Janne Myhre

• Vossius, Corinna Elisabeth; Borda, Miguel Germán; Lichtwarck, Bjørn; Myhre, Janne; Sollid, May Ingvild Volungholen & Borza, Tom [Vis alle 9 forfattere av denne artikkelen] (2023). Body mass index in nursing home residents during the first year after admission. BMC Nutrition. ISSN 2055-0928. 9(1). doi: 10.1186/s40795-023-00710-3. Fulltekst i vitenarkiv Vis sammendrag

  Background: Malnutrition - comprising both undernutrition and overweight - has to be addressed in the medical follow-up of older adults due to the negative consequences for the functional state and general health. Still, little is known about the nutritional state of nursing home (NH) residents, especially with respect to weight gain or weight loss after NH admission. Therefore, this study aims to evaluate changes in the body mass index (BMI) during the first year following NH admission, and to explore demographic and clinical characteristics related to BMI changes. Methods: Data from two prospective studies that recruited participants at NH admission were combined. Demographic and clinical characteristics including the BMI were assessed at baseline and after one year. A linear regression model was estimated to explore the impact of demographic and clinical characteristics on the change in BMI. Results: The study cohort consisted of 1,044 participants with a mean age of 84.3 years (SD7.6) at baseline; 64.2% were female. At baseline, 33% of the NH residents had severe to moderate undernutrition, while 10% were obese. During the first year of their NH stay, residents with severe to moderate undernutrition had an average increase in BMI of 1.3 kg/m2 (SD 2.2; p < 0.001), while weight changes were either very small or not significant in the other BMI groups. Characteristics related to weight gain were younger age and less agitation. Conclusion: Malnutrition is a common health challenge at NH admission, with one third of NH residents being moderately to severely underweight and 10% being obese. However, during the first year of NH stay, there was a favourable development for underweight NH residents, as they increased their BMI, and 43.6% changed to a higher weight classification, while we observed no changes in the BMI in residents with obesity. As NH residents are in the last phase of their lives, interventions to prevent malnutrition or overweight should be initiated while still home-dwelling, and then continued in the nursing homes. Keywords: BMI; Malnutrition; Nursing home; Nursing home residents; Overweight; Unternutrition; Weight changes. © 2023. The Author(s).

• Guazzarini, Anna Giulia; Casanova, Georgia; Buchholz, Friederike; Kozori, Mahi; Lavolpe, Sara & Lichtwarck, Bjørn [Vis alle 15 forfattere av denne artikkelen] (2022). The Special Care Unit for People with Behavioral and Psychological Symptoms of Dementia (SCU- B) in the Context of the Project “RECage-Respectful Caring for Agitated Elderly”: A Qualitative Study. International Journal of Environmental Research and Public Health (IJERPH). ISSN 1661-7827. 19(24). doi: 10.3390/ijerph192416913. Fulltekst i vitenarkiv
• Vossius, Corinna Elisabeth; Bergh, Sverre; Selbæk, Geir; Lichtwarck, Bjørn & Myhre, Janne (2022). Cause and place of death in Norwegian nursing home residents. Scandinavian Journal of Public Health. ISSN 1403-4948. doi: 10.1177/14034948221140195. Vis sammendrag

  Nursing home (NH) residents are in their last phase of life, and two aims of the NH’s medical care in Norway is to prevent unnecessary hospital admissions that would not benefit the resident and to facilitate a peaceful death in familiar surroundings when the time comes. However, little is known about the share of residents dying in NHs and the causes of death. We therefore evaluated the cause and place of death in a cohort of NH residents followed from the time of NH admission until death. Methods: NH residents were followed from admission to the NH and over the entire course of their NH stay. Demographic and clinical data were collected. Cause and place of death were retrieved from the Norwegian Cause of Death Registry. Results: Of 1283 residents, 6.2% died in hospital and 91.2% in a NH. Those who died in hospitals were more often male, died sooner after NH admission, had a less severe degree of dementia and had poorer general health. Dementia was the most common underlying cause of death, followed by cardiovascular disease. Conclusions: Dementia is one of the main causes of death in NH residents. In addition, our findings indicate a low number of inappropriate referrals to hospital during the last stage of life. However, further research should explore whether the terminal phase of NH residents is formed in accordance with their preferences and whether appropriate palliative care is offered.

• Vossius, Corinna Elisabeth; Bergh, Sverre; Selbæk, Geir; Saltyte Benth, Jurate; Myhre, Janne & Aakhus, Eivind [Vis alle 7 forfattere av denne artikkelen] (2022). Mortality in nursing home residents stratified according to subtype of dementia: a longitudinal study over three years. BMC Geriatrics. ISSN 1471-2318. 22(1), s. 1–10. doi: 10.1186/s12877-022-02994-9. Fulltekst i vitenarkiv Vis sammendrag

  Background: There are several subtypes of dementia caused by different pathophysiology and with different clinical characteristics. Irrespective subtype, the disease is progressive, eventually leading to the need for care and supervision on a 24/7 basis, often provided in nursing homes (NH). The progression rate and course of the disease might vary according to subtype. The aim of this study was to explore whether the mortality rate for NH residents varied according to the subtype of dementia. Methods: NH residents were followed from admission to NH over a period of 36 months or until death with annual follow-up examinations. Demographic and clinical data were collected. The diagnosis of dementia and its subtype at baseline (BL) were set according to international accepted criteria. Kaplan-Meier analysis was performed to estimate median survival time. A Cox regression model was estimated to assess the impact of dementia diagnosis and demographic and clinical variables on mortality. Results: A total of 1349 participants were included. When compared to persons with Alzheimer's disease (AD), persons with frontotemporal dementia (FTD) and dementia with Lewy bodies or Parkinson's disease dementia (DLB/PDD) were younger and had more neuropsychiatric symptoms. Median survival for the total sample was 2.3 years (95% confidence interval: 2.2-2.5). When compared to persons with AD, having no dementia or unspecified dementia was associated with higher mortality, while we found similar mortality in other subtypes of dementia. Higher age, male gender, poorer general health, higher dependency in activities of daily living, and more affective symptoms were associated with higher mortality. Conclusion: Mortality did not differ across the subtypes of dementia, except in persons with unspecified dementia or without dementia, where we found a higher mortality. With a median survival of 2.3 years, NH residents are in the last stage of their lives and care and medical follow-up should focus on a palliative approach. However, identifying the subtype of dementia might help carers to better understand and address neuropsychiatric symptoms and to customize medical treatment. Keywords: Dementia; Dementia subtypes; Long term nursing home residents; Mortality; Nursing home; Nursing home mortality. © 2022. The Author(s).

• Myhre, Janne & Lichtwarck, Bjørn (2021). Kan kompleksitetsteori bidra til bedre forståelse og tiltak ved aggresjon, overgrep og forsømmelser i sykehjem? Geriatrisk sykepleie. ISSN 1891-1889. 2, s. 18–25. Fulltekst i vitenarkiv Vis sammendrag

  Sammendrag: Utfra vår erfaring og forskning vet vi at hendelser med aggresjon, overgrep og forsømmelse i sykehjem har en sterk sammenheng, opptrer ofte samtidig, og har flere sammenfallende determinanter. De er vanligvis komplekse fenomener som har en tendens til å gjenta seg, og som praksisfeltet opplever som krevende. Tradisjonelt er vi opplært til å tenke lineært om slike hendelser, dvs. at det finnes en eller flere årsaker vi kan gjøre noe med ved å sette inn noen generelle tiltak som f.eks. tradisjonell opplæring, kurs og forelesninger. Vi stiller spørsmål med om denne lineære måten å forstå aggresjon, overgrep og forsømmelser på, er tilstrekkelig for å tilnærme seg og forebygge disse hendelsene. I denne artikkelen vil vi diskutere hvordan vi ved bruk av kompleksitetsteori kan endre vår forståelse av disse fenomenene og sammenhengen mellom beboeren, ansatte, relasjonene de alle inngår i og konteksten sykehjemmet og samfunnet. En slik forståelse kan også være viktig i utviklingen av effektive modeller for forebygging og tilnærming i praksis. For å underbygge hvordan konsepter fra kompleksitetsteori kan bidra til endringer i vår forståelse av og vår tilnærming til disse fenomenene, har vi anvendt empiri fra våre to dr. gradsprosjekter: Utvikling og evaluering av TID, Tverrfaglig Intervensjonsmodell ved utfordrende atferd ved Demens (TID-studien) og Lederskapets rolle for å fremme pasientsikkerhet og forebygge vold, overgrep og forsømmelser i sykehjem (Ledelse- og pasientsikkerhetsstudien). Nøkkelord: kompleksitet, kompleksitetsteori, aggresjon, overgrep, forsømmelse, wicked problems, TID, ledelse, sykehjem. Can complexity theory contribute to a better understanding and more appropriate measures for aggression, abuse, and neglect in nursing homes?

• Myhre, Janne; Saga, Susan; Malmedal, Wenche Karin; Ostaszkiewicz, Joan & Nakrem, Sigrid (2020). React and act: a qualitative study of how nursing home leaders follow up on staff-to-resident abuse. BMC Health Services Research. ISSN 1472-6963. 20(1). doi: 10.1186/s12913-020-05969-x. Fulltekst i vitenarkiv Vis sammendrag

  Background: Elder abuse in nursing homes is a complex multifactorial problem and entails various associations across personal, social, and organisational factors. One way leaders can prevent abuse and promote quality and safety for residents is to follow up on any problems that may arise in clinical practice in a way that facilitates learning. How nursing home leaders follow up and what they follow up on might reflect their perceptions of abuse, its causal factors, and the prevention strategies used in the nursing home. The aim of this study was to explore how nursing home leaders follow up on reports and information regarding staff-to-resident abuse. Methods: A qualitative explorative design was used. The sample comprised 43 participants from two levels of nursing home leadership representing six municipalities and 21 nursing homes in Norway. Focus group interviews were conducted with 28 care managers, and individual interviews took place with 15 nursing home directors. The constant comparative method was used for the analyses. Results: Nursing home leaders followed up incidents of staff-to-resident abuse on three different levels as follows: 1) on an individual level, leaders performed investigations and meetings, guidance, supervision, and occasionally relocated staff members; 2) on a group level, feedback, openness, and reflection for shared understanding were strategies leaders used; and 3) on an organisational level, the main solutions were to adjust to available resources, training, and education. We found that leaders had difficulties defining harm and a perceived lack of power to follow up on all levels. In addition, they did not have adequate tools for evaluating the effect of the measures that were taken. Conclusions: Nursing home leaders need to be clear about how they should follow up incidents of elder abuse on different levels in the organisation and about their role in preventing elder abuse. Evaluation tools that facilitate systematic organisational learning are needed. Nursing homes must operate as open, blame-free cultures that acknowledge that incidents of elder abuse in patient care arise not only from the actions of individuals but also from the complex everyday life of which they are a part and in which they operate. Keywords: Nursing home, Leaders, Patient safety, Organisational learning, Elder abuse, Staff-to-resident abuse, Adverse events

• Myhre, Janne; Malmedal, Wenche Karin; Saga, Susan; Ostaszkiewicz, Joan & Nakrem, Sigrid (2020). Nursing home leaders’ perceptions of factors influencing the reporting of elder abuse and neglect: a qualitative study . Journal of Health Organisation and Management. ISSN 1477-7266. 34(6). doi: 10.1108/JHOM-02-2020-0031. Fulltekst i vitenarkiv
• Myhre, Janne; Saga, Susan; Malmedal, Wenche Karin; Ostaszkiewicz, Joan & Nakrem, Sigrid (2020). Elder abuse and neglect: an overlooked patient safety issue. A focus group study of nursing home leaders’ perceptions of elder abuse and neglect. BMC Health Services Research. ISSN 1472-6963. 20(199 ), s. 1–14. doi: 10.1186/s12913-020-5047-4. Fulltekst i vitenarkiv
• Lichtwarck, Bjørn; Myhre, Janne; Selbæk, Geir; Kirkevold, Øyvind; Rokstad, Anne Marie Mork & Saltyte Benth, Jurate [Vis alle 7 forfattere av denne artikkelen] (2019). TIME to reduce agitation in persons with dementia in nursing homes : a process evaluation of a complex intervention. BMC Health Services Research. ISSN 1472-6963. 19, s. 1–16. doi: 10.1186/s12913-019-4168-0. Fulltekst i vitenarkiv Vis sammendrag

  Background: The Targeted Intervention Interdisciplinary Model for Evaluation and Treatment of Neuropsychiatric Symptoms (TIME) has recently in a three-month cluster randomised controlled trial demonstrated reduction in agitation in nursing home residents with dementia. To ease replication and future implementation, and to clarify possible causal mechanisms, we performed a process evaluation of the intervention based on the RE-AIM framework (Reach, Effectiveness, Adoption, Implementation, Maintenance). Methods: An exploratory and a quasi-experimental design with mixed methods were used. The RE-AIM dimensions were explored by questionnaires to 807 staff members and 46 leading ward nurses in both the intervention nursing homes (INH) and the control nursing homes (CNH), before the start of the trial (baseline), and six and 12 months later. These questionnaires assessed data regarding the reach, effectiveness (staff level) and adoption dimensions. To assess implementation, we used a checklist for performance of the main components in TIME and analysed the minutes from 84 case conferences in the INH. To explore adoption and maintenance, five focus group interviews with 32 participants from the staff in the INH were conducted three to 6 months after the end of the trial. Results: Reach: On average 61% (SD 22) of the staff in each ward in the INH attended the training sessions. Effectiveness at staff level: There were no between-group differences throughout the study period for attitudes towards dementia, perceived competence or perception of mastery and social interaction. Adoption: 16 of the 17 INH completed the intervention. Implementation: 75% or more of the components of TIME were performed for 91% of the included residents. Maintenance: Most of the nursing homes used TIME three to 6 months after the end of the trial. An easy to grasp model and an engaged leadership facilitated the intervention and maintenance. Conclusions: A high degree of reach, adoption, implementation and maintenance contributed to the effectiveness of TIME at resident level. One other causal assumption of the effectiveness of TIME is the development in the staff of a new, shared and situated knowledge about each individual resident, not reflected by measurements in general knowledge and attitudes.

• Lichtwarck, Bjørn; Myhre, Janne; Goyal, Alka Rani; Rokstad, Anne Marie Mork; Selbæk, Geir & Kirkevold, Øyvind [Vis alle 7 forfattere av denne artikkelen] (2018). Experiences of nursing home staff using the targeted interdisciplinary model for evaluation and treatment of neuropsychiatric symptoms (TIME) : a qualitative study. Aging & Mental Health. ISSN 1360-7863. 23(8), s. 966–975. doi: 10.1080/13607863.2018.1464116. Vis sammendrag

  Background/Aims: Neuropsychiatric symptoms (NPS) in dementia pose great challenges for residents and staff in nursing homes. The Targeted Interdisciplinary Model for Evaluation and Treatment of Neuropsychiatric Symptoms (TIME) has recently in a randomized controlled trial demonstrated reductions in NPS. We explored the participating staff's experiences with the model and how it meets the challenges when dealing with the complexity of NPS. Methods: Three to six months after the end of the intervention, we interviewed 32 of the caregivers, leaders, and physicians participating in the trial, in five focus groups. We used thematic content analysis. Results: The analysis yielded two main themes: (1) a systematic reflection method enhanced learning at work; (2) the structure of the approach helped staff to cope with NPS in residents with dementia. Conclusion: TIME shifts the way of learning for the staff from a traditional to a more innovative and reflection-based learning through a process of learning how to learn at work. The staff's experienced increased coping in their approach to complex problems. Our results emphasise the importance of a structured and biopsychosocial approach to NPS in clinical practice. Future research should explore models for integrating situated learning in daily routines in nursing homes. Keywords: neuropsychiatric symptoms, agitation, dementia, case conference, psychosocial intervention, nursing home

• Myhre, Janne; Lichtwarck, Bjørn & Bergh, Sverre (2018). Delt forståelse og felles forpliktelse. En kvalitativ studie av personalets erfaringer med TID-refleksjon i en alderspsykiatrisk avdeling. Tidsskriftet aldring og helse. ISSN 1890-4130. 22(1), s. 38–45.
• Myhre, Janne; Tonga, Johanne Bjørnstad; Ulstein, Ingun; Høye, Sevald & Kvaal, Kari (2018). The coping experiences of spouses of persons with dementia. Journal of Clinical Nursing (JCN). ISSN 0962-1067. 27(3-4), s. e495–e502. doi: 10.1111/jocn.14047. Vis sammendrag

  Aims and objectives The aim of the present study was to explore how spouses who are caregivers to persons with dementia experience everyday life six to twelve months after participation in the intervention condition in the Norwegian Cognitive Behavioural Therapy for Early Dementia (N-CORDIAL) study. Background There is no current medical curative treatment for cognitive impairment and dementia-associated conditions. These conditions will lead to an increased need for daily assistance and care, as well as greater stress for caregivers. The Norwegian CORDIAL Study is a manual-based randomized controlled trial based on the German CORDIAL study (Cognitive rehabilitation and cognitive behavioural treatment for early dementia in Alzheimer's disease), consisting of cognitive rehabilitation, cognitive behavioural therapy and life review methods. Design and Methods A descriptive exploratory study with qualitative semi-structured in-depth interviews with six spouses of persons with dementia who had participated in the Norwegian CORDIAL study. The transcribed text was analysed by systematic text condensation. Result The main theme identified, “An everyday search for meaning”, referred to the stress experienced by the caregivers and their coping strategies in everyday life. Conclusion The caregivers had gained increased awareness of coping strategies in everyday life six to twelve months after the intervention. Caregivers who experienced fewer neuropsychiatric symptoms in their spouses with dementia benefitted most from the intervention.

• Lichtwarck, Bjørn; Selbæk, Geir; Kirkevold, Øyvind; Rokstad, Anne Marie Mork; Saltyte Benth, Jurate & Myhre, Janne [Vis alle 8 forfattere av denne artikkelen] (2016). TIME – Targeted interdisciplinary model for evaluation and treatment of neuropsychiatric symptoms : protocol for an effectiveness-implementation cluster randomized hybrid trial. BMC Psychiatry. ISSN 1471-244X. 16, s. 1–12. doi: 10.1186/s12888-016-0944-0. Fulltekst i vitenarkiv Vis sammendrag

  Background: Nearly all persons with dementia will experience neuropsychiatric symptoms (NPS) during the course of their disease. Clinicians and researchers emphasize the need for an evidence-informed standardized approach to managing NPS that integrates pharmacological and nonpharmacological treatments for real-world implementation. The Targeted Interdisciplinary Model for Evaluation and Treatment of Neuropsychiatric Symptoms (TIME) represents such an approach and is a multicomponent intervention based on the theoretical framework of cognitive behavioural therapy. Methods/design: The trial is a 3-month cluster randomized trial conducted in 30 nursing homes including 168 participants with dementia and a high level of agitation. Each nursing home defined as a cluster will be randomized to receive either the TIME intervention (the intervention group) or a brief education-only intervention regarding dementia and NPS (the control group). TIME is a manual-based, multicomponent programme that includes a rigorous assessment, one or more case conferences and the treatment and evaluation of NPS. Patient-level measurements are taken at baseline (prior to randomization) and 8 and 12 weeks later. The primary outcome measure is the change in agitation, as defined by the Neuropsychiatric Inventory-Nursing Home Version, at 8 weeks from baseline. Secondary outcome measures include change in agitation at 12 weeks from baseline, and change from baseline at 8 and 12 weeks in other NPS, quality of life, and the use of psychotropic and analgesic medications. Mixed methods will be used to follow, measure and explore the implementation process and the effect of the intervention at the individual staff level and the organization level. Combining measurements of clinical effectiveness and implementation outcomes define this trial as an effectiveness-implementation hybrid trial. Discussion: Measuring the implementation and effect of complex interventions aimed at reducing NPS in nursing homes is challenging. In this study protocol, we describe a multicomponent program, TIME, and discuss how an effectiveness-implementation cluster randomized hybrid trial can meet these challenges. Trial registration: ClinicalTrials.gov identifier NCT02655003. Registered 6 January 2016. Keywords: dementia, neuropsychiatric symptoms, behavioural and psychological symptoms of dementia (BPSD), psychosocial interventions, nursing home, case conference

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• Lichtwarck, Bjørn & Myhre, Janne (2022). Dumme pasienter og troll til pleiere?: Ny forståelse av aggresjon, overgrep og utelatt helsehjelp i institusjon. Fagbokforlaget. ISBN 978-82-450-3560-5. 190 s. Vis sammendrag

  I denne boka belyser forfatterne ny kunnskap om hvordan aggresjon, overgrep og utelatt helsehjelp utspiller seg i praksisfeltet, og beskriver ulike tilnærminger for å forebygge og redusere aggresjon, overgrep og utelatt helsehjelp i institusjon. Aggresjon, overgrep og utelatt helsehjelp er komplekse fenomener som er nært knyttet til hverandre, til dels overlappende, og ofte del av et og samme fenomen med felles risiko-, utløsende og vedlikeholdende faktorer. Betydningen av å forstå disse fenomenene i en helhetlig sammenheng både i forskning og praksis framheves. Boka tar for seg begreper og teorier om fenomenene og om kompleksitet, refleksjon, makt og ledelse i institusjon.

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• Væringstad, Anette; Dalbak, Ellen Thea Gjelseth; Holle, Daniela; Myhre, Janne; Kirkevold, Øyvind & Bergh, Sverre [Vis alle 7 forfattere av denne artikkelen] (2024). Preventing and Approaching Crises for frail community-dwelling patients Through Innovative Care (PRACTIC): protocol for an effectiveness cluster randomised controlled trial. Trials. ISSN 1745-6215. 25. doi: 10.1186/s13063-024-08117-6.
• Myhre, Janne & Lichtwarck, Bjørn (2023). A Video-based qualitative analysis of case conferences to reduce BPSD.
• Sandmoe, Astrid; Myhre, Janne; Iversen, Maria; Eriksen, Siren & Lichtwarck, Bjørn (2022). Vold, overgrep, utelatt helsehjelp, forsømmelser og aggresjon: Begrepsbruk i en norsk sykehjemskontekst. Tidsskrift for omsorgsforskning. ISSN 2387-5976. 8(3), s. 1–15. doi: 10.18261/tfo.8.3.7. Fulltekst i vitenarkiv Vis sammendrag

  Vold, overgrep, trusler, aggresjon, krenkelser, mishandling, forsømmelser, omsorgssvikt, kvalitetsbrist og utelatt helsehjelp er noen av de begrepene som brukes for å beskrive hendelser vi ikke ønsker, men som kan oppstå i sykehjem. Kunnskapen og forståelsen om disse fenomenene er i kontinuerlig endring. Dette vises gjennom skiftende bruk av begreper og hvordan disse begrepene oppfattes. Uønskede hendelser kan føre til skade, men ikke alltid (WHO, 2005; Cooper et al., 2018). Grensene for uønskede hendelser påvirkes av konteksten, samfunnets normer, lover og retningslinjer. En begrepsavklaring er viktig fordi en felles forståelse av begrepene øker muligheten for at forskning og praksis snakker med samme språk om de samme fenomenene. Ulike forståelser og ulik begrepsbruk kan være et vesentlig hinder i arbeidet med å redusere uønskede hendelser. I denne artikkelen vil vi se nærmere på de mest brukte begrepene i norsk sammenheng, det vil si vold, overgrep, utelatt helsehjelp, forsømmelser og aggresjon i sykehjem. Målet vårt er å komme fram til begreper som er hensiktsmessige og gjenkjennbare både i forskning og praksis, og som avspeiler at disse fenomenene er komplekse og utspiller seg i en kompleks kontekst.

• Myhre, Janne; Saga, Susan; Malmedal, Wenche Karin; Ostaszkiewicz, Joan & Nakrem, Sigrid (2019). Nursing home leaders perception of elder abuse and neglect- A qualitative study .
• Myhre, Janne (2019). Vold og overgrep mot eldre .
• Myhre, Janne; Kvaal, Kari; Tonga, Johanne Bjørnstad; Høye, Sevald & Ulstein, Ingun (2016). Cognitive behaviour therapy in dementia care - the Norwegian KORDIAL study: The relatives' perspectives on everyday life after the intervention.
• Kvaal, Kari; Myhre, Janne; Høye, Sevald; Tonga, Johanne Bjørnstad & Ulstein, Ingun (2016). Cognitive behavioural therapy in dementia care: The Norwegian KORDIAL-study.
• Myhre, Janne (2021). The role of leadership in promoting safety for nursing home residents and preventing elder abuse and neglect. NTNU Norwegian University of Science and Technology,. ISSN 978-82-326-5730-8. 99.
• Myhre, Janne (2011). Fra vask til bad. Miljøet, taktil stimulering og berøringens betydning for personer med demens i sykehjem. Utviklingssenter for sykehjem og hjemmetjenester.

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