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This paper reports a study conducted to illuminate older adults' perceptions of multiproffesional team's caring skills as success factors for health support in short‐term goal‐directed reablement. The fact that older adults are given perquisites to live in their own homes puts great demands on the professional care given them at home. An option offered could be short‐term goal‐directed reablement delivered by an interprofessional team. This means after periods in hospitals to strengthen their multidimensional health, older adults' reablement processes are supported to return to their daily life as soon as possible. Crucial in making these intentions a reality seems to be identifying the professional's approach that works as success factors for health support in the reablement process. A descriptive qualitative design with a phenomenographic approach based on interviews with 23 older persons who had received short‐term goal‐directed reablement at home after a period at hospital was used. The study was approved by an ethical board. The analysis revealed four major referential aspects of multiproffesional team's caring skills as success factors for health‐support in short‐term goal‐directed reablement: a motivating caregiver, a positive atmosphere‐creating caregiver, a human fellowship‐oriented caregiver and a caregiver that goes beyond the expected. In this study, all caring skills in the continuum are perceived as positively loaded necessities in different situations during the reablement process. Caring skills as success factors are initially shown at a practical level, such as how the professional caregivers encourage and motivate the older persons in different training situations. At a deeper level, the caregivers open their hearts and have the capacity to go beyond the expected in the professional caregiver–patient relationship. The multiproffesional team's best fit caring skills during the home reablement process need to be addressed as evidence base in the area of elderly home care. [ABSTRACT FROM AUTHOR]

Background In 2007, a literature review was undertaken of palliative care research from Sweden during the 1970s-2006, paving the way for a follow-up study to explore the recent developments. The aim was to systematically examine palliative care research from Sweden between 2007 and 2012, with special attention to methods, designs and research foci. Methods A literature review was undertaken. The databases Academic search elite, Age line, Ahmed, Cinahl, PsychInfo, PubMed, Scopus, Soc abstracts, Web of science and Libris were reviewed for Swedish palliative care research studies published from 2007 to 2012, applying the search criteria 'palliative care OR palliative medicine OR end-of-life care OR terminal care OR hospice care OR dying OR death'. Results A total of 263 papers met the inclusion criteria, indicating an increased volume of research compared to the 133 articles identified in the previous review. Common study foci were symptom assessment and management, experiences of illness and care planning. Targeting non-cancer-specific populations and utilisation of population-based register studies were identified as new features. There was continued domination of cross-sectional, qualitative and mono-disciplinary studies, not including ethnic minority groups, nonverbally communicable people or children <18 years of age. Conclusions The trend is that Swedish palliative care research has expanded in volume from 2007 to 2012 compared to during the 1970s to 2006, with increasing participation of non-cancer-specific populations. A domination of qualitative approaches and small, cross-sectional studies with few interventions is still characteristic. Still more strategies are needed to expand the knowledge development of palliative care to respond to demographical, epidemiological, therapeutic and healthcare structure changes. [ABSTRACT FROM AUTHOR]

Scand J Caring Sci; 2012; 26; 104-112 My, your and our needs for safety and security: relatives' reflections on using information and communication technology in dementia care Aim: The present paper reports on a study aimed at describing relatives′ reflections on different kinds of information and communication technology (ICT) devices that are used or can be used in the daily care of persons with dementia. Background: Many persons with dementia continue living in their own homes, which requires the support of their relatives. One way to meet the needs of relatives and persons with dementia is to use ICT. Methods: An interview study was conducted in Sweden (2007-2008) with a purposive sample of 14 spouses of a person with dementia. Qualitative content analysis was used to identify categories and themes in the data. Findings: Relatives′ reflections on the use of ICT were described as ICT - a support in daily life, ICT - internal and external conditions and ICT - the decision to use or not use. Based on these categories, a theme was revealed: shifting between different perspectives: my, your and our needs for safety and security. Conclusion: Relatives struggle to create a situation of safety and security in daily life for themselves and the persons with dementia. ICT devices with the right functionality and used at the right time are regarded as useful in solving everyday problems. In the decision to use or not use ICT, the opportunity to create a safe and secure environment overshadows potential ethical problems. Providing early information about ICT to persons with dementia and their relatives could facilitate joint decision-making regarding use of ICT. [ABSTRACT FROM AUTHOR]

Background and Aim: Domestic violence is a prevalent public health issue. While clinical guidelines and care programs for its identification and handling have been formulated in all administrative regions of Sweden, their degree of implementation is largely unknown. This study aims to assess the implementation of one administrative region's care program, including how it is seen to align with and function in clinical practice, and any perceived barriers to or facilitators of its use. Methods: A survey was distributed to first‐line managers for healthcare units with patient contact in the region (n = 807). The responses were analysed using descriptive statistics. Open responses were analysed thematically. Group interviews (n = 5) were held with caregivers (n = 15) working primarily with young patients and analysed thematically. Results: 73% of the survey respondents reported previous awareness of the care program, and 27% reported knowledge of its content. The extent to which their staff knew about and followed the care program was assessed to be relatively low. The survey response rate was 19%. Among interview participants, knowledge of the care program was generally quite low. Survey responses and interview discussions pointed to the importance of developing routines, of collegial and managerial support and of training on domestic violence and the care program. Conclusion: This study indicates that the knowledge and use of the regional care program is limited among healthcare staff, including among those working with young patients. This underscores the importance of information and training for furthering the implementation of clinical guidelines on domestic violence. [ABSTRACT FROM AUTHOR]

Background: Children with down syndrome (DS) are breastfed to a lesser extent than infants in general, despite research showing that it is possible for these children to breastfeed successfully. Aim: The aim was to describe how mothers of children with DS experienced breastfeeding and breastfeeding support from healthcare professionals. Method: A qualitative study with an inductive approach. Individual interviews were performed with seven mothers from southern Sweden. The interviews were analysed using qualitative content analysis. Result: The mothers felt that the support varied, as some healthcare professionals were supportive, while others had preconceptions regarding breastfeeding and DS. They also experienced that the guidelines could be an obstacle in the encounter with healthcare professionals thereby affecting the possibility to establish breastfeeding. Information and support were important to the mothers, and when insufficient, they turned to the internet for help. Conclusions: Mothers felt that healthcare professionals were bound to ward routines and guidelines, which could be contrary to their own and the family's wishes. They were also sensitive to the attitudes of healthcare professionals, which can affect their own state of mind. Healthcare professionals' preconceptions regarding breastfeeding and DS have not changed, despite research showing that infants with DS can breastfeed successfully. Increased awareness of the possibility to breastfeed an infant with DS is needed to provide better support to mothers. [ABSTRACT FROM AUTHOR]

Parents' experiences of family health conversations after having a child in need of neonatal intensive care Background: When a newborn child requires neonatal intensive care, it is often the beginning of a journey of stress and worry for the parents. Such situations could cause difficulties in problem-solving and communication within the family and result in decreased family functioning. Studies have shown that nurse-led interventions in the form of Family Health Conversations promote family's well-being and functioning and strengthen their relationships. However, this model has not previous been used and evaluated with families who have a child in need of neonatal intensive care. Aim: To describe parents' experiences of participating in Family Health Conversations after having a child in need of neonatal intensive care. Method: Family interviews were conducted with 12 families from three neonatal intensive care units in southern Sweden, six months after a Family Health Conversations intervention. Data were analysed using qualitative content analysis. Findings: The parents experienced the Family Health Conversations as an opportunity to co-create a comprehensive picture of what had happened after their child was born. Parents shared their experiences of the Family Health Conversations in terms of feeling validated and strengthened as individuals, as a couple, and as a family. They found the conversations to be supportive to their well-being and to processing experiences and becoming equipped for the future. The parents reported that it was valuable to talk with conversational leaders who had knowledge in neonatal care and who thereby understood what the parents were talking about. This provided a different type of support compared with other conversational contacts. Conclusion: These results highlight the importance of having an early onset of family conversations in order to help the parents to cope with their challenges and improve their well-being. [ABSTRACT FROM AUTHOR]

Background: Mental health problems are one of the most pressing public health concerns of our time. Sweden has seen a sharp increase in mental disorders among children and youth during the last decade. The evidence base for treatment of psychiatric conditions has developed strongly. Clinical practice guidelines aim to compile such evidence and support healthcare professionals in evidence‐based clinical decision‐making. In Sweden, the national guidelines for the treatment of depression and anxiety disorders in children and adolescents were launched in 2010. The aim of this study was two folded, (i) to explore to what extent these guidelines were known and adhered to by health professionals in Child and Adolescent Mental Health Services and (ii) to investigate factors influencing implementation of the guidelines informed by the Consolidated Framework for Implementation Research. Methods: A qualitative approach was used, and data were collected through interviews with 18 health professionals in Child Mental Health Services in Sweden and a combination of conventional and directed content analyses was used. The Consolidated Framework for Implementation Research guided and structured data collection and analysis. Results: The guidelines were largely unknown by health professionals in Child Mental Health Services in all the clinics investigated. Adherence to guideline recommendations was reported as very low. Barriers to implementation were found in relation to the characteristics of the intervention, outer setting, inner setting and characteristics of the individuals involved. Conclusions: The government initiative to develop and disseminate the guidelines seems to have made very little impact on health professionals' clinical practice. The guidelines were poorly aligned with the health professionals' knowledge and beliefs about effective mental health services for children and youth with depression and anxiety disorders. Suggestions for future efforts to improve the development and implementation of guidelines in Child Mental Health Services settings are given. [ABSTRACT FROM AUTHOR]

Background: Timely identification of patients with palliative care needs is a prerequisite for being able to carry out effective and equal palliative care. The Supportive and Palliative Care Indicators Tool (SPICT) identifies patients likely to benefit from a palliative approach. Aim: The main objective was to describe the translation, cross‐cultural adaptation and content validation process of the SPICT‐SE. In this process, the prefinal SPICT‐SE was tested in focus group interviews to explore how the tool was perceived and interpreted by healthcare professionals in a Swedish healthcare context. Methods: In this qualitative descriptive study, the translation, cross‐cultural adaptation and content validation process of the SPICT‐SE was based on a recommended method for cross‐cultural adaptation of self‐report measures. The process included two independent forward translations, a synthesis, and one independent back‐translation. An expert committee consolidated all the versions and developed the prefinal version of the SPICT‐SE. The prefinal version of the SPICT‐SE was tested in four focus group interviews with physicians and nurses engaged in inpatient or outpatient care in south‐west Sweden. A thematic analysis of the transcribed interviews was performed. The SPICT‐SE was then revised to the final version. Results: In the thematic analysis, four themes were constructed that together described how the SPICT‐SE was perceived and interpreted by healthcare professionals: The mindset is familiar and relevant; the tool needs to be adjusted in order to be clearer; the purpose and consequences of the tool are ambiguous; and the tool supports a palliative approach. Conclusion: The SPICT‐SE has now been successfully translated, culturally adapted and content validated in a Swedish healthcare context. [ABSTRACT FROM AUTHOR]

Background: Oral health is important for well‐being and overall health. Older peoples′ oral health is well described in the residential care context, but remains understudied in short‐term care. Objective: The aim of this study was to describe oral health, daily oral care and related factors among older people in short‐term care and to compare self‐perceived oral health with professional assessment. Materials and methods: This cross‐sectional study included 391 older people in 36 short‐term units in 19 Swedish municipalities. Oral health was assessed professionally by clinical oral assessment and the Revised Oral Assessment Guide (ROAG). The older peoples' perceptions of their own oral health were measured with a global question on self‐perceived oral health. Self‐care ability was assessed with Katz Index of Activities of Daily Living (Katz‐ADL). Results: Mean age was 82.9 years, 19% of participants were totally edentulous, and 43% had ≥20 teeth. Almost 60% had coating or food debris on their teeth, but only 19% received help with daily oral care. Those who were dependent on help with self‐care had around a sixfold higher risk of having oral problems. There was a low level of agreement between the clinical assessment based on ROAG and self‐perceived oral health. Conclusion: Professionals' assessments of oral health differed considerably from the older peoples′ own assessments. A higher risk of oral problems and more occurrence of coating or food debris or broken teeth were seen among those dependent on help with self‐care (ADL). This study indicates that in order to improve older peoples′ oral health and oral care we need to provide person‐centred oral care and to develop a close collaboration between nursing and dental staff. [ABSTRACT FROM AUTHOR]

Background: Being involved in the care of a loved one is a desire of many next of kin. However, according to several studies of the perceptions of nursing home staff, the involvement of next of kin is not an obvious part of care. To be able to involve next of kin in care at nursing homes, the perceptions of what participation means are an important piece of knowledge. The aim of this study was therefore to describe variations in next of kin's perceptions of the meaning of participation in the care of older persons living in nursing homes. Methods: Eighteen next of kin of older persons living in ten nursing homes in Sweden were recruited for interviews. The study design was based on a phenomenographic approach, focusing on the qualitatively different ways in which a person perceives, experiences or conceptualises a phenomenon or certain aspect of reality. Results: Five categories emerged from analysis of the interviews, representing the next of kin's perceptions of the meaning of participation in the care of older persons in nursing homes: be present; communicate; monitor; do practical tasks; and to represent. The next of kin expressed meanings that belonged to more than one category, and the categories were interdependent. Conclusions: Our results indicate that there are several meanings of next of kin's perceptions of participation at nursing homes. Nursing home staff's knowledge of these perceptions is important to enable next of kin to participate according to their own preferences. [ABSTRACT FROM AUTHOR]

Background: Nurses have expressed doubts about the ongoing digitalisation of Swedish primary health care. Given the potential role of eHealth in primary health care, including supporting interactive self‐management for people with chronic conditions, it is important to highlight nurses’ experiences. This study is part of a larger project aimed at implementing person‐centred interactive self‐management support (iSMS) in primary health care. Aim: The aim of this study was to describe Swedish primary healthcare nurses’ perceptions of using digital eHealth systems and services to support patient self‐management. Methods: Focus group interviews were conducted with primary healthcare nurses (n = 20). The interview transcriptions were analysed using qualitative content analysis. Results: Three themes emerged from the content analysis: caregiving in the midst of digital chaos; a lack of overview and control in daily work; and mixed feelings towards digitalisation. Each theme was subdivided into three subthemes. Conclusion and relevance to clinical practice: The results of this study provide insight into a number of concerns that stand in the way of success when it comes to the implementation and use of digital technology. If nurses are to adapt to the new policies and practices that accompany the current digitalised development in Swedish primary health care, the concept of a nurse's traditional work role needs to be amended in terms of the scope of work tasks and established views of traditional nursing. The study also highlights the need for more research to enable eHealth systems/services to be designed to fulfil multiple requirements. The digitised systems should be a tool for achieving good quality self‐management support as well as giving the primary healthcare nurses adequate resources to support patients’ self‐management while still maintaining the values associated with person‐centred care. [ABSTRACT FROM AUTHOR]

Background: Residential care homes (RCHs) play an important role in end‐of‐life care, being the most common place of death for elderly people in several European countries. Care pathways such as the Liverpool Care Pathway for the Dying Patient (LCP) are used to improve and ensure quality care at the end of life. There is a lack of scientific evidence supporting the use of care pathways. Design: A descriptive qualitative study. Objective: The aim was to describe care professionals’ experiences of using the Liverpool Care Pathway for the Dying Patient in the care of dying residents in residential care homes. Methods: Five focus group interviews and two individual interviews with enrolled nurses (n = 10), Registered Nurses (n = 9) and general practitioners (n = 5) were carried out and analysed using qualitative content analysis. Results: Care professionals expressed that they became confident through a shared approach to care, were supported to tailor the care according to the residents’ individual needs, were supported to involve family members in decision‐making and care and became more aware of the care environment. Conclusion: The results of this study indicate that the LCP might be a useful tool for care professionals in improving end‐of‐life care in RCHs through increased attention to the goals of care, the individual needs of residents and family involvement. [ABSTRACT FROM AUTHOR]

Aim: The aim of this study was to examine whether professional collaboration in home health care is associated with clear boundaries between principals′ areas of responsibility and the professions areas of responsibility, respectively. Methods: Data were derived from a web‐based survey that was carried out in one county in the middle of Sweden during spring 2013. Participants were health professionals and managers from the county council and from all the municipalities in the county. Both structured and open‐ended questions were utilised. A total of 421 individuals (90% women) answered the structured questions, and 91 individuals (22% of the 421) answered the open‐ended questions. Quantitative data were analysed with descriptive statistics methods, tests of independence and of correlation strength. Qualitative data were analysed with content analysis. Results: The results from the structured questions showed that well‐functioning collaboration was associated with clear boundaries between principals in the county overall, and for respondents in two of three parts of the county. Association between clear boundaries between professions and well‐functioning collaboration was found in the county overall among the municipality population. However, in one part of the county, we did not find any correlations between well‐functioning collaboration and clear boundaries between professions or principals, with the exception of home help services. The analysis of the open questions gave similar results as the quantitative analysis, illustrated within three themes: The significance of concepts, trust and interdependence, and collaboration as a means for well‐being. Conclusion: The results indicate that, recently after an organisational change, clear boundaries between the principals′ areas of responsibility and professions' area of responsibility respectively are necessary for effective cooperation between professionals. If the organisation and professionals have previous positive experience of colocated activities, clear boundaries do not share the same importance. [ABSTRACT FROM AUTHOR]

Background To empower patients and improve the quality of care, policy-makers increasingly adopt systems to enhance person-centred care. Although models of person-centredness and patient-centredness vary, respecting the needs and preferences of individuals receiving care is paramount. In Sweden, as in other countries, healthcare providers seek to improve person-centred principles and address gaps in practice. Consequently, researchers at the University of Gothenburg Centre for Person-Centred Care are currently delivering person-centred interventions employing a framework that incorporates three routines. These include eliciting the patient's narrative, agreeing a partnership with shared goals between patient and professional, and safeguarding this through documentation. Aim To explore the barriers and facilitators to the delivery of person-centred care interventions, in different contexts. Method Qualitative interviews were conducted with a purposeful sample of 18 researchers from seven research studies across contrasting healthcare settings. Interviews were transcribed, translated and thematically analysed, adopting some basic features of grounded theory. Ethical issues The ethical code of conduct was followed and conformed to the ethical guidelines adopted by the Swedish Research Council. Results Barriers to the implementation of person-centred care covered three themes: traditional practices and structures; sceptical, stereotypical attitudes from professionals; and factors related to the development of person-centred interventions. Facilitators included organisational factors, leadership and training and an enabling attitude and approach by professionals. Trained project managers, patients taking an active role in research and adaptive strategies by researchers all helped person-centred care delivery. Conclusion At the University of Gothenburg, a model of person-centred care is being initiated and integrated into practice through research. Knowledgeable, well-trained professionals facilitate the routines of narrative elicitation and partnership. Strong leadership and adaptive strategies are important for overcoming existing practices, routines and methods of documentation. This study provides guidance for practitioners when delivering and adapting person-centred care in different contexts. [ABSTRACT FROM AUTHOR]

Background Living in a nursing home may be challenging to the residents' experience of dignity. Residents' perception of how their dignity is respected in everyday care is important. Aim To examine how nursing home residents experience dignity through the provision of activities that foster meaning and joy in their daily life. Method A qualitative design was used and 28 individual semistructured interviews conducted with nursing home residents from six nursing homes in Denmark, Norway and Sweden. The data were analysed with qualitative content analysis. Independent ethical committees in all participating countries granted their approval for the study. Findings The participants highlight two dimensions of the activities that foster experiences of dignity in nursing homes in Scandinavia. These two categories were (i) fostering dignity through meaningful participation and (ii) fostering dignity through experiencing enjoyable individualised activities. Conclusion Activities are important for residents to experience dignity in their daily life in nursing homes. However, it is important to tailor the activities to the individual and to enable the residents to take part actively. Nurses should collect information about the resident's preferences for participation in activities at the nursing home. [ABSTRACT FROM AUTHOR]

As part of the Swedish state-funded healthcare system, housing adaptations are used to promote safe and independent living for disabled people in ordinary housing through the elimination of physical environmental barriers in the home. The aim of this study was to describe the cohabitants' expectations and experiences of how a housing adaptation, intended for the partner, would impact their everyday life. In-depth interviews were conducted with cohabitants of nine people applying for a housing adaptation, initially at the time of the application and then again 3 months after the housing adaptation was installed. A longitudinal analysis was performed including analysis procedures from Grounded Theory. The findings revealed the expectations and experiences in four categories: partners' activities and independence; cohabitants' everyday activities and caregiving; couples' shared recreational/leisure activities; and housing decisions. A core category putting the intervention into perspective was called 'Housing adaptations - A piece of the puzzle'. From the cohabitants' perspective, new insights on housing adaptations emerged, which are important to consider when planning and carrying out successful housing adaptations. [ABSTRACT FROM AUTHOR]

The aim of this study was to further investigate the psychometric properties (with focus on construct validity and scale function) of the Swedish version of the Person-centred Care Assessment Tool (P- CAT) in a sample consisting of staff working in elderly care units (N = 142). The aim was also to further develop and psychometrically test a modified, noncontext-specific version of the instrument ( mP- CAT) in a sample consisting of staff working in primary health care or within home care for older people (N = 182). Principal component analysis with varimax rotation initially suggested a three-factor solution for the P- CAT, explaining 55.96% of variance. Item 13 solely represented one factor wherefore this solution was rejected. A final 2-factor solution, without item 13, had a cumulative explained variance of 50.03%. All communalities were satisfactory (>0.3), and alpha values for both first factor (items 1-6, 11) and second factor (items 7-10, 12) were found to be acceptable. Principal component analysis with varimax rotation suggested a final 2-factor solution for the mP- CAT explaining 46.15% of the total variance with communalities ranging from 0.263 to 0.712. Cronbach's α for both factors was found to be acceptable (>0.7). This study suggests a 2-factor structure for the P- CAT and an exclusion of item 13. The results indicated that the modified noncontext-specific version, mP- CAT, seems to be a valid measure. Further psychometric testing of the mP- CAT is however needed in order to establish the instrument's validity and reliability in various contexts. [ABSTRACT FROM AUTHOR]

Background Spousal concordance on risk factors and lifestyle habits exists and can partly be explained by patients' and spouses' health beliefs and underuse of cardiac rehabilitation. However, there have been very few qualitative comparisons of health beliefs between patients and spouses after a cardiac event. Aim To examine and qualitatively compare the health beliefs of patients with coronary heart disease and their spouses about lifestyle habits, 1 year after the cardiac event. Design Explorative and descriptive. Method Semi-structured focus group interviews were conducted with patients (n = 14) 1 year after a cardiac event, as well as individual interviews with spouses (n = 8). The transcriptions underwent a deductive qualitative content analysis, within the framework of the Health Belief Model. Findings Patients' and spouses' health beliefs about lifestyle habits qualitatively differed in most predetermined main analytical categories of the Health Belief Model. The patients relied more on their own capacity and the healthcare system than on collaboration with their spouses who instead emphasised the importance of mutual activities to establish lifestyle habits. The spouses therefore experienced problems with different family preferences compared to the patients' wishes. Moreover, only patients believed supervised exercise was beneficial for risk reduction of coronary heart disease and they related barriers for medication to a self-healing body and a meaningless life without relatives and old habits. Patients and spouses agreed that despite the severity of illness, life was captured and that normalisation to a life as usual was possible. Conclusion The patients' and spouses' qualitatively different health beliefs regarding health-related behaviours imply a new approach. Nurses and associated professionals need to follow-up patients' and spouses' in primary health care to support them in a tailored way, for example in problem-based sessions. Recognition and understanding of their different views and otherness could lead to compromises and goals to work with. [ABSTRACT FROM AUTHOR]

Rational The current state of knowledge about the prevalence of constipation among persons living in institutional geriatric-care settings is limited. Aim The aim was to investigate the prevalence of constipation among institutional geriatric-care residents and identify resident characteristics related to constipation. Methodological design In a cross-sectional study of all the institutional geriatric-care settings in a county in northern Sweden, 2970 residents were assessed. The member of staff who knew each resident best used the Multi-Dimensional Dementia Assessment Scale and the resident's records of prescribed medication to monitor cognitive function, activities in daily life, behavioural and psychological symptoms, physical restraints, speech ability, nutrition and pharmacologic agents. The study was approved by the Regional Ethical Review Board. Result The prevalence of constipation was 67%. The mean age was higher among those with constipation. A significantly higher proportion of the constipated had cognitive and/or physical impairments, physical restraints, impaired speech, problems with nutrition, and higher numbers of drugs for regular use. Of those with constipation, 68% were prescribed laxatives for regular use. Twenty-three per cent of the constipated residents were prescribed opioid analgesics (n = 465), and 29% (n = 134) of these were not prescribed any laxatives. Study limitation Due to the cross-sectional design, the results should be interpreted with caution in terms of causal reasoning, generalisation and conclusions about risk factors. Another limitation is the use of proxy assessments of constipation. Conclusion The results show that constipation is common among residents in institutional geriatric-care settings in Sweden, which is in line with previous studies from other Western countries. Despite being constipated when having prescribed opioid analgesics, a large number did not have prescribed laxatives. The results indicate the urgency of finding strategies and implementing suitable interventions to improve bowel management in residents in institutional geriatric-care settings. [ABSTRACT FROM AUTHOR]

Objective To analyse patient and professional perceptions about (in)equity of care and rehabilitation of chronic pain patients from primary health care to assessment at a specialty rehabilitation clinic. Setting and methods This qualitative study consists one focus group interview with eight general practitioners who refer patients to pain rehabilitation clinics, 10 individual interviews with patients who were assessed at a pain rehabilitation clinic and seven interviews with professionals participating in multimodal assessment teams at a pain rehabilitation clinic. Interview analysis was conducted by the grounded theory method. Results The core category Via Dolorosa, the way of suffering and pain, captured how gender and sociocultural context may contribute to advantages and disadvantages during patient journeys from primary health care to a pain rehabilitation clinic. Patients and professionals perceived pain as a low-ranking illness, and women and men used different gendered strategies to legitimise the pain and to be taken seriously. Being 'a proper patient ready to change' and having 'likeness' between patients and professionals were viewed as advantageous in rehabilitation of pain patients. Patients with higher educational levels were perceived as easier to interact with and had better access to health care. Professional thoughts about gender norms influenced the rehabilitation options. The rehabilitation programme was seen by several professionals to be better suited for women than men, which could lead to unequal care. Conclusion From an equity and gender perspective, our study highlights the complexity in rehabilitation of chronic pain patients - both from patient and professional perspectives. Awareness of gendered and the biased preconceptions and norms is crucial when professionals struggle to offer equitable health care and rehabilitation. [ABSTRACT FROM AUTHOR]

Background: In a holistic view of care, the family is important for the patient as well as for the staff and integration of family members in health care is a growing trend. Yet, family participation in the care is sparsely investigated and valid assessment instruments are needed. Setting: Data were collected from 200 family members participating in an intervention study at an emergency department (ED) in Sweden. Method: The Person-centred Climate Questionnaire - Family (PCQ-F) is a measure for how family members perceive the psychosocial climate. PCQ-F is a self-report instrument that contains 17 items assessing safety, everydayness and hospitality - three subscale dimensions that mirror the Swedish patient version of the questionnaire, the PCQ-P. Aim: The aim of this study was to evaluate the psychometric properties of the Swedish version of the PCQ-F in an ED context. Results: The psychometric properties of the PCQ-F were evaluated using statistical estimates of validity and reliability and showed high content validity and internal consistency. Cronbach's Alpha was >0.7 and item-total correlations were >0.3 and <0.7. Conclusion: In terms of psychometrics, the findings in this study indicate that the PCQ-F can be used with satisfactory validity and reliability to explore to what degree family members perceive ED settings as being person-centred, safe, welcoming and hospitable within an everyday and decorated physical environment. As the PCQ already exists in a valid and reliable patient (PCQ-P) and staff (PCQ-S) version, this new family member version is a significant addition to the literature as it enables further comparative studies of how diverse care settings are perceived by different stakeholders. [ABSTRACT FROM AUTHOR]

In the recovery process of arthroplasty patients, their family members play an important role due to short hospital stay and increased age of patients. Family members need to have knowledge to be able to support the patient. The aim of this study was to explore expected and received knowledge in family members of arthroplasty patients and describe the relationships between the differences in received and expected knowledge and background factors, country, information and control preferences and access to knowledge. The study was conducted in six European countries (Cyprus, Greece, Finland, Iceland, Spain and Sweden). The study design was cross-cultural, prospective and comparative with two measurement points: pre-operative and at discharge from hospital. Knowledge Expectations of significant other-scale and Krantz Health Opinion Survey were used before surgery and Received Knowledge of significant other-scale and Access to Knowledge at discharge. Patients undergoing elective hip or knee arthroplasty in seventeen hospitals were asked to identify one family member. The sample size was decided by power calculation. A total of 615 participants answered the questionnaires at both measurements. Family members perceived to receive less knowledge than they expected to have, most unfulfilled knowledge expectations were in the financial, social and experiential dimensions of knowledge. Seventy-four per cent of participants had unfulfilled knowledge expectations. Increased access to information from healthcare providers decreased the difference between received and expected knowledge. Compared to family members in southern Europe, those in the Nordic countries had more unfulfilled knowledge expectations and less access to information from healthcare providers. The evidence from this study highlights the need to involve the family members in the educational approach. [ABSTRACT FROM AUTHOR]

Objectives Previous studies suggest that not only education but also personal aspects such as experience of working as a registered nurse ( RN) and age can influence competence. The objective was to explore the educational and self-rated competence of RNs and their duties within the care of older people. Methods A cross-sectional descriptive design was used. All RNs in two counties in Sweden were asked to complete a written questionnaire: a study specific questionnaire with educational and work related questions using the Nurse Competence Scale. The response rate was 61% (n 344). Results Higher self-rated satisfaction with own professional competence was related to older age, more years after nursing education and possessing at least one postgraduate education in specialist nursing. Educational needs were related to younger age and fewer years since nursing graduation. Education within elder care, including education about drugs was rated the most urgently needed area of education. The most frequently reported tasks were found in the domain helping role, whereas ensuring quality was less present in their daily work. Conclusions Educational level, age and years of experience had an impact on RNs' self-perceived competence, which is in accordance with previous descriptions of the concept competence. It seems imperative that RNs working in care of the old and with the demands placed on them are given the opportunity to take a postgraduate specialist education in order to gain a competence level in their desired area of work. It is also important that RNs working in care of the old get tailored education in line with the requirements the organisation places on them. [ABSTRACT FROM AUTHOR]

Little research has been done to try to understand how patient-centred care is understood and practised by healthcare professionals specialising in patients with diabetes. Experiences from patient-centred practices need to be highlighted as a way of motivating diabetes specialist nurses to take a patient-centred approach. The aim of this study was to describe diabetes specialist nurses' experiences of practising patient-centred care in the context of a type 2 diabetes intervention. The study design was descriptive and used qualitative methods. Focus group interviews complemented by individual semi-structured interviews were analysed by qualitative content analysis. The main theme of the diabetes specialist nurses' experiences of practising patient-centred care was an altered professional role. The main theme was based on two themes: ambivalence towards practising patient-centred care and enriched relationships with the patients. The ambivalence towards practising patient-centred care was based on the three subthemes: a position of withdrawn expertise, inconvenience of changing routines and insights that patient-centred care is difficult but possible. Their experiences of enriched relationships with patients were based on the two subthemes: courage to discuss the severity of diabetes and increased engagement in patients' daily lives. The diabetes specialist nurses' experiences with practising patient-centred care included doubts about their ability to practise in such a way and about the feasibility of such care. At the same time, their enriched relationships with patients were seen as an opportunity to engage in patients' lives. Training and support for practising patient-centred care may improve diabetes specialist nurses skills in patient-centred care and self-management support in type 2 diabetes. [ABSTRACT FROM AUTHOR]

The aim of this study was to describe parents' conceptions of the mental health care provided to adult children suffering from mental illness. Data were collected using qualitative research interviews with a purposive sample of sixteen mothers and ten fathers. Phenomenographic analysis was used to identify conceptions and formulate descriptive categories. The first category, questioning the availability of care, describes mental health care as being unequal in terms of accessibility and lacking in continuity. The second category, disapproval of parental exclusion, illustrates conceptions that mental healthcare professionals disregard parents and do not provide them with adequate information. The third category, questioning the quality of care, encompasses conceptions of lack of trust in the professionals' competence, an unsatisfactory environment as well as inadequate cooperation with other healthcare providers and authorities. Positive aspects, such as being seen and confirmed, were mentioned as valuable by the parents. [ABSTRACT FROM AUTHOR]

Caring for people with dementia and working in dementia care is described as having both rewarding and unpleasant aspects and has been studied to a minor extent. This study aims to explore care providers' narrated experiences of caring for people with dementia disease ( DD) and working in a private not-for-profit residential care facility for people with DD. Nine care providers were interviewed about their experiences, the interviews were recorded, transcribed and analysed using thematic analysis. The analysis revealed that participants were struggling to perform person-centred care, which meant trying to see the person behind the disease, dealing with troublesome situations in the daily care, a two-edged interaction with relatives, feelings of shortcomings and troubled conscience, and the need for improvements in dementia care. The analysis also revealed an ambiguous work situation, which meant a challenging value base, the differently judged work environment, feelings of job satisfaction and the need for a functional leadership and management. The results illuminate participants' positive as well as negative experiences and have identified areas requiring improvements. It seems of great importance to strive for a supportive and attendant leadership, a leadership which aims to empower care providers in their difficult work. Using conscience as a driving force together in the work group may benefit care providers' health. [ABSTRACT FROM AUTHOR]

Purpose To translate and validate the wound-specific health-related quality of life instrument, the Cardiff Wound Impact Schedule ( CWIS) in a Swedish population. Methods The instrument was first translated into Swedish, using the Standard Linguistic Validation Process. The Swedish version of the CWIS was then tested for its psychometric properties in a Swedish context. A total of 117 patients with acute and hard-to-heal wounds were included. The patients were asked to fill in the Swedish version of the CWIS and the generic instrument SF-36 at baseline and after 1 week. Patients with acute wounds were also asked to fill in both instruments after 6 weeks. Results Face validity and content validity were assessed by patients and an expert group, and judged as good. Criterion validity was calculated with correlation between CWIS and SF-36, reaching moderate to high values. Reliability of the three domains of the CWIS measured with internal consistency and test-retest stability was acceptable to excellent. Internal responsiveness was assessed with standardised response mean and showed moderate to high sensitivity. Conclusions This study concludes that the Swedish version of CWIS is a valid and reliable tool for measuring health-related quality of life in patients with acute and hard-to-heal wounds. [ABSTRACT FROM AUTHOR]

Check Your Health was constructed as four-two-sided vertical thermometers (0-100) measuring physical and emotional health, social well-being and quality of life today and before onset of diabetes. Burden of diabetes was calculated as the difference between the two scores (today and before onset of diabetes). The aim was to examine concurrent and discriminant validity and reliability of Check Your Health in a convenience sample of 180 people with diabetes, who visited the diabetes clinic during a 3-month period. A randomly selected subsample of 43 of the 180 patients responded to the questionnaire twice (test-retest). Besides Check Your Health, three additional questionnaires were mailed to the patients, the EVGFP scale ( EVGFP stands for Excellent-Very good-Good-Fair-Poor health) for measuring concurrent validity, the Diabetes Empowerment Scale ( Swe- DES-23) and an attitude measure, Semantic Differential in Diabetes ( SDD) for calculation of discriminant validity. There was significant agreement between Check Your Health and the five EVGFP health groups. The instrument discriminated well between patients with and without late diabetic complications. The measure on burden of diabetes showed that the higher the burden of diabetes, the lower the quality of life. The same pattern was found for both Swe- DES 23 and SDD; the higher the burden, the lower the sense of empowerment and the lower the burden, the more positive the attitudes towards diabetes. Check Your Health showed good stability (0.88-0.68). The results indicate that Check Your Health can be used as an acceptable and sufficiently accurate method for detecting health distress in people with diabetes. [ABSTRACT FROM AUTHOR]

Aim The aim of this study was to describe the experiences of district nurses in caring for patients with home-parenteral nutrition ( HPN) in palliative care. Method A qualitative approach was adopted using thematic content analysis of semi-structured interviews. Twelve district nurses working with primary health care in Sweden participated in the study that was conducted during 2011. Findings The analysis resulted in one overarching theme: The agony of terminating hope and three categories: all focus is on the infusion, alone without support, confidence in the relationship. HPN seemed to have a symbolic meaning when patients and family members connected the infusion with hope and life. District nurses expressed that they felt alone with the responsibility for the HPN due to the lack of a structured plan. Difficult discussions around termination of the infusion seemed to be connected to a feeling of agony of terminating hope among the district nurses. All district nurses expressed a need for support in their work, and factors like experience and the development of a good relationship with the patient and the family, could decrease the agony. Conclusion The draw up of a plan when starting HPN, could be a support for the district nurse and make the aim, follow-up and future termination clearer. The establishment of a plan could make the work easier and reduce the feeling of agony of terminating hope among the district nurses. [ABSTRACT FROM AUTHOR]

Background Crashes occur regularly throughout the world and can result in multiple fatalities and many injuries. Research into how survivors experience a crash is very limited. Aim To describe and analyse the nonphysical consequences of a multifatality bus crash in Sweden and the subsequent effect on the surviving passengers' lives. Method The participants were all (n = 56) of the survivors of a major bus crash. The passengers were interviewed approximately one month after the bus crash. The interviews were analysed using a qualitative content analysis. Results Prior to the arrival of rescue personnel at the crash site, helpfulness emerged among the passengers. Further, the crash generated an impact on the surviving passengers' lives from a short-term perspective. The passengers displayed a diverse need for crisis support; informal support from family and friends was essential for the early healing process. Sleep difficulties and a change in travel routines were the most common consequences. Lastly, passengers sought closure in order to move on with their lives. Conclusion The passengers' reactions to and behaviour following a crash offer an insight into the, relatively unexplored, interaction between people experiencing a major road traffic crash. It is necessary to have a flexible crisis support system, and the vital role of family support ought to be upgraded. [ABSTRACT FROM AUTHOR]

Background The syndrome of exhaustion is currently a medical diagnosis in Sweden. The description of the syndrome largely corresponds to the suggested core component of burnout, that is exhaustion. Karolinska Exhaustion Scale ( KES) has been constructed to provide specific assessment of exhaustion in clinical and research settings. Aim The purpose of the present study was to examine the psychometric properties of this scale in its original and revised versions by examining the factorial structure and measures of convergent and discriminant validity. Methods Data gathered from two independent samples (n1 = 358 & n2 = 403) consisting of patients diagnosed with 'reaction to severe stress, and adjustment disorder' were subjected to confirmatory factor analysis. The study's instruments were Karolinska Exhaustion Scale and Shirom Melam Burnout Measure. Correlation analyses were employed to follow up the established factorial structure of the scale. The study was ethically approved by Karolinska Institute regional ethic committee. Results The findings demonstrated adequate fit of the data to the measurement model provided by the revised version of KES Limitations: The main limitation of the present study is the lack of a gold standard of exhaustion for direct comparison with KES. ( KES-26) and partially supported convergent validity and discriminant validity of the scale. Conclusion The demonstrated psychometric properties of KES-26 indicate sound construct validity for this scale encouraging use of this scale in assessment of exhaustion. The factorial structure of KES-26 may also be used to provide information concerning possible different clinical profiles. [ABSTRACT FROM AUTHOR]

Scand J Caring Sci; 2013; 27; 475-486 Adaptation to Swedish and further development of the 'Consequences of Screening - Breast Cancer' questionnaire: a multimethod study Rationale: Experiencing a false-positive screening mammography can cause considerable psychosocial distress. The Consequences of Screening - Breast Cancer questionnaire (COS-BC parts 1 and 2), recently developed in Denmark, is the only condition-specific questionnaire for measuring short- and long-term psychosocial consequences of false-positive mammographic screening. Additional studies are needed to further test the COS-BC before use across cultures. Furthermore, studies have suggested that the consequences of false-positive screening results are partly common across cancer screening settings, although this hypothesis remains largely untested. Objectives: This study (i) assesses content validity of a Swedish version of the COS-BC, (ii) tests whether items expressing long-term consequences of false-positive lung cancer screening results are relevant in a breast cancer screening context and (iii) explores the usefulness of taking results from Rasch analyses of the source version as an aid in questionnaire translation and adaptation. Methods: Following dual-panel translation, content validity was assessed through qualitative interviews with representatives of the target population and the content validity index (CVI). Item locations and Rasch model fit of the source questionnaires were considered in the translation and assessment process. Results: The COS-BC items were generally found relevant and provided coverage of the target construct. Content validity was supported also for nine of 10 lung cancer screening items. Scale CVI values were ≥0.81. Previous Rasch data were useful in facilitating translation and assessing item content validity. The resulting Swedish version of the COS-BC parts 1 and 2 consists of 34 and 23 items, respectively. Conclusion: This study illustrates the value of methodological triangulation and use of data from previous Rasch analyses in questionnaire translation and adaptation. We found support for the hypothesis that consequences of false-positive screening are common across cancer screening settings. Psychometric properties of the Swedish COS-BC remain to be established. [ABSTRACT FROM AUTHOR]

Scand J Caring Sci; 2013; 27; 388-395 Care priorities- Registered Nurses' clinical daily work in municipal care settings Common in Swedish elderly home care is that Registered Nurses work independently, and lead the care team without being a part of it. People involved in the care of the patient can be social services, physician, Registered Nurse (RN), nurses in inpatient care and family. In according to current model for nursing documentation RNs interventions is described as participation, information/education, support, environment, general care, training, observation/surveillance, special care drug administration and coordination. Time pressure is perceived as high, but the nurses have the opportunity to influence their daily work situation and make priorities. The purpose of this study was to investigate how RNs prioritise interventions in municipal elderly care settings. A quantitative descriptive method was used for the study. Data were collected during the months of April and October 2004 - 2008, using a web-based form. The nurses filled in patient's type of housing, performed interventions, and if the interventions were delegated. Interventions were described as keywords and were attributed a certain amount of time, calculated in previous time studies. The inclusion criteria were: all patients 80 years of age and older, in a municipality in south-western Sweden, who received some form of health care from a RN, or performed by non-certified staff by delegation. Results indicate that differences in priority could be observed, depending on the patient's gender, or whether the patient was living in independent or sheltered housing. Drug administration was prioritised for female patients, while coordination became a priority for patients living in ordinary housing. Support received the highest priority, regardless if the patient lived in ordinary or sheltered housing. However, it is not entirely clear what support signifies in municipal health care settings, and this issue would therefore require further investigation. [ABSTRACT FROM AUTHOR]

Purpose: To evaluate the properties and suitability of a disease-specific questionnaire to assess parent-reported health-related quality of life (HRQL) of children and parents of children suffering from food hypersensitivity (FHS) or allergy to furred pets (AFP). Methods: The parents of 202 children with FHS and of 131 children with AFP filled in questionnaires comprising the CHQ-PF28 and the Food-Pet-Allergy in Children (FPAC) Questionnaire. Psychometric properties of the FPAC questionnaire were evaluated separately for FHS and AFP. Results: Analyses resulted in five proposed scales: Limitations of Family/Child Activities (I), Parents' Distress (II), Child's Emotions (III), Child in School (IV) and Family Conflicts (V). Convergent/discriminant validity for scales I, II and III of both questionnaires was high; for scale IV it was moderate. All five FHS and four AFP scales were able to distinguish significantly between children with and without clinical allergy symptoms (known-group validity). Internal consistency reliability was good for scales I, II and III, but poor for scale IV. Conclusion: Three valid scales were determined for both FHS and AFP (Limitations of Family/Child Activities, Parents' Distress and Child's Emotions) and can be used in clinical research. [ABSTRACT FROM AUTHOR]

Scand J Caring Sci; 2011; 25: 558-566 Learning to live with illness: experiences of people recently diagnosed with diabetes Background: The process of learning to live with an illness is complex. By better understanding the learning process for persons with diabetes in the early stage of the illness, the role of the health care can be shown. Aim: To reach an understanding of how learning to live with diabetes is experienced in the first 2 months after diagnosis. Method: A qualitative descriptive design was used, and interviews were conducted. Thirteen participants with a recent diagnosis of diabetes were included and asked to narrate about their experience of living with diabetes. Qualitative inductive content analysis was used. Findings: Four themes emerged: 'taken over by a new reality', 'the body plays a role in life', 'different ways of learning' and 'the healthcare service as a necessary partner'. Conclusion: People with short-term experience of the illness gained knowledge through personal resources such as their own experience and self-reflection. The learning process includes an inner dialogue between the self, the body and the life. Participants were concerned with grasping a new reality and understanding a different self and body where lifestyle changes and uncertainty were present. When health care was accessible and sensitive to their needs, those with short-term experience of diabetes chose the staff as key players in the early stages of their life with diabetes. [ABSTRACT FROM AUTHOR]

Scand J Caring Sci; 2010; 24; 716-725 Becoming a parent is overwhelming for most men and women and alters the sexual relationship for many couples. To describe fathers' experience about sexual life after childbirth within the first 6 months after childbirth. A descriptive design, using content analysis with a qualitative approach, based on focus group discussions and one-to-one interviews. Eight first-time and two subsequent fathers participated. Three subthemes were identified: Struggling between stereotypes and personal perceptions of male sexuality during transition to fatherhood; new frames for negotiating sex; a need to feel safe and at ease in the new family situation. The overarching theme emerged as ' transition to fatherhood brings sexual life to a crossroads' and guided us to a deeper understanding of the difficulties men experience during the transition to fatherhood. To get sexual life working, a number of issues had to be resolved, such as getting involved in the care of the baby and the household and getting in tune with their partners in regard to sexual desire. The men needed to be reassured and prepared for this new situation by health care professionals. New fathers in our study put the baby in focus in early parenthood and were prepared to postpone sex until both parties were ready, although they needed reassurance to feel at ease with the new family situation. The fathers' perceptions of sexual life extended to include all kinds of closeness and touching, and it deviated from the stereotype of male sexuality. This is important information for health care providers and midwives to be aware of for their encounters with men (and women) during the transition to fatherhood, and parenthood and can contribute to caring science with a gender perspective on adjustment of sexual life after childbirth. [ABSTRACT FROM AUTHOR]

Scand J Caring Sci; 2013; 27; 345-353 Provision of Kangaroo Mother Care: supportive factors and barriers perceived by parents Background: Kangaroo Mother Care (KMC) supports parents' role at the neonatal intensive care unit (NICU). To enhance parents' provision of KMC, it is essential to obtain knowledge of what parents perceive as supportive factors and barriers regarding their opportunities to perform KMC. Aim: To identify factors that parents of preterm infants perceived as supportive factors or barriers for their performance of KMC and to explore the timing of and reasons for parents' discontinuation of KMC. Methods: A descriptive study performed at two NICUs in Sweden with 76 mothers and 74 fathers of preterm infants born at gestational ages ranging from 28 to 33 weeks. Data on infant characteristics were obtained from the infants' medical records. A questionnaire, based on scientific literature and the researchers' clinical experience, was completed by the mothers and the fathers separately, shortly after the infant's discharge from the hospital. The data were analyzed with qualitative content analysis and descriptive statistic. Results: Four categories were identified in parents' responses regarding support and barriers for their performance of KMC: Parent related factors, Time, Infants related factors and The NICU and home environment. The hospital staff and environment were described by the parents as both supportive and barriers for their application of KMC. Some mothers described the infants' feeding process as an obstacle to KMC. Sleeping with the infant skin-to-skin in the same position throughout the night could be difficult, as an uncomfortable sleeping position caused insufficient sleep. A majority of both mothers and fathers continued providing their infant with KMC to some extent after discharge. Conclusion: Interventions for enhancing parents' opportunities for performing KMC should address both hospital staff attitudes and practices and the NICU environment. [ABSTRACT FROM AUTHOR]