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Background and rationale: Ageism in nursing, particularly regarding oldest‐old adults (age ≥80 years), adversely affects patient safety and care quality. Nurse education can reduce ageist attitudes. Swedish and Austrian nursing students' attitudes towards adults age ≥80 years have not been assessed. Aims: To analyse attitudes towards adults age ≥80 years among nursing students from universities in Sweden and Austria. Design: A prospective cross‐sectional survey including the four‐factor, 26‐item validated Ageing Semantic Differential scale and demographic questions. Methods: A pen‐and‐paper survey was administered to nursing students at the Medical University of Graz, Austria (May–June 2019); an online survey was conducted at the University of Gothenburg, Sweden (January–June 2020). Demographic data were analysed descriptively; means and individual item ratings were calculated for each country. Multiple logistic regression was performed for each factor of the instrument: (1) Instrumentality, (2) Autonomy, (3) Acceptability and (4) Integrity. Six independent variables were included in the regression analysis. Results: In total, 136 Austrian and 222 Swedish students responded (88% women). Compared with Austrian students, Swedish students were older and had more positive attitudes about oldest‐old adults. Swedish students' median factor ratings (7‐point scale) were 3.62 (Factor 1), 3.50 (Factor 2), 2.71 (Factor 3) and 3.80 (Factor 4). Austrian students' median ratings were 4.25 (Factor 1), 3.83 (Factor 2), 3.28 (Factor 3) and 4.00 (Factor 4). Regression analyses showed that the variables country, older family member/acquaintance, and age were associated with the different factors. Discussion: Compared with Austrian students, Swedish students' attitudes towards oldest‐old adults were more favourable. We discussed the findings at individual, interpersonal/intergroup and societal/cultural levels and present implications for education and research. Conclusions: Nurse education should address ageism as a multilevel phenomenon, and include the person‐centred care perspective. Further research comparing nursing students' attitudes from different cultures is needed. [ABSTRACT FROM AUTHOR]

Background: Family members provide the majority of informal care for older adults in Sweden. Nevertheless, by providing a range of assistance, peers often emerge as a central to counter social isolation among older adults. Therefore, there is a need to know more about what informal care provision by older adults to their peers means for different groups of older adults. Aim: This study investigated the types of informal care and support that older adults provide to their peers in Sweden, and how these types of care and support are associated with demographic characteristics and social isolation. We also compared older adults who provide informal care and support with those who do not. Method: For this purpose, we used a national online survey named "Involuntary loneliness among senior citizens" answered by 10,044 older adults enrolled in the Swedish Citizen Panel. We adopted a mixed‐method design to analyse the survey data, including free‐text options (n = 2155) and numerical data. Social isolation was assessed using a score built from the social loneliness items of the UCLA Loneliness Scale. Results: In our population, 21.5% of the older adults were providing informal care and support to their peers. Practical/instrumental help was frequently offered by younger participants (<75 years), men and respondents who were less socially isolated. On a general level, the factors that were positively associated with giving informal care and support to peers were older age, being male, retired, married/living in a relationship, living in an urban area/big city and exhibiting greater isolation. Focusing specifically on social support shows that older participants (>80) and those experiencing less social isolation (score < 24) were more engaged in social activities. Conclusion: This paper is unique in exploring the informal peer‐caregiver's perceptions of isolation. Data were collected during the COVID‐19 pandemic; this highlights the need to recognise informal care and support between older adults and to acknowledge their contributions as an essential component of Swedish civil society, especially during a societal crisis. [ABSTRACT FROM AUTHOR]

Policy makers in Sweden and other European Member States pay increasing attention as to how best support working carers; carers juggling providing unpaid family care for older family members while performing paid work. Exploring perceived benefits and challenges with web-based information and communication technologies as a means of supporting working carers' in their caregiving role, this paper draws on findings from a qualitative study. The study aimed to describe working carers' experiences of having access to the web-based family care support network 'A good place' ( AGP) provided by the municipality to support those caring for an older family member. Content analysis of interviews with nine working carers revealed three themes: A support hub, connections to peers, personnel and knowledge; Experiencing ICT support as relevant in changing life circumstances; and Upholding one's personal firewall. Findings indicate that the web-based family care support network AGP is an accessible, complementary means of support. Utilising support while balancing caregiving, work obligations and responsibilities was made easier with access to AGP; enabling working carers to access information, psychosocial support and learning opportunities. In particular, it provided channels for carers to share experiences with others, to be informed, and to gain insights into medical and care issues. This reinforced working carers' sense of competence, helping them meet caregiving demands and see positive aspects in their situation. Carers' low levels of digital skills and anxieties about using computer-based support were barriers to utilising web-based support and could lead to deprioritising of this support. However, to help carers overcome these barriers and to better match web-based support to working carers' preferences and situations, web-based support must be introduced in a timely manner and must more accurately meet each working carer's unique caregiving needs. [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]

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]

Introduction: Worldwide, countries are struggling with strained healthcare systems, especially due to the growing number of frail elderly. Developing the role of nurse practitioner in the care of the frail elderly is therefore of interest to make the care chain more efficient. In Sweden, the role is in an early development phase, but more research is needed. Aim: The aim was to investigate how stakeholders at the national level express the challenges and opportunities of the evolving nurse practitioner role in Swedish municipal elderly care. Method: A Delphi survey technique with three rounds of electronic questionnaires was used. Twenty‐seven experts responded to the first questionnaire, containing two open questions; what opportunities respectively challenges do you see in developing and implementing the nurse practitioner role in municipal elderly care? The following questionnaires consisted of statements to rate using a four‐grade Likert scale, and 20 and 17 responded to the second and third, respectively. The first round was analysed using content analysis, and the other two with descriptive statistics. Results: Thirty‐four statements about challenges and opportunities related to the nurse practitioner role in municipal elderly care were identified and rated as important. Conclusion: The findings provide knowledge that can contribute to discussions and decisions to refine the nurse practitioner role in Swedish municipal elderly care. The nurse practitioner role may contribute with much‐needed competence to the elderly care. However, it is important to consider the challenges that need to be overcome before the development of the role. To solve this, it is necessary to have clear national guidelines concerning issues of education, title protection and the mandate and authority of the NP role. [ABSTRACT FROM AUTHOR]

Rationale: Undergraduate nursing students' learning opportunities to practice caring behaviours to assure compassionate and competent nursing practice with standardised patients are few. Earlier studies primarily focused on practicing communication skills in relation to mental health or developing psychomotor skills while caring for a patient with a specific diagnosis. Aim: The study aim was to describe undergraduate nursing students' experiences of practicing caring behaviours with a standardised patient. Method: A sample of forty‐eight undergraduate nursing students in semester four at a school of nursing in southern Sweden, enrolled in a full‐time, 5‐week, on‐campus elective caring behaviour course, were at the first and last week individually video‐recorded during two caring behaviour simulations encountering a standardised patient. After observing each of their video‐recordings, students completed written reflections focusing on their own compassionate and competent verbal and nonverbal caring behaviour. In total, 96 individual written reflections were analysed using qualitative content analysis to describe the experience. Results: One main theme emerged: The challenge of being mindfully present in patient encounters. Four themes further described the experience: A challenging but realistic learning experience, learning the impact of nonverbal behaviour, recognising the complexity of verbal behaviour, and learning to be with the patient instead of only doing for the patient. Conclusion: When caring is intertwined with visible and realistic nursing practice in simulations using standardised patients it facilitates undergraduate nursing students learning compassionate and competent caring behaviour. The learning experience opened the students' eyes to the impact of practicing caring, recognising that being with is not the same as doing for the patient, and thus, how challenging it is to be mindfully present in patient encounters. Designing caring behaviour simulations with standardised patients is a feasible and efficacious educational learning didactic to facilitate students' learning caring behaviour and enhancing patients' experiences. [ABSTRACT FROM AUTHOR]

Background: The principles of palliative care were developed in hospices and specialised palliative care units and have not been sufficiently adapted to and evaluated in nursing homes. Therefore, an educational intervention from an interprofessional education perspective was performed within the project Implementation of Knowledge‐Based Palliative Care in Nursing Homes. The aim of this study was to evaluate professionals' experience of palliative care delivery before and after the educational intervention. Methods: The educational intervention for nursing home professionals consisted of five 2‐h seminars over 6 months at 20 nursing homes. The intervention and control groups consisted of 129 and 160 professionals from 30 nursing homes respectively. The questionnaire 'Your experience of palliative care' was completed 1 month before (baseline) and after (follow‐up) the intervention. Descriptive and inferential statistics were calculated. Results: The positive effects at follow‐up concerned the use of a valid scale for grading symptoms, attendance to the needs of next of kin (including bereavement support), documentation of older persons' wishes regarding place to die and conversations about their transition to palliative care and about how they were treated. Conclusions: This study demonstrates a promising interprofessional educational model. However, the paucity of improvements brought to light at follow‐up indicates a need for research directed towards a revision of this model. Supervision of professionals during palliative care delivery is one suggestion for change. [ABSTRACT FROM AUTHOR]

Background: Although extubation is a high‐risk phase associated with risk of severe complications for patients undergoing general anaesthesia, there is a lack of research about this phenomenon from the perspective of anaesthesiologists' experiences of the process of extubation in the anaesthesia setting. Aim: To describe Swedish anaesthesiologists' experiences of the extubation process in the anaesthesia setting. Methods: A qualitative descriptive design study with individual semi‐structured interviews was conducted in three hospitals in Sweden with a total of 17 anaesthesiologists. A qualitative manifest content analysis method was used to analyse the data. Results: The anaesthesiologists' experiences were described in two categories: To assemble sensibilities, where the anaesthesiologists are receptive to inputs, create tailored plans, are guided by emotions and experiences, and sense the atmosphere in the process of extubation; and To stay focused, where they understand the importance of preparation and being prepared, and of being calm and strategic, and of needing to trust the registered nurse anaesthetist in the process of extubation. Conclusions: Decision‐making regarding the process of extubation does not rely solely on monitoring signs; rather, the anaesthesiologists described how, by looking beyond the monitors and by being receptive to inputs from the patient and other professionals, their experience and intuition guides them through the process of extubation. [ABSTRACT FROM AUTHOR]

Background: In coming decades, the number of people affected by illnesses who need palliative care will rise worldwide. Registered Nurses are in a central position in providing this care, and education is one of the necessary components for meeting coming requirements. However, there is a lack of knowledge about palliative care in undergraduate nursing education curricula, including the extent of the education provided and the related pedagogical methods. Aim: The aim was to investigate the extent, content and pedagogical methods used and to explore lecturers' experiences of being responsible for teaching and learning about palliative care for undergraduate nursing students on nursing programmes at Swedish universities. Setting: All 24 universities responsible for providing undergraduate nursing education in Sweden participated. Participants: One lecturer with in‐depth knowledge about palliative care or end‐of‐life care education participated in the quantitative (n = 24) and qualitative (n = 22) parts of the study. Method: A mixed‐method research study with an explorative design was used. Descriptive statistics were used to analyse quantitative data, and content analysis for qualitative, with both also analysed integratively. Results: Few undergraduate nursing programmes included a specific course about palliative care in their curricula, however, all universities incorporated education about palliative care in some way. Most of the palliative care education was theoretical, and lecturers used a variety of pedagogical strategies and their own professional and personal experience to support students to understand the palliative care approach. Topics such as life and death were difficult to both learn and teach about. Conclusions: There is a need for substantial education about palliative care. Lecturers strive on their own to develop students' understanding and increase the extent of palliative care education with innovative teaching strategies, but must compete with other topics. Palliative care teaching must be prioritised, not only by the universities, but also by the national authority. [ABSTRACT FROM AUTHOR]

Background: Pain is common and often more complex to assess among nursing homes residents with cognitive impairments. Thus, more research is needed of different pain assessment methods in elderly care and how these assessments outcomes are related to quality of life, as there mostly should be a negative relationship. There is a risk that pain are under diagnosed among persons with cognitive impairment. Aim: The aim was to describe and compare pain prevalence among nursing home residents (1) using different pain assessment methods (2) in relation to cognitive status and to (3) examine associations between pain and quality of life or well-being. Methods: A cross-sectional correlational design was used, participants were 213 nursing home residents and data were collected through interviews using standardised protocols. Instrument used were Katz index of ADL, Mini-Mental-State-Examination, Quality of Life in Late-Stage Dementia scale, WHO-5 well-being index, Numeric Rating Scale and Doloplus-2 scale. Results: The results showed high pain prevalence, but no significant difference based on cognitive level. Pain classifi- cation at the individual level varied somewhat when different instruments are used. The results indicated that use of a single-item proxy-measure for pain tends to show higher pain prevalence and was not statistically significant related to quality of life. The relationship with quality of life was statistically significant when self-rated pain instruments or multi-component observation were used. Conclusions: The study shows that it is difficult to estimate pain in residents living at nursing homes and that it continues to be a challenge to solve. Self-rated pain should be used primarily to assess pain, and a multi-component observation scale for pain should be used when residents are cognitively impaired. Both self-rated pain and multicomponent observation also support the well-known link between pain and quality of life. Single-item proxy assessments should only be used in exceptional cases. [ABSTRACT FROM AUTHOR]

Background: Recovery from life-threatening illness may be experienced as more demanding and lasts longer than patients first expect. Many patients experience recovery after life-threatening illness, as filled with complex problems. These problems are primarily physical and psychological, although also social, and adversely affect daily life as well as perceived quality of life. Patients experience uncertainty about living with the legacy of a life-threatening illness and how it negatively limits their daily lives and experienced health. Aim: The purpose is to illuminate experiences of the meaning of recovery from life-threatening disease. Ethical approval: Approval for the study was obtained through a Regional Research Ethics Committee. Methods: This study was conducted as a qualitative narrative study. This means that written stories of human recovery beyond suffering from life-threatening disease were collected and analysed with a phenomenological hermeneutic method. Results: The findings reveal two major areas -- intrapersonal meanings and relational meanings. Four themes were found in these areas, each of which was divided into subthemes as follows: obstacles, for example disappointment of life, alienation of self and opportunities/resources: for example balance, own knowledge, hope and gratitude; relational obstacles, for example a lack of care, stigmatisation and economic stress; and relational resources such as informal care and professional care. Study limitations: The informants were predominantly women that may be explained by the fact that females seem to be more often engaged in social media and willing to participate in these kinds of studies. Another limitation is that we only reached out to Swedish speaking Facebook groups when recruiting our informants. Conclusions: In the narratives of their recovery process, surprisingly few focused on professional health care as a resource. Experiences from the study may be used to further develop care, especially to support patient self-care regarding intrapersonal and relational resources that promote patient recovery beyond suffering from life-threatening disease. [ABSTRACT FROM AUTHOR]

Background: Depression is a common disorder in old age and increases with hospitalisation. The aim was to investigate whether improvement in depressive symptoms after hospitalisation is associated with education level, age, gender, living situation, self‐efficacy, activities in daily living and quality of life by (1) examining the prevalence of depressive symptoms at baseline and at 1st and 2nd follow‐up (2) examining different factors' association with depressive symptoms at baseline and (3) examining different factors' association with improvement in depressive symptoms at baseline and at 1st and 2nd follow‐up. Methods: The study consisted of 145 patients, 65 years and older. Data were collected between February 2015 and September 2016 through interviews conducted using structured protocols. The instrument used was Katz index of ADL, Geriatric Depression Scale‐20, Life Satisfaction Questionnaire and the General Self‐Efficacy Scale. The participants were interviewed before discharge from hospital, after 1.5 month and after 3 months. Results: The prevalence of depressive symptoms in older persons was high after hospitalisation. Factors associated with improvement of depressive symptoms after hospitalisation were higher educational level, improvement in activities in daily living and quality of life. Non‐significant results were found for improvement of depressive symptoms and gender, age, living situation or self‐efficacy. Conclusions: Depression is a common health problem in older persons, especially after hospitalisation. It is therefore important that healthcare staff screen older persons for depression during hospitalisation, as this allows identification of those in need and a possibility to help them in an appropriate manner. Persons with lower educational level and depressive symptoms need special attention. [ABSTRACT FROM AUTHOR]

Background: Takotsubo syndrome (TTS) is an acute and reversible type of heart failure that shares common features with acute coronary syndrome. It is usually caused by psychological or physical stress, but for a third, triggers cannot be identified. Patients also suffer from residual symptoms and decreased mental health in the recovery phase and may struggle to comprehend and manage everyday living. Aim: To describe patients' experiences when afflicted by takotsubo syndrome, after discharge from hospital. Method: An inductive explorative design using a qualitative approach with semi‐structured individual interviews. The text was analysed using qualitative content analysis according to Graneheim and Lundman. Result: Ten women and one man afflicted by TTS were interviewed two to twelve months after discharge. Six sub‐categories were identified, and a main category emerged: The process from symptom onset and understanding to increased awareness and changes in life. The patients suffered from emotional reactions and they sought answers and understanding about the underlying causes. The disease led to changes in patients' daily lives as they were affected physically and psychologically. Spouses and/or bystanders had a positive supporting role, but the patients desired more support from the healthcare professionals such as an earlier appointment for follow‐up with a nurse. Conclusion: Being afflicted by TTS can lead to changes in life conditions but these changes vary among patients. Becoming ill was associated to acute physical stress and prolonged psychological stress and they suffered from emotional reactions. The follow‐up care needs to improve as the patients need more guidance from healthcare professionals and earlier appointment for follow‐up with a nurse. A structured and multiprofessional treatment with a person‐centred approach could support patients in their recovery. [ABSTRACT FROM AUTHOR]

Background: Currently, no available tool easily and effectively measures both the frequency, intensity and distress of symptoms among patients receiving radiotherapy. A core symptom set (fatigue, insomnia, pain, appetite loss, cognitive problems, anxiety, nausea, depression, constipation, diarrhoea and skin reaction) has been identified and assessed across oncology research to better understand the pattern of symptoms and treatment side effects. Aim: The aim was to develop a tool measuring the multiple‐symptom experience in patients undergoing radiotherapy and evaluate its psychometric properties (validity, reliability and responsiveness). Design: This study has a prospective, longitudinal and quantitative design. Methods: We developed a patient‐reported outcome questionnaire, the Radiotherapy‐Related Symptoms Assessment Scale to assess the frequency, intensity and distress associated with symptoms. Patients (n = 175) with brain tumours undergoing proton beam therapy completed the Radiotherapy‐Related Symptoms Assessment Scale and the health‐related quality of life questionnaire (EORTC QLQ‐C30) during treatment. We assessed the validity, reliability and responsiveness of the Radiotherapy‐Related Symptoms Assessment Scale and evaluated the validity against QLQ‐C30. Results: There were significant questionnaire–questionnaire correlations regarding selected items, primarily fatigue, insomnia and pain, indicating satisfactory criterion‐related validity. The Radiotherapy‐Related Symptoms Assessment Scale had fair to good retest reliability. Conclusion: The Radiotherapy‐Related Symptoms Assessment Scale is a valid instrument for assessing symptom intensity and distress in patients with brain tumour undergoing PBT, with psychometric properties within the expected range. The Radiotherapy‐Related Symptoms Assessment Scale provides nurses with substantial information on symptom experience but requires little effort from the patient. Additional studies are required to further assess the psychometric properties in patients with different cancer diagnoses receiving conventional radiotherapy. [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]

Main problem: Self‐management is essential for patients both before and after kidney transplantation and requires an adequate level of health literacy (HL), that is the ability to comprehend and process health information. Low HL is associated with poor clinical outcome and an increased risk of death. In Europe, HL has been scarcely studied. The aim of this study was to investigate the levels of HL in a Swedish cohort of kidney transplant (KTx) candidates and KTx recipients. Methods: A single centre cross‐sectional cohort study. Participants; n = 50 KTx candidates and n = 49 KTx recipients. HL was measured with the Newest Vital Sign instrument (NVS). Statistical analysis was made using the chi‐square, Mann–Whitney U‐ or t‐test. Results: Study participants; n = 99, 61.6% male, mean age 52 years. Low or possible inadequate HL was seen in 20%. There was no statistical difference in the levels of HL related to sex, educational level, ability to work or between KTx candidates and KTx recipients. Conclusions: In this cohort, one fifth had low or possible inadequate HL measured by the NVS. Screening is needed to identify persons with poor HL. These persons require tailored education and person‐centred care to cope with self‐management. [ABSTRACT FROM AUTHOR]

Sleeping difficulties are increasingly prevalent among adolescents worldwide and have negative consequences for adolescent health and education. The aim of this study was to describe the reasons for sleeping difficulties as perceived by adolescents. Sleeping difficulties include insufficient sleep, trouble falling asleep, waking up at night or sleep that does not leave an individual rested. Data were collected in 2015 using an open‐ended question. The sample consisted of n = 475 adolescents from a city in Sweden, aged 15–16 years, with self‐assessed sleeping difficulties. The results described the reasons for the adolescents' sleeping difficulties, at a general, thematic level, as an imbalance between requirements and preconditions, distributed to stress, technology use, poor sleep habits, existential thoughts, needs and suffering. To find a balance in their daily lives, adolescents may need support from parents, school nurses and school health services to deal with their sleeping difficulties. [ABSTRACT FROM AUTHOR]

This study is part of a larger research project designed to examine the view of home nursing care from the perspective of older South Sami people in Sweden. In the present study, we present findings from the point of view of their expectations of home nursing care. The Sami are an indigenous population living in northern Sweden, Norway, Finland and the Kola Peninsula, and consist of different Sami people, of which the South Sami population is one. This population consists of approximately 2000 persons living in the central regions of Sweden and Norway. Fifty‐six older South Sami people participated in the study. Semi‐structured interviews were conducted over the telephone and were analysed using latent content analysis. The main findings show how older South Sami people's expectation for home nursing care contains the same care providers over time, individual adjustments and competent care providers and do not differ from the general Swedish population. Interpersonal interaction is a hallmark of nursing care and other healthcare disciplines. Ideally, interpersonal care is achieved when individual care providers have few care receivers, which promote continuity in care, individual adjustments based on the care receivers individual needs and care providers with professional and relational competence. [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]

Workplace bullying is a taboo event which occurs worldwide, although the prevalence varies significantly between and within countries. Nurses have been regarded an occupational risk group for bullying at the work place. Bullying in health and social care contexts is sometimes reported as frequent and, other times, as not occurring, which sparked our interest in mapping the occurrence of bullying in the health and social care system in Sweden. Thus, the purpose of the study was to examine the prevalence of bullying, and to discuss cultural traditions and environmental factors that affect bullying in workplaces. The sample (n = 2810) consisted of employees at inpatient wards at four hospitals, and employees at municipal eldercare wards in Sweden. A questionnaire including NAQ‐22 R was distributed and subsequently analysed with descriptive statistics using SPSS. The youngest group of respondents scored higher than the older groups. Using contrasting estimates of bullying, the prevalence varied between 4.1 and 18.5%, with the lowest prevalence in regards to self‐reported exposure. According to the cut‐off scores, NAQ‐22 R, 8.6% of the respondents were occasionally exposed to bullying while 2.3% were considered to be victims of severe bullying. Work‐related negative acts were more common than personal negative acts. The variations in prevalence of bullying as a result of contrasting estimation strategies are discussed from perspective of the 'law of Jante', the 'tall poppy syndrome' and shame. Bullying deteriorates the working conditions which may have an impact on quality of patient care. [ABSTRACT FROM AUTHOR]

Background: The use of measurement scales to assess pain in neonates is considered a prerequisite for effective management of pain, but these scales are still underutilised in clinical practice. Aim: The aim of this study was to describe and compare pain assessment practices including the use of pain measurement scales in Norwegian and Swedish neonatal care units. Methods: A unit survey investigating practices regarding pain assessment and the use of pain measurement scales was sent to all neonatal units in Sweden and Norway (n = 55). All Norwegian and 92% of Swedish units responded. Results: A majority of the participating units (86.5%) assessed pain. Swedish units assessed and documented pain and used pain measurement scales more frequently than Norwegian units. The most frequently used scales were different versions of Astrid Lindgren's Pain Scale (ALPS) in Sweden and Echelle Douleur Inconfort Noveau‐Ne (EDIN), ALPS and Premature Infant Pain Profile (PIPP) in Norway. Norwegian head nurses had more confidence in their pain assessment method and found the use of pain measurement scales more important than their Swedish colleagues. Conclusion: The persisting difference between Swedish and Norwegian units in pain assessment and the use of pain measurement scales are not easily explained. However, the reported increased availability and reported use of pain measurement scales in neonatal care units in both countries may be seen as a contribution towards better awareness and recognition of pain, better pain management and potentially less suffering for vulnerable neonates. [ABSTRACT FROM AUTHOR]

Background: Patients’ complaints have been highlighted as important for constructively improving healthcare services. In so doing, it may be important to identify disparities in experiences based on patients’ demographics, such as sex. Aim: To explore hospital recorded complaints addressing potential sex differences and whether complaints were reported by the patient or a relative. Methods: Quantitative study of all 835 closed patient complaints during 2013 at three mid‐sized hospitals in Sweden. The complaints were categorisation based on perceived quality theory and analysed using a probabilistic graphical model. The findings were validated through qualitative interviews. Findings: Female patients were more likely than male patients to report dissatisfaction with interpersonal issues, whereas male patients were more likely to report dissatisfaction with administration. If a complaint from a male patient had been reported by a relative, the matter was more likely to be interpersonal. Improvement suggestions were predominantly reported by staff. However, patients and relatives proved more likely than staff to report improvement suggestions when dissatisfied with interpersonal matters. Conclusion: Using a Bayesian network, this article suggests that complaints in health care should be more holistically understood and the factors should be viewed as interconnected. This article addresses complaints as an important source of identifying not only perceived healthcare deficiencies and sex disparities, but also improvement suggestions. [ABSTRACT FROM AUTHOR]

Background: What already is known is that as many as 50% of all Swedish Ambulance Care Service assignments are considered as non‐emergency. Therefore, due to medical protocols and triage system, patients are refused conveyance to the Accident and Emergency Department by the Ambulance Care Service. Aim: The aim of this study was to psychometrically explore the construct validity of a possible dimension of person‐centredness, developed from a previous published qualitative study in a nonemergency ambulance care context. A second aim was to explore patients’ experiences of the person‐centred climate and to explore possible relationship between it and person‐centredness. Design/Methods: A retrospective, explorative, cross‐sectional survey design with a convenience sample was employed. A total of 111 questionnaires were analysed using descriptive and comparative statistics. An explanatory factor analysis was also conducted. Findings: A one‐factor solution for the specific items possibly constructing person‐centredness was found. The responses to the Person‐centred Climate Questionnaire‐Patient version (PCQ‐P) revealed that the climate was received as highly person‐centred. Relationships were found between the specific items possibly constructing person‐centredness and PCQ‐P. Conclusion: A highly valid construct of person‐centredness exists within nonurgent Ambulance Care Service assignments comprising eight aspects of being taken seriously. The climate in which nonemergency ambulance care is provided has great potential to facilitate person‐centredness by means of taking patients seriously. The psychosocial aspects of PCQ‐P and person‐centredness are somewhat related to each other. [ABSTRACT FROM AUTHOR]

Background: The progression of dementia disease implies increasing needs for both informal and formal care and services but also risk of institutionalisation. To better adjust care and services in the phase preceding institutionalisation it is important to find out whether utilisation of formal and informal care and services is determined by increased needs and by who meets the needs. Aim: The aim was to compare persons with dementia (65+) with different levels of cognitive impairment, regarding utilisation of formal and informal care and service at home. Methods: The participants consisted of 177 persons with dementia ≥65 years old and at risk of nursing home admission, divided into groups according to their cognitive function. Structured interviews were conducted based on questionnaires about type and amount of formal and informal care utilised, as well as questions regarding cognitive impairment, dependency in activities of daily living (ADLs) and neuropsychiatric symptoms. To analyse the data, descriptive and comparative statistics were used. Results: The findings revealed that the group with severe dementia used significantly more help with ADLs and supervision in terms of time (number of hours and days) provided by the informal caregiver, compared with the group with moderate dementia. Utilisation of formal care and services was highest in the group with the most severe cognitive impairments (Standardized Mini‐Mental State Examination score of <9). The group with severe dementia were more dependent in ADLs and had more neuropsychiatric symptoms (hallucinations and motor disturbances). They were younger and more often cohabitated with the informal caregiver, compared with the group with moderate dementia. Conclusion: This study shows that in the phase preceding institutionalisation the ADL and supervision needs due to progression of dementia appear to tend to be met first and foremost by the informal caregivers. [ABSTRACT FROM AUTHOR]

Introduction: Lymphoedema may cause complex problems that can strongly influence patients' health‐related quality of life (HRQoL). The main purpose of this study was to investigate the impact of lymphoedema on HRQoL in patients with varying forms of lymphoedema. Methods: The Lymphoedema Quality of Life Inventory (LyQLI), measuring three domains, physical, psychosocial and practical, and the Short Form 36 Health Survey Questionnaire (SF‐36), measuring eight health domains, were sent to 200 lymphoedema patients. Out of those who answered both questionnaires, 88 patients had lymphoedema secondary to cancer treatment and they additionally received the Functional Assessment of Cancer Therapy Scale‐General (FACT‐G). The relation between continuous variables and the three domains were analysed by Spearman's correlation coefficients, and Kruskal–Wallis test was used to analyse categorical variables. Results: Altogether 129 patients completed the LyQLI and SF‐36 and 79 of them also completed FACT‐G. Twenty per cent had a high mean score (≥2.0) in at least one domain of the LyQLI, thus having a low HRQoL. Lower HRQoL was found in the practical domain of LyQLI in patients with lower limb lymphoedema compared to patient with lymphoedema in upper limb or head/neck (p = 0.002) and in patients working part‐time compared to patients working full‐time (p = 0.005). The impact on HRQoL tended to decrease with age, with a significant correlation in the psychosocial domain (rs = 0.194, p = 0.028). Compared with the general Swedish population, patients with lymphoedema scored significantly lower in general health (p = 0.006), vitality (p = 0.002) and social functioning (p = 0.025) assessed by the SF‐36. From a cancer‐specific view, HRQoL was similar to other Swedish studies using the FACT‐G. Conclusions: This study indicates that about 20% of the patients with lymphoedema had major impact on their HRQoL. More effort and research is needed to identify, understand and support groups of patients with severe lymphoedema‐related problems. [ABSTRACT FROM AUTHOR]

The major aim of the present study was to explore what people with psychiatric disabilities, living in two different types of housing, consider to be the best and the worst in their housing situation. A secondary aim was to explore to what extent additional questions to a questionnaire with a free‐response format can provide complementary information to the previous knowledge in the field. The content analysis revealed that the physical attributes were of great significance for the residents in ordinary housing, while both psychosocial aspects and physical attributes were important for those living in supported housing. When providing good housing solutions for people with psychiatric disabilities, attention needs to be given to these aspects by politicians, policymakers as well as by nursing staff. [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]

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]

Background Higher levels of parental stress have long-term effects on children's health and could lead to dysfunction in the parent-child interaction. Different background factors can be predictors of high parental stress. Aim The aim of this study was to examine parental stress among Swedish women and identify different factors linked to women's parental stress. Method About 702 women were recruited to a clinical study and followed up six months after birth. Data were collected by two questionnaires, and 279 women completed the Swedish Parental Stress Questionnaire ( SPSQ). Findings Less than very good mental health and depressive symptoms after birth were strongly associated with parental stress, and the strongest association was found between post-partum depressive symptoms and high levels of stress in the subscale Incompetence. Multiparity was associated with high stress in two subscales, and lower level of education was a protective factor for stress in nearly all subscales. Conclusions Depressive symptoms and perceived poor mental health post-partum are the most important factors related to high parental stress. The results point to the importance of identifying and supporting mothers with depressive symptoms, since these women have both mental illness and increased stress. [ABSTRACT FROM AUTHOR]

Background Interlinked aspects, as demographic changes, accentuation on home-based community care, increase the amount of informal caregivers to older adults. To preserve and enhance their health are subsequently essential and a reoccurring topic on political agendas. How this may be achieved is vividly debated and mainly focused on elimination of risks and stresses associated with caregiving. Within health promotion, the salutogenic approach focusing on resources to health is recognised and this approach was used to acquire necessary knowledge to enhance caregivers' health 'the salutogenic way'. Aim To present Generalised and Specific Resistance Resources ( GRRs/ SRRs) described by caregivers as stemming from themselves and their carerecipients. Methodology To unravel caregivers' GRRs/ SRRs, a theory-driven, explorative design guided by definitions of GRRs/ SRRs was utilised. Data were collected through salutogenically guided interviews with 32 Swedish caregivers in one municipality. Inductively, data were analysed using content analysis to identify each caregiver's SRRs and thereafter deduction to identify the population's GRRs. Findings The synthesis of findings, caregivinghood, encompasses several domains of GRRs seemingly involved in caregivers' movements towards health. In the caregiver domain, 'Being someone significant in my own eyes' unites the essence of having access to GRRs stemming from oneself and 'Being 'blessed' with a co-operative co-worker' that of having access to GRRs stemming from the carerecipient. This may be the core in an orientation to life which creates positive life experiences, since it enables caregivers to find a 'fit' between the possible and desired when resolving challenges. Conclusion and implications Health-promoting initiatives should be conducted as partnerships between formal and informal sources due to the versatility of GRRs. It also seems essential to empower both parties so that they may make sense of their situation and use their available GRRs/ SRRs in this 'joint venture' of managing. Thereby, their motivation to continue the journey through Caregivinghood may be enhanced. [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]

Background/Aim New surgical procedures, early operation and medical optimisation in patients with hip fracture have shown positive results on length of hospital stay. Our aims were to investigate whether patient empowerment along with an individually designed, postoperative rehabilitation programme could reduce length of hospital stay and whether the patients would have better chances to return to their previous living. Design/Method Patients were recruited during a 12-month period 2009-2010, with an intervention group treated with an individually designed, postoperative rehabilitation programme and a control group treated in a traditional way according to the hospitals routines. Final assessment was performed 4 month after surgery. The postoperative programme for the intervention group consisted of four standardised care tracks adapted individually for the patients. Assessments of Activity of Daily Living, American Society of Anesthesiologists classification of medical disease status and Short Portable Mental Status Questionnaire and living conditions were used to determine which care track was most appropriate. The patients were cared for with focus of empowerment in their rehabilitation. Results The study involved 503 hip fracture patients, 285 patients in the intervention group and 218 patients in the control group. The mean length of stay was 4 days shorter in the intervention group than in the control group (p = 0.04). Varied only to a small extent between the age groups in the intervention group and was greater between the age groups in the control. Patients in the intervention group returned to their previous living in 90% compared with 80% in the control group (p < 0.05). There were no significant differences between the age groups. Conclusion Patient empowerment administrated by specially trained nursing staff and with specialised, tailor-made rehabilitation programme may be of benefit in helping patients to a shorter hospital stay and to return to their previous living. [ABSTRACT FROM AUTHOR]

Senior citizens get around, to a large extent, as pedestrians, and safe walking is desirable for senior citizens allowing them to stay mobile, independent and healthy in old age. Senior citizens are over-represented in injury statistics, and fall-related injuries are common. The aim of this study was to investigate fall-related injuries including healthcare costs among senior citizen pedestrians injured when walking in public outdoor environments and to describe their self-reported causes and suggested preventive strategies. The data were based on a combination of information from injury data and a questionnaire. Three hundred senior citizens attended one emergency department after sustaining injuries from pedestrian falls; 60% suffered nonminor injuries, mostly fractures. One-fifth of the pedestrians were hospitalised for an average of 8 days with an indirect hospital cost of 6.2 million EUR (55 million SEK). Environmental factors such as ice were the most commonly described cause of the injury incident. Forty per cent of the respondents indicated that the municipality was responsible for the cause of the injury incident. Fewer respondents mentioned their own responsibility as a preventive strategy. Thirty per cent described a combination of improvements such as better road maintenance, changes in human behaviour and use of safety products as preventive strategies. It is of great importance to highlight general safety, products and preventive strategies to minimise injury risks, so that pedestrians can safely realise the known health benefits of walking and thereby limit healthcare costs. [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]

Background and aim When a child is diagnosed with type 1 diabetes, it is a complex and challenging situation for the whole family. The management of the disease places substantial demands on the family and they need to change their daily life. The short- and long-term impact on the family has rarely been described; therefore, the aim of this study was to describe and compare the disease impact on parents and children in terms of health-related quality of life ( HRQOL) at diagnosis and 1 year subsequent to the child's diagnosis with type 1 diabetes. A further aim was to describe and compare the parents' satisfaction with the care received. Method Sixty-nine children and their parents were included. Parents independently filled in the Peds QL™ Family Impact Module and the Peds QL™ Health Care Satisfaction Generic Module. The Peds QL™ 3.0 Diabetes Module was filled in by parents and children over the age of 5. Results Mothers reported a lower HRQOL than fathers both at the time of diagnosis (p = 0.003) and 1 year later (p = 0.041). For diabetes-specific HRQOL, children aged 5-7 years and their parents reported more worry than children and parents in older age groups (p = 0.037). Children aged 8-12 and 13-18 years reported a higher treatment adherence than mothers (p = 0.011 and p = 0.039, respectively); no differences were found between children and fathers. Both parents expressed overall satisfaction with the child's health care. Conclusion The family is affected during the first year after their child is diagnosed with type 1 diabetes. Both parents and the youngest children estimated a high degree of worry. The diabetes team needs to be aware of this and to take it into consideration. [ABSTRACT FROM AUTHOR]

Chronic stress is among the most common diagnoses in Sweden, most commonly in the form of exhaustion syndrome ( ICD-10 classification - F43.8). The majority of patients with this syndrome also have disturbed breathing (hyperventilation). The aim of this study was to investigate the association between hyperventilation and exhaustion syndrome. Thirty patients with exhaustion syndrome and 14 healthy subjects were evaluated with the Nijmegen Symptom Questionnaire ( NQ). The participants completed questionnaires about exhaustion, mental state, sleep disturbance, pain and quality of life. The evaluation was repeated 4 weeks later, after half of the patients and healthy subjects had engaged in a therapy method called ' Grounding', a physical exercise inspired by African dance. The patients reported significantly higher levels of hyperventilation as compared to the healthy subjects. All patients' average score on NQ was 26.57 ± 10.98, while that of the healthy subjects was 15.14 ± 7.89 ( t = −3.48, df = 42, p < 0.001). The NQ scores correlated strongly with two measures of exhaustion ( Karolinska Exhaustion Scale KES r = 0.772, p < 0.01; Shirom Melamed Burnout Measure SMBM r = 0.565, p < 0.01), mental status [Hospital Anxiety and Depression Score (HADS) depression r = 0.414, p < 0.01; HADS anxiety r = 0.627, p < 0.01], sleep disturbances ( r = −0.514, p < 0.01), pain ( r = −.370, p < 0.05) and poor well-being ( Medical Outcomes Survey Short Form 36 questionnaire- SR Health r = −0.529, p < 0.05). In the logistic regression analysis, the variance in the scores from NQ were explained to a high degree ( R2 = 0.752) by scores in KES and HADS. The brief Grounding training contributed to a near significant reduction in hyperventilation ( F = 2.521, p < 0.124) and to significant reductions in exhaustion scores and scores of depression and anxiety. The conclusion is that hyperventilation is common in exhaustion syndrome patients and that it can be reduced by systematic physical therapy such as Grounding. [ABSTRACT FROM AUTHOR]

This study addresses predictors of occupational value, empowerment and satisfaction with the rehabilitation received in day centres for people with psychiatric disabilities. These outcomes represent varying aspects of relevance for the day centre context and together create a manifold outcome picture. This was a longitudinal study with approval from the regional research vetting board. Self-report instruments were used, and the investigated predictors motivation for going to the day centre, occupational engagement, socio-demographic factors and self-reported diagnosis. Attendees (N = 108) at 8 day centres participated and filled in self-report questionnaires regarding the predictor and outcome variables. A baseline measurement and a 14-month follow-up composed the data. Occupational engagement at baseline could predict all three outcomes at the follow-up. Motivation for the day centre activities and not preferring work before attending the day centre were positive for satisfaction with the day centre. A low participation rate, although comparable with previous studies on the target group, was a limitation of this study. To conclude, both occupational engagement and motivation are factors that can be stimulated by the staff in day centres. Actions for how to accomplish that, and thereby also more positive outcomes of the day centre services, are proposed, such as a system of freedom of choice among day centres, and between day centres and supported employment. [ABSTRACT FROM AUTHOR]

Aim The aim of this study was to describe and explore individual and organisational factors potentially influencing registered nurses' ( RNs) attitudes towards patient advocacy. Methods and Sample In a quantitative cross-sectional study, data were collected from 226 RNs in community health care of elders. A questionnaire was used to measure a number of factors including attitudes towards patient advocacy, nursing competence, personality traits, individual preferences regarding the quality of health care and working climate. A multiple regression analysis was performed. Results The results showed that individual factors of nursing competence and individual preferences of the quality of health care, as well as organisational factors of the working climate, explained 26.2% of the variance in the RNs' attitudes towards patient advocacy. Conclusions Although the mentioned individual factors may be intertwined, the conclusion is that both individual and organisational factors influenced RNs' attitudes towards patient advocacy. The results do not verify that nursing experience, workplace experience, educational level or personality traits influence the RNs' attitudes towards patient advocacy. The proportion of explained variance indicates that additional factors also influence attitudes towards patient advocacy, and more research is needed to shed further light on these factors. [ABSTRACT FROM AUTHOR]

Background It is important to clarify nurses' perceptions of conditions for patient education in daily work as research findings are ambiguous. There is a gap between societal regulations on nurses' competence in accomplishment/achievement of patient education and research findings. Aim The aim was to describe nurses' perceptions of conditions for patient education, focusing on aspects of competence. The aim was also to describe differences in conditions for nurses working in primary, municipal and hospital care. Methods The study is a cross-sectional survey and is part of a project about nurses' patient-education. A randomized selection of nurses (842) received a questionnaire comprising 47 items concerning factual experience and attitudes to patient education and 13 background items. Questionnaires were returned by 83% of participants. Descriptive statistics, non-parametric tests and content analysis for open-ended items were used. Results Nurses' perceptions of conditions for patient education differ between health-care settings. Primary care nurses are at an advantage in following research in patient education, perception of their own competence (prioritizing and knowing their mandate in patient teaching), pedagogical education and post graduate specializations. Conclusions Nurses' patient education must be more visualized and appropriate conditions created at each workplace. In this change process, managers' support is considered vital. [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]

Aim This article investigates attitudes towards and awareness of research and use of research findings among primary healthcare nurses, determinants of attitudes and evaluation of psychometric properties of an instrument measuring nurses' attitudes. Background The production of new knowledge is ongoing and the amount of research of relevance for health care has increased, but there remains a gap between what is known and what is done in practice. To enhance evidence-based practice and patient safety, the use of research findings needs to be encouraged and promoted. Method An explanatory study using a cross-sectional survey was conducted in 2005-2006. The survey included items about background data and the instrument attitudes towards and awareness of research and development in nursing. 1054 nurses participated in the study. Factor analyses and Cronbach's alpha were used to evaluate internal structure and internal consistency of the instrument. Result The nurses generally held positive attitudes towards research. Although most of the nurses reported using research in practice, 37% claimed that they never or rarely used research findings. Half of the respondents perceived they had the ability to analyse scientific reports/articles. This ability and research use were significant determinants of attitudes. Factor analysis of the scale resulted in a three-factor solution, which differs from the seven-factor structure previously identified by the originators of the instrument. Conclusion Our results support the view that implementation of research is a complex process involving several factors. The different factor structure identified suggests that further work is needed on this instrument. [ABSTRACT FROM AUTHOR]

Aims The aim of this study was to investigate nurses′ perceptions of working according to standardized care plans (SCPs), regarding usability, documentation, quality of care and the implementation process. Background Administrative work is an extensive part of nursing practice which leads to decreased time for the near patient-related care. In addition, the number of very sick patients with short hospital stays has increased. This places new demands on healthcare teams to guarantee a high quality of care. For this reason development and use of standardized care plans has increased in Sweden during recent years. Method This was a cross-sectional survey and 116 registered nurses who had experience of working according SCPs answered a questionnaire with the option of providing written comments. Result The nurses reported that the use of SCPs facilitated their daily work, especially for new employees and worked well as a checklist ensuring the quality of care. The documentation was experienced as easy, less time consuming with less redundant information. The implementation process of SCPs was reported as satisfactory but a majority reported that they were not involved in the development of the SCP. However, even though 85.5% reported a positive attitude towards working according to an SCP, it was also sometimes experienced as inflexible. Conclusion The nurses had overall positive perceptions of working according to an SCP mainly in terms of usability, documentation and quality of care. The implementation process was not optimal and it was doubtful whether the SCP rendered any positive side effects. [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]

Background: Nowadays, nursing research is seen as an integral part of professional nursing although implementing knowledge derived from nursing research into the practice setting is still problematic. Current research, conducted mainly with a descriptive quantitative design, highlights the struggle experienced by Registered Nurses (RNs) to use and implement research findings in clinical practice. Therefore, the aim of this naturalistic inquiry was to explore nurses' perception of nursing research and its implementation in a clinical context. Method and sample: A qualitative approach was chosen, and four focus group discussions were conducted. The groups comprised a total of 16 RNs (three men and 13 women) working in a secondary care setting. The transcribed texts were analysed, inspired by Burnard's description of content analysis. Findings: The texts were interpreted as representing three predominant themes: scholastic, individual and contextual influences highlighted as influential components impacting on the RNs' views on research and its implementation as well as on their readiness to accept and support it. However, the most influential aspect permeating our themes was their educational background - the type of qualification they held. In general, the RNs with a Bachelor of Science in Nursing viewed research and the implementation of knowledge in practice more favourably than those RNs with a diploma. Conclusion: Our findings, although based on a small qualitative study, are congruent with others, indicating that further research is warranted concerning the impact of education on RNs' views of nursing research and its implementation. Hence, it might well be that the RNs' educational point of departure needs to be stressed more than what so far have been anticipated. In the meanwhile, it is possible that a number of strategies could be tested to promote a more favourable view in these issues and where the nursing education has the possibility to influence this endeavour. [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]

Scand J Caring Sci; 2013; 27; 224-230 Factors influencing compliance to hygiene routines in community care - the viewpoint of medically responsible nurses in Sweden Aims and objectives: The aim of the study was to describe factors influencing compliance to hygiene routines in community care in Swedish municipalities from the perspective of medically responsible nurses (MRN). Method: A web-based questionnaire was sent to all MRNs in Swedish municipalities, N = 268. Beside demographical background data, the questionnaire contained two core open-ended questions generating free text data. Data were analysed with descriptive statistics and qualitative content analysis. Result: Four categories of factors were found: resources, management, staff and external factors. All four categories contained subcategories. Conclusion: To some extent, the challenges to uphold adequate compliance to hygiene routines seem different in community care than in hospitals. Resources regarding equipment and supplies seem as an uncertain asset and uneven distributed among municipalities. Home likeness was seen as a major obstacle for upholding adequate hygiene routines. To uphold sufficient hygiene routines in a person's home or in a home-like environment might be one of the major challenges for community health care in the future. The MRN's narratives suggest that Registered Nurses have a key role in upholding sufficient hygiene in community care. This report might contribute in providing them with more knowledge to take on this urgent task. [ABSTRACT FROM AUTHOR]