Hildegunn Sundal

• Sundal, Hildegunn & Alteren, Johanne (2024). Lack of hands-on competence in future paediatric nursing : examining student nurses’ paediatric competence after graduation – a hermeneutic study. Nordic journal of nursing research. ISSN 2057-1585. 44. doi: 10.1177/20571585241252880. Show summary

  Paediatric nursing training has been reduced in scope, which has become a concern in nursing education. Little is known regarding students’ experiences and what they learn about children as patients during courses. For the students in this study, paediatric nursing training consists of a 1-day observation practice. The aim of the present study was to examine this observation practice in paediatric nursing and discuss the consequences of the reduction of practical training for the level of knowledge of student nurses after graduation. A descriptive and interpretative design with a hermeneutical approach was employed to examine students’ experience in hospitals. Individual interviews were conducted with 11 students, and the data analysis followed Brinkmann and Kvale's three levels of interpretation. The study was reported in accordance with the COREQ checklist. Three themes emerged: ‘preparing the child for a procedure or treatment’; ‘the importance of the care provided by parents’; and ‘the lack of hands-on paediatric nursing training for students’. This study has implications for nursing in terms of paediatric competence. The findings suggest that students receive insufficient practical training in paediatric nursing. A discussion is required regarding paediatric nursing in nursing education, as well as how to meet national and international requirements.

• Vasset, Frøydis Perny; Ulvund, Ingeborg & Sundal, Hildegunn (2024). Methods to learn clinical pediatric nursing for nurse students. In David, Liliana (Eds.), Nursing studies : a path to success. IntechOpen. ISSN 978-0-85466-244-9. doi: 10.5772/intechopen.1004207. Show summary

  It is useful to learn about somatically ill children when implementing project-based learning. The students interview children’s nurses/parents with sick children and this enables/strengthens the students’ learning. Students learned pediatric nursing after completing the pediatric project, which is part of the nursing program. Some students learned in an international clinical placement in a pediatric ward. Combined learning from inside and outside educational institutions is useful. How can nursing students learn pediatric nursing in nursing education in the future, with large cohorts of nurses and few internships? This chapter is composed of several studies, both quantitative studies with questionnaires from 159 nursing students and qualitative studies with individual interviews of 18 nursing students after international clinical placement in a pediatric ward and eight nurses who had an international clinical placement in a pediatric ward as nurse students. And some studies about simulation in nursing studies and studies about clinical practice in other countries.

• Lorentzen, Isabelle Lindseth & Sundal, Hildegunn (2024). Nurse anesthetists’ experience with the Safe surgery Checklist. Inspira – tidsskrift for anestesi-, operasjon- og intensivsykepleiere. ISSN 0809-9707. 19(1), p. 1–16. doi: 10.23865/inspira.v19.5436. Show summary

  Background: Nurse anesthetists work as part of a surgical team, providing care for patients during surgical interventions. A surgical safety checklist is used for all surgical interventions to ensure patient safety during these procedures. However, studies suggest that the checklist is not always implemented as recommended. Aim: The purpose of this study is to acquire knowledge about nurse anesthetists’ experiences of collaboration and task allocation when using the surgical safety checklist. Method: Individual in-depth interviews were conducted with six nurse anesthetists. The obtained data was analyzed using systematic text condensation. Result: The study identified three themes and seven subthemes: 1) Distribution of responsibilities in the surgical team: addressing all three parts of the checklist, and unclear procedures for execution. 2) The significance of communication: daring to speak up, challenging situations, and seeing each other. 3) Creating distractions: conflicts of simultaneity and inadequate execution, and barriers to implementation. Conclusion: The nurse anesthetists experienced collaboration and task allocation following the surgical safety checklist as a collective responsibility. Distribution of responsibilities and the significance of communication during checklist implementation were crucial for ensuring patient safety. The nurse anesthetists experienced, that situations concerning the patient contributed to distractions, leading to the checklist being partially or entirely disregarded. The degree of urgency in attending to the patient contributed to unclear procedures for completing the checklist.

• Liepelt, Silje; Sundal, Hildegunn & Kirchhoff, Ralf (2023). Team experiences of the root cause analysis process after a sentinel event : a qualitative case study. BMC Health Services Research. ISSN 1472-6963. 23. doi: 10.1186/s12913-023-10178-3. Full text in Research Archive Show summary

  Background: Root cause analysis (RCA) is a systematic approach, typically involving several stages, used in healthcare to identify the underlying causes of a medical error or sentinel event. This study focuses on how members of a Norwegian RCA team experience aspects of an RCA process and whether it complies with the Norwegian RCA method. Method: Based on a sentinel event in which a child died unexpectedly during childbirth in a Norwegian hospital in 2021, the following research questions are addressed: 1. What was the RCA team’s experience of the RCA process? 2. Was there compliance with the Norwegian RCA method in this case? A case study was chosen out of the desire to understand complex social phenomena and to allow in-depth focus on a case. Results: The result covered three main themes. The first theme related to the hospital’s management system and aspects of the case that made it challenging to follow all recommendations in the Norwegian RCA guidelines. The second theme encompassed external and internal assessment. The RCA team was composed of members with methodological and medical expertise. However, the police’s involvement in the case made it complex for the team to carry out the process. The third and final theme covered intrapersonal challenges RCA team members faced. Team members experienced various challenges during the RCA process, including being neutral, dealing with role-related challenges, grappling with ambivalence, and managing the additional time burden and resource constraints. As anticipated in the RCA guidelines, the team’s ability to remain neutral was tested. Conclusion: The findings of this study can help stakeholders better comprehend how an inter-professional RCA teamwork intervention can affect a healthcare organization and enhance the teamwork experience of healthcare staff while facilitating improvements in work processes and patient safety. Additionally, these results can guide stakeholders in creating, executing, utilizing, and educating others about RCA processes.

• Sundal, Hildegunn (2023). Home-like care: Collaboration between parents and nurses in everyday situations when children are hospitalized. Journal of Child Health Care. ISSN 1367-4935. p. 1–13. doi: 10.1177/13674935221149778. Show summary

  When children are hospitalized, parents and nurses need to collaborate. This study aims to investigate how parents and nurses experience collaborating and sharing responsibilities and tasks when providing home-like care for hospitalized children in everyday situations. This qualitative study used a hermeneutic phenomenological approach with observations and interviews and was conducted in a general medical pediatric unit. Twelve parents of eleven hospitalized children between the ages of 1 and 6 years with various medical diagnoses and seventeen nurses who cared for those children participated in the study. Parents and nurses collaborated and shared responsibilities and tasks to provide home-like care for hospitalized children in everyday situations by making mealtimes seem familiar, maintaining customary sleeping patterns, adapting washing and dressing routines, and facilitating play and activity. Parents and nurses collaborated to maintain a familiar rhythm in an unfamiliar environment to enhance the children’s well-being. The nurses’ degree of involvement in the children’s everyday situations varied from little to moderate to strong, with parents assuming the main responsibilities. Nurses’ involvement in children’s everyday situations was variable, depending on the complexity of the situations.

• Sundal, Hildegunn & Vasset, Frøydis Perny (2022). Project-based learning in pediatric nursing. Klinisk Sygepleje. ISSN 0902-2767. 36(4), p. 240–252. doi: 10.18261/ks.36.4.3. Show summary

  Background: Studies on nursing students’ learning in pediatric nursing and nursing students’ learning outcome requirements, limited access to practical learning, actualizing project-based learning (PjBL) as a method. Aim: To examine nursing students’ learning outcomes by conducting PjBL on somatically ill children and their relatives, and the nursing practice in that connection. Method: A quantitative survey on nursing students’ (N-159) learning outcomes at PjBL in pediatric nursing, with frequency analysis, factor analysis and cross-tabulations. Result: There are useful learning outcomes about somatically ill children when completing PjBL. At future meetings with somatically ill children as students, the learning outcomes are very useful. Emphasis is placed on creating themes and problem formulation, and on interviewing people with experience in pediatric nursing as motivating and useful. Discussion and conclusion: PjBL, especially the students’ interviews of people with experience, enables students’ learning outcomes, which contributes to nursing students’ learning outcomes requirements in pediatric nursing. Keywords: nursing students, pediatric nursing, PjBL, project-based learning, questionnaire

• Ulvund, Ingeborg; Dadi, Gezahegn Bekele & Sundal, Hildegunn (2022). Nurses benefit from international clinical placement as nurse students : a qualitative study. Nurse Education Today. ISSN 0260-6917. 121(February), p. 1–6. doi: 10.1016/j.nedt.2022.105663. Show summary

  Background: A goal of studying abroad is increased cultural knowledge as well as strengthening the participants' disposition for active participation in society and in future careers. Empirical studies have shown a positive impact on nursing students', but little is known about the effects of international clinical placement on professional nursing. The aim was to investigate nurses' experiences after participating in international clinical placement as students, and how the stay influences their future career as professional nurses. Design: Qualitative design, and a hermeneutic phenomenological approach. Methods: Individual semi-structured interviews were conducted with a sample of eight nurses who had participated in an international clinical placement as nursing students and worked for at least two years as nurses. The participants were students at one University College in Norway. The data analysis method was inspired by Max van Manen's thematic analysis. Results: The international clinical placement promoted personal and professional development of importance to professional nursing practice. The informants benefited from increased global and cultural awareness and noted that mastering the emotional challenges during the placement strengthen their ability to manage demanding situations in nursing work. The students evaluated guided reflection before, during and after the stay to contributing to learning outcome. Conclusion: The potential for increased global and cultural competence and personal and professional development is high in international clinical placements. If the opportunity is taken, the participants' future careers can be affected in a way that benefits patients and colleagues. We recommend that educators and supervisors of students on international clinical placements should facilitate guided reflection to the participating students. Keywords: international clinical, placement, nursing, reflection, cultural competence, professional development

• Sundal, Hildegunn & Ulvund, Ingeborg (2022). Experiences after international clinical placement as nursing students in a paediatric ward. Nurse Education in Practice. ISSN 1471-5953. 66(January), p. 1–5. doi: 10.1016/j.nepr.2022.103512. Show summary

  Aim: The aim of this study is to investigate nurses’ experiences after participating in an international clinical placement programme as nursing students while staying for one to three weeks in a paediatric ward. Background: Student mobilisation is expected to increase the quality of education. Hence, offering international clinical placement programme in low- and high-income countries is a commonly used learning activity in bachelor programmes in nursing. Many studies have mainly examined the general experiences gained from international clinical placement programme but have not specifically focussed on the setting of paediatric wards in hospitals. Nursing students are required to acquire knowledge of paediatric nursing with children as patients. Design and method: In this qualitative study, a hermeneutic, phenomenological approach was adopted. Data were collected through individual interviews with eight nurses after they participated in an international clinical placement programme as nursing students in a paediatric ward. Results: Meetings with children’s destinies as patients were overwhelming, being an observer provided insights into and an overview of paediatric nursing, access to the resources required for treating children is limited, nurses had a different role and parents had an extended caring role. Conclusion: All participants gained knowledge of children as patients at a hospital and also gained knowledge of the parents’ and nurses’ roles and the treatment methods of various diseases that are relevant to paediatric nursing. This helped provide them with the cultural knowledge, awareness and sensitivity required, given the contrasting situation at their home country. Keywords: nurse, nursing students, international clinical placement, paediatric nursing

• Orseth, Wenche & Sundal, Hildegunn (2021). Intensivsykepleiernes erfaringer med teoretisk og praktisk opplæring for å gjennomføre inhalasjonssedering til respiratorpasienter i intensivavdelingen. Inspira – tidsskrift for anestesi-, operasjon- og intensivsykepleiere. ISSN 0809-9707. 16(1), p. 1–15. doi: 10.23865/inspira.v16.2939. Full text in Research Archive Show summary

  Bakgrunn: Intensivpasienter som ligger på respirator kan ha behov for sedering. De mest brukte medikamentene kan føre til komplikasjoner som delir og forlenget tid på respirator. I 2005 kom det et nytt filter som kan administrere sedative flyktige gasser som sevofluran og isofluran til respiratorpasienten i intensivavdelingen. Dette filteret heter Anaesthetic Conserving Device (AnaConDa). Disse gassene akkumuleres ikke i kroppen og kan redusere forekomsten av delir, føre til raskere oppvåkningstid og kortere tid på respirator. Det har medført at intensivsykepleiere må lære en ny sederingsmetode. Hensikten med studien var å undersøke intensivsykepleierens erfaringer med teoretisk og praktisk opplæring for å gjennomføre inhalasjonssedering til respiratorpasienter i intensivavdelingen. Metode: Studien hadde et kvalitativt design, med semi-strukturerte intervjuer av 6 intensivsykepleiere som hadde erfaring med opplæring og administrering av sevofluran og isofluran via AnaConDa. Intervjumaterialet ble transkribert og analysert etter Malteruds tekstkondensering i fire trinn. Resultater: Studien har tre hovedfunn: erfaringer knyttet til opplæring, erfaringer knyttet til gjennomføring og erfaringer etter opplæring var avsluttet. Konklusjon: Studien viser at intensivsykepleierne opplevde opplæring med teoretisk undervisning sammen med å øve praktisk uten respiratorpasient som nødvendig, og at støtte under gjennomføring av inhalasjonssedering på pasient var viktig. Behandling med inhalasjonsgass administrert via AnaConDa til respiratorpasienter ga stort sett ønsket effekt. Det motiverte dem til å fortsette å utøve for å bli trygg på bruken av AnaConDa. Nøkkelord: AnaConDa, inhalasjonssedering, intensivavdeling, intensivsykepleier

• Sundal, Hildegunn & Lykkeslet, Else (2020). «Sometimes falling out of normal life» : a qualitative study of children and their experiences with a life with allergy and asthma. Nordisk sygeplejeforskning. ISSN 1892-2678. 10(3), p. 213–222. doi: 10.18261/issn.1892-2686-2020-03-07. Show summary

  The combination of asthma and allergy is one of the most common chronic diseases in childhood. The aim of this article is to illuminate children’s experiences with allergies and asthma through their stories of everyday life. The study is grounded in a phenomenological philosophy of lifeworld and thus employs a qualitative design. The data were collected through qualitative in-depth interviews with four children, aged 9-12 years, with each child interviewed three times. A narrative analysis was conducted from the responses. Four stories, one from each child, were written and later analyzed as one narrative, representing the findings of the study. The main finding is that living with a disease may cause a child to fall out of normal life. This narrative contains three sub-narratives: everyday life with an intrusive disease, supporters in everyday life, and the hope to be included in normal life. Using a narrative analytical approach provided a cohesive story of the children’s experiences. In these narratives, the contexts of the children’s lives are prominent, yielding stories in which everyday life, the children’s lifeworld, emerges. These stories, in turn, offer healthcare professionals insight into the experiences of children living with chronic disease. Keywords: children with allergy and asthma, everyday stories, narratives, phenomenology, qualitative design

• Sundal, Hildegunn (2020). Children's co-determination during challenging procedures : nurses and parents experiences of caring under short-term hospital stays in Norway. Journal of Pediatric Nursing : Nursing Care of Children and Families. ISSN 0882-5963. 57(March–April), p. e34–e39. doi: 10.1016/j.pedn.2020.09.018. Full text in Research Archive Show summary

  Background: Medical and clinical procedures can cause varying levels of discomfort to children. Purpose: This study is to deepen the understanding of the lived experiences of parents and nurses related to challenging medical and clinical procedures performed on children during short-term hospital stays. Design and Methods: This qualitative study, which comprises part of a larger study, adopted a hermeneutic phenomenological approach. The data were obtained through a combination of in-depth interviews and observations of twelve parents of eleven children and seventeen nurses. A narrative re-analysis was conducted of four challenging medical and clinical procedures. Four stories were written and subsequently analyzed as one narrative that represents the findings. Results: The form of nurses' and parents' care for the children ranged from encouraging the children's consent and receptiveness to the procedures, to coercion. The analysis indicates that promoting the children's co-determination and participation in the procedures encouraged their consent and receptiveness and facilitated a successful outcome. In contrast, an absence of efforts to involve the children in the procedures contributed to the need for coercion to be employed by parents and nurses. Moreover, parental influence and the responsibilities of nurses had an impact on children's co-determination and participation. Conclusions: Preparing parents and children before and during a procedure was important to minimize the degree of coercion of the children. Practice implications: The findings of this study are relevant to clinical practice because they suggest preparing parents and children before and during a procedure situation. Keywords: children in hospital, nurse, parents, lived experience, narrative, procedure situations, coercing, consent

• Synnes, Oddgeir; Orøy, Aud Jorun; Råheim, Målfrid; Bachmann, Liv; Ekra, Else Mari Ruberg & Gjengedal, Eva [Show all 12 contributors for this article] (2020). Finding ways to carry on : stories of vulnerability in chronic illness. International Journal of Qualitative Studies on Health and Well-being. ISSN 1748-2623. 15(1), p. 1–13. doi: 10.1080/17482631.2020.1819635. Full text in Research Archive Show summary

  Purpose: In this study, we explore the lived experiences of chronic illness in four groups of patients; children with asthma, adolescents with diabetes, young adults with depression, and adult patients with chronic, obstructive pulmonary disease (COPD). Persons living with chronic illness are often designated as vulnerable. This study builds on the assumption that being vulnerable belongs to being human, and that vulnerability also might entail strength and possibilities for growth. Methods: A narrative analysis was undertaken to illuminate how experiences of vulnerability were narrated across the four patient groups, presenting four individual stories, one from each of the patient groups. Results/conclusion: The stories illuminate how living with a chronic illness implies differing capabilities and capacities dependent on the specific condition. At the same time the stories point to how various abilities and challenges in living with chronic illness can be alleviated or seen as resources. Considered together, the stories underscore how ´finding ways to carry on´ in chronic illness requires interpretational work. By calling upon resources among significant others, in the surroundings and in oneself, the narrator can find ways of interpreting living with chronic illness that might open towards a hopeful future. Keywords: chronic illness, vulnerability, narrative analysis, life

• Sundal, Hildegunn & Vatne, Solfrid (2020). Parents’ and nurses’ ideal collaboration in treatment-centered and home-like care of hospitalized preschool children : a qualitative study. BMC Nursing. ISSN 1472-6955. 19, p. 1–10. doi: 10.1186/s12912-020-00445-7. Full text in Research Archive Show summary

  Background: The hospitalization of children requires collaboration between parents and nurses in partnerships. This study examines parents’ and nurses’ experiences of ideal collaboration in treatment-centered and home-like care of hospitalized preschool children. Methods: This qualitative study is part of a larger study of 12 parents and 17 nurses who were responsible for 11 hospitalized children. Data collection took place at a Norwegian general paediatric unit, and the data were gathered from observations of and qualitative interviews with the parents and nurses. The analysis was conducted in six steps, in alignment with Braun and Clarke. Results: Two essential themes emerged from the analysis. (1) Treatment-centered care focuses on the following tasks in building relationships – gaining trust, securing – gaining voluntariness, distracting and comforting, and securing and gaining voluntariness. The purpose of treatment-centered care is to perform diagnostic procedures and offer treatment. (2) Home-like care, the purpose of which is to manage a child’s everyday situations in an unfamiliar environment, focuses on the following tasks: making familiar meals, maintaining normal sleeping patterns, adjusting to washing and dressing in new situations, and normalizing the time in between. From this pattern, we chose two narratives that capture the essence of ideal collaboration between parents and nurses. Conclusion: The ideal collaboration between nurses and parents is characterized by flexibility and reciprocity, and is based on verbal and action dialogues. In treatment-centered care, parent-nurse collaboration was successful in its flow and dynamic, securing the children’s best interests. Meanwhile, the achievement of the children’s best interest within home-like care varied according to the level of collaboration, which in turn was related to the complexity of the children’s everyday situations. Keywords: children’s hospitalization, preschool, nurse-parent collaboration, qualitative design, field study, interview

• Sundal, Hildegunn & Lykkeslet, Else (2019). Hospitalized children : parents' and nurses' collaboration in procedural situations. Pediatric Nursing. ISSN 0097-9805. 45(4), p. 174–179. Show summary

  Background: When children are hospitalized, collaboration between parents and nurses is initiated. This qualitative study explored parents' and nurses' experiences of collaboration, and the sharing of responsibility and tasks in the care of hospitalized children regarding procedural and treatment situations. Methods: A hermeneutic, phenomenological approach was used, which included field study and interviews. Participants included 11 children hospitalized in a general medical pediatric unit with their parents (3 fathers and 9 mothers) and the 17 nurses (all female) who cared for them. The children were between 1 and 6 years old (3 boys and 8 girls), and had various medical diagnoses. Findings: Parents and nurses collaborated and shared responsibilities and tasks in caring for the children in procedural and treatment situations by building relationships with the children, motivating and distracting the children, and causing discomfort and comforting the children. In this way, while carrying out procedures and treating the children, nurses and parents alternated responsibilities and tasks. Caring in these situations was characterized by a dynamic and flexible collaboration for the children's best interests. Conclusions: This study reveals the dynamics of collaboration and a sharing of responsibility and tasks between parents and nurses. This study highlights that nurses must be aware of parents' contributions and competence in terms of collaboration in both procedural and treatment situations. Keywords: children in hospital, care, treatment, procedure, collaboration, responsibility, nursing, parents

• Sundal, Hildegunn; Petersen, Karin Anna & Boge, Jeanne Helene (2019). Exclusion and inclusion of parents of hospitalized children in Norway in the period 1877–2017. BMC Nursing. ISSN 1472-6955. 18(6). doi: 10.1186/s12912-019-0330-6. Full text in Research Archive Show summary

  Background: Today, Norwegian parents have the right to stay with their children when they are in hospital. This right is relatively new. The purpose of this article is to examine the nursing profession’s ideas on how parents should be included/excluded when their children are in hospital, and to examine the social and ideological conditions that made the nursing profession’s ideas on inclusion/exclusion practices possible. Methods: The analyses are done in the tradition of the French philosopher Michel Foucault’s writings on how different kinds of knowledge have been used to discipline citizens. Such studies include analyses of descriptive and normative material and analyses of the ideological and social conditions that made the practices possible. The analyses are based on Norwegian textbooks on nursing. Results: Parents are rarely mentioned in Norwegian nursing textbooks from the period 1877–1940, and they are not present in photos from hospitals. The exclusion of parents may be due to the absence of welfare services and the fear of parents transmitting diseases from the hospitals to the general population. The first Norwegian nursing textbook that argued for the importance of letting parents visit their children in hospital was published in 1941. In 1968, nursing textbooks started to argue for parents’ participation in the care. Since 1987, nursing textbooks have advocated full parental participation. The inclusion of parents was in accordance with humanistic ideology. The inclusion of parents occurred in a period of great nursing shortage. In this situation, it would have been of interest to entrust as much as possible of the nurse’s work to the family. Conclusions: Our conclusion is that ideas break through when they are in line with social conditions. From 1877 to 1940 social and economic conditions made it difficult for parents to be with their children in hospital, and hygiene ideology/theory contributed to legitimization of the exclusion of the parents in the care. During the period 1941–2017 it has been economically advantageous for the hospitals that parents care for their children. Ideas on the vulnerable child and self-help ideology have contributed to legitimization of the inclusion of the parents. Keywords: children, hospital, parents, exclusion, inclusion, Michel Foucault, discipline

• Sundal, Hildegunn; Petersen, Karin Anna & Boge, Jeanne Helene (2018). Parents perform most of the care when children have short-term stays in hospitals. Klinisk Sygepleje. ISSN 0902-2767. 32(2), p. 80–93. doi: 10.18261/issn.1903-2285-2018-02-02. Show summary

  The article explores how parents are included and excluded in the care of hospitalized children and examines the inclusion/exclusion practices by the ideology of human needs. Method: Interviews with parents/nurses, observations of parents/nurses/children in a Norwegian children’s ward; the material is analyzed in the extension of Henderson’s and Orem’s ideas on human needs. Result: Parents performed a major part of the work to take care of basic nursing and care tasks. They had also a central role in the performing of a variety of medical procedures, although the nurse was primarily responsible. Parents were only relieved when the nurse had time. Conclusion: Parents performed most of the care and contributed to medical treatment. These practices were usually in harmony with the parents’ need to be with their children. Keywords: children, exclusion, hospital, inclusion, parents

• Sundal, Hildegunn; Petersen, Karin Anna & Boge, Jeanne Helene (2016). Fra 1960-tallet har det blitt forventet at foreldre skal være inkludert i pleien av barn på sykehus. Barn – forskning om barn og barndom i Norden. ISSN 0800-1669. 34(3), p. 23–37. doi: 10.5324/barn.v34i3.3626. Show summary

  I perioden 1877–1940 var foreldre sjelden nevnt i norske lærebøker i sykepleie når barn på sykehus var omtalt. I 1941 utgis den første norske læreboken der det argumenteres for at foreldre bør få besøke barna sine når de er på sykehus. På 1960-tallet tas dette videre og det argumenteres i lærebøkene for at foreldre bør få delta i pleien av barn på sykehus. Siden slutten av 1980-tallet har det i norske lærebøker i sykepleie vært argumentert for omfattende foreldredeltakelse når barn er på sykehus. I denne artikkelen har vi undersøkt og drøftet mulighetsbetingelsene for inklusjonsargumentasjonen som oppstod i norske lærebøker i sykepleie på midten av 1900-tallet. Vi har argumentert for at inklusjonsnormene oppstod fordi det var til beste for barnet, men også samfunnsmessig og økonomisk fordelaktig at foreldre var sammen med barna sine på sykehus. Analysene er gjort i forlengelsen av den franske filosofen Michel Foucaults utlegninger om selvstyrt disiplinering.

• Boge, Jeanne Helene; Storum, Hilde; Sundal, Hildegunn; Callewaert, Staf & Petersen, Karin Anna (2016). Muligheter og begrensninger ved analyser av sykepleiepraktikker i et Foucault-perspektiv . Klinisk Sygepleje. ISSN 0902-2767. 30(1), p. 31–44. doi: 10.18261/issn.1903-2285-2016-01-04. Show summary

  The reason for the article is discussions that have taken place in the praxeologiske research group at the University of Bergen about the differences between studies on nursing in a philosophical and a sosiological perspective. The purpose with this text is to discuss possibilities and limitations in doing studies on nursing practices in the perspective of the philosopher Michel Foucault. Three studies in nursing are used as examples. One of the studies was about body wash, the other about nursing documentation and the third about exclusion and inclusion of parents when children are in the hospital. The methodological basis for the studies were a discussion with Foucault on how he studied punishment. The articles conclusion is that researchers who go out into the world to examine how practices actually are being made, move out of philosophical methodology.

• Sundal, Hildegunn; Petersen, Karin Anna & Boge, Jeanne Helene (2015). Thoughts on the exclusion of parents of hospitalized children in nursing. Nordisk tidsskrift for helseforskning. ISSN 1504-3614. 11(2), p. 76–85. doi: 10.7557/14.3713. Full text in Research Archive Show summary

  Analyses of textbooks in nursing, of photographs and numerous other documents suggest that parents had limited access to participate in the care for their hospitalized children in Norway in the period 1877-1940. The analyses are conducted in the tradition of the French philosopher Michel Foucault’s writings on discipline. In accordance with Foucault’s understanding, it seems logical that ideas about parenting exclusion had impact even within the hospital health care system in the current era, provided the general separation of parents and children in the modern industrial society at large. In this perspective, exclusion of parents in the hospital health care system may be considered a consequence of employers’ interests with regard to productivity, the lack of welfare services for parents, and the fear of parents transmitting infections from the hospitals.

• Gjengedal, Eva; Ekra, Else Mari Ruberg; Hol, Hege Bente; Kjelsvik, Marianne; Lykkeslet, Else & Michaelsen, Ragnhild K A [Show all 11 contributors for this article] (2013). Vulnerability in health care – reflections on encounters in every day practice. Nursing Philosophy. ISSN 1466-7681. 14(2), p. 127–138. doi: 10.1111/j.1466-769X.2012.00558.x. Show summary

  Vulnerability is a human condition and as such a constant human experience. However, patients and professional health care providers may be regarded as more vulnerable than people who do not suffer or witness suffering on a regular basis. Acquiring a deeper understanding of vulnerability would thus be of crucial importance for health care providers. This article takes as its point of departure Derek Sellman's and Havi Carel's discussion on vulnerability in this journal. Through different examples from the authors' research focusing on the interaction between health professionals and patients, existential, contextual, and relational dimensions of vulnerability are illuminated and discussed. Two main strategies in the professionals' interactions with patients are described. The strategy that aims at understanding the patients or families from the professional's own personal perspective oftentimes ends in excess attention to the professional's own reactions, thereby impairing the ability to help. The other strategy attempts to understand the patients or families from the patients' or families' own perspective. This latter strategy seems to make vulnerability bearable or even transform it into strength. Being sensitive to the vulnerability of the other may be a key to acting ethically.

• Sundal, Hildegunn (2001). "Mors" uklare rolle når barnet er innlagt i sjukehus Unclear maternal roles when children are hospitalized? Vård i Norden. ISSN 0107-4083. 21(3), p. 39–42. Show summary

  The paper describes a Norwegian study from 1998, (2) based on a phenomenological approach where six mothers are interviewed. The mothers stayed together with their children in hospital. The children were hospitalized for minor surgery. They stayed in ho spital for three to four days at a small section for children location at a ward for adults. The children were from four to eleven years old. This paper focuses division of labour and responsibility between mothers and nurses, during hospital stays for children. In Norway such interactions are regulated by law (1). The findings from this study indicate that the mothers take responsibility for basic mothering care. According to the mothers the nurses involvement in nursing care for the children is redu ced by the presence of the mothers in the ward.

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• Sundal, Hildegunn (2023). The significance for adult life – When children have been hospitalized without their parents.
• 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.
• Ulvund, Ingeborg & Sundal, Hildegunn (2022). Sykepleieres utbytte av kliniske studier som sykepleierstudent på en barneavdeling i et lavinntektsland. Show summary

  Begrunnelsen for å tilby internasjonale utvekslingsopphold for studenter er å øke kvaliteten på utdanningene. En vanlig læringsaktivitet på bachelorstudier i sykepleie er kliniske praksis i helse- og omsorgstjenesten. Tidligere studier har i hovedsak undersøkt de generelle erfaringene fra internasjonale kliniske utvekslingsprogram og har ikke spesifikt fokusert på erfaringer fra en barneavdelinger i sykehus. For sykepleierstudenter er det et krav at de tilegner seg kunnskap om barnesykepleie med barn som pasienter. Hensikten med studien er å undersøke sykepleieres erfaringer etter å ha deltatt i et internasjonalt utvekslingsprogram som sykepleierstudenter. Læringsaktivitetene omfattet en til to uker på en pediatrisk avdeling på et sykehus. I denne kvalitative studien ble en hermeneutisk, fenomenologisk tilnærming benyttet. Datainnsamlingen ble gjennomført ved individuelle intervjuer med åtte sykepleiere etter at de hadde deltatt i et internasjonalt utvekslingsprogram som sykepleierstudenter og hatt kliniske praksis på en barneavdeling. Funnene var at sykepleiere som studenter hadde opplevd «sterke møter med syke barn, fått innsikt i ukjente sykdommer og behandlinger og at personalet gjorde sitt beste». Studiens konklusjoner var: Studentene tilegnet seg kunnskap om barn som pasienter ved sykehus og behandlingsmetoder for ulike sykdommer som er relevante for barnesykepleie. Ved å sammenligne de nye erfaringene med erfaringer fra hjemlandet tilegnet studentene seg også kulturell kunnskap, bevissthet og sensitivitet. Denne kunnskapen benytter de i møte med pasienter som kommer fra andre land og gjør kunnskapen relevant og bærekraftig og er en nyskaping i det norske samfunnet med stor grad av innvandring.

• Sundal, Hildegunn & Ulvund, Ingeborg (2022). International clinical placement as nursing students in a paediatric ward - registered nurses’ experiences.
• Foldøy, Reidun Elise; Sundal, Hildegunn & Bergersen, Ida (2022). Var alene på sykehus som barn: - Det føltes utrygt. [Internet]. kk.no.
• Reitan, Laila Solli & Sundal, Hildegunn (2019). Sykepleiers erfaring med NEWS som scorings verktøy på sengepost for å oppdage pasienter med tidlig forverret sykdomstilstand .
• Sundal, Hildegunn (2019). Challenging procedure situations in hospitals - caring between encouraging the child’s receptiveness and coercing the child .
• Reitan, Laila Solli & Sundal, Hildegunn (2019). Nurse`s experiences with NEWS as a tool in early recognition of deterioration: “Before we didn`t count respiratory frequency" .
• Reitan, Laila Solli & Sundal, Hildegunn (2018). «Sykepleierens erfaring med verktøyet NEWS i tidlig oppdagelse av forverret tilstand. Er NEWS bare et tall?» . Show summary

  Hensikt: Var å undersøke hvilke erfaringer sykepleiere har med NEWS som verktøy og implementeringsprossesen. Bakgrunn: National Early Warning Score (NEWS) er et verktøy bestående av vitale målinger, som på en strukturert måte kan identifiserer pasienter med forverret tilstand. NEWS innføres på flere somatiske sykehus i forbindelse med pasientsikkerhetskampanjen Tidlig oppdagelse av forverret tilstand. Et sykehus i Norge startet med NEWS i 2016 og studien ble utført året etter. Problemstilling: Hvilke erfaring har sykepleiere på sengepost med bruka av NEWS i Tidlig oppdagelse av forværret tilstand. Metode: Kvalitative dybde intervju av 5 sykepleiere ble brukt for å få svar på problemstillingen Resultat: Sykepleiere opplever at NEWS har ført til bedre rutiner, de er i forkant og er tryggere i sine vurderinger. Men de opplever manglende interesse og respons på høy NEWS fra legene. Konklusjon: Sykepleierne ser NEWS som et hjelpemiddel i kliniske vurderinger. Men skal NEWS funger er de avhengig av at sykepleierne tar en høy NEWS på alvor og kontakter lege. Effekten er og avhengig av at legene responderer.

• Sundal, Hildegunn & Hernæs, Nina (2018). Det var helt vanlig at barn lå alene på sykehus. [Business/trade/industry journal]. Sykepleien.no.
• Sundal, Hildegunn & Lykkeslet, Else (2018). Living with allergy and asthma : a qualitative study of children, aged 8-12 years, and their experiences of life. Show summary

  Asthma and allergy is one of the most common chronic diseases in childhood. This presentation focuses on how children tell their everyday stories of living with allergy and asthma. The study is grounded in a phenomenological philosophy of the lifeworld and, as such, has a qualitative design. Data were collected through qualitative research interviews with four children, aged 8-12 years, each child being interviewed three times. A narrative analysis was conducted. Four stories, one from each child, were written up as findings, and later analyzed as one narrative. The main findings are: living with sickness makes you sometimes fall out of normal life. This contains three minor narratives: everyday life with an intrusive disease, supporters in everyday life, and hoping to be included in normal life. Using a narrative analytical approach may yield a more coherent story of the children’s experiences. In these narratives the contexts of the children’s lives are prominent, yielding stories in which everyday life, the children’s lifeworlds, emerges. The stories may give healthcare professionals insight into and understanding of children living with disease.

• Gjengedal, Eva; Bachmann, Liv; Ekra, Else Mari Ruberg; Høye, Magnhild Mjåvatn; Jørgensen, Else & Lykkeslet, Else [Show all 12 contributors for this article] (2017). Vulnerability as an existential challenge in chronic illness : a balance between self and others.
• Sundal, Hildegunn (2017). Barn på sykehus i historisk perspektiv.
• Sundal, Hildegunn (2016). Vil «fleksible sengeområde» ivareta syke barn i det nye sjukehuset? Romsdals Budstikke.. ISSN 0806-5160.
• Sundal, Hildegunn (2015). Inclusion and exclusion of parents in the care of hospitalized children.
• Sundal, Hildegunn (2014). Doktorgrader : Hildegunn Sundal disputerte 30. mai 2014 for doktorgraden ved Universitetet i Bergen, Det medisinsk-odontologise fakultet. Nordvestsykepleieren : medlemsblad for Møre og Romsdal. 16(2).
• Sundal, Hildegunn & Hernæs, Nina (2014). Da barn lå alene på sykehus : foreldre var ekskludert når barn lå på sykehus : Hildegunn Sundal har forsket på hvorfor. [Journal]. sykepleien.no.
• Sundal, Hildegunn & Waagbø, Arild Johan (2014). Fikk ikke pleie sine barn. [Newspaper]. Panorama.himolde.no.
• Sundal, Hildegunn (2014). Då sjukehusa slapp foreldra inn. [Newspaper]. Morgenbladet.
• Sundal, Hildegunn (2014). Viktige foreldre : gir avlastning for pleierne når barn er på sjukehus. [Newspaper]. Romsdals budstikke.
• Sundal, Hildegunn; Lykkeslet, Else; Gjengedal, Eva & Blåka, Gunnhild (2010). Hospitalized children – How do parents and nurses experience their collaboration? In Krycka, Kevin C (Eds.), 29th International Human Science Research Conference : Giving Voice to Experience. Seattle University, August 4-8, 2010. Seattle University College of Arts and Sciences. p. 66–67.
• Gjengedal, Eva; Lykkeslet, Else; Orøy, Aud Jorunn; Michaelsen, Ragnhild K A; Sundal, Hildegunn & Skrondal, Torill Helene [Show all 8 contributors for this article] (2010). Vulnerable groups’ experiences as basis for health care interaction. In Krycka, Kevin C (Eds.), 29th International Human Science Research Conference : Giving Voice to Experience. Seattle University, August 4-8, 2010. Seattle University College of Arts and Sciences. p. 17–17. Show summary

  Vulnerability is a characteristic of human existence. Therefore, it plays an important part in almost all human interaction, in particular with "significant others", like family members and health care workers. In the context of the health care system some patient groups are regarded as particularly vulnerable, and therefore represent a challenge for health care providers. For example, major mentally ill patients are regarded as a particularly vulnerable group. Research in mental health care has indicated that the professionals try to avoid conflicting situations with these patients, using various subtle or covert coercion strategies. Such strategies may be regarded as indistinct and non-therapeutic. An alternative approach would be to rely on empathy, self-reflection and self-limitation. Similar strategies may be found in other situations with other groups. The aim of the panel presentation is to give voice to the experiences of different groups who are considered as vulnerable and to professionals who are interacting with such groups. Potential patterns in the experiences across the groups will be elaborated. Finally, the aim is to discuss how knowledge about these experiences can contribute to improved interaction. There will be given a short presentation of four phenomenological qualitative studies of interactions with vulnerable groups along the lifespan. These groups are hospitalized children and their parents, persons with dementia, hospitalized mentally ill persons, and intensive care providers’ interaction with families to donor patients. Some findings from these studies will be presented as condensed descriptions illustrating experience of vulnerability and fragility as well as challenges related to interaction. Further, experiences with interactions across the different groups that seem to both fail and succeed will be visualized. Preliminary results indicate that taking vulnerable patients’ experiences into consideration may ease their situation and improve quality of health care. These preliminary findings will be further elaborated in the presentation.

• Sundal, Hildegunn (2009). Hospitalized children - collaboration between parents and nurse.
• Sundal, Hildegunn; Boge, Jeanne Helene & Petersen, Karin Anna (2014). Inclusion and exclusion of parents care of children hospitalized The analyzes are historical and contemporary and has basis in Norwegian textbooks in nursing, pictures, literature and other documents from period 1877-2013, and interviews and observations with parents and Nurses at a children's section in 2007 . Universitetet i Bergen. ISSN 978-82-308-2900-4. Show summary

  What has made it possible to include parents in the care of children at certain points in time and exclude them at other points in the history of nursing? When did these inclusion and exclusion practices arise and how have they been practiced? Theoretical perspective:. I have not found any studies that directly answer my questions. However, Nordic Foucault inspired nursing studies on the relationship between practices and knowledge constitute the background for basing this study on the assumption that knowledge has been used to support socially useful practices of inclusion and exclusion of parents when children are in hospital. According to the French philosopher Michel Foucault, both objectifying and subjectifying knowledge have been used to support what has been considered socially useful practices in modern western democracies. Objectifying knowledge has been used for external control of individuals. Foucault calls such control discipline. Subjectifying knowledge has been used to make individuals control themselves and in the context of this study this is called selfdiscipline. Methodology and material: I have used a dispositive approach as the overreaching methodological analytical tool in my empirical research on inclusion and exclusion of parents in care when children are in hospital. I use the concept of the dispositive mainly from what is considered Foucault’s genealogical phase (1971-1984). The study’s empirical object has thus been illuminated by a dispositive approach, with corresponding archaeological and genealogical studies of the practices that emerge as inclusion/ exclusion of parents in the care of children in hospital. The analyses take as their point of departure Norwegian nursing textbooks from the period 1877-2013. I have described what these textbooks include and do not include on parents. Based on the mention or non-mention of parents I have identified periods in which it is probable that parents have been excluded from and included in the care of children in hospital. To support and challenge the findings in the textbooks I have analysed pictures,short stories and other relevant material from the past, as well as recent notes of observation and transcribed interviews from a Norwegian children’s ward. In order to examine the social preconditions for the inclusion and exclusion practices, I have analysed publicly accessible laws, rules and regulations, works on general history, childhood history, the history of nursing, the history of the health services, the history of hospitals and other material that may yield increased understanding of the inclusion and exclusion practices. I have discussed inclusion and exclusion practices, respectively, in light of the knowledge that was at play in the epoch in question and which may support the practices. These analyses and discussions are performed in light of Foucault’s accounts of practices of discipline and self-discipline.

• Sundal, Hildegunn (2014). Inklusjon og eksklusjon av foreldre i pleie av barn innlagt på sykehus : analysene er historiske og nåtidige og har utgangspunkt i norske lærebøker i sykepleie, bilder, litteratur og andre dokumenter fra perioden 1877-2013, og intervju og observasjoner med foreldre og sykepleiere ved en barneavdeling i 2007. Universitetet i Bergen. ISSN 978-82-308-2900-4.
• Bakken, Hege; Sundal, Hildegunn & Valla, Astrid (2000). "Prosjekt barn". Kommunikasjon med og om barnet - som pasient i sykehus uten egen barneavdeling: en studie av pårørendes opplevelser ved å ha barnet sitt som pasient ved Fylkessykehuset i Molde. Fylkessykehuset i Molde.
• Sundal, Hildegunn (1998). Barn på sykehus : ein fenomenologisk studie av kva røynsler mødrer har av å vere innlagt i sjukehus saman med barna sine. Universitetet i Bergen.

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