Johanne Alteren

• Sunde, Olivia Sissil; Alteren, Johanne & Ytrehus, Siri (2023). Caring for a home-dwelling older parent with mental health problems : a narrative analysis of family caregivers’ experiences. International Journal of Qualitative Studies on Health and Well-being. ISSN 1748-2623. 18(1), p. 1–14. doi: 10.1080/17482631.2023.2236373. Full text in Research Archive Show summary

  Purpose: To gain knowledge regarding family caregivers of home-dwelling older adults with mental health problems and the meaning-making of the caregiver’s role. Design An explorative qualitative study involving narrative analysis. Methods: Semi-structured individual interviews were conducted among eight adult children. Interview data were analysed using narrative analysis. The reporting adhered to consolidated criteria for reporting qualitative studies. Results: Each participant narrated unique and nuanced stories of the caregiver role, but their stories also revealed prominent themes across participants’ experiences and meaning-making. The analysis revealed three themes: family relationships through a long life, a demanding and difficult caregiver role, and reconstructing the caregiver’s role by leaving the responsibility to healthcare services. Conclusion: Family caregivers experienced the role as purposeful and demanding. Mostly, psychological reactions to behaviour symptoms and duration of caregiving were considered difficult and demanding. They described that they lacked knowledge of the illness and how to perform care. Sharing care responsibility with healthcare services had the potential to ease family caregivers’ burden. However, based on a long life as caregivers, some experienced difficulties when reconstructing and adjusting the role to their life situation.

• Malones, Bente Dale; Melbye, Marita Christina Susanne; Eines, Trude Fløystad & Alteren, Johanne (2023). Alternative Clinical Practice During the COVID-19 Pandemic: A Qualitative Study of Nursing Students’ Potential Loss of Experience. Sage Open Nursing. ISSN 2377-9608. 9, p. 1–9. doi: 10.1177/23779608231178066. Show summary

  Introduction: During the COVID-19 pandemic, the lockdown of nursing institutions changed nursing students’ learning conditions in clinical practice. They were removed from their ordinary clinical practice and isolated in their homes for one week before resuming an alternative clinical practice. Owing to the changed learning conditions, nursing students had to readjust and find new and different solutions to manage their own learning. Objectives: This study aimed to investigate the impact of removing first-year nursing students from clinical practice during the COVID-19 pandemic on their perceived learning and development. Methods: A qualitative descriptive and interpretative design based on group and individual interviews was used. Eleven first-year nursing students from a university college in Norway participated in the study. They were interviewed from their homes, after completing their first 10-week clinical practice. Three group interviews and two individual interviews were recorded using the digital live video aid Zoom and analyzed using systematic text condensation. Results: The main theme “loss of experience,” summarized how the nursing students experienced their first clinical practice during the COVID-19 lockdown. The nursing students shifted from a predictable to an unpredictable clinical practice without supervision from the nurse supervisor or the nurse educator. The organization and planning of the practice were left to the students, who bore the responsibility of achieving the learning outcomes. Three categories were identified: unpredictable learning situations, compensating learning activities, and achieving learning outcomes. Conclusions: Nursing students faced difficulties in their first clinical practice during the COVID-19 lockdown, which made a challenging study situation. Too much autonomy and responsibility for their own learning reinforced a loss of experience. The uncertainty of the study situation potentially harmed their professional development, learning outcomes, and self-efficacy, especially concerning basic nursing skills.

• Alteren, Johanne; Johannessen, Aud; Lyberg, Anne Marit & Magnussen, Inger-Lise (2023). Giving voice to people with dementia and perspectives regarding a dementia-friendly society : a synthesis of qualitative studies. Journal of Multidisciplinary Healthcare. ISSN 1178-2390. 16, p. 851–861. doi: 10.2147/JMDH.S398570. Full text in Research Archive Show summary

  Introduction: The World Health Organization [WHO] and governments worldwide envision the development of dementia-friendly societies that are based on a person-centered culture. A limited number of studies have described the features of dementia-friendly societies based on the viewpoints of people with dementia. Purpose: To synthesize qualitative empirical research that expands the knowledge of what people with dementia consider to be essential for daily living in a dementia-friendly society. Methods: The authors searched phrases in the databases AgeLine, CINAHL, EMBASE, MedLine, PsycINFO, PubMed, ORIA, SveMed+, and Cochrane Library. Research articles that involved people with dementia and were conducted in Western countries, written in English, published in peer-reviewed academic journals using qualitative methods, and published within the past decade were included. The research included was critically and systematically appraised using the critical appraisal skills program checklist for qualitative research, and the findings were analyzed according to Graneheim and Lundman’s method of qualitative content analysis. Results: Overall, 1122 records—561 from 2019 and 561 from 2021—were identified through the search, and nine studies were included in the final synthesis. The studies included were from the United Kingdom (five studies), Australia (three studies), and New Zealand (one study). Through the analysis process, the following main theme emerged: giving voice to people with dementia, which summarizes the essence of what people with dementia believe is essential for daily living in a dementia-friendly society. The main theme covered two themes: a sense of being valued and a sense of being safeguarded, each of which contained subthemes. Conclusion: To meet the WHO’s and the governments worldwide intention to develop dementia-friendly societies, further research should focus on the voices of people with dementia. By including those concerned, the political goals of a dementia-friendly society can be achieved. Keywords: approachable society, user involvement, decision-making, systematic review, qualitative research, person-centered culture

• Hauan, Marianne; Kvigne, Kari Johanne & Alteren, Johanne (2023). Politically engaged mindset of everyday coping in relation to nursing values : a phenomenological-hermeneutic study of district nurses’ experiences. Sage Open Nursing. ISSN 2377-9608. 9, p. 1–8. doi: 10.1177/23779608231157969. Full text in Research Archive Show summary

  IntroductionTo accommodate challenges threatening the healthcare sector's sustainability, district nursing in Norway implemented the rehabilitative and health promoting mindset of everyday coping. When implementing new ideas and practices in nursing care, understanding the significance of this mindset on patient care and whether it corresponds to nursing values are important to ensure healthcare quality. ObjectiveThis study aimed to understand how nurses practice care where everyday coping is implemented in district nursing and their experience of everyday coping as a mindset in relation to nursing values. MethodsA qualitative study was conducted including 19 observations and 19 narrative interviews with 10 district nurses, during two data collection periods. Data were analyzed using a phenomenological-hermeneutic method. The analysis process consisted of three steps: naïve reading, structural analysis, and comprehensive understanding. ResultsThe following two main themes and four sub-themes emerged from the data analyses: (i) Understanding individual patient situations; “Creating a nurse–patient relationship to understand the patient landscape” and “providing care based on individual patient needs,” (ii) knowing when and how to motivate or help patients; “distinction between motivating patients and causing stress” and “realistic and desirable demands to motivate patients to perform tasks.” ConclusionParticipants determined how to provide care to patients based on their values, professional knowledge, and individual patient situations. The patient landscape is diverse and everyday coping is unable to capture the diversity of patient groups. Thus, everyday coping is not expressed as an overall mindset in nursing practice. Keywords: nursing values, everyday coping, political strategies, health promotion models

• Alteren, Johanne (2022). Work interruption as a source of knowledge when nurses administer medicines in nursing homes : hermeneutic approach to narratives. In Olsen, Rose Mari & Sletvold, Hege (Ed.), Medication safety in municipal health and care services. Cappelen Damm Akademisk. ISSN 9788202738792. p. 279–294. doi: 10.23865/noasp.172.ch13. Full text in Research Archive Show summary

  Nurses administer medicines amidst constant interruptions. They must simultaneously perform other tasks, such as direct patient care or addressing system failures. However, there is a lack of research relating to nurses’ perspectives on these work interruptions: what they are, and what they are not. The purpose of this chapter is to elucidate nurses’ perspectives on and experience of work interruptions, as well as discuss the significance of their perspectives for safe drug management among nursing home residents. The study has a qualitative design. Data consisted of narratives on work interruptions shared by nurses. The narratives were analyzed, and a sample narrative was developed using Gadamer’s hermeneutical circle. The narrative stems from several years of experience as a nurse administering medicines in nursing homes, and as a researcher doing field studies, along with testimony developed from narratives nurses shared on how they view work interruptions during medicine rounds. In a sample narrative, a nurse reflects on administering medicines during constant interruptions in a somatic ward in a Norwegian nursing home. The residents’ needs define whether a work interruption is a work interruption, or a source of knowledge important for medication treatment and care in nursing homes. Keywords: work interruption, medicine administration, nursing homes, nurses, narrative, source of knowledge

• Zarea, Kourosh; Mohammadi, Eesa; Alteren, Johanne & Sayadi, Neda (2022). An Evaluation of Psychometric Properties of Needs Assessment Instruments in Patients with Coronary Artery Disease Undergoing Cardiac Rehabilitation Programs: A Systematic Review. Nurse Media Journal of Nursing. ISSN 2087-7811. 12(2), p. 269–287. doi: 10.14710/nmjn.v12i2.43808. Show summary

  Background: Coronary Artery Disease (CAD) is the foremost reason of illnesses and death in the world. Assessment of the needs is a priority in these patients. However, there is a paucity of tools for the evaluation of needs, with the controversy surrounding their validity. Purpose: This review aimed to evaluate the psychometric properties of tools used to assess needs of patients with CAD undergoing cardiac rehabilitation (CR) plans. Methods: An online literature search combined with manual search was carried out on 11 databases to identify relevant articles. The terms used in the search were: cardiac rehabilitation AND coronary artery disease, cardiac rehabilitation AND acute coronary syndrome, and questionnaires OR need assessment OR tool OR scale. Articles from 1989 to 2021 were selected using some inclusion criteria and no validation studies were excluded. The quality of the questionnaires was evaluated by researchers using consensus-based standards for the selection of health status measurement instruments (COSMIN) list. Data analysis had been done by calculating overall methodological quality scores per study on a measurement property using COSMIN checklist. A methodological quality score per box was obtained by taking the lowest rating of any item in a box (‘worse score counts’). Results: Of 653 articles, 15 papers were involved in the study. Six studies reported cross-cultural validity, nine studies for criterion validity, and none reported measurement error, hypothesis testing, and responsiveness. There is no vigorous and valid single scale for the measurement of needs in CAD patients. Overall, the CADE-Q questionnaire was good and a patient self-assessment tool for cardiac rehabilitation was poor based on psychometric properties. Conclusions: The findings of this study disclosed that even though it has been more than 32 years, from 1989 to 2021, of the development in need assessment instruments, each instrument has as a minimum of one “poor” psychometric property according to the COSMIN checklist. So, it is recommended for the next studies to design and develop instruments with better psychometric validities for clinical environment.

• Hogset, Heidi; Alteren, Johanne; Jæger, Bjørn & Straume, Solveig (2022). Det vanskelige bærekraftsbegrepet. In Hogset, Heidi; Alteren, Johanne; Jæger, Bjørn & Straume, Solveig (Ed.), Bærekraft : Fjordantologien 2022. Universitetsforlaget. ISSN 978-82-15-06293-8. p. 13–25. doi: 10.18261/9788215062938-2022-01. Full text in Research Archive
• Elvevoll, Linda Dragvik; Isaksen, Kamilla Torsdatter; Hauan, Marianne & Alteren, Johanne (2022). Nurses' experiences with the use of checklists in the specialist health service: a qualitative study. Klinisk Sygepleje. ISSN 0902-2767. 36(2), p. 109–122. doi: 10.18261/ks.36.2.4. Full text in Research Archive Show summary

  The purpose of checklists in the health care service is to ensure quality and improve patient safety. The purpose of this study was to illuminate and discuss how nurses in the specialist health service use checklists in everyday work. Qualitative, in-depth interviews were conducted of eight nurses working in three departments. Content analysis guided the analysis of data. Two main categories were identified: ‘Checklists, a tool for organizing everyday work’and ‘Random implementation and use of checklists in the departments’.The nurses made professional assessments and adjustments in the patient situation on how and what to use of the points in the checklists, as well as when it was appropriate to use the checklists. They spent a lot of time on documentation related to checklists, which was at the expense of patient contact. Working conditions and at what level in the organization the checklists were prepared, had an impact on how the professionals used the checklists. Keywords: checklists, nurses, patient safety, qualitative study, special health service

• Johansen, Grethe & Alteren, Johanne (2021). Oppmerksomt nærvær : studentenes forståelse av relasjonskompetanse etter endt videreutdanning i psykisk helsearbeid, en hermeneutisk studie. Nordisk tidsskrift for helseforskning. ISSN 1504-3614. 17(2). doi: 10.7557/14.5724. Full text in Research Archive Show summary

  Relasjonskompetanse innen psykisk helsearbeid har betydning for menneskers håp og livsmuligheter ved kriser og psykisk uhelse. Hensikten med studien er å utdype studentenes beskrivelse og forståelse av relasjonskompetanse etter endt videreutdanning innen psykisk helsearbeid. Studien har et beskrivende og utforskende design med en hermeneutisk tilnærming. Fem sykepleiere og to sosionomer ble intervjuet. Kvales tre nivåer av forståelse ble benyttet i analysen. Resultatet ble hovedtemaene: Å være menneske i møte med den andre og Å forstå hva som kreves i den konkrete situasjonen. Studentene beskrev og forsto relasjonskompetanse som oppmerksomt nærvær - en bevegelse mellom indre og ytre prosesser. Oppmerksomt nærvær ble uttrykt som bevegelse mellom det personlige og faglige og gjennom bevissthet om grenser i praksis. Oppmerksomt nærvær fremstår som en kompetanse og bør videreutvikles i videreutdanningen og praksisfeltet, knyttet til erfaringskunnskap. Nøkkelord: relasjonskompetanse, psykisk helsearbeid, videreutdanning i psykisk helsearbeid, oppmerksomt nærvær, studenterfaring

• Alteren, Johanne; Hermstad, Marit; Nerdal, Lisbeth & Jordan, Sue (2021). Working in a minefield; Nurses’ strategies for handling medicine administration interruptions in hospitals, -a qualtiative interview study. BMC Health Services Research. ISSN 1472-6963. 21. doi: 10.1186/s12913-021-07122-8. Full text in Research Archive Show summary

  Background: Administering medicines is one of the most high-risk tasks in health care. However, nurses are frequently interrupted during medicine administration, which jeopardises patient safety. Few studies have examined nurses’ experiences and the strategies they adopt to cope with interruptions during medicine rounds. This paper identifies nurses’ strategies for handling and reducing interruptions and ensuring safety during medicine rounds, within the confines of the hospitals’ organisational systems. Methods: This descriptive and exploratory research study was undertaken with experienced nurses in Norwegian hospitals in 2015 using semi-structured interviews. Interviews were designed to elicit experiences and strategies used for handling interruptions to medicine rounds. Data were analysed using qualitative content analysis based on inductive reasoning to identify meaningful subjects and reach an interpretive level of understanding regarding nurses’ experiences. Results: All 19 senior nurses who were approached were interviewed. From 644 condensed meaning units, we identified eight interpretative units and three themes: ‘working in environments of interruptions’, ‘personal coping strategies’, and ‘management-related strategies’. Nurses’ working environments were characterised by interruptions and distractions, which often threatened patient safety. To handle this unpredictability and maintain ward organisation, nurses developed their own personal strategies to overcome inherent problems with their working conditions, the absence of effective management, and colleagues’ reluctance to assume responsibility for minimising interruptions. Conclusions: Administration of medicines in hospitals can be described as ‘working in a minefield’. Our findings indicate that the hospital management, in cooperation with nurses and other healthcare professionals, should take responsibility for improving the routine process of medicine administration by minimising avoidable interruptions. Patient safety can be improved when the hospital management takes steps to protect nurses’ work environments and assumes responsibility for resolving these challenges.

• Magnussen, Inger-Lise; Alteren, Johanne & Bondas, Terese (2021). “Human flourishing with dignity” : a meta-ethnography of the meaning of gardens for elderly in nursing homes and residential care settings. Global Qualitative Nursing Research. ISSN 2333-3936. 8, p. 1–17. doi: 10.1177/23333936211035743. Full text in Research Archive Show summary

  This study aims to identify and synthesize qualitative research regarding residents’ experiences of gardens while living in nursing homes and residential care facilities. To provide an optimal nursing environment inspired by nature, we need to derive knowledge from the residents’ perspective. An interpretive meta-synthesis approach, a meta-ethnography, was chosen for this study. Altogether, six articles representing three continents and comprising 124 participants were included. The six articles that fulfilled the inclusion criteria were analyzed and synthesized according to Noblit & Hare’s seven phases of meta-ethnography and the recent eMERGe guidelines. Four themes were identified: (1) The garden—a place to feel a connection with life, (2) the garden—a place to sense and find comfort, (3) the garden—a place to feel healthy and alive, and (4) the garden—a place to relate past and present. An overarching metaphor, “human flourishing with dignity,” offers a deeper understanding of the meaning of the garden for older people in nursing homes and residential care. This meta-ethnography provides a reflective, systematic, data-driven synthesis based on literature spanning ten years. Rather than simply relying on retelling, the narration of experiences according to the primary researcher’s descriptions and interpretations results in new knowledge. The significance of gardens for older people’s health and well-being needs to be given greater attention and space in nursing practice, education, and health policies. Keywords: residents, nursing home, residential care, garden, meta-ethnography, nursing care and dignity

• Devik, Siri Andreassen; Alteren, Johanne & Olsen, Rose Mari (2021). Kunnskap og vilje, men uten myndighet? : sykepleieres erfaringer med samhandling om legemiddelgjennomgang hos hjemmeboende eldre. In Hedlund, Marianne; Ingstad, Kari & Moe, Aud (Ed.), God helse : kunnskap for framtidens kommunehelsetjeneste. Universitetsforlaget. ISSN 978-82-15-04297-8. p. 45–68. doi: 10.18261/9788215042985-2021-03. Full text in Research Archive Show summary

  Fokusgruppeintervjuene i denne studien viste at hjemmesykepleiere erfarer å ha kunnskap og vilje, men liten myndighet i tverrfaglig legemiddelgjennomgang for hjemmeboende eldre. Data ble analysert ved hjelp av kvalitativ innholdsanalyse og resulterte i to hovedkategorier med tilhørende underkategorier: Aktørenes ansvar og oppgaver (sykepleieren, legen, farmasøyten) og Organisasjonens betydning for samhandlingen (ledelse, kommunikasjon og logistikk, rutiner og retningslinjer, tid og bemanning). Nøkkelord legemiddelsikkerhet | hjemmesykepleie | tverrfaglig samhandling Abstract The focus group interviews in this study showed that homecare nurses experience having knowledge and will, but little authority in interdisciplinary drugreviews for elderly people living at home. The content analysis resulted in two main categories with seven subcategories: The actors' responsibilities and tasks (nurse; doctor; pharmacist) and the Organization's significance for the interaction (management; communication and logistics; routines and guidelines; time and staffing). Keywords drug safety | home nursing care | multiprofessional collaboration

• Hov, Jorunn; Alteren, Johanne & Kvigne, Kari Johanne (2021). Rehabilitation of the frail older adults in primary healthcare in rural areas: a scoping review protocol. BMJ Open. ISSN 2044-6055. 11(6), p. 1–5. doi: 10.1136/bmjopen-2021-048820. Full text in Research Archive Show summary

  Introduction Frail older adults are particularly vulnerable to functional decline and adverse outcomes because they lack the necessary resistance and ability to cope. Rehabilitation services for the frail older adults are thus vital and require clarification. The aim of this review is to identify and map the scope and breadth of literature regarding rehabilitation of the frail older adults to develop a holistic rehabilitation service in primary healthcare in rural areas. The concept of rehabilitation, how rehabilitation services are organised, how patients and next of kin are involved in planning and evaluating services during rehabilitation, as well as reported results will be identified and mapped. Methods and analysis This scoping review will be conducted based on the methodology developed by Arksey and O’Malley. The search strategy will aim to locate both published and unpublished studies in relevant databases. Key information sources include CINAHL, MEDLINE, Embase, ProQuest and Google Scholar. Data will be extracted from papers that all three reviewers have chosen to include in the review. All three reviewers will participate in screening, assessment and selection of studies against the inclusion criteria for the review and work in teams of two. The full text of selected citations will be assessed in detail against the inclusion criteria by the same teams. Data will be extracted from papers included in the scoping review by two of the reviewers. Modifications will be detailed in the full review report. Any disagreements that arise between two reviewers will be resolved through discussion or with the third reviewer’s mediation. A narrative summary of the findings will be presented accompanied by tables that reflect the objective of the review. Ethics and dissemination Data will be obtained only from already publicly available materials. Special ethical approval is, therefore, not required.

• Sayadi, Neda; Alteren, Johanne; Mohammadi, Eesa & Zarea, Kourosh (2021). Development and psychometric properties evaluation of a care needs questionnaire in phase 1 cardiac rehabilitation for patients with coronary artery disease: CNCR-Q. Journal of Caring Science (JCS). 10(1), p. 29–36. doi: 10.34172/jcs.2021.006. Full text in Research Archive Show summary

  Introduction: Cardiovascular diseases (CVDs) are one of the most common chronic illnesses and the leading cause of mortality worldwide. This study aimed to design and assess the psychometric properties of questionnaire to examine the care needs of patients with coronary artery disease (CAD) in phase 1 of cardiac rehabilitation (CR). Methods: This sequential exploratory study used a mixed method with two phases. In the first phase, qualitative study was performed by analyzing the concept of Schwartz-Barcott-Kim hybrid model; and in the second phase, quantitative data were obtained and analyzed for the psychometric parameters of the designed tool. Results: The questionnaire for care needs was based on the indicators of measurement, which was identified in the qualitative phase of the study, as a tool with 40 items. After conducting face validity qualitatively, all tool items were considered important and were retained for the next steps. After completing the steps for determining the content validity ratio (CVR) and content validity index (CVI) of 40 items, they were preserved for decision making at a later stage. The results of exploratory factor analysis revealed four factors; the factor analysis of three items was eliminated and the final version of the questionnaire CNCR-Q (Care Needs Cardiac Rehabilitation-Questionnaire) with 37 items remained. Conclusion: The findings indicated that the questionnaire with properties, such as simple scoring, reliability and validity, is an appropriate tool for assessing care needs in Iranian patients with CAD. Moreover, the CNCR-Q is an effective instrument for assessing patient needs before discharge. Keywords: questionnaire design, cardiac rehabilitation, coronary artery disease, CNCR-Q, care needs

• Hauan, Marianne; Kvigne, Kari Johanne & Alteren, Johanne (2021). The health and care services of the future from an everyday coping perspective : a conceptual analysis of everyday coping in political documents. Klinisk Sygepleje. ISSN 0902-2767. 35(4), p. 289–303. doi: 10.18261/ISSN.1903-2285-2021-04-03. Full text in Research Archive Show summary

  Background: Demographic trends are creating challenges for a sustainable health care sector. In order to accommodate these challenges, new concepts are being introduced in political documents. The goal is to create changes towards a more sustainable health care sector. One of these concepts is «everyday coping». Purpose: To increase understanding of the implications «everyday coping» may have for nursing in community care. Methods: Four political documents are analyzed using Koselleck’s method of concept analysis. The concept analysis consists of two steps: diachronic and synchronous analysis. Results: The health care service has changed from compensating care towards healthpromoting,preventive priorities, and attitudes. The concept «everyday coping» promotes active care, where the patient themselves are largely responsible for their daily lives. Conclusion: The definition and use of the concept «everyday coping» in political documents has implications for the patient’s health care, practice of nursing and the organization of the health sector.

• Alteren, Johanne (2019). Narratives in student nurses' knowledge development: A hermeneutical research study. Nurse Education Today. ISSN 0260-6917. 76, p. 51–55. doi: 10.1016/j.nedt.2019.01.015. Full text in Research Archive Show summary

  Background: Knowledge development, and how student nurses learn to be nurses, is essential in nurse education and has implications for quality of care. There is a lack of research concerning how student nurses' knowledge development is expressed through narratives and how they deal with challenges in patient situations in professional learning. Objectives: To clarify the usefulness of narratives in student nurses' knowledge development and the narratives implications for learning in clinical training. Design and methods: The study has a qualitative design with field methodology. Data consisted of observations, interviews, and fieldnotes. The data was analysed, and narratives were developed using Gadamer's hermeneutical circle. Participants and settings: Seven first- and second-year student nurses from a bachelor programme were closely followed in different patient situations during their eight weeks of clinical studies in nursing homes. Results: In a sample narrative, a student nurse explained how she reflected on her actions and decisions made when she shielded a patient who was in a difficult situation. Conclusion: Narratives are useful for the development of student nurses' knowledge in clinical training. Student nurses' decisions and actions in the patient situation are made evident through narratives. Nursing educators and student nurses awareness of the relevance of this knowledge for understanding student nurses learning processes is of importance in professional education. Nursing educators should be more open minded to narratives as a starting point for reflection. Increased use of narratives in professional education will contribute to development of knowledge so that student nurses can manage to face patient situations as long as the situation themselves demands. Areas for further studies are other professional educations, for examples, doctor, physiotherapist, and occupational therapist.

• Magnussen, Inger-Lise; Alteren, Johanne & Bondas, Terese (2019). Appreciative inquiry in a Norwegian nursing home: a unifying and maturing process to forward new knowledge and new practice. International Journal of Qualitative Studies on Health and Well-being. ISSN 1748-2623. 14(1). doi: 10.1080/17482631.2018.1559437. Full text in Research Archive
• Mohammadi, Eesa; Zarea, Kourosh; Alteren, Johanne & Sayadi, Neda (2018). Care needs in the phase I of cardiac rehabilitation: A hybrid concept analysis. Nursing and Midwifery Studies. ISSN 2322-1488. 8(1), p. 48–54. doi: 10.4103/nms.nms_76_17. Full text in Research Archive
• Alteren, Johanne; Hermstad, Marit; White, Jo & Jordan, Susan (2018). Conflicting priorities: Observation of medicine administration. Journal of Clinical Nursing (JCN). ISSN 0962-1067. 27(19-20), p. 3613–3621. doi: 10.1111/jocn.14518. Full text in Research Archive
• Alteren, Johanne (2018). Emotions as one basis for the nursing profession. Development of practical knowledge. In Danielsen, Inger Jorun & Alteren, Johanne (Ed.), Erfaring som kunnskapskilde i profesjonspraksis. En vitenskapelig antologi.. Novus Forlag. ISSN 978-82-7099-905-7. p. 71–82.
• Magnussen, Inger-Lise; Bondas, Terese & Alteren, Johanne (2017). Sansehagens betydning for dannelsen av 'nærhetsrommet' - aksjonsforskning i sykehjem. Klinisk Sygepleje. ISSN 0902-2767. 31(2), p. 96–113. doi: 10.18261/issn.1903-2285-2017-02-03. Full text in Research Archive
• Hassel, Anne Marit; Hilstad, Laila & Alteren, Johanne (2016). Å være i relasjon med seg selv og andre. Pasientens erfaringer med temabasert samtalegruppe i allmennpsykiatrisk døgnavdeling. Tidsskrift for psykisk helsearbeid. ISSN 1503-6707. 13(3), p. 188–199. doi: 10.18261/issn.1504-3010-2016-03-02.
• Magnussen, Inger-Lise; Bondas, Terese & Alteren, Johanne (2016). Bringing in Health Geography in Nursing Home Care – An Action Research. Klinisk Sygepleje. ISSN 0902-2767. 30(3), p. 168–182. doi: 10.18261/issn.1903-2285-2016-03-03. Show summary

  The sensory garden is understood as a cultivated area used in caring for persons who suffer from dementia. There is previous knowledge about the significance of the sensory garden in nursing homes, but we know little about how it can be developed as part of the nursing care of older persons. Action research using appreciative interviews was conducted with thirteen participants. The aim of the study was to collect and illuminate nurses’, assistant nurses’ and managers’ experiences and wishes about nature and sensory gardens, in order to increase understanding of nature's possibilities and meaning in nursing home care. Findings show that caregivers’ awareness of their personal relationship with nature can be a source of knowledge for nursing care, and inspired by health geography, further perspectives for the development of sensory gardens may be uncovered. The study forms the basis for nursing care intervention in the community.

• Alteren, Johanne & Nerdal, Lisbeth (2015). Relationship between High School Mathematics Grade and Number of Attempts Required to Pass the Medication Calculation Test in Nurse Education: An Explorative Study. Healthcare. ISSN 2227-9032. 3(2), p. 351–363. doi: 10.3390/healthcare3020351. Full text in Research Archive

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• Hogset, Heidi; Alteren, Johanne; Jæger, Bjørn & Straume, Solveig (2022). Bærekraft : Fjordantologien 2022. Universitetsforlaget. ISBN 978-82-15-06293-8. 321 p.
• Danielsen, Inger Jorun & Alteren, Johanne (2018). Erfaring som kunnskapskilde i profesjonspraksis. En vitenskapelig antologi. Novus Forlag. ISBN 978-82-7099-905-7. 307 p.

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• Reitan, Laila Solli & Alteren, Johanne (2024). Er NEWS et effektivt observasjonsverktøy eller en tvangstrøye? Sykepleien.no.
• Alteren, Johanne (2023). The decision-making process in nursing. A reflection on the decision-making process from a phenomenological and hermeneutic perspective.
• Alteren, Johanne (2023). Medforskere som brukermedvirkere i forskning. Erfaringer fra et samarbeid mellom akademia og praksis.
• Alteren, Johanne (2023). Læringsprosessen i et fronesisk perspektiv: en bevegelse innenfor ulike kunnskapsformer.
• Sundal, Hildegunn; Ulvund, Ingeborg; Orøy, Aud Jorun & Alteren, Johanne (2023). 35 forskere deltok på helsefaglig fenomenologi-seminar på Molde campus. Panorama : nettavis for Høgskolen i Molde.
• Alteren, Johanne (2023). PROFRES Den tverrfaglige og tverrprofesjonelle forskerskolen for praksisnær forskning «The Future of the Welfare State» Forskerskolen PROFRES 2.0.
• Alteren, Johanne (2023). Helse- og sosialfaglig utdanningsforskning i regionen (HMN). Show summary

  Presentasjon av saksnotat fra arbeidsgruppe utdanningsforskning i Helse Midt-Norge med vurderinger og anbefalinger til Samarbeidsutvalget for utdanning SUU, januar 2023. Arbeidsgruppen besto av Kjersti Grønning Helse Nord-Trøndelag HF, Kari Hanne Gjeilo St. Olavs Hospital HF, Hilde Grimstad NTNU leder, Johanne Alteren, Høgskolen i Molde og Malvin Torsvik Nord universitet

• Alteren, Johanne (2022). «The Future of the Welfare State». Forskerskolen PROFRES 2.0.
• Alteren, Johanne (2021). "Å stå i pasientsituasjonen". Læringsprosessen i et fronesisk perspektiv.
• Alteren, Johanne (2020). Anerkjennelse av det norske språket i vitenskapelige artikler . Nordisk tidsskrift for helseforskning. ISSN 1504-3614. 16(1). doi: 10.7557/14.5351.
• Alteren, Johanne (2019). Livsmot som fenomen i et helsefaglig perspektiv. Nordisk tidsskrift for helseforskning. ISSN 1504-3614. 15(2). doi: 10.7557/14.5270.
• Hilli, Yvonne & Alteren, Johanne (2019). New Nordic-Baltic network in health care education. [Internet]. NORD. Show summary

  New Nordic-Baltic network in health care education Shared experiences seeks to educate better health care practitioners. The Estonian -Nordic Network in Health Care Education (ENNHANCE) was initiated in the spring of 2019 to promote didactic knowledge taken into account different cultural and educational perspectives. Professor Yvonne Hilli and associate professor Johanne Alteren, Faculty of Nursing and Health Sciences at Nord University says that the goal of the health care education is to support learning and development of students in becoming qualified health care professionals and to strengthen the professional development of faculty in higher health care education. - Actually, the overall purpose of this network is to share experiences and knowledge between the participating organisations to allow for the development of evidence-based teaching practices, Hilli says. The network encompasses nine international higher education institutions (HEIs) with different programs in health care education. The network plans to have three administrative meetings on site and online meetings twice every semester, during the years 2019-2020, in order to plan and share innovations and ideas for future activities, focusing student and faculty exchange opportunities, joint courses and seminars. These shared experiences will enhance professional confidence and broaden knowledge and awareness of cultural strengths and differences from student and faculty perspectives. In addition, international conferences aimed towards health care education its challenges and implications for meeting global health care challenges will be arranged every third year. The network has received initial NordPlus funding for the period May 2019 to September 2020. - We will apply for additional funding to enable inclusion of universities from Denmark, Iceland, Latvia and Lithuania, says Johanne Alteren. Coordinating institution: Nord University Bodö Norway

• Magnussen, Inger-Lise; Bondas, Terese Elisabet & Alteren, Johanne (2019). Sensory Garden and Dementia Care - "The room of closeness" - a sensory garden-patient-nurse relationship.
• Alteren, Johanne (2019). Erfaring som kilde til kunnskapsutvikling i helseforskning. Nordisk tidsskrift for helseforskning. ISSN 1504-3614. 15(1). doi: 10.7557/14.4868.
• Magnussen, Inger-Lise; Bondas, Terese & Alteren, Johanne (2018). The significance of a sensory garden in the formation of the room of closeness-An action research in a nursing home in Norway.
• Alteren, Johanne (2018). Øvingsavdelingen som læringsarena for kunnskapstilegnelse i sykepleierutdanning. Refleksjon over en studentfortelling. En hermeneutisk tilnærming. .
• Alteren, Johanne (2018). God organisering av helsetjenesten - samarbeid om et felles mål. Nordisk tidsskrift for helseforskning. ISSN 1504-3614. 14(2). doi: 10.7557/14.4627.
• Olsen, Ruth Helene; Danielsen, Inger Jorun & Alteren, Johanne (2018). Hvordan lærer vi av erfaring? [Internet]. Forskning.no.
• Olsen, Ruth Helene; Danielsen, Inger Jorun & Alteren, Johanne (2018). Ny bok om yrkeserfaring som kunnskapskilde. Yrkeserfaring er en viktig kilde til kunnskap, mener forskere ved Nord universitet. Det er det blitt bok av. . [Internet]. Nord universitet Bodø.
• Alteren, Johanne (2018). Brukerkunnskap om relasjonens betydning for god helse. Nordisk tidsskrift for helseforskning. ISSN 1504-3614. doi: 10.7557/14.4467.
• Danielsen, Inger Jorun & Alteren, Johanne (2018). Introduksjon. In Danielsen, Inger Jorun & Alteren, Johanne (Ed.), Erfaring som kunnskapskilde i profesjonspraksis. En vitenskapelig antologi.. Novus Forlag. ISSN 978-82-7099-905-7.
• Hauan, Marianne; Kvigne, Kari Johanne & Alteren, Johanne (2018). FRA Å GI PLEIE TIL Å SKAPE HVERDAGSMESTRING –En begrepsanalyse av «morgendagens omsorg» og «brukermedvirkning» i offentlige dokumenter.
• Alteren, Johanne (2017). Å være medforsker. .
• Alteren, Johanne (2017). Integrate theory and practice. Nurse students’ experiences in the learning process. How can “the voice” of the student be seen? .
• Alteren, Johanne (2017). Når helsehjelpen oppleves stigmatiserende. Nordisk tidsskrift for helseforskning. ISSN 1504-3614. 13(2). doi: 10.7557/14.4299.
• Alteren, Johanne (2017). Møte pasienten der pasienten er. Nordisk tidsskrift for helseforskning. ISSN 1504-3614. 13(1). doi: 10.7557/14.4126.
• Alteren, Johanne; Didriksen, Åsmund Roald; Hov, Jorunn; Lysfjord, Linda Alexandra & Nerdal, Lisbeth (2017). Sterke bidrag fra Nord universitet i Estland. [Internet]. Nord universitet.
• Alteren, Johanne (2017). Nursing students educate as helpers. Emotions and development of pracitcal knowledge.
• Sayadi, Neda & Alteren, Johanne (2017). Norsk-iransk forskning på omsorg i rehabilitering. [Internet]. Nord universitet.
• Sayadi, Neda & Alteren, Johanne (2017). Reiste 4.500 km for å forske i Rana. [Newspaper]. Rana Blad.
• Sayadi, Neda & Alteren, Johanne (2017). Nord universitet satser på internasjonalisering. [Newspaper]. Rana.No.
• Alteren, Johanne (2017). "Walking in a minefield". Nurses' experiences during medication administration in hospitals.
• Alteren, Johanne (2017). Integrate theory and practice. Nurse students' experiences in the learning process. How can "the voice" of the student be seen?
• Magnussen, Inger-Lise; Bondas, Terese & Alteren, Johanne (2017). Ny bruk av sansehager kan gi bedre demensomsorg. [Internet]. Nord universitet.
• Alteren, Johanne (2017). Å lære legemiddelhåndtering.
• Alteren, Johanne (2016). Et tidsskrift med mangfold. Nordisk tidsskrift for helseforskning. ISSN 1504-3614. 12(2). doi: 10.7557/14.4060.
• Alteren, Johanne; Fredriksen, Ronja; Hermstad, Marit & Nerdal, Lisbeth (2016). "Walking in a minefield". Nurses' experiences during medication administration in hospitals.
• Alteren, Johanne (2016). To integrate theory and practice: Nurse students' experiences in the learning process.
• Magnussen, Inger-Lise; Bondas, Terese & Alteren, Johanne (2016). Symposium: Action Research - a complex collaborative ocean for possibilities. Appreciative interaction between researcher and staff in a nursing home action research - thinking outside the box.
• Johansen, Grethe & Alteren, Johanne (2016). Fra Mo i Rana til Cambridge. [Internet]. Nord på kryss og tvers uke 37.
• Alteren, Johanne; Fredriksen, Ronja; Hermstad, Marit & Herseth, Susanne (2015). A work interruption is not necessarily a work interruption. Nurses' experiences during medication administration in hospitals. Show summary

  Introduction Medication administration in surgical wards is predominately a nursing responsibility. Nurses are frequently interrupted during safety-critical stages of medication administration. They are rarely able to complete a nursing care activity without being interrupted. Interruptions in the nursing work environment can have significant and detrimental effects on patient safety. The purpose of the study is to explore nurses’ experiences on work interruptions (WI) during medication administration in surgical wards in the hospital. Method In this study, a smaller qualitative data collection phase is embedded within a larger quantitative study, also described as a nested design. The quantitative study is direct structured observations of nurses during medication administration. The qualitative study is semi-structured one-by-one interviews with nurses on work interruptions (WI) during medication administration. Twenty-four (24) nurses from two hospitals in North-Norway participated in the study. The interviews are analyzed using qualitative content analysis by Graneheim and Lundman. This presentation will focus on the findings from the qualitative data. Results A work interruption is when the nurses have to exit the medication administration round to do something completely different. Whether nurses experience the interruption as an intrusion depends on where they get interrupted and what task they are doing. The interruption is not necessarily experienced as an interruption, but is also about being familiar with the patient. When nurses handle medication, they emphasize to secure the care and medication to be given. They clarify the dosage and professional issues regarding the patient and or medication. Interference steals their time available for medication administration. Time pressure is experienced as a challenge during medication administration in the hospitals. Discussion In the presentation, we will elaborate the findings and discuss the implications the findings may have for nurses’ practice.

• Alteren, Johanne (2015). Et spirende miljø innen helsefaglig forskning i Helgelandssykehuset. The Third Nordic Forum for Nurse Educators, 12-14 oktober UiN Campus Helgeland. [Internet]. Intranett og websider Helgelandssykehuset.
• Hauan, Marianne & Alteren, Johanne (2015). Ti års forskning i sykepleie føres videre. Hverdagsmestring som forskningsprosjekt ved Campus Helgeland. [Internet]. Universitetet i Nordlands websider.
• Alteren, Johanne; Hassel, Anne Marit & Hilstad, Laila (2015). Internasjonalt forskningsmiljø til Campus Helgeland. Spirende forskning. Campus Helgeland fylt av internasjonal forskning. [Newspaper]. Rana Blad.
• Hassel, Anne Marit; Hilstad, Laila & Alteren, Johanne (2015). Development of patient's relationship-skills. Theme-based group in a general psychiatric ward. Show summary

  Introduction The basis for the research project is a theme-based group in a general psychiatric ward. The group was established as a pilot-project in 2011. Previously research shows that there is a lack of research concerning theme-based group. However, there exists research on group therapy, which have certain similarities with the group in this study. The purpose of the study is therefore to increase knowledge about the importance the theme-based group may have, from a patient’s perspective. The purpose is also further development of using theme-based group as a treatment. Methods The research has a descriptive and exploratory design. A qualitative method emphasize the patient’s experiences. Seven former patients participated. A semi-structured interview guide was used. The overall perspective of the analysis is qualitative content analysis by Graneheim and Lundman. Results and discussion Through the analysis, the main theme “Having a relationship to oneself and others”, emerged. The main theme summarizes the essence of the participants’ experiences. The results were categorized into four themes: “the exchange of experiences”, “to be seen by others”, “to cope with “oneself””, and “the importance of group-structure”. The participants experienced the group as a safe arena, where they after a while dared to be themselves, worked with self-knowledge and learned how to cope with everyday challenges. They became acquainted with others in different ways than otherwise. When they discovered others had similar experiences, the loneliness of having a mental illness decreased. In the presentation, we want to elaborate the findings and discuss central issues of the patient’s experiences.

• Alteren, Johanne (2015). Welcome to, Keynote speaker, and Closing "The Third Nordic Forum for Nurse Educators".
• Alteren, Johanne; Fredriksen, Ronja; Hermstad, Marit; Herseth, Susanne & Nerdal, Lisbeth (2015). A collaboration between clinical practice and academia. Handling medication in hospitals, - exploration of nursing practice.
• Alteren, Johanne (2015). Keynote speaker: Research in Nursing at University of Nordland - clinical nursing, learning and leadership.
• Johansen, Grethe & Alteren, Johanne (2015). Framtidskonferanse. Mange har meldt seg på UiNs første internasjonale konferanse på Campus Helgeland der spørsmålet om teknologien kan erstatte menneskelige møter, tas opp. Profesjongshøgskolen ved Universitetet i Nordland arrangerer sin første internasjonale konferanse på Campus Helgeland 12. - 14. oktober. [Newspaper]. Rana Blad.
• Christiansen, Øyvind; Nerdal, Lisbeth; Johansen, Grethe; Jacobsen, Kjell; Alteren, Johanne & Frøysa, Kirsten Jessen (2015). Nordic og Baltikum til Mo. Campus Helgeland tiltrekker seg foredragsholdere og deltakere fra flere land. [Newspaper]. Rana Blad.
• Magnussen, Inger-Lise; Bondas, Terese & Alteren, Johanne (2015). Action Research - Development together with employees in nursing home.
• Helme, Rita & Alteren, Johanne (2014). Aksepterer vold på jobben. Mange sykepleiere aksepterer vold fra eldre personer med demenssykdom som en del av jobben. Tidsskriftet sykepleien. ISSN 0806-7511. p. 40–42.
• Helme, Rita & Alteren, Johanne (2014). Violence by elderly residents in nursing homes.
• Alteren, Johanne (2014). Nurses' work interruptions during medication administration.
• Fredriksen, Ronja; Herseth, Susanne; Hermstad, Marit & Alteren, Johanne (2014). Forstyrrelser under legemiddelhåndtering II.
• Alteren, Johanne & Hermstad, Marit (2014). Forstyrrelser under legemiddelhåndtering i sykehus.
• Hassel, Anne Marit; Hilstad, Laila & Alteren, Johanne (2014). Pasienters erfaringer med samtalegruppe på en psykiatrisk døgnavdeling.
• Alteren, Johanne; Fredriksen, Ronja & Herseth, Susanne (2014). Forstyrrelser under legemiddelhåndtering.
• Alteren, Johanne; Christiansen, Øyvind; Aag, T.; Hegerholm, Hallstein; Jacobsen, Kjell & Leenheer, Anneke Sijtske (2014). Forskningsdagene. Studiesamarbeid for å pirre nysgjerrighet. Campus mot nye høyder. [Newspaper]. Rana Blad.
• Alteren, Johanne (2014). Samarbeid med Swansea. UiN vil forske på medikamenthåndtering. [Internet]. Websidene Universitetet i Nordland.
• Alteren, Johanne (2014). Nurses' work interruptions during medication administration: An intercultural study in Iran, Finland and Norway.
• Alteren, Johanne & Johansen, Grethe (2014). Mer enn bare teknikk. Universitetet i Nordland Helgeland arrangerer onsdag et seminar om å være i relasjon med en annen. [Newspaper]. Rana Blad.
• Risan, Merete Stokkeland & Alteren, Johanne (2022). Å lære helsefagarbeidet uten å være lærling - enomt og usikkert. En kvalitativ studie av elevers erfaring fra alternativ Vg3 i skole. Høgskolen i Molde - Vitenskapelig høgskole i logistikk.
• Amundsen, Turid & Alteren, Johanne (2019). "Det usikre mellomrommet". Sykepleiernes utfordringer i vurdering av den akutte geriatriske pasienten i akuttmottak. En hermeneutisk studie. Nord universitet.
• Magnussen, Inger-Lise; Bondas, Terese & Alteren, Johanne (2019). Nærhetsrommet - en sansehage-pasient-pleier-relasjon: Aksjonsforskning i sykehjem. Nord universitet. ISSN 978-82-93196-27-3.
• Sayadi, Neda; Mohammadi, Eesa; Zarea, Kourosh & Alteren, Johanne (2018). Development and Psychometric Validation of Care Needs questionnaire in phase 1 Cardiac Rehabilitation in patients With Coronary Artery Disease. Ahvaz Jundishapur University of Medical Sciences.
• Elvevoll, Linda Dragvik; Hay, Kamilla Isaksen; Alteren, Johanne & Hauan, Marianne (2018). Pasientsikkerhet og bruk av sjekklister - sykepleierens erfaringer i spesialisthelsetjenesten. Nord universitet.
• Ingilæ, Therese Johansen; Alteren, Johanne & Magnussen, Inger-Lise (2018). Den åpenbare men likevel usynlige. Hvordan opplever sykepleier sitt møte med den pleietrengende CFS/ME-syke pasienten? Nord universitet.
• Punsvik, Johanne Temine & Alteren, Johanne (2016). Kontroll versus tillit og relasjon. Sykepleieres erfaringer med å inspisere munnhulen til pasienter i rusbehandling etter utlevering av vanedannende medikamenter. Master i klinisk sykepleie. Nord universitet.
• Leppänen, Maria & Alteren, Johanne (2016). Opplevelse av trygghet hos kreftsykepleiere som administrerer cytostatika intravenøst til voksne pasienter med kreft. Master i sjukepleie. UiT Norges arktiske universitet.
• Bjørgum, Marthe; Wangsfjord, Ellen & Alteren, Johanne (2016). Selvbestemmelsesrett innenfor rammer av tvang - balansekunst i møte med tvangsinnlagte pasienter. Master i klinisk sykepleie. Nord universitet.
• Lundestad, Rita & Alteren, Johanne (2015). Refleksjon - en metode i studentenes utvikling av praktisk kunnskap. Master i praktisk kunnskap. Universitetet i Nordland, Profesjonshøgskolen, Senter for praktisk kunnskap.
• Deinboll, Anne & Alteren, Johanne (2015). Å synliggjøre sykepleiefaget. Sykepleiedokumentasjon i elektronisk pasientjournal. Master i praktisk kunnskap. Universitetet i Nordland, Profesjonshøgskolen, Senter for praktisk kunnsakp.
• Helme, Rita & Alteren, Johanne (2014). Vold fra eldre pasienter i sykehjem. Master i klinisk sykepleie. Universitetet i Nordland, Profesjonshøgskolen.

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