method was utilized for data collection and analysis. Results We identified three themes: (1) the importance of nurses listening to the women's own perceptions of sexuality, (2) post-treatment sexual challenges influence the women's need to communicate about sexual health, and (3) nursing communication can help women regain their sexual health. Conclusions Women who have undergone treatment for gynecological cancer find communication with trained nurses regarding sexual health beneficial. We recommend integration of trained nurses in the follow-up team. The nurses should adjust communication according to each gynecological cancer survivor's unique understanding of sexuality and inform women with sexual health concerns at that end of treatment, that sexual health can improve during follow-up.
Håkstad, Katrine; Fegran, Liv; Hovden, Ewa Alicja Szyszko & Köpp, Unni Mette Stamnes (2023). Orofacial signs of child or adolescent maltreatment identified by dentists and dental hygienists: A scoping review. International Journal of Paediatric Dentistry. ISSN 0960-7439. p. 1–17. doi: 10.1111/ipd.13139. Full text in Research Archive Show summary
Background Child maltreatment, the abuse or neglect of children aged 0–18 years, is a severe and underreported global problem. Compared with other body parts, the orofacial region displays more signs of child maltreatment. Dentists and dental hygienists are therefore well situated to identify orofacial signs of child maltreatment. Aim To map the current literature on orofacial signs of child maltreatment identified by dentists or dental hygienists. Design A scoping review was conducted based on systematic searches of Medline (Ovid), Embase (Ovid), and CINAHL (EBSCOhost) for primary qualitative and quantitative studies through June 6, 2022. Results Twenty-nine studies were included in this scoping review. Though all child maltreatment types were identified in dental settings, physical abuse and dental neglect were most commonly identified. Reports of caries dominated the orofacial signs, followed by bruises (intra- and extraoral), poor oral hygiene, dental trauma, and lacerations (intra- and extraoral). Case reports were used most commonly to describe orofacial signs of child maltreatment. Conclusion Dental clinicians identify orofacial signs of all child maltreatment types intraorally. Dentists identify the same extraoral signs as do other healthcare professionals, with bruising being the most common.
Mølland, Eirin; Haraldstad, Kristin; Abildsnes, Eirik; Håland, Åshild Tellefsen; Köpp, Unni Mette Stamnes & Fegran, Liv [Show all 7 contributors for this article] (2023). Use of the Strengths and Difficulties Questionnaire in child and school health services among children aged 4 and 6 years in Southern Norway: clinical considerations. BMC Pediatrics. 23(30). doi: 10.1186/s12887-023-03837-1. Full text in Research Archive Show summary
Background Parent reported mental health can be assessed by the Strengths and Difficulties Questionnaire (SDQ). Currently, Norwegian norms for parent-reported SDQ do not exist, whereas Swedish, Danish, and United Kingdom (UK) norms have been published. We aimed to (1) describe parent-reported SDQ among children aged 4 and 6 years in Southern Norway, (2) evaluate empirical cutoff values within the context of the Starting RightTM project in relation to the Swedish, Danish, and UK cutoffs, and (3) evaluate the representativeness of the study sample with regard to parental socioeconomic status. Methods This study included parent-reported observations for 665 children (63% consent rate). Means and standard deviations were calculated for the domains of SDQ, and gender differences were assessed. Based on the Swedish, Danish, and UK cutoffs and the 80th and 90th percentile cutoff values within the study, we calculated the total number of children with borderline and abnormal scores. Results Boys had higher mean total difficulties (7.3 vs 5.6) and impact scores (0.3 vs 0.1) and lower prosocial scores (8.3 vs 8.8) than girls. The differences in means were largest in the case of externalizing symptoms (5.0 vs 3.6) and hyperactivity subscore (3.2 vs 2.3). Using the UK cutoff values, 28 and 25 children had borderline and abnormal total difficulties scores, respectively. The corresponding numbers using the within study or Scandinavian cutoff values were 84–99 and 54–79, respectively. Overall, our study sample was well representative of the target population. Conclusions Our findings consistently indicated that girls had better SDQ scores than boys among children aged 4 and 6 years. Fewer children would be identified as having mental health difficulties using the UK cutoff values than using the Scandinavian age- and gender-relevant cutoff values.
Fegran, Liv; Westergren, Per Christer Thomas; Hall, Elisabeth OC; Aagaard, Hanne & Ludvigsen, Mette Spliid (2023). Nurses’ and Doctors’ Experiences of Transferring Adolescents or Young Adults With Long-Term Health Conditions From Pediatric to Adult Care: A Metasynthesis. Global Qualitative Nursing Research. 10. doi: 10.1177/23333936231189568. Full text in Research Archive Show summary
The transfer of adolescents and young adults (AYA) with long-term health conditions from pediatric to adult care is a multidisciplinary enterprise where nurses and doctors play an important role. This review aimed to identify and synthesize evidence from qualitative primary reports on how nurses and doctors experience the transfer of AYA aged 13 to 24 years with long-term health conditions to an adult hospital setting. We systematically searched seven electronic databases for reports published between January 2005 and November 2021 and reporting nurses’ and doctors’ experiences. We meta-summarized data from 13 reports derived from 11 studies published worldwide. Using qualitative content analysis, we metasynthesized nurses’ and doctors’ experiences into the theme “being boosters.” Boosting AYA’s transfer was characterized by supporting AYA’s and their parents’ changing roles, smoothening AYA’s transition from pediatric to adult care, and handling AYA’s encounters with a different care culture.
Marthinsen, Gunhild Nordbø; Helseth, Sølvi; Småstuen, Milada Cvancarova; Bjorvatn, Bjørn; Bandlien, Signe Marie & Fegran, Liv (2022). Sleep patterns and psychosocial health of parents of preterm and full-born infants: a prospective, comparative, longitudinal feasibility study. BMC Pregnancy and Childbirth. 22(1). doi: 10.1186/s12884-022-04862-1. Full text in Research Archive Show summary
Background: The early birth and hospitalization of a preterm infant in neonatal intensive care unit can produce several emotional and behavioural responses including sleep problems for parents. Few studies have explored sleep and its associations with health and HRQoL over time in this vulnerable parent population. This purpose of this study was to evaluate the feasibility of a prospective, comparative, longitudinal study of the sleep patterns and psychosocial health of preterm and full-born infants’ parents during the first postpartum year. Methods: A prospective, comparative, longitudinal feasibility study was conducted. Parents of preterm infants were compared to parents of full-born infants to identify if there were differences in outcomes between the groups. The parents were instructed to wear actigraphs and complete sleep diaries for two consecutive weeks, and responded to a digital questionnaire covering stress, insomnia, fatigue, depression, social support, self-efficacy, and health-related quality of life. Survey data were collected at infant ages of 2, 6, and 12 months, actigraphy and sleep diary data were collected at infant age of 2 months only. Descriptive analysis was used to describe recruitment and attrition rates. Differences between completers and dropouts were analysed with a chi-square test (categorical data) and Mann–Whitney–Wilcoxon test for two independent samples (continuous variables). Results: Between June 2019 and March 2020, 25 parents of a preterm infant and 78 parents of a full-born infant were recruited from four neonatal intensive care units and two maternity wards, respectively, in four Norwegian hospitals. Feasibility was predefined as recruiting ≥ 75 parents each of preterm and full-born infants. The target for the full-born group was reached. However, the preterm group recruitment was challenging. Actigraphs, sleep diaries, and questionnaires were evaluated as feasible for use in a future study. Attrition rates were high in both groups at 6 and 12 months. No parent-related characteristics were associated with participation at 6 months. At 12 months, dropouts had a statistically significantly lower age in the full-born group (both parents) and higher age and body mass index in the preterm group (fathers). Conclusions: A longitudinal study is feasible; however, procedural changes, including using active methods and contacting participants, are necessary to increase the recruitment of preterm infants’ parents.
Audulv, Åsa; Hall, Elisabeth O. C.; Kneck, Åsa; Westergren, Per Christer Thomas; Fegran, Liv & Pedersen, Mona Kyndi [Show all 9 contributors for this article] (2022). Qualitative Longitudinal Research in Health Research: A Method Study. BMC Medical Research Methodology. 22(1), p. 1–19. doi: 10.1186/s12874-022-01732-4. Full text in Research Archive Show summary
Background: Qualitative longitudinal research (QLR) comprises qualitative studies, with repeated data collection, that focus on the temporality (e.g., time and change) of a phenomenon. The use of QLR is increasing in health research since many topics within health involve change (e.g., progressive illness, rehabilitation). A method study can provide an insightful understanding of the use, trends and variations within this approach. The aim of this study was to map how QLR articles within the existing health research literature are designed to capture aspects of time and/or change. Methods: This method study used an adapted scoping review design. Articles were eligible if they were written in English, published between 2017 and 2019, and reported results from qualitative data collected at diferent time points/time waves with the same sample or in the same setting. Articles were identifed using EBSCOhost. Two independent reviewers performed the screening, selection and charting. Results: A total of 299 articles were included. There was great variation among the articles in the use of methodological traditions, type of data, length of data collection, and components of longitudinal data collection. However, the majority of articles represented large studies and were based on individual interview data. Approximately half of the articles self-identifed as QLR studies or as following a QLR design, although slightly less than 20% of them included QLR method literature in their method sections. Conclusions: QLR is often used in large complex studies. Some articles were thoroughly designed to capture time/ change throughout the methodology, aim and data collection, while other articles included few elements of QLR. Longitudinal data collection includes several components, such as what entities are followed across time, the tempo of data collection, and to what extent the data collection is preplanned or adapted across time. Therefore, there are several practices and possibilities researchers should consider before starting a QLR project.
Robstad, Anja Nastasja; Westergren, Per Christer Thomas; Mølland, Eirin; Abildsnes, Eirik; Haraldstad, Kristin & Køpp, Unni Mette Stamnes [Show all 8 contributors for this article] (2022). Experiences of Norwegian child and school health nurses with the “Starting Right™” child health assessment innovation: a qualitative interview study. BMC Health Services Research. 22(1). doi: 10.1186/s12913-022-08088-x. Full text in Research Archive Show summary
Background: Although child health services are well established in Norway, the use of information technology for the systematic collection of evidence-based child- and proxy-reported health measures may be benefcial in the early identifcation of child development problems. The Norwegian “Starting Right™” health service innovation consists of parent- and child-reported online structured health assessments tools, including practical routines for child and school health assessments. The aim of this study was to explore the experiences of child and school health nurses with the Starting Right innovation. Methods: We used a qualitative design and conducted three focus group interviews with 18 child and school health nurses from three child health centres one year after the implementation of the innovation. Results: The experiences of professionals with the Starting Right innovation were captured by three themes: (1) the digital innovation could be used to obtain a good overview of a child’s health and development; (2) interpreting the questionnaires was a challenge; and (3) implementing the new digital innovation was time-consuming. Conclusions: Overall, the child and school health nurses experienced that the Starting Right innovation was useful for providing a comprehensive overview of child development and health. The challenges related to interpreting the parents’ scores and follow-up of children, as well as providing the questionnaires in relevant foreign languages, should be addressed to allow all children and families to be reached
Ebitu, Anne Katrine Sandnes; Fegran, Liv; Haraldstad, Kristin; Johannessen, Berit; Chiduo, Mercy Grace & Hovland, Olav Johannes (2022). The banana project: A qualitative study of caregivers' and teachers' experiences of preschool children participating in a free banana school fruit scheme in rural Tanzania. BMJ Nutrition, Prevention and Health. doi: 10.1136/bmjnph-2021-000403. Full text in Research Archive Show summary
Introduction Good nutrition is the foundation of sustainable growth and development among children. The United Nations aims to achieve food security and improve nutrition through its Sustainable Development Goal 2 - Zero Hunger. In close collaboration with local communities and authorities, the Tanga International Competence Centre, Tanzania, supports projects aimed at achieving the United Nations Sustainable Development Goals. One of their initiatives, The Banana Project, which is a free school fruit scheme, started in 2011 based on a recognised need for nutritional support among preschool children at a rural school in Tanga District. In the interest of improving nutrition, the free school fruit scheme provides one banana 5 school days a week to each child in the class. This study aimed to explore caregivers’ (parents and/or guardians) and teachers’ experiences with preschool children’s participation in the project, with a specific focus on nutrition and health. Methods This qualitative study was performed in 2017. A total of 16 semistructured indepth interviews with 14 caregivers and 2 teachers of the preschool children participating in the project were conducted. Data were analysed using a hermeneutic perspective. Results Caregivers and teachers of the preschool children participating in the intervention experienced that bananas (1) reduced children’s hunger and nutritional deficiency, (2) increased fruit intake and improved their appetite for other foods, (3) improved their physical health and provided energy, and (4) supported cognitive and socioemotional development. Conclusion These findings indicate that the banana intervention has several benefits to preschool children and has an impact on their families. To improve health and reduce the risk of malnutrition of children in rural Tanzania, The Banana Project can be an recommended as a simple, cost-effective and sustainable health and nutrition promotion initiatives.
Grasaas, Erik; Helseth, Sølvi; Fegran, Liv; Stinson, Jennifer; Småstuen, Milada Cvancarova & Lalloo, Chitra [Show all 7 contributors for this article] (2022). App-based intervention among adolescents with persistent pain: a pilot feasibility randomized controlled trial. Pilot and Feasibility Studies. 8. doi: 10.1186/s40814-022-01113-0. Full text in Research Archive Show summary
Background: Persistent pain in adolescence adversely afects everyday life and is an important public health problem. The primary aim was to determine the feasibility of an 8-week app-based self-management intervention to reduce pain and improve health-related quality of life in a community-based population of adolescents with persistent pain. A secondary aim was to explore diferences in health outcomes between the intervention and control groups. Methods: A sample of 73 adolescents aged 16–19 years with persistent pain from a community-based population were randomized into 2 groups. The intervention group received the Norwegian culturally adapted version of the iCanCope with PainTM app, which includes symptom tracking, goal setting, self-management strategies, and social support. The attention control group received a symptom tracking app. Feasibility was assessed as attrition rates and level of engagement (interactions with the app). The secondary outcomes included pain intensity, health-related quality of life, self-efcacy, pain self-efcacy, perceived social support from friends, anxiety and depression, and patient global impression. Statistical analyses were conducted using SPSS. Results: Demographic and baseline outcome variables did not difer between the 2 groups. No diferences were found between the participants completing the study and those who withdrew. Twenty-eight adolescents completed the intervention as planned (62% attrition). Both groups had a low level of app engagement. Intention-to-treat analysis (n = 19 + 14) showed no signifcant diferences in outcomes between groups. However, the large efect size (Cohen’s d = .9) for depression suggested a lower depression score in the intervention group. Conclusions: High treatment attrition and low engagement indicate the need for changes in trial design in a fullscale randomized controlled trial to improve participant retention.
Føreland, Anne Marit; Engesland, Helene; Kristoffersen, Laila & Fegran, Liv (2022). Postpartum Experiences of Early Skin-to-Skin Contact and the Traditional Separation Approach After a Very Preterm Birth: A Qualitative Study Among Mothers. Global Qualitative Nursing Research. 9. doi: 10.1177/23333936221097116. Full text in Research Archive Show summary
Traditional care immediately after very preterm birth separates the mother and child by the transfer of the infant to the neonatal intensive care unit. A nonseparation approach is currently being considered, allowing early skin-to-skin contact in the delivery room/postoperative care unit. This study aimed to explore mothers’ experiences of early skin-to-skin contact and traditional care. A qualitative study using individual semi-structured interviews with five mothers from each of the two groups was conducted. Content analysis revealed that both groups’ experiences were characterized by (i) mothers’ need to be affirmed of their infants’ vitality, (ii) bonding challenges, and (iii) benefits of skin-to-skin contact. We suggest that early skin-to-skin contact after very preterm births is crucial for the bonding process and mothers’ feelings of safety and well-being. When early skin-to-skin contact is infeasible, our findings reveal the significance of photos, information, and the father’s presence at the time of postpartum separation.
Ludvigsen, Mette Spliid & Fegran, Liv (2022). Med Meleis på klinikk for ungdom. In Martinsen, Bente; Dreyer, Pia & Norlyk, Annelise (Ed.), Sykepleiens superhelter: Sykepleieteoretikere som styrker klinisk praksis. Fagbokforlaget. ISSN 9788245038224. p. 99–118. Full text in Research Archive
Skorstad, Mette; Vistad, Ingvild; Fegran, Liv; Berntsen, Sveinung & Johannessen, Berit (2022). Nurse-led consultations reinforced with eHealth technology: a qualitative study of the experiences of patients with gynecological cancer. BMC Nursing. 21. doi: 10.1186/s12912-022-01104-9. Full text in Research Archive Show summary
Background: During the last decade, the health care profession has moved toward personalized care and has focused on the diversity of survivorship needs after initial cancer treatment. Health care providers encourage empowering patients to participate actively in their own health management and survivorship. Consequently, we developed and piloted a new follow-up model for patients at a Norwegian hospital, referred to as the Lifestyle and Empowerment Techniques in Survivorship of Gynecologic Oncology (LETSGO) model. Using LETSGO, a dedicated nurse replaces the physician in every second follow-up consultation, providing patients who have undergone cancer treatment with self-management techniques that are reinforced with eHealth technology via a specially designed app. Encouraging behavioral change and evaluating the late effects of treatment and recurrence symptoms are central components of self-management techniques. In addition, the app encourages physical activity and positive lifestyle changes, helps identify recurrence-related symptoms, and provides reminders of activity goals. This study aims to investigate experiences with nurse-led consultations supported by eHealth technology among the patients who piloted the LETSGO intervention. Methods: Semi-structured qualitative interviews were conducted to analyze the participants’ experiences with the LETSGO intervention after six to seven months. Results: The participants in the LETSGO pilot felt safe and well cared for. They thought the nurse was less busy than the doctors appear to be, which made it easy for them to share any cancer-related challenges. Many participants reported increased empowerment and confidence in recognizing symptoms of cancer recurrence, and participants who used the app regularly were motivated to increase their physical activity levels. However, the participants also experienced some limitations and technical errors with the app. Conclusions: Generally, the participants positively received the nurse-led consultations and eHealth technology, but an intervention study is required for further evaluation. In addition, the reported technical app errors should be resolved and tested prior to eHealth application implementation. Regardless, this study may be useful in planning personalized survivorship care studies.
Fegran, Liv; Ham-Baloyi, Wilma ten; Fossum, Mariann; Hovland, Olav Johannes; Naidoo, Joanne R. & Rooyen, Dalena van [Show all 8 contributors for this article] (2022). Simulation debriefing as part of simulation for clinical teaching and learning in nursing education: A scoping review. Nursing Open. 9(5). doi: 10.1002/nop2.1426. Full text in Research Archive Show summary
Aim: To map the evidence of the simulation debriefing phase in simulation activities of nursing education, to address and inform clinical teaching and learning in nursing.Design: A scoping review.Methods: A systematic review of literature published between 2008–2021 was conducted using CINAHL & ERIC, MEDLINE, EMBASE, APA PsycInfo, the Cochrane Library and JBI Evidence synthesis. Inclusion criteria were primary studies published in English on simulation debriefing at all levels in nursing education.Results: Of 140 included references, only 80% (N= 112) framed simulation debriefing theoretically either by specific theories/models or as a literature review of the topic. A variety of simulation debriefing methods were identified; however, debriefing methods were only described in 79% (N= 110) of the references. There appears to be a gap in consensus concerning the theoretical or methodological frameworks characterizing simulation debriefing in nursing education. The majority of studies (86%) were conducted at a bachelor's degree level (N= 121).
Aagaard, Hanne; Hall, Elisabeth; Audulv, Åsa; Ludvigsen, Mette Spliid; Westergren, Per Christer Thomas & Fegran, Liv (2022). Parents’ experiences of transitioning to home with a very-low-birthweight infant: A meta-ethnography. Journal of Neonatal Nursing. ISSN 1355-1841. 29(3). doi: 10.1016/j.jnn.2022.11.012. Full text in Research Archive Show summary
Medical-technological advances and neurodevelopmental care have improved the survival of extremely- and very-low-birthweight infants born before 32 weeks’ gestation. After months in neonatal care, the infants are discharged, and parents exited but full of anxiety. This review is designed as a meta-ethnography, addressing parents’ discharge experiences to comprehend the synthesised research, which includes 12 eligible studies. From the analysis, we constructed three themes: ‘approaching discharge with both uncertainty and confidence’; ‘discharge as a longed-for though disordering turning point’; and ‘facing joys, worries and multiple challenges when at home’. The overarching interpretation was ‘discharge as double-edged sword’. We conclude that bringing home very-low-birthweight infants is a joyful event, yet parents also experience discharge as never- endingly worrying, as a time filled with challenges to which parents must adapt and as necessitating contin- uous support from knowledgeable providers.
Stea, Tonje Holte; Jong, Miek C.; Fegran, Liv; Sejersted, Ellen; Jong, M. & Wahlgren, Sophia Louise Hjorth [Show all 7 contributors for this article] (2022). Mapping the Concept, Content, and Outcome of Family-Based Outdoor Therapy for Children and Adolescents with Mental Health Problems: A Scoping Review. International Journal of Environmental Research and Public Health (IJERPH). ISSN 1661-7827. 19(10). doi: 10.3390/ijerph19105825. Full text in Research Archive Show summary
Outdoor therapy and family-based therapy are suggested to be promising interventions for the treatment of mental health problems. The aim of the present scoping review was to systematically map the concept, content, and outcome of combining family- and outdoor-based therapy for children and adolescents with mental health problems. The Joanna Briggs Institute methodology and PRISMA guidelines were applied. Eligible qualitative and quantitative studies were screened, included, and extracted for data. Seven studies were included. Findings from these studies indicated that family-based outdoor therapy programs have a positive impact on family- and peer relationships, adolescent behavior, mental health, self-perceptions (self-concept), school success, social engagement, and delinquency rates. However, participant characteristics, study design, and content and mode of delivery of the interventions varied substantially, hence preventing detailed comparison of outcomes across studies. In addition, most of the studies included few participants and lacked population diversity and comparable control groups. Although important ethical concerns were raised, such as non-voluntary participation in some of the programs, there was a lack of reporting on safety. This review indicates that a combination of family- and outdoor-based therapy may benefit mental health among children and adolescents, but due to the limited number of studies eligible for inclusion and high levels of heterogeneity, it was difficult to draw firm conclusions. Thus, future theory-based studies using robust designs are warranted.
Ludvigsen, Mette Spliid & Fegran, Liv (2021). Med Meleis på ungeklinik. In Martinsen, Bente; Dreyer, Pia & Norlyk, Annelise (Ed.), Sygeplejens Superhelte. Sygeplejeteoretikere der styrker klinisk praksis. Munksgaard Forlag. ISSN 9788762819962. p. 91–109. Full text in Research Archive
Fegran, Liv; Johannessen, Berit; Ludvigsen, Mette Spliid; Westergren, Thomas; Høie, Magnhild & Slettebø, Åshild [Show all 9 contributors for this article] (2021). Experiences of a non-clinical set of adolescents and young adults living with persistent pain: a qualitative metasynthesis. BMJ Open. 11(4), p. 1–11. doi: 10.1136/bmjopen-2020-043776. Full text in Research Archive Show summary
Purpose Around 15%–30% of adolescents and young adults (AYAs) experience persistent or chronic pain. The purpose of this study was to synthesise evidence from qualitative primary studies on how AYAs in a non-clinical population experience living with persistent pain. Method A qualitative metasynthesis guided by Sandelowski and Barroso’s guidelines was used. The databases Medline, Embase, Cinahl, PsycINFO, Mednar and ProQuest were searched for studies from 1 January 2005 to 15 February 2021. Inclusion criteria were AYAs aged 13–24 years with first-hand experience of living with persistent, recurrent or episodic non-clinical pain in any body site. Pain associated with a medical diagnosis, malignant diseases, medical procedures or sport activities was excluded. Results Of 2618 screened records, data from nine studies conducted in a Western cultural context including 184 participants (127 female and 57 male aged 11–28 years) were analysed into metasummaries and a metasynthesis. Headaches was the most focused pain condition (n=5), while three of the studies did not specify type of pain. The participants’ experiences were characterised by (1) juggling pain with everyday life; (2) exploring sources of information to manage pain; (3) AYAs’ use of medication to find relief and (4) non-pharmacological strategies for pain relief. Conclusion These AYAs experience of how pain influences everyday life, and their striving to find relief from pain by support from family, friends, professionals and the Internet should be strongly respected. Public health nurses and other healthcare professionals encountering AYAs need to respect their pain experiences, and to support them in healthy coping strategies. Further studies on this issue are needed, especially research focusing on AYAs pain in exposed populations and AYAs from non-Western cultures.
Westergren, Thomas; Mølland, Eirin; Haraldstad, Kristin; Håland, Åshild Tellefsen; Køpp, Unni Mette & Fegran, Liv [Show all 7 contributors for this article] (2021). Implementation of the norwegian ‘Starting right’ child health service innovation: implementation adjustments, adoption, and acceptability. BMC Health Services Research. 21. doi: 10.1186/s12913-021-06096-x. Full text in Research Archive Show summary
Background: An increased and/or stable proportion of the child and adolescent population reports symptoms ofimpaired health, and the symptoms can be identified early. Therefore, structured child- and parent-reportedoutcome measures need to be implemented in child and school health services for decision support andidentification of children at risk. We aimed to (a) qualitatively examine adjustments of active implementation fromthe pilot implementation of the Norwegian‘Starting Right’health service innovation including an online childhealth assessment tool and practical routines, and (b) measure practitioners ́ adoption and parental acceptability. Methods: We used a mixed-methods design to qualitatively examine adjustments from working notes andmeeting memoranda, and quantitatively assess adoption and acceptability from user rates provided by the systemslog. Twenty-one child and school health nurses (CSHNs) from two child health centers participated in theimplementation pilot of online health assessments in children aged 2-, 4- and 6-year. We used a deductive andnarrative analysis approach using Fixsen et al. ́s core implementation components to code and sort adjustments. Results: Core implementation components were adjusted throughout the pilot implementation. Researchers ́increased their availability in reciprocity with staff evaluation to integrate active implementation adjustments. Welaunched a project for improved data systems integration. The overall CSHNs adoption rate was satisfactory andhigher in center A, where a medical secretary supported the nurses through the entire pilot phase, than in center B(96 vs. 55 %). Parental acceptability rate was overall high (77 %) with increased rates among parents of 6-year-oldchildren (98 %) compared with younger ones (78–85 %), and in cases where both parents received thequestionnaires. Conclusions: The ‘Starting Right’ health service innovation implementation was actively adjusted by integration of core implementation components mainly based on staff evaluation. The CSHNs adopted the innovation which was also acceptable to parents.
Westergren, Thomas; Fegran, Liv; Antonsen, Anne Jørstad; Mikkelsen, Hilde E. Timenes; Hennig, Camilla Bæck & Køpp, Unni Mette (2021). Prevention of overweight and obesity in a Norwegian public health care context: a mixed-methods study. BMC Public Health. 21. doi: 10.1186/s12889-021-11096-x. Full text in Research Archive
Dalsmo, Ingrid Espegren; Haraldstad, Kristin; Johannessen, Berit; Hovland, Olav Johannes; Chiduo, Mercy Grace & Fegran, Liv (2021). “Now I Feel That I Can Achieve Something”: Young Tanzanian Women’s Experiences of Empowerment by Participating in Health Promotion Campaigns. International Journal of Environmental Research and Public Health (IJERPH). ISSN 1661-7827. 18(16). doi: 10.3390/ijerph18168747. Full text in Research Archive
Westergren, Thomas; Ludvigsen, Mette Spliid; Audulv, Åsa; Aagaard, Hanne; Hall, Elisabeth O.C. & Pedersen, Mona Kyndi [Show all 7 contributors for this article] (2020). Physical activity experiences of children and adolescents with asthma: a qualitative systematic review protocol. JBI Evidence Synthesis. 18, p. 2390–2395. doi: 10.11124/JBIES-20-00004. Full text in Research Archive
Bjørnarå, Helga Birgit; Westergren, Thomas; Fegran, Liv; Velde, Saskia J. te; Fyhri, Aslak & Deforche, Benedicte [Show all 9 contributors for this article] (2020). Cumbersome but desirable — Breaking the code of everyday cycling. PLOS ONE. 15(9), p. 1–20. doi: 10.1371/journal.pone.0239127. Full text in Research Archive Show summary
Introduction Cycling for transport could integrate physical activity (PA) into daily routines and potentially increase total PA levels. However, for parents with young children, most factors affecting transport mode choice tend to facilitate car use. Greater insight is necessary into reasons for (not) using sustainable transport modes in parents with young children. Therefore, the objective of this study was to explore the experiences, including motives, perceptions, attitudes, and norms, of parents of young children by using an e-bike, a longtail bike, and a traditional bike for everyday travel to the workplace, kindergarten, and the grocery store during the autumn, winter, and spring, in nine months. Methods Semistructured focus group interviews were conducted with 18 parents of young children residing in southern Norway. Parents were recruited through Facebook announcements and direct contact with kindergartens, selected organisations, and companies in the Kristiansand municipality. Data were analysed by systematic text condensation by using NVivo V.11. Results Participants’ experiences were summarised by three main themes: ‘cycling is cumbersome’, ‘cycling reflects the desirable me’, and ‘breaking the cycling code’. Time use, planning, logistics, wet and cold weather, long distances, and no cycling habit were frequently mentioned barriers, and the most notable facilitator was the children’s attitude towards cycling. In general, children loved to cycle and preferred cycling to driving. Additionally, the freedom and independence of cycling were emphasised and valued. Conclusion In challenging weather conditions, parents of young children may experience cycling as cumbersome but desirable, and bike access could increase the feasibility of daily cycling.
Mildestvedt, Thomas; Hovland, Olav Johannes; Berntsen, Sveinung; Bere, Elling Tufte & Fegran, Liv (2020). Getting physically active by e-bike: An active commuting intervention study. Physical Activity and Health (PAAH). 4(1), p. 120–129. doi: 10.5334/paah.63. Full text in Research Archive
Johannessen, Berit; Høie, Magnhild; Haraldstad, Kristin; Helseth, Sølvi; Fegran, Liv & Westergren, Thomas [Show all 8 contributors for this article] (2020). School nurses’ and teachers’ perceptions of pain in young immigrants living in Norway. International Journal of Migration, Health and Social Care. ISSN 1747-9894. 16(1). doi: 10.1108/IJMHSC-01-2019-0005. Full text in Research Archive Show summary
Purpose The number of adolescents experiencing pain is increasing. Pain has a major impact on several areas of daily living, such as function at school and school absenteeism, loss of appetite and socializing. One out of ten pupils in Norwegian schools is immigrants, and surveys have shown that immigrants suffer from poor health more often than the general population. The purpose of this study was to explore how school nurses and teachers experience pain in young immigrants in the school setting. Design/methodology/approach A qualitative design using focus group interviews was chosen for data collection. A total of 11 focus groups (17 school nurses and 25 teachers) consisting of school nurses and teachers in junior high schools (age: 13-16 years) in Southern Norway were conducted. Data were analyzed using a qualitative content analysis. Findings School nurses and teachers experienced communication of pain with young immigrants as characterized by cultural differences and language problems. Immigrants waiting for residency permits experienced pain more often than others. They also experienced that young immigrants often were absent from school and used pain as an excuse for not participating in classes, but this was not the case at the special school for immigrants. During Ramadan, they experienced that immigrant pupils had an increase of pain, especially headaches. Originality/value Culture affects the assessment and management of pain and different strategies may assist school nurses and teachers in their encounter with young immigrants with pain. There is a need for education in cultural competence among teachers and school nurses.
Mildestvedt, Thomas; Hovland, Olav Johannes; Berntsen, Sveinung; Bere, Elling Tufte & Fegran, Liv (2020). Getting Physically Active by E-Bike : An Active Commuting Intervention Study. Physical Activity and Health (PAAH). 4(1), p. 120–129. doi: 10.5334/paah.63. Full text in Research Archive Show summary
Introduction: Increased physical activity (PA) is a major component in promoting public health, and active commuting could make an important contribution. Using an electric bicycle (e-bike) is reported to be of at least moderate intensity PA and is an alternative to other modes of transport for commuting. We aimed to explore the experience of commuting by e-bike in an intervention study. Methods: Focus group interviews with 21 previously inactive participants from three cities in Norway, who were given access to an e-bike for commuting for three (N = 2) or eight months (N = 19). Participants cycled for 226 days on average. The interviews were analyzed using systematic text condensation. Results: The use of e-bikes and active commuting stimulated some participants to take on additional PA in their leisure time. Others preferred active commuting to be their daily PA. Participants’ experiences of commuting by e-bike were characterized by a motivational shift from external reasons for e-biking, such as pressure to get fit, to feelings of well-being, enjoyment and recognition of the health benefits. Conclusion: Commuting by e-bike was convenient and promoted good health. Promoting e-bikes could lead to long term changes among inactive people because positive experiences stimulate autonomous reasons for active commuting.
Grasaas, Erik; Helseth, Sølvi; Fegran, Liv; Stinson, Jennifer; Småstuen, Milada Cvancarova & Haraldstad, Kristin (2020). Health-related quality of life in adolescents with persistent pain and the mediating role of self-efficacy: a cross-sectional study. Health and Quality of Life Outcomes. 18(19). doi: 10.1186/s12955-020-1273-z. Full text in Research Archive Show summary
Background: Persistent pain has a high prevalence among adolescents. Pain has been shown to reduce all aspects of the adolescent’s health-related quality of life (HRQOL). In adult patients with pain, self-efficacy has been shown to mediate the relationship between pain intensity, disability and depression. However, little is known about whether self-efficacy acts as a mediating variable in the relationship between persistent pain and HRQOL sub-scale scores in a school-based population of adolescents. Objectives: To describe the experience of pain, HRQOL and self-efficacy, and to explore the association between pain intensity, general self-efficacy and HRQOL in adolescents with persistent pain by testing self-efficacy as a possible mediator. Methods: The study participants were 78 adolescents with persistent pain, aged 16–19 years, who were recruited from five high schools in southern Norway. All participants completed an electronic survey consisting of the Lubeck Pain Questionnaire, which included a visual analogue scale (VAS) measuring pain intensity, the General Self-Efficacy Scale (GSE) and the KIDSCREEN-52 Questionnaire measuring HRQOL. Statistical analyses were conducted using the PROCESS macro for SPSS developed by Andrew Hayes. Results: All participants reported pain in multiple locations, of which the head was most common (88.5%). Mean (SD) pain intensity score of the participants was 5.4 (1.8). The study sample had poor HRQOL, with mean (SD) scores for several sub-scales ranging from 45.2 (21.0) to 91.0 (13.3) on a 0–100 scale. The associations between pain intensity and the HRQOL sub-scales of physical well-being, psychological well-being, mood, self-perception, autonomy and school environment were mediated by self-efficacy. The highest degree of mediation and, thus, the largest indirect effect was estimated for the HRQOL sub-scale physical well-being (67.2%). Conclusions: This school-based sample of adolescents with persistent pain had impaired HRQOL. Up to 67% of the reduction in the HRQOL sub-scale scores for physical well-being, psychological well-being, mood, self-perception, autonomy and school environment could be explained by the mediating variable self-efficacy. Thus, future painmanagement interventions that aim to increase HRQOL in school-based populations of adolescents with persistent pain should consider promoting self-efficacy and providing more targeted interventions.
Rasalingam, Anurajee; Fegran, Liv; Brekke, Idunn & Helseth, Sølvi (2020). Young people with long-term health challenges experiences in transition to adulthood: A qualitative metasynthesis. Journal of Advanced Nursing. ISSN 0309-2402. 77(2), p. 595–607. doi: 10.1111/jan.14641. Full text in Research Archive Show summary
Aims: The aim of this study was to describe the experiences of the transition to adulthood for young people with long-term health challenges. Design: The metasynthesis approach was based on the guidelines by Sandelowski and Barroso for synthesizing qualitative research. Data sources: Seven electronic databases: CINAHL, Medline, Embase, PsycINFO, Web of Science, Scopus and SocIndex were searched on 6-10 February 2020. Review Methods: Studies were critically appraised using the Joanna Briggs critical appraisal tool. Qualitative data were extracted, meta-summarised, then meta-synthesized. Findings: Nineteen qualitative studies were included in this review. Six themes illustrated experiences in the transition to adulthood: wishing for an “ordinary” life, significance of close network, working towards independence, in need of systemic resources and services, psychosocial challenges and keeping a positive attitude. Conclusion: Young people with long-term health challenges wished for as “ordinary” a life as possible in the future. In the transition to adulthood, they gradually gained more competence in self-management skills and knowledge and strived to become more independent. By having a positive attitude and utilising other coping strategies, young people can work on some of the difficulties they experience in this phase. However, to achieve and maintain independence young people with long-term health challenges are dependent on the support of a close network and systemic support and services. Impact: The findings highlight the need to help alleviate the fears and worries of young people with long-term health challenges and create opportunities for successful transition to adulthood by increased awareness and interventions from policy-makers and professionals within the health and social system.
Ludvigsen, Mette Spliid; Hall, Elisabeth O.C.; Westergren, Thomas; Aagaard, Hanne; Uhrenfeldt, Lisbeth & Fegran, Liv (2020). Being cross pressured - parents’ experiences of the transfer from paediatric to adult care services for their young people with long term conditions: a systematic review and qualitative research synthesis. International Journal of Nursing Studies. ISSN 0020-7489. 115. doi: 10.1016/j.ijnurstu.2020.103851. Full text in Research Archive Show summary
Background Family members of young people (13–24 years) with long-term conditions tend to experience multiple challenges when their children transfer from paediatric to adult care, as do the patients themselves. Objectives To identify, interpret and theoretically conceptualise the meaning of parents’ experiences of the transfer from paediatric to adult care of their young people with long-term conditions. Design A qualitative research synthesis. Data sources We obtained articles from Medline, CINAHL, PsycINFO, EMBASE, Scopus, and Web of Science. Unpublished theses and dissertations were searched for using Google Scholar, Mednar, and ProQuest Dissertations and Theses. Review methods Based on a previously published protocol, we followed the guidelines from the Joanna Briggs Institute. Sandelowski and Barroso's qualitative research synthesis approach guided the metasynthesis. Articles published between 1999 and March 2019 were systematically searched for. Findings Twenty-three reports from seven Western countries representing 454 parents including significant others such as aunts and grandparents of 462 young people with various diagnoses contributed to the review. ‘Being cross-pressured’ was the metasynthesis found to reflect parents’ experiences of the transfer from paediatric to adult care of their young people with long-term conditions. The metasynthesis comprised four themes: ‘Fluctuating between parental roles’, ‘Navigating contrasting healthcare contexts’, ‘Making decisions in the face of inner conflict’, and ‘Trusting their child's self-management ability’. Conclusions Our metasynthesis finding of parents’ experiences of being cross-pressured provides a new way of thinking about the study phenomena which is supported by transitions theory holding that multiple transitions can take place simultaneously involving myriads of concurrent and conflicting demands. The cross pressure may overwhelm parents. The clinical implications are to recognise parents’ experiences and distress in healthcare planning to promote safe and predicable transfers of their young people. Provision of healthcare to parents during transfer needs to be tailored to a collaborative decision-making process between parents, their young people, and involved practitioners across paediatric and adult healthcare services.
Robstad, Anja Nastasja; Westergren, Thomas; Siebler, Frank; Söderhamn, Ulrika & Fegran, Liv (2019). Intensive care nurses' implicit and explicit attitudes and their behavioural intentions toward obese intensive care patients. Journal of Advanced Nursing. ISSN 0309-2402. 75(12), p. 3631–3642. doi: 10.1111/jan.14205. Full text in Research Archive
Grasaas, Erik; Fegran, Liv; Helseth, Sølvi; Stinson, Jennifer; Martinez, Santiago & Lalloo, Chitra [Show all 7 contributors for this article] (2019). iCanCope With Pain: Cultural Adaptation and Usability Testing of a Self-Management App for Adolescents With Persistent Pain in Norway. JMIR Research Protocols. 8(6), p. 1–14. doi: 10.2196/12940. Full text in Research Archive
Vassbakk-Brovold, Karianne; Antonsen, Anne Jørstad; Berntsen, Sveinung; Kersten, Christian & Fegran, Liv (2018). Experiences of Patients With Breast Cancer of Participating in a Lifestyle Intervention Study While Receiving Adjuvant Chemotherapy. Cancer Nursing. ISSN 0162-220X. 41(3), p. 218–225. doi: 10.1097/NCC.0000000000000476. Full text in Research Archive
Fegran, Liv (2018). At blive og være forældre til et sygt nyfødt barn. In Uhrenfeldt, Lisbeth & Hall, Elisabeth (Ed.), Et omsorgsvidenskabeligt perspektiv som ramme for forskning : professor Emeritus Elisabeth O.C. Halls 80 år dag. Aarhus Universitetsforlag. ISSN 9788793117631. p. 57–66. Full text in Research Archive
Vassbakk-Brovold, Karianne; Berntsen, Sveinung; Fegran, Liv; Lian, Henrik; Mjåland, Odd & Mjåland, Svein [Show all 9 contributors for this article] (2018). Lifestyle changes in cancer patients undergoing curative or palliative chemotherapy: is it feasible? Acta Oncologica. ISSN 0284-186X. 57(6), p. 831–838. doi: 10.1080/0284186X.2017.1413247. Full text in Research Archive
Marthinsen, Gunhild Nordbø; Helseth, Sølvi & Fegran, Liv (2018). Sleep and its relation to health in parents of preterm infants: a scoping review. BMC Pediatrics. 18(1), p. 352–352. doi: 10.1186/s12887-018-1320-7. Full text in Research Archive Show summary
Background: Sleep is essential for human health and functioning. Parents of preterm infants are susceptible to sleep disturbances because of stress related to the preterm birth. Poor sleep has the potential to affect parental health and well-being. The aim of this study was to identify and map evidence on sleep and its relationship to health in parents of preterm infants. No review has summarized the evidence on this topic. Methods: A scoping review was conducted. Seven health and medical electronic research databases were searched for relevant quantitative and qualitative primary studies, including grey literature. The search was performed March 2–7, 2017. Results: Ten American studies and one Australian study were included in the review. Most research was quantitative and focused on maternal sleep and mental health within the first two weeks after the childbirth. Both objective and subjective sleep measures were used to study sleep at the hospital; actigraphs were not used after discharge. Maternal sleep was poor early postpartum, and this was associated with negative health outcomes. Two cohort studies compared sleep in mothers of preterm and term infants, but the results were conflicting. In one qualitative study, fathers described their inability to catch up on sleep after homecoming with a preterm baby. Conclusions: Quantitative studies reporting on maternal sleep early postpartum was most frequently occurring in the results. Qualitative research on the topic was identified as a knowledge gap. More cultural and geographical breadth, including research on fathers’ sleep, is recommended in future research.
Mikkelsen, Hilde Elisabeth Timenes; Brovold, Karianne Vassbakk; Antonsen, Anne Jørstad; Berntsen, Sveinung; Kersten, Christian & Fegran, Liv (2018). Cancer Patients' Long-term Experiences of Participating in a Comprehensive Lifestyle Intervention Study While Receiving Chemotherapy. Cancer Nursing. ISSN 0162-220X. doi: 10.1097/NCC.0000000000000650. Full text in Research Archive Show summary
BACKGROUND: Lifestyle interventions seem promising with regard to cancer patients' potential for physical and psychological health benefits and as an empowerment tool. Nevertheless, there is a lack of knowledge concerning cancer patients' longer-term experiences of participating in comprehensive lifestyle interventions. OBJECTIVE: The aim of this study was to explore cancer patients' long-term experiences of participating in a 12-month individualized comprehensive lifestyle intervention study focusing on physical activity, diet, smoking cessation, and stress management while receiving curative or palliative chemotherapy. METHODS: A qualitative design with semistructured interviews of 7 curative and 7 palliative cancer patients was conducted 12 months after inclusion in lifestyle intervention. Data were analyzed following a phenomenological-hermeneutic approach. RESULTS: Two main themes emerged: (1) awareness of the importance of a healthy lifestyle during cancer treatment and (2) individual follow-up; it's good to have someone to talk to. CONCLUSIONS: Participation in a 12-month comprehensive lifestyle intervention is both feasible and desirable in curative and palliative patients. However, although the curative participants' motivation and perceived ability to adhere to lifestyle recommendations increased during the intervention period, the palliative participants' perceived ability to adhere decreased even though they were overall highly motivated. IMPLICATIONS FOR PRACTICE: Our findings encourage the future implementation of lifestyle interventions during cancer treatment, even in cancer patients with advanced disease. However, when implementing lifestyle interventions, healthcare professionals must keep the patients' motivation, perceived ability to adhere to lifestyle recommendations, and individual needs in mind.
Johannessen, Berit; Helland, Sissel Heidi; Øverby, Nina Cecilie; Fegran, Liv & Bere, Elling (2018). "A bumpy road": Kindergarten staff experiences of participation in an intervention to promote healthy diets in toddlers. Appetite. ISSN 0195-6663. 127, p. 37–43. doi: 10.1016/j.appet.2018.04.008. Full text in Research Archive
Uhrenfeldt, Lisbeth; Fegran, Liv; Aagaard, Hanne & Ludvigsen, Mette Spliid (2018). Significant others’ experience of hospitalized patients’ transfer to home: A systematic review and meta-synthesis. Zeitschrift fur Evidenz, Fortbildung und Qualitat im Gesundheitswesen. ISSN 1865-9217. 139, p. 1–9. doi: 10.1016/j.zefq.2018.11.006. Full text in Research Archive
Robstad, Anja Nastasja; Siebler, Frank; Söderhamn, Ulrika; Westergren, Thomas & Fegran, Liv (2018). Design and psychometric testing of instruments to measure qualified intensive care nurses' attitudes toward obese intensive care patients. Research in Nursing and Health. ISSN 0160-6891. p. 1–10. doi: 10.1002/nur.21914. Full text in Research Archive
Aagaard, Hanne; Hall, Elisabeth O.C.; Ludvigsen, Mette Spliid; Uhrenfeldt, Lisbeth & Fegran, Liv (2018). Parents´ experiences of neonatal transfer. A meta-study of qualitative research 2000-2017. Nursing Inquiry (NI). ISSN 1320-7881. 25:e12231(3), p. 1–11. doi: 10.1111/nin.12231. Full text in Research Archive Show summary
Transfers of critically ill neonates are frequent phenomena. Even though parents’ participation is regarded as crucial in neonatal care, a transfer often means that parents and neonates are separated. A systematic review of the parents’ experiences of neonatal transfer is lacking. This paper describes a meta‐study addressing qualitative research about parents’ experiences of neonatal transfer. Through deconstruction and reflections of theories, methods, and empirical data, the aim was to achieve a deeper understanding of theoretical, empirical, contextual, historical, and methodological issues of qualitative studies concerning parents’ experiences of neonatal transfer over the course of this meta‐study (2000–2017). Meta‐theory and meta‐method analyses showed that caring, transition, and family‐centered care were main theoretical frames applied and that interviewing with a small number of participants was the preferred data collection method. The meta‐data‐analysis showed that transfer was a scary, unfamiliar, and threatening experience for the parents; they were losing familiar context, were separated from their neonate, and could feel their parenthood disrupted. We identified ‘wavering and wandering’ as a metaphoric representation of the parents’ experiences. The findings add knowledge about meta‐study as an approach for comprehensive qualitative research and point at the value of meta‐theory and meta‐method analyses.
Robstad, Anja Nastasja; Söderhamn, Ulrika & Fegran, Liv (2017). Intensive care nurses’ experiences of caring for obese intensive care patients: a hermeneutic study. Journal of Clinical Nursing (JCN). ISSN 0962-1067. 27(1-2), p. 386–395. doi: 10.1111/jocn.13937. Full text in Research Archive Show summary
Aim and objectives: To obtain a deeper understanding of qualified intensive care nurses’ experiences of caring for obese patients in intensive care. Background: Admission of obese patients with complex health care needs to intensive care units is increasing. Caring for obese critically ill patients can be challenging and demanding for the intensive care nurse because of the patients’ weight, critical situation, and physical challenges. There is a gap in knowledge at present about qualified intensive care nurses’ experiences of caring for obese patients in intensive care units. Design: A qualitative hermeneutic approach. Accepted Article This article is protected by copyright. All rights reserved. Method: The study took place in 2016 at intensive care units of two different hospitals. Semi-structured individual interviews were conducted with 13 qualified intensive care nurses. The interviews were analysed according to a Gadamerian-inspired research method. Results: Intensive care nurses perceived caring for obese intensive care patients as emotionally demanding owing to these patients’ vulnerability, dissimilarity and physical challenges compared to normal weight patients. They experienced ambivalent feelings caring for these patients: while they endeavoured to provide good and equal care to all patients, they simultaneously held negative beliefs and attitudes towards obese patients. Furthermore, frustration arose among the intensive care nurses relating to the physically demanding care situations and an unwillingness to care for such patients among some colleagues. Conclusion: The qualified intensive care nurses’ experiences of caring for obese patients revealed ambivalent feelings, attitudes, and beliefs towards these patients, which must be considered in intensive care unit practice as well as in the education of these nurses. Relevance to clinical practice: The results have implications for clinical practice with respect to increasing intensive care nurses’ awareness of their attitudes and beliefs towards obese intensive care patients and to improve the education of these nurses.
Bjørnarå, Helga Birgit; Berntsen, Sveinung; Velde, Saskia J. te; Fegran, Liv; Fyhri, Aslak & Deforche, Benedicte [Show all 8 contributors for this article] (2017). From cars to bikes – the feasibility and effect of using e-bikes, longtail bikes and traditional bikes for transportation among parents of children attending kindergarten: design of a randomized cross-over trial. BMC Public Health. 17(981). doi: 10.1186/s12889-017-4995-z. Full text in Research Archive Show summary
Background The present study aims to increase bicycling and level of physical activity (PA), and thereby promote health in parents of toddlers, by giving access to different bicycle types. There is a need for greater understanding of e-bikes and their role in the transportation network, and further effects on PA levels and health. Moreover, longtail bikes could meet certain practical needs not fulfilled by e-bikes or traditional bikes, hence increased knowledge regarding their feasibility should be obtained. No previous studies have investigated whether providing an e-bike or a longtail bike over an extended period in a sample of parents of toddlers influence objectively assessed amount of bicycling and total PA level, transportation habits, cardiorespiratory fitness, body composition and blood pressure. Methods A randomized cross-over trial will be performed, entailing that participants in the intervention group (n = 18) complete the following intervention arms in random order: (i) three months access to an e-bicycle with trailer for child transportation (n = 6), (ii) three months access to a longtail bicycle (n = 6), and (iii) three months access to a regular bicycle with trailer (n = 6), in total nine months. Also, a control group (n = 18) maintaining usual transportation and PA habits will be included. A convenience sample consisting of 36 parents of toddlers residing in Kristiansand municipality, Southern Norway, will be recruited. Total amount of bicycling (distance and time), total level of PA, and transportation habits will be measured at baseline and in connection to each intervention arm. Cardiorespiratory fitness, body composition and blood pressure will be measured at baseline and post-intervention. Main outcome will be bicycling distance and time spent cycling. Discussion New knowledge relevant for the timely issues of public health and environmental sustainability will be provided among parents of toddlers, representing a target group of greatest importance. There is a call for research on the influence of e-bikes and longtail bikes on travel behavior and PA levels, and whether voluntary cycling could improve health. If the present study reveals promising results, it should be replicated in larger and more representative samples. Eventually, inclusion in national public health policies should be considered.
Bjørnarå, Helga Birgit; Berntsen, Sveinung; Velde, Saskia J. Te; Fegran, Liv; Fyhri, Aslak & Deforche, Benedicte [Show all 8 contributors for this article] (2017). From cars to bikes – the feasibility and effect of using e-bikes, longtail bikes and traditional bikes for transportation among parents of children attending kindergarten: design of a randomized cross-over trial. BMC Public Health. doi: 10.1186/s12889-017-4995-z. Full text in Research Archive
Høie, Magnhild; Haraldstad, Kristin; Rohde, Gudrun E.; Fegran, Liv; Westergren, Thomas & Helseth, Sølvi [Show all 8 contributors for this article] (2017). How school nurses experience and understand everyday pain among adolescents. BMC Nursing. 16(1). doi: 10.1186/s12912-017-0247-x. Full text in Research Archive Show summary
Pain problems are a rapidly growing health problem found among both children and adolescent, and about 15–30% have reported chronic pain problems. School nurses in Norway meet adolescents with various ailments, including pain. Yet research on how school nurses perceive the pain experienced by adolescents is limited. The aim of the present study was to explore how school nurses explain and experience the everyday pain of adolescents. A qualitative study with an explorative design comprising five focus group interviews. Each group consisted of three to five school nurses. Seventeen female school nurses in five junior high schools in Norway, age range 29–65 years participated. To cover the issues a semi structured interview guide was used. The transcribed text was analysed with qualitative content analysis. The experience of school nurses with adolescents’ pain in everyday life is mainly that pain is a social, physical, and psychological phenomenon. School nurses experienced that everyday pain is reflecting: 1) high expectations, 2) difficult relationships and traumatic experiences and 3) an unhealthy lifestyle. School nurses have ambivalent attitudes to medicalisation of pain. Despite of a biopsychosocial understanding of pain, the school nurses maintained referral practice of medical examinations, with the results that many adolescents became shuttlecocks in the health system. Although the school nurses´ were sceptical of the tendency towards medicalization in society, it appears that they actually help maintain this tendency.

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Paulsen, Anita; Fegran, Liv & Vistad, Ingvild (2026). Seksuell helse ved gynekologisk kreft : Kvinners erfaringer med kommunikasjon. doi: https:/kreftrehabilitering.no/kreftrehab-2026-takk/. Full text in Research Archive
Hall, Elisabeth O.C.; Fegran, Liv; Robstad, Anja Nastasja; Aagaard, Hanne & Ludvigsen, Mette Spliid (2026). Et indblik i sygeplejeteoretikeren Afaf Meleis liv og virke. Klinisk Sygepleje. ISSN 0902-2767. 40(1), p. 1–13. doi: 10.18261/ks.40.1.5. Full text in Research Archive
Håkstad, Katrine; Fegran, Liv; Hovden, Ewa Alicja Szyszko & Köpp, Unni Mette Stamnes (2025). Orofaciale tegn på mishandling hos barn og ungdom. Tannstikka : tidsskrift for Norsk tannpleierforening. ISSN 1501-8636. 2, p. 33–34. doi: 10.56373/2024-11-6. Full text in Research Archive
Paulsen, Anita; Vistad, Ingvild & Fegran, Liv (2024). 207 Gynecological cancer survivors' experiences with sexual health communication in nurse-led follow-up consultations. doi: https:/eposters.emma.events/esgo2024eposters/poster/Poster_152041/Poster_152041.jpg?ver=1. Full text in Research Archive
Håkstad, Katrine; Fegran, Liv; Hovden, Ewa Alicja Szyszko & Köpp, Unni Mette Stamnes (2024). Tannhelseundersøkelse kan avdekke vold, overgrep og omsorgssvikt mot barn og ungdom. Den norske tannlegeforenings Tidende. ISSN 0029-2303. 134(11), p. 964–965. doi: 10.56373/2024-11-6. Full text in Research Archive
Håkstad, Katrine; Fegran, Liv; Hovden, Ewa Alicja Szyszko & Köpp, Unni Mette Stamnes (2024). Tannhelseundersøkelse kan avdekke vold, overgrep og omsorgssvikt mot barn og ungdom. Den norske tannlegeforenings Tidende. ISSN 0029-2303. doi: 10.56373/2024-11-6. Full text in Research Archive
Fegran, Liv (2024). Transitions Theory – a relevant framework within nursing care? Full text in Research Archive
Håkstad, Katrine; Fegran, Liv; Hovden, Ewa Alicja Szyszko & Köpp, Unni Mette Stamnes (2024). Orofacial signs of child or adolescent maltreatment identified by dentists and dental hygienists. Full text in Research Archive
Paulsen, Anita; Vistad, Ingvild & Fegran, Liv (2023). Sexual health communication in gynecological cancer follow-up. doi: https:/www.nfks.no/NACS2023-program/. Full text in Research Archive
Paulsen, Anita; Vistad, Ingvild & Fegran, Liv (2023). CN49 Nurse–patient sexual health communication in gynecological cancer follow-up: A qualitative study from nurses’ perspectives. doi: https:/www.annalsofoncology.org/action/showPdf?pii=S0923-7534%2823%2902480-8. Full text in Research Archive
Fegran, Liv (2023). Parents’ lived experiences of parenting in neonatal care units - a review of publications between 2003-2023. Full text in Research Archive
Robstad, Anja Nastasja & Fegran, Liv (2023). The lived experiences of obese patients during hospital admissions. Full text in Research Archive
Fegran, Liv (2023). Nurses’ and Doctors’ Experiences of Transferring Adolescents or Young Adults With Long-Term Health Conditions From Pediatric to Adult Care: A Metasynthesis. [Internet]. Podcast. Full text in Research Archive Show summary
Podcast published on the jorunal's website, linked to published article in fulltext.
Føreland, Anne Marit; Engesland, Helene; Kristoffersen, Laila Marie & Fegran, Liv (2023). Tidlig hudkontakt er viktig også ved svært premature fødsler. Tidsskriftet sykepleien. ISSN 0806-7511. doi: 10.4220/Sykepleiens.2023.91977. Full text in Research Archive
Eriksen, Alison Axisa; Fegran, Liv; Fredwall, Terje Emil & Larsen, Inger Beate (2023). Pasienters negative erfaringer med bruk av helsetjenester brakt frem i lyset av formelle klager: en kvalitativ metasyntese. Full text in Research Archive
Fegran, Liv (2022). The complexity of young people's transfer from pediatric to adult care – using systematic literature reviews to expand our understanding of the lifeworld of the involved participants. Full text in Research Archive
Fegran, Liv (2022). A future-oriented perspective on parent-nurse collaboration in neonatal care - where do we stand, and where are we going? Full text in Research Archive
Fegran, Liv & Føreland, Anne Marit (2022). Sykepleieforskning: Hvorfor skal sykepleiere forske? Full text in Research Archive
Audulv, Åsa; Hall, Elisabeth O. C.; Ludvigsen, Mette Spliid; Westergren, Per Christer Thomas; Kneck, Åsa & Pedersen, Mona Kyndi [Show all 9 contributors for this article] (2021). Exploring longitudinal qualitative research method using adapted scoping review method: Lessons learnt while conducting research on research. Full text in Research Archive
Ludvigsen, Mette Spliid; Hall, Elisabeth O. C.; Westergren, Per Christer Thomas; Aagaard, Hanne & Fegran, Liv (2021). Effect sizes in qualitative research synthesis: How effect size calculations improve the quality of qualitative research synthesis. Full text in Research Archive
Fegran, Liv; Ludvigsen, Mette Spliid; Westergren, Per Christer Thomas & Aagaard, Hanne (2021). A meta-aggregative approach to the synthesis of nurses' and physicians' experiences in a health-care contex. Full text in Research Archive
Aagaard, Hanne; Hall, Elisabeth O.C.; Audulv, Åsa; Pedersen, Mona Kyndi; Ludvigsen, Mette Spliid & Westergren, Thomas [Show all 7 contributors for this article] (2021). Parents@ experiences of transition from NICU to home with and ELBW or WLBW infant: a metaethnography of qualitative research 2009-2019. Full text in Research Archive
Ludvigsen, Mette Spliid; Fegran, Liv; Aagaard, Hanne & Audulv, Åsa (2021). Symposium: Analysis and synthesis in systematic reviews – how to capture the quality of qualitative findings. Full text in Research Archive
Fegran, Liv (2020). Methods for systematic review - metasynthesis. Full text in Research Archive
Fegran, Liv (2020). Qualitative review methods - Metasynthesis. Full text in Research Archive
Fegran, Liv & Helseth, Sølvi (2019). Sleep and its relationship to health in parents of preterm infants: A scoping review (poster og abstract konferanse bidrag). Full text in Research Archive Show summary
Sleep is essential for human health and functioning. Parents of preterm infants are susceptible to sleep disturbances because of stress related to the preterm birth. Poor sleep can affect parental health and well-being negatively. Adequate sleep is crucial to parent’s ability to be caregivers.
Ludvigsen, Mette Spliid & Fegran, Liv (2019). Kvalitative metoder i sygepleje. In Hundborg, Steen (Eds.), Sygepleje & klinisk lederskab - bind 2. FADL's Forlag a/s. ISSN 9788793590359. p. 330–357. Full text in Research Archive
Bjørnarå, Helga Birgit; Berntsen, Sveinung; Velde, Saskia Te; Deforche, Benedicte; Fegran, Liv & Fyhri, Aslak [Show all 8 contributors for this article] (2019). E-bikes for family transportation: Project From Cars to Bikes. Full text in Research Archive
Løyland, Borghild; Klausen, Susanne Hwiid; Angelhoff, Charlotte; Kristjansdottir, Gudrun; Sjølie, Hege & Winger, Anette [Show all 16 contributors for this article] (2018). Nordic Network for Research in Children and Parents' Sleep. Full text in Research Archive
Westergren, Thomas; Berntsen, Sveinung & Fegran, Liv (2018). PSYCHOSOCIAL ASPECTS OF ASTHMA RELATED EXERCISE LIMITATION IN THE LITERATURE. Full text in Research Archive
Aagaard, Hanne; Hall, Elisabeth O.C.; Ludvigsen, Mette Spliid; Fegran, Liv & Uhrenfeldt, Lisbeth (2018). Challenges in using meta-study in advancing qualitative evidence. Full text in Research Archive
Fegran, Liv (2018). Å bli og være foreldre til et sykt nyfødt barn.. Full text in Research Archive
Dalsmo, Ingrid Espegren; Haraldstad, Kristin; Johannessen, Berit; Hovland, Olav Johannes & Fegran, Liv (2018). School drop-outs and health-promotion campaigns in Tanga-region, Tanzania. Full text in Research Archive
Ebitu, Anne Katrine S; Fegran, Liv; Hovland, Olav Johannes; Johannessen, Berit & Haraldstad, Kristin (2018). The Banana project- A qualitative study of parents and teachers experiences of pre-school children participating in a banana project at a pre-school in TZ. Full text in Research Archive
Bjørnarå, Helga Birgit; Berntsen, Sveinung; Velde, Saskia Te; Fegran, Liv; Fyhri, Aslak & Deforche, Benedicte [Show all 8 contributors for this article] (2018). From cars to bikes – the feasibility and effect of using e-bikes, longtail bikes and traditional bikes for transportation among parents of children attending kindergarten. Full text in Research Archive
Robstad, Anja Nastasja; Söderhamn, Ulrika & Fegran, Liv (2017). Intensive care nurses’ experiences of caring for obese intensive care patients: a hermeneutic study. Full text in Research Archive
Westergren, Thomas; Mowinckel, Petter; Håland, Geir; Fegran, Liv & Berntsen, Sveinung (2017). Opplever barn med astma at sykdommen begrenser deltakelse i fysisk aktivitet? Best Practice Lungemedisin i Norge. 7(25), p. 13–15. Full text in Research Archive
Ludvigsen, Mette Spliid; Hall, Elisabeth O.C.; Uhrenfeldt, Lisbeth; Aagaard, Hanne; Westergren, Thomas & Fegran, Liv (2017). A systematic review and metasynthesis of parent experiences of chronic ill adolescents and young adult's transfer from pediatric to adult care. Full text in Research Archive
Uhrenfeldt, Lisbeth; Aagaard, Hanne; Fegran, Liv; Hall, Elisabeth O.C. & Ludvigsen, Mette Spliid (2017). Significant others’ experience of hospitalized patients’ transfer to home: A systematic review and metasynthesis. Full text in Research Archive
Fegran, Liv; Haraldstad, Kristin; Westergren, Thomas; Johannessen, Berit; Slettebø, Åshild & Helseth, Sølvi [Show all 9 contributors for this article] (2017). Adolescents and young adults’ experiences of living with everyday pain – a qualitative metasynthesis. Full text in Research Archive
Wik, Gunnar; Thomassen, Synnøve Nepstad & Fegran, Liv (2021). Tverrfaglig oppfølging av hjertesyke barn ved SSHF. Foreningen for hjertesyke barn. Full text in Research Archive

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Published Apr. 16, 2024 10:52 AM - Last modified Nov. 28, 2024 9:44 AM