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PURPOSE: The purpose of this review was to identify supporting and hindering factors for student nurse anesthetists' (SNAs') learning in the operating room during clinical practice, from students' and supervisors' perspectives. DESIGN: An integrative review. METHODS: Systematic searches were conducted in Medline, Cinahl, PsycInfo, and ERIC. Search terms were related to nurse anesthetist, education, operating room context, and clinical setting. Searches were performed at three points in time and in total 1,530 unique articles were identified. After screening using Covidence and using Joanna Briggs Institute appraisal tools, 34 articles remained. These were analyzed inductively using a constant comparison method. FINDINGS: Supporting factors include preparation before clinical practice, clearly stated expectations, a respectful relationship with the supervisor, daily planning and communication, and constructive feedback. Hindering factors include lack of time, disruptive behavior from supervisors or other team members, and environmental factors such as a high room temperature and noisy environment. CONCLUSIONS: SNAs' learning situation in the operating room resembles undergraduate nurses' learning during clinical practice. Educators and supervisors can take several actions to promote SNAs' learning. Further research is warranted on the effect of teamwork on SNAs' learning.

Aim: Dignity in older persons is a goal of palliative care. This study aimed to perform a process evaluation of the Swedish Dignity Care Intervention (DCI-SWE) in municipal palliative care in Sweden, focusing on implementation, context, and mechanism of impact. Methods: This study had a process evaluation design. The Knowledge to Action framework supported the implementation of the DCI-SWE. The intervention was used by community nurses with older persons (n = 18) in home healthcare and nursing homes. Data were collected by focus groups- and individual interviews with community nurses (n = 11), health care professionals (n = 5) and managers (n = 5), reflective diaries, and field notes. Results: Grasping the DCI-SWE was challenging for some community nurses. Enhanced communication training and increased engagement from managers were requested. However, the DCI-SWE was perceived to enhance professional pride in nursing. In terms of fidelity, dose and reach the project was not fully achieved. Regarding mechanism of impact the DCI-SWE contributes to address older persons' loneliness and existential life issues, as it put conversations with older persons on community nurses' agenda. Conclusions: The DCI-SWE provided opportunities to maintain older persons' dignity and quality of life. However, with refinements of design and the DCI-SWE, the sustainability in the context may increase.

Aim: Dignity in older persons is a goal of palliative care. This study aimed to perform a process evaluation of the Swedish Dignity Care Intervention (DCI-SWE) in municipal palliative care in Sweden, focusing on implementation, context, and mechanism of impact. Methods: This study had a process evaluation design. The Knowledge to Action framework supported the implementation of the DCI-SWE. The intervention was used by community nurses with older persons (n = 18) in home healthcare and nursing homes. Data were collected by focus groups- and individual interviews with community nurses (n = 11), health care professionals (n = 5) and managers (n = 5), reflective diaries, and field notes. Results: Grasping the DCI-SWE was challenging for some community nurses. Enhanced communication training and increased engagement from managers were requested. However, the DCI-SWE was perceived to enhance professional pride in nursing. In terms of fidelity, dose and reach the project was not fully achieved. Regarding mechanism of impact the DCI-SWE contributes to address older persons' loneliness and existential life issues, as it put conversations with older persons on community nurses' agenda. Conclusions: The DCI-SWE provided opportunities to maintain older persons' dignity and quality of life. However, with refinements of design and the DCI-SWE, the sustainability in the context may increase.

Background There are a few previous studies on home phototherapy but there is a lack of randomised controlled trials. The aim of this study was therefore to assess whether home phototherapy is a safe and effective alternative to hospital treatment and whether it has an impact on bonding and stress. Methods This was a randomised controlled, multicentre, trial in which newborns with a total serum bilirubin of 18-24 mg/dl (300-400 µmol/) were randomized to either home phototherapy or conventional in-hospital phototherapy. The inclusion criteria were a chronological age of more than 48 hours, a gestational age above 36 +0 weeks and a bilirubin above 20.5 mg/dl (350 µmol/L) after 72 hours of age. After inclusion, the patients were randomised, to either home phototherapy or hospital treatment. Results 147 patients were recruited from 6 hospitals, 69 patients were randomized to conventional phototherapy and 78 to home phototherapy Safety/feasability The duration of phototherapy, length of stay, amount of blood tests and weight change showed no statistically significant differences between hospital and home phototherapy (table 2). However, home treatment failed in three patients and the total readmission rate was 4 %. It is recommended to provide daily check-ups and 24/7 telephone support to the parents. Bonding and stress Parents in the intervention group had better bonding both at discharge (p = 0.034) and at 4 months (p = 0.008; effect size r = 0.2) and lower levels of stress at 4 months (p = 0.024) compared with controls. Cost The cost was €337 per patient for home phototherapy compared with €1156 for the hospital alternative indicating average cost savings of €819 (95% confidence interval €613–1025) or 71% per patient. Descriptive qualitative study A total of 15 interviews were performed (8 mothers, 7 fathers).The interviews showed that parents felt secure at home. The overall experience of home phototherapy was positive, and five categories were identified describin

OBJECTIVES: To explore health problems and the recovery process after being deployed in a major incident. DESIGN: Qualitative, explorative design. SETTING: Ambulance services in Sweden. PARTICIPANTS AND METHODS: Semistructured, individual two-session interviews with 15 ambulance nurses with the experience of being deployed to major incidents were conducted. Data were analysed with thematic analysis. RESULTS: Being deployed in major incidents was perceived to be straining and led to both physical health problems and distress. To recover, the ambulance nurses strived to use strategies to distance themselves from the situation and created supportive conditions for their recovery, and if successful, the experiences led to both professional and personal growth and self-awareness. However, being deployed in major incidents without significant preparedness or experience could harm individuals and, in the worst case, end their career. CONCLUSIONS: A successful recovery from the physical and mental exhaustion experienced after being deployed in a major incident required both individual abilities and self-care strategies as well as a supportive working environment. Supporting individual recovery strategies and following up on physical and mental well-being over time should be part of all ambulance services procedures after major incidents.

BACKGROUND: Deciding whether to transition to wound palliation is challenging for health care professionals because there is no agreed definition or understanding of palliative wound care, including the goals, core elements and differences from general wound management. OBJECTIVES: To conduct a scoping review with qualitative synthesis to define palliative wound care in terms of its conceptual framework, goals, principles, components, and differences from general wound management, and provide a new definition of palliative wound care based on this scoping review. ELIGIBILITY CRITERIA: Published literature that refers to the definitions, concept, goals and core elements of palliative wound care using any methodological approach, without any time limits, published in English. SOURCES OF EVIDENCE: The searches were conducted in CINAHL Complete via Ebsco, Medline via Ovid, Cochrane Library, Scopus, and Google Scholar. CHARTING METHODS: A data extraction form was developed by the review team and used independently for data charting purposes. Braun and Clarke's six phases of thematic analysis guided the qualitative synthesis. RESULTS: A total of 133 publications met the inclusion criteria. Three main themes were developed to define palliative wound care and understand its differences from general wound management: 1- Healing potential of wounds and patient vulnerability, 2- Understanding the impact on individuals and family to address needs, 3- Towards new goals and perspectives in approach to care. CONCLUSIONS: Palliative wound care focuses on symptom management, comfort, and dignity, but does not always target the healing of the wound, which is the goal of general wound care. The needs of the individual and their family must be addressed by clinicians through the provision of care and support that takes into account the true meaning of living and dying with a palliative wound. PROTOCOL REGISTRATION: A review protocol was developed but not registered.

Background/Objective: This study aimed to investigate children’s’ and parents’ attitudes and knowledge about HPV (human papillomavirus) following introduction of gender-neutral HPV vaccination in the national immunization program (NIP) in Sweden. An evaluation of a tailored information package for parents and children launched by the Public Health Agency (PHAS) alongside the introduction of gender-neutral HPV vaccination was also performed Method: In total, 276 parents and 206 children from 22 School Health Services responded to a web-based survey, spring 2021 to January 2022. Result: Overall, parents (78%) perceived HPV vaccination to be of importance for their child’s health. About half of the participating children and two thirds of the parents had used the tailored information package for the HPV vaccination. The fact sheet was mostly used by parents (55%) and children (20%) and also perceived as easy to understand (99% and 68% respectively). For both children and parents, the school nurse (70% respectively) was the primary source for information. The teacher (59%) was also a common source of information of HPV vaccination for the children. Conclusion: The school nurse is essential for informing about HPV vaccination for both children and parents. There is a need to strengthen the knowledge regarding HPV vaccination among teachers as they also are a key source of information for the majority of the children. Additional interventions are needed to support parents in making informed decisions for HPV vaccinations.

Aim To describe and compare the clinical learning environment in community-based home care and primary health care in postgraduate district nursing students' education. Design Cross-sectional study design. Methods A convenience sample of postgraduate district nursing students was derived from five Swedish universities in 2016 and 2017. Results The postgraduate district nursing students were generally satisfied with the clinical learning environment in their clinical placement. In clinical placement, several factors affected the students' opportunities to learn, such as sufficiently meaningful learning situations with multidimensional content. A working environment that imposed psychosocial strain and high levels of stress among the staff negatively affected the students' learning. To further improve their learning from clinical practices, the students need preceptors who have the skills and competence required to support more advanced reflections and critical thinking on caring situations., CC BY 4.0First published: 05 September 2022Correspondence: Margaretha Larsson, Institution of Health Sciences, University of Skövde, Skövde SE-541 28, Sweden. Email: margaretha.larsson@his.seNo external funding. The respective universities funded their scientists.

Aim To describe and compare the clinical learning environment in community-based home care and primary health care in postgraduate district nursing students' education. Design Cross-sectional study design. Methods A convenience sample of postgraduate district nursing students was derived from five Swedish universities in 2016 and 2017. Results The postgraduate district nursing students were generally satisfied with the clinical learning environment in their clinical placement. In clinical placement, several factors affected the students' opportunities to learn, such as sufficiently meaningful learning situations with multidimensional content. A working environment that imposed psychosocial strain and high levels of stress among the staff negatively affected the students' learning. To further improve their learning from clinical practices, the students need preceptors who have the skills and competence required to support more advanced reflections and critical thinking on caring situations., CC BY 4.0First published: 05 September 2022Correspondence: Margaretha Larsson, Institution of Health Sciences, University of Skövde, Skövde SE-541 28, Sweden. Email: margaretha.larsson@his.seNo external funding. The respective universities funded their scientists.

Aim To describe and compare the clinical learning environment in community-based home care and primary health care in postgraduate district nursing students' education. Design Cross-sectional study design. Methods A convenience sample of postgraduate district nursing students was derived from five Swedish universities in 2016 and 2017. Results The postgraduate district nursing students were generally satisfied with the clinical learning environment in their clinical placement. In clinical placement, several factors affected the students' opportunities to learn, such as sufficiently meaningful learning situations with multidimensional content. A working environment that imposed psychosocial strain and high levels of stress among the staff negatively affected the students' learning. To further improve their learning from clinical practices, the students need preceptors who have the skills and competence required to support more advanced reflections and critical thinking on caring situations., CC BY 4.0First published: 05 September 2022Correspondence: Margaretha Larsson, Institution of Health Sciences, University of Skövde, Skövde SE-541 28, Sweden. Email: margaretha.larsson@his.seNo external funding. The respective universities funded their scientists.

Aim To describe and compare the clinical learning environment in community-based home care and primary health care in postgraduate district nursing students' education. Design Cross-sectional study design. Methods A convenience sample of postgraduate district nursing students was derived from five Swedish universities in 2016 and 2017. Results The postgraduate district nursing students were generally satisfied with the clinical learning environment in their clinical placement. In clinical placement, several factors affected the students' opportunities to learn, such as sufficiently meaningful learning situations with multidimensional content. A working environment that imposed psychosocial strain and high levels of stress among the staff negatively affected the students' learning. To further improve their learning from clinical practices, the students need preceptors who have the skills and competence required to support more advanced reflections and critical thinking on caring situations.

Aim To describe and compare the clinical learning environment in community-based home care and primary health care in postgraduate district nursing students' education. Design Cross-sectional study design. Methods A convenience sample of postgraduate district nursing students was derived from five Swedish universities in 2016 and 2017. Results The postgraduate district nursing students were generally satisfied with the clinical learning environment in their clinical placement. In clinical placement, several factors affected the students' opportunities to learn, such as sufficiently meaningful learning situations with multidimensional content. A working environment that imposed psychosocial strain and high levels of stress among the staff negatively affected the students' learning. To further improve their learning from clinical practices, the students need preceptors who have the skills and competence required to support more advanced reflections and critical thinking on caring situations., CC BY 4.0First published: 05 September 2022Correspondence: Margaretha Larsson, Institution of Health Sciences, University of Skövde, Skövde SE-541 28, Sweden. Email: margaretha.larsson@his.seNo external funding. The respective universities funded their scientists.

Aim To describe and compare the clinical learning environment in community-based home care and primary health care in postgraduate district nursing students' education. Design Cross-sectional study design. Methods A convenience sample of postgraduate district nursing students was derived from five Swedish universities in 2016 and 2017. Results The postgraduate district nursing students were generally satisfied with the clinical learning environment in their clinical placement. In clinical placement, several factors affected the students' opportunities to learn, such as sufficiently meaningful learning situations with multidimensional content. A working environment that imposed psychosocial strain and high levels of stress among the staff negatively affected the students' learning. To further improve their learning from clinical practices, the students need preceptors who have the skills and competence required to support more advanced reflections and critical thinking on caring situations.

BACKGROUND: National guidelines in Sweden recommend preoperative full-body disinfection (FBD) with 4% chlorhexidine to prevent surgical-site infection (SSI) after hip fracture surgery, a method causing patients' severe pain. Although, due to little evidence in research, orthopedic clinics in Sweden are wavering in favor of simpler methods such as local disinfection (LD) of the surgical site. PURPOSE: The aim of this study was to describe the experiences of nursing personnel regarding the performance of preoperative LD on patients prior to hip fracture surgery after having switched from FBD. METHODS: This study has a qualitative design where data were collected via focus-group discussions (FGDs) including in total 12 participants and analysed using content analysis. RESULTS: Six categories were identified describing the aim: sparing the patients' physical harm, sparing the patients' psychological distress, involving the patients in the procedure, improving the working environment for personnel, preventing unethical situations and a more adequate utilization of resources. CONCLUSIONS: All participants considered LD of the surgical site as a favorable method to FBD, witnessing of an increased wellbeing in patients and the method facilitating a better involvement of patients in the procedure, findings that are supported by other studies promoting person-centered care.

BACKGROUND: Human papillomavirus (HPV) self-sampling has shown to be acceptable and feasible across cultures and effective in reaching women who do not participate in regular cervical cancer screening. However, most of these studies have included younger women. There is a lack of knowledge of how older women reason about HPV self-sampling. OBJECTIVE: The aim of this study was to describe how women (>60 years old) experience the offering of self-sampling of HPV, compared to having a sample collected by a healthcare professional. DESIGN AND PARTICIPANTS: The study had a qualitative explorative design. Four focus group discussions were conducted with women 60-69 years old (n = 22). Data were analysed using principles of interpretive description. RESULTS: Five themes were identified: self-sampling-convenient and without pain, lack of knowledge, worries related to HPV self-sampling, need for information and taking a societal perspective. CONCLUSION: Women aged >60 years found that HPV self-sampling was convenient and easy to perform. Further, they stressed the importance of being able to remain in the screening programme in advanced age and that self-sampling could be a possible solution. This study also revealed a lack of knowledge among women in this age group regarding HPV infection, how the disease is transmitted and its relation to cervical cancer. PUBLIC CONTRIBUTION: Women who had performed HPV self-sampling participated in the focus group discussion.

AIM: To describe and compare the clinical learning environment in community-based home care and primary health care in postgraduate district nursing students' education. DESIGN: Cross-sectional study design. METHODS: A convenience sample of postgraduate district nursing students was derived from five Swedish universities in 2016 and 2017. RESULTS: The postgraduate district nursing students were generally satisfied with the clinical learning environment in their clinical placement. In clinical placement, several factors affected the students' opportunities to learn, such as sufficiently meaningful learning situations with multidimensional content. A working environment that imposed psychosocial strain and high levels of stress among the staff negatively affected the students' learning. To further improve their learning from clinical practices, the students need preceptors who have the skills and competence required to support more advanced reflections and critical thinking on caring situations.

BACKGROUND: Palliative care needs in older persons can endanger their dignity. To provide dignity-conserving care to older persons, the Swedish Dignity Care Intervention (DCI-SWE) can be used. The DCI-SWE is built on Chochinov's dignity model and the original version, developed and tested in UK and Scotland. AIM: To describe older persons' and their relatives' experiences of dignity and dignity-conserving care when using the DCI-SWE in municipal health care. RESEARCH DESIGN: A mixed method study with convergent parallel design. PARTICIPANTS AND RESEARCH CONTEXT: The DCI-SWE was used and evaluated in a Swedish municipality health care context. Older persons' (n=17) dignity-related distress and quality of life were assessed after the intervention. Interviews with older persons (n=10) and their relatives (n=8) were analysed using thematic analysis. ETHICAL CONSIDERATIONS: The study followed the World Medical Association Declaration of Helsinki. Ethical approval was obtained from the Regional Ethical Review Board in Uppsala, Sweden (Reg No. 2014/312) and the National Swedish Ethical Review Authority (Reg. No. Ö 10-2019). Informed consent was collected from older persons and their relatives. FINDINGS: The older persons' dignity-related distress did not significantly change over time (p = 0.44) neither was their overall quality of life (p = .64). Only psychological quality of life was decreased significantly (p = 0.01). The older persons and their relatives emphasized the importance of valuing the individual. CONCLUSIONS: The DCI-SWE provides a forum to talk about dignity issues, but relevant competence, continuity and resources are needed. Psychological care actions and health care professionals' communication skills training are important. To fully evaluate, the DCI-SWE a larger sample and validated instruments are necessary., Funding agency:Research School of Successful Ageing, Örebro University, Örebro, Sweden

Background Palliative care needs in older persons can endanger their dignity. To provide dignity-conserving care to older persons, the Swedish Dignity Care Intervention (DCI-SWE) can be used. The DCI-SWE is built on Chochinov's dignity model and the original version, developed and tested in UK and Scotland. Aim To describe older persons' and their relatives' experiences of dignity and dignity-conserving care when using the DCI-SWE in municipal health care. Research design A mixed method study with convergent parallel design. Participants and research context The DCI-SWE was used and evaluated in a Swedish municipality health care context. Older persons' (n=17) dignity-related distress and quality of life were assessed after the intervention. Interviews with older persons (n=10) and their relatives (n=8) were analysed using thematic analysis. Ethical considerations The study followed the World Medical Association Declaration of Helsinki. Ethical approval was obtained from the Regional Ethical Review Board in Uppsala, Sweden (Reg No. 2014/312) and the National Swedish Ethical Review Authority (Reg. No. o 10-2019). Informed consent was collected from older persons and their relatives. Findings The older persons' dignity-related distress did not significantly change over time (p = 0.44) neither was their overall quality of life (p = .64). Only psychological quality of life was decreased significantly (p = 0.01). The older persons and their relatives emphasized the importance of valuing the individual. Conclusions The DCI-SWE provides a forum to talk about dignity issues, but relevant competence, continuity and resources are needed. Psychological care actions and health care professionals' communication skills training are important. To fully evaluate, the DCI-SWE a larger sample and validated instruments are necessary.

Aim To describe and compare the clinical learning environment in community-based home care and primary health care in postgraduate district nursing students' education. Design Cross-sectional study design. Methods A convenience sample of postgraduate district nursing students was derived from five Swedish universities in 2016 and 2017. Results The postgraduate district nursing students were generally satisfied with the clinical learning environment in their clinical placement. In clinical placement, several factors affected the students' opportunities to learn, such as sufficiently meaningful learning situations with multidimensional content. A working environment that imposed psychosocial strain and high levels of stress among the staff negatively affected the students' learning. To further improve their learning from clinical practices, the students need preceptors who have the skills and competence required to support more advanced reflections and critical thinking on caring situations., CC BY 4.0First published: 05 September 2022Correspondence: Margaretha Larsson, Institution of Health Sciences, University of Skövde, Skövde SE-541 28, Sweden. Email: margaretha.larsson@his.seNo external funding. The respective universities funded their scientists.