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Objective: To illuminate child healthcare nurses' experiences of communication with 4‐year‐old children during their visit to the child healthcare center. Design: A qualitative method, using data collected from individual interviews. Sample: Fifteen semistructured interviews with nurses working in a child healthcare center. Measurements: The results were analyzed using reflexive thematic analysis. Results: The analysis resulted in three themes and eight subthemes: Adapting to the child in the conversation, based on the subthemes Preparing for the visit, Listening in and observing, and Creating a welcoming environment; Combining strategies for the conversation, based on the subthemes Engaging the child, Using visual tools, and Parental involvement; and Challenges due to language barriers, based on the subthemes Using an interpreter and Parent acts as interpreter. Conclusion: Child healthcare nurses focus on the child when communicating and strive to create joy and a welcoming environment. The communication strategies employed during the visit include engaging the child directly, involving parents in the conversation, and balancing the parental involvement. Communication challenges related to language barriers are addressed, particularly during interpreter‐assisted conversations. The study indicates a need for tailored strategies, collaboration, and sensitivity to ensure a child‐centered approach. [ABSTRACT FROM AUTHOR]

Background: Previous research found that healthcare professionals had low preparedness for palliative care. Thus, it is necessary to explore healthcare professionals' self‐efficacy. The Swedish Self‐Efficacy in Palliative Care Scale (SEPC‐SE) evaluates readiness in communication, patient management and multidisciplinary teamwork; however, it should be tested on a larger population. Furthermore, the constructs of the SEPC‐SE should be compared to that of the original SEPC. Aim: This study aimed to evaluate the consensus between the construct validity and reliability of the SEPC and the translated and adapted SEPC‐SE. Furthermore, it aimed to describe and compare the self‐efficacy of nurses and physicians in hospitals and explore the associated factors. Methods: The nurses (n = 288) and physicians (n = 104) completed the SEPC‐SE. Factor analysis with Cronbach's alpha evaluated validity and reliability, and an analysis using the Mann‐Whitney U test compared self‐efficacy and multiple linear regression‐associated factors. Results: The SEPC‐SE revealed three factors with high reliability. Education or experience in specialised palliative care was minor, especially for nurses. Self‐efficacy was highest in patient management (nurses, median [md] = 74.57, physicians md = 81.71, p = 0.010) and communication (nurses md = 69.88, physicians md = 77.00, p = 0.141) and lowest in multidisciplinary teamwork (nurses md = 52.44, physicians md = 62.88, p = 0.001). The strongest associations with self‐efficacy were education at work and advanced homecare experiences. In addition, there were significant associations between years in the profession, male sex, physicians and university education. Conclusion: The SEPC‐SE is valid and reliable for measuring self‐efficacy. Nurses had lower self‐efficacy than physicians. Physicians were associated with higher self‐efficacy and had more education and experience in palliative care settings, which may explain their levels of self‐efficacy. [ABSTRACT FROM AUTHOR]

Aim: To gain insight into child‐health nurses' experiences of using pictorial support in health visits within child‐health services. Methods: A qualitative study involving interviews conducted with 17 child‐health nurses in Sweden. The interview data were analysed using content analysis. Results: The nurses experienced that pictorial support could facilitate communication with families and increase opportunities for children to participate in child‐health services, although it may come with challenges. This theme can be broken down into three main categories: (1) Pictorial support makes interaction with families clearer and easier and is used in different ways; (2) The design and extensiveness of the pictorial support can create obstacles; and (3) Pictorial support influences children's attitudes towards, and participation in, health visits. Conclusion: Pictorial support is an important and useful tool in child‐health nurses' own work and improves their communication with children and caregivers during health visits. It can also increase children's participation and help them express themselves. Communicative tools such as pictorial support are very helpful to healthcare professionals striving to offer child‐ and family‐centred care. [ABSTRACT FROM AUTHOR]

Objective: To describe who seeks care and for what reasons at a nurse‐led primary healthcare walk‐in center in an immigrant‐dense area. Studies evaluating the use of nurse‐led walk‐in centers in primary healthcare, emphasizing migrants, are limited. Due to language difficulties and a healthcare system based on telephone consultations, access to care is limited/problematic for the care seeker and the healthcare provider. The center aims to provide migrants and Swedish‐born persons equal access to primary healthcare. Care was integrated into a healthcare center with a multi‐professional environment, offering Arabic and Somali interpreters. Design: Cross‐sectional descriptive registry study. Sample: All consecutive patients visiting during 1‐month. Results: Most individuals (70%) seeking care at the nurse‐led walk‐in center were non‐European migrants from Syria, Iraq and Somalia, but Swedish‐born persons (30%) also consulted the clinic. Women, middle‐aged, and lower‐educated patients dominated. Reasons for seeking care included different kinds of pain, ear/nose/throat issues, and skin problems. Migrants prioritized non‐specific pain and dizziness/headaches, while Swedes sought help primarily for upper respiratory tract infections. About 25% of the migrants needed interpreters, mostly females. Conclusion: The nurse‐led walk‐in center provides accessible care in a multi‐professional team, if needed, serving migrants and Swedish‐born persons, promoting equal healthcare for all. [ABSTRACT FROM AUTHOR]

Purpose: Childhood immunizations have proven to be one of the most beneficial interventions to promote public health and prevent childhood deaths due to disease. However, global coverage of childhood immunization has decreased throughout the world due to guardians' growing hesitancy towards immunizations. This study aims to describe how specialist nurses promote legal guardians to adhere to national childhood immunization programmes. Design and Methods: This study had a qualitative design. Semistructured interviews with 11 specialist nurses, who were paediatric primary care nurses or nurse practitioners, were conducted. Data were analysed using qualitative content analysis. Results: The findings, with four main categories including four subcategories, showed nurses using both local guidelines and national guidelines to promote guardians to adhere to the childhood immunization programme. The main intervention the nurses did to promote childhood immunization coverage was giving legal guardians general information about the programme. With hesitant guardians, adopting a person‐centred approach towards the legal guardian improved adherence. Practice Implications: Further research should focus on how specialist nurses can respond to guardians who decline immunization for their children, as this study identified difficulties in this area. Furthermore, research on guardians' perspectives towards childhood immunization may also help generate further effective guidance on how to promote immunization coverage among children. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

Aim: To describe patients' with chronic obstructive pulmonary disease (COPD) experiences of group‐based self‐management education with a digital website. Design: A qualitative approach with a phenomenologicalmethod. Patients participating in an earlier study, with self‐experience of COPD as a special competence, were involved as research partners at the design of this study. Methods: Eleven individual and two group interviews with five participants in each group were conducted. Results: Group‐based self‐management education with a digital website supports learning. Sharing experiences with others in similar situations creates security and reduces the feeling of being alone. Based on questions and discussion in the group, and through self‐reflection, general information is transformed into useful knowledge and understanding of one's own situation. COPD information on the website provides an opportunity to gain knowledge continuously based on needs that contributes to learning. This research has demonstrated that adapting learning activities to individual learning styles increases sustainability of learning. Sharing experiences reduces feelings of loneliness. It is therefore important to create spaces for sharing experiences and in‐depth reflection that support learning over time. [ABSTRACT FROM AUTHOR]

Aim: To elucidate the meaning of being a close relative of a critically ill person cared for in intensive care during the initial phase of the COVID‐19 pandemic. Design: A narrative inquiry design following the COREQ guidelines. Methods: Individual interviews with fifteen close relatives of patients critically ill with COVID‐19 were analysed using phenomenological hermeneutics. Results: The surreal existence of not being allowed to be near was emotionally difficult. While distancing due to restrictions was challenging, physicians' phone calls served as a connection to their relatives and brought a sense of security. Keeping notes helped them remember what happened and brought order to a chaotic situation. Conclusion: Close relatives feel secure when they receive regular information about their critically ill relative, not just when their condition worsens. They wish to be physically near to their critically ill person; when this is impossible, digital technology can provide support, but further accessibility developments are needed. [ABSTRACT FROM AUTHOR]

Medical libraries in Sweden are digitised to a large extent, technically advanced and developing rapidly. This paper investigates technological trends among Swedish medical libraries in the near and distant future and their application within different areas of library activities. The authors also present a roadmap to increase technological developments within medical libraries in Sweden. Current technological trends include digital collaboration tools, mobile technologies and visualisation. Artificial intelligence, big data and smart technologies are upcoming trends. Technologies are applied within all areas of library activities, but preconditions for academic and hospital libraries differ. To remain a relevant provider of information services, libraries must be able to monitor, test and adopt new technologies. [ABSTRACT FROM AUTHOR]

Aim: Swedish Child Health Services provide regular health surveillance of children 0–5 years and support to parents, with the aim to contribute to equitable child healthcare and to promote physical, emotional, and social health for children. Individual conversations with the child health nurse, including screening for postnatal depression, have been recommended and well implemented for mothers, whereas routines for a visit specifically for the nonbirthing parent vary and are not well studied. The aim of this study was therefore to explore how nonbirthing parents experienced individual conversations with their child health nurse, held 3 months after the birth of their child. Design: Qualitative interview study. Methods: Semistructured interviews were conducted with 16 fathers who had participated in individual conversations with a nurse at their child health centre, 3 months post‐partum. Data were analysed with qualitative content analysis. The study adhered to the COREQ checklist for qualitative studies. Results: The findings are presented in three categories: 'Being invited into a supportive context', 'Talking about what was important' and 'Taking it home', each of them including three subcategories. The individual conversations, without the mother present, made the fathers feel important and allowed for a different type of content, tailored to their own needs. The conversations were validating and led to changes in daily routines with their child for some fathers. [ABSTRACT FROM AUTHOR]

The aim of this paper is to analyse approaches to issues of risk, responsibility and representations of violence in women social workers' conversations with alleged or confirmed violent fathers. The study adds to a growing body of research on agencies' handling of intimate partner violence (IPV) in the context of separation. Empirically, the study draws from 12 structured, audio recorded and transcribed interviews with support‐seeking and divorced fathers, from five municipalities in Sweden, conducted as part of a cooperation project in which a risk‐detection method (Family Law Detection Of Overall Risk Screen [FL‐DOORS]) was also tested. The results suggest a tension between different professional tasks. To validate information on IPV, detect risk and enhance a child perspective competes with other professional projects, most obviously with promoting cooperation between parents. The study confirms previous research, which demonstrates unique challenges facing women social workers and counsellors when working with men as perpetrators. In conclusion, the paper concurs with the call for a focus on responsibility and on safe parenting in professional conversations with allegedly or confirmed abusive fathers. [ABSTRACT FROM AUTHOR]

Background: The risks of developmental language disorder (DLD) for both educational progress and socio‐emotional development are well documented, but little is known about how children and young people with DLD experience and describe their language and communication. The need to complement experimental and quantitative studies with qualitative perspectives of the lived experience of individuals with DLD for speech and language therapists (SLT) practice has recently been foregrounded. Aims: To understand further the experiences of young people with DLD focusing on language and communication in a school context, and thereby contribute to the improvement of the communicative situation in school for this group. The study is guided by the following research question: How do young people diagnosed with DLD describe their experiences of language and communication in school? Methods & Procedures: The study is based on data generated from qualitative semi‐structured interviews with 23 participants diagnosed with DLD (age 13–19 years old) living in Sweden. All participants attended mainstream schools. To enable data to be collected during COVID‐19 restrictions, all interviews were conducted using Zoom. Reflexive thematic analysis was used to analyse the data. Outcomes & Results: Four main themes related to experiences of language and communication in school were constructed from the interviews: (1) feelings of inadequacy and comparisons with others; (2) feelings of being misjudged and misunderstood; (3) the importance of feeling safe and comfortable; and (4) the significance of the social and communicative context. The results bear witness of difficult and challenging aspects related to language and communication in school, including educational, social and emotional dimensions. An important outcome of this study is how young people diagnosed with DLD describe their language and communication functioning to be dependent on both individual characteristics and abilities, as well as situational, contextual and social factors. Conclusions & Implications: The results from this study show that young people with DLD can have persisting problems related to language and communication in school, including educational, social and emotional dimensions. SLT services may therefore be needed throughout the school years to ensure that students with DLD receive adequate support. In addition, support that goes beyond language abilities and targets social, contextual and emotional aspects should be considered. WHAT THIS PAPER ADDS: What is already known on this subject: Children and young people have unique knowledge about their language and communication which is instrumental for designing interventions and support strategies. Qualitative analyses of interview data have been able to identify both risk factors and protective strategies in relation to the well‐being of individuals with DLD. Despite this, children and young people with DLD are rarely heard in research or clinical discussions. What this paper adds to existing knowledge: In this study we listen to the voices of young people with DLD as they describe their experiences of language and communication in school. The participants describe a condition that makes them struggle to keep up with peers and puts them at risk of being misjudged by teachers, but also give examples of situations where negative consequences are hardly felt. What are the potential or actual clinical implications of this work?: DLD is a complex and dynamic disorder where contextual and social factors interact with individual abilities in creating the end result. The results of the study indicate that DLD can cause persisting problems related to language and communication in school, with impact on educational, social and emotional dimensions. To counteract these effects, SLT services may be needed throughout the school years, and support that goes beyond language abilities must be considered. [ABSTRACT FROM AUTHOR]

Aim: To explore nursing assistants' (NAs') experiences of developing communication skills while participating in an educational intervention on person‐centred communication. Design: A descriptive qualitative study was conducted. Methods: Data were collected from interviews and written assignments before, during and after an educational intervention on person‐centred communication targeting NAs in home care services. The data were analysed using a phenomenological approach. A total of 25 NAs participated in the study. Results: The findings describe NAs' experiences concerning the communication skills needed for building relationships with older persons and handling emotionally challenging situations. The educational intervention increased their knowledge and awareness of the importance of communication skills and how such skills are developed and refined. [ABSTRACT FROM AUTHOR]

Background: Health promotion and disease prevention are of utmost importance for sustainable health care and primary health care. District nurses play a key role in primary health care centres, where they meet people suffering from, and/or having risk factors for, non‐communicable diseases. Aim: The study aim was to describe district nurses' perspectives on their health‐promotive/disease‐preventive work at primary health care centres. Methods: Interviews were conducted with 16 district nurses at primary health care centres in Sweden. An interpretive descriptive approach was employed for the analysis. Findings: The district nurses integrated a focus on health‐promotive and disease‐preventive work into every patient encounter, which manifested through four intertwined themes: finding opportunities and striving for visibility; building relationships; considering patients' life situations; and inviting patients to share responsibility. Our findings show how, through a flexible approach, the district nurses strived for equal health and care for all, and how the care was built on a shared responsibility between the district nurse and patient, where district nurses aimed to empower patients to take action for their own health. Conclusion: The district nurses described health‐promotive endeavours, in line with person‐centred care in prioritising building relationships with patients, starting from their lived experience. They spoke of barriers, at both micro and macro levels, to health‐promotive/disease‐preventive work. These included language barriers, the impact of the media, and the overall organisation of primary health care. The work at primary health care centres should be restructured to clarify the district nurse's role, and to strengthen community outreach, and thereby improve individuals' access to support in lifestyle changes. [ABSTRACT FROM AUTHOR]

Background: In dementia with Lewy bodies (DLB), limitations in linguistic and cognitive abilities may lead to difficulties in participating in conversations. The conversational outcome is also dependent on how the conversation partner adjusts to potential communicative challenges. Aims: This study explored resources and barriers in communication in DLB. Methods & Procedures: Linguistic and cognitive function was explored through standard clinical testing. The dyad's perception of function in daily life was explored through semi‐structured interviews analysed with content analysis. Interactional patterns and participation in casual conversation was analysed with conversation analysis. Outcome & Results: The results show how the husband diagnosed with DLB performed with high scores across most cognitive and linguistic test tasks. The interview data, however, revealed how both he and his wife experienced significant challenges regarding, for example, conversational tempo, as well as negative feelings relating to adjusting to these conversational changes. The interactional data from the casual conversation revealed, among other patterns, how the wife engaged in most of the storytelling in the conversation. The husband contributed details when his wife asked for help, or he acknowledged a faulty or missing detail in his wife's storyline. Thus, they both oriented to the husband's competence in monitoring and keeping track of the conversational content, despite challenges in taking the floor. Conclusions & Implications: A holistic picture of communication in DLB necessitates the use of different evaluation approaches. Both monological (e.g., test tasks revealing cognitive and linguistic resources) and dialogical information sources (e.g., observations of conversations revealing adjustments in conversations), as well as the perceptions of those engaging in everyday conversations (i.e., people with DLB and their conversation partner(s)), need to be evaluated when assessing resources and barriers in communication. What this paper adds: What is already known on the subject: It is well‐known that dementia with Lewy bodies (DLB) affects language and cognition. In conversations, persons with DLB experience difficulties in turn‐taking, topic initiation, entering conversations and keeping up with the conversational tempo. What this study adds: This study sheds light on conversations in one dyad where the husband has been diagnosed with DLB. The results from three different information sources (testing of language and cognition, interviews and a video‐recorded conversation) reveal patterns of resources and barriers that at first appear to contradict each other. However, the contradictions can be resolved when these discrepancies are examined in light of the differences in task structure, in terms of, for example, predetermined topics and how turn‐taking is managed. What are the potential or actual clinical implications of this work?: In order to gather a holistic picture of a person's conversational abilities, clinicians need to include information from both monological tasks (e.g., linguistic testing) as well as dialogical tasks (e.g., video recordings from conversation). The results also need to be evaluated in light of all conversation partners' perspectives on function in daily life. Furthermore, it is important to consider the nature of assessment tasks (particularly their interactional structure) when interpreting assessment results. [ABSTRACT FROM AUTHOR]

Aim: Having a culture of safety is crucial when providing high‐quality health care, yet preventable adverse events are common in the Swedish healthcare system, especially in the field of surgical care. Research shows that patient participation can improve patient safety. This study aimed to explore patients' experience of the safety leaflet, "Your safety in hospital," including participation in care and feelings of safe care. Design: This study uses a descriptive qualitative study design. Methods: Twenty patients from surgical wards received patient safety leaflets and participated in semi‐structured interviews during their hospital stay. Data were analysed using qualitative content analysis. Results: Three categories emerged from the analysis: Positive and negative experiences of provided information, Experiences of participation in own care, and Feelings of being safe arising from a perception of good quality care. Most participants were satisfied with their participation in their care and felt safe during their hospital stay. Oral information about the safety leaflet from healthcare personnel was lacking. [ABSTRACT FROM AUTHOR]

Aim: To explore the feasibility of evaluating a novel educational intervention on person‐centered communication for nursing assistants (NAs) in home care. Design: A feasibility study with pre‐ and post‐assessments. Methods: Feasibility was assessed pre‐ and post‐intervention, including evaluation of data collection procedures, completion rates and missing data in two questionnaires: Self‐efficacy Questionnaire measuring communication skills and Measure of Job Satisfaction, analysed descriptively and statistically. Results: The questionnaires were feasible and acceptable for the NAs to complete and understand. The pre‐ and post‐assessments showed 83% and 61% completion rates, respectively, and a low proportion of missing data. Barriers for not participating in data collection were stress caused by staff shortages and high workload. Preliminary analysis of the questionnaires showed no significant difference pre‐ and post‐intervention, even though an overall tendency of increased communication self‐efficacy was observed. The NAs' self‐efficacy ratings also revealed a ceiling effect. [ABSTRACT FROM AUTHOR]

Background: Relevance to clinical practice The findings from the study highlighting family involvement, high‐quality communication and flexible visiting policy as central aspects of family care may inspire clinicians to identify aspects of everyday family care in their ICUs calling for further improvement. Aims and objectives: To describe family involvement, communication practices and visiting policies in adult ICUs. Design: A cross‐sectional survey. Method: A questionnaire consisting of 11 sections was developed, pilot tested and e‐mailed to 196 ICUs. The participants were intensive care nurses in adult ICUs in four Nordic countries. Results: The survey was conducted in October to December 2019. The response rate was 81% (158/196) of the invited ICUs. Most of the units had fewer than 11 beds. Family participation in patient care, including involvement in ward rounds and presence during cardiopulmonary resuscitation, varied between the countries, whereas most families in all countries were involved in decision‐making. Family conferences were generally initiated by staff or family members. Children under 18 did not always receive information directly from the staff, and parents were not advised about how to inform their children. Although most respondents described open visiting, restrictions were also mentioned in free‐text comments. Conclusions: The level of family care in ICUs in the four Nordic countries is generally based on nurses' discretion. Although most Nordic ICUs report having an open or flexible visiting policy, a wide range of potential restrictions still exists. Children and young relatives are not routinely followed up. Family members are included in communication and decision‐making, whereas family involvement in daily care, ward rounds and family‐witnessed resuscitation seem to be areas with a potential for improvement. [ABSTRACT FROM AUTHOR]

Person‐centred care, with its central focus on the patient in partnership with healthcare practitioners, is considered to be the contemporary gold standard of care. This type of care implies effective communication from and by both the patient and the healthcare practitioner. This is often problematic in the case of the paediatric population, because of the many communicative challenges that may arise due to the child's developmental level, illness and distress, linguistic competency and disabilities. The principle of universal design put forth in conventions and legislation means that the design of products and services should be usable by all people, to the greatest extent possible. Augmentative and alternative communication encompasses strategies, for example pictures and apps, that are typically used with people with communication disability. In this position paper, we argue for the universal use of augmentative and alternative communication to support person‐centred communication and care for children, regardless of age or potential disability. Clinical examples are shared from three different paediatric care settings where pictorial supports were applied universally. Interviews were conducted with children and adolescents (with and without disabilities), parents and healthcare practitioners, and the principles of universal design were used as a framework to demonstrate how person‐centred communication is supported in paediatric care. [ABSTRACT FROM AUTHOR]

Aim: To test the effectiveness of a person‐centred and theory‐based educational intervention to increase adolescents′ adherence to adequate oral hygiene behaviour, that is, self‐performed periodontal infection control. Materials and Methods: Data were derived from a prospective, multi‐centred, two‐arm, quasi‐randomized field study in which treatment was performed by dental hygienists (DHs) within the Public Dental Service, Västra Götaland, Sweden. Adolescents with poor oral hygiene conditions were invited to participate. The test intervention was based on cognitive behavioural theory and principles, and the DHs used a collaborative communicative approach, inspired by motivational interviewing. The control intervention consisted of conventional information/instruction. Clinical assessments and oral hygiene behaviours were evaluated at 6 months. Results: Three‐hundred and twelve adolescents were enrolled, of whom 274 followed the treatment to 6‐month follow‐up. There were significant improvements in gingival bleeding and plaque scores for both treatment groups at 6 months, with significantly greater improvements in the test group. Adolescents in the test group brushed their teeth and used interdental cleaning aids more frequently compared to participants in the control group at 6 months. Conclusion: A person‐centred and theory‐based oral health education programme is more effective than conventional oral health education in improving adolescents' oral hygiene behaviour and periodontal infection control. ClinicalTrials.gov (NCT02906098). [ABSTRACT FROM AUTHOR]

Aims and objectives: This study aims to provide insight into healthcare professionals' lived experiences of digital health competence with the objective of improving the knowledge of how digital health competence is perceived by healthcare professionals. Background: Healthcare professionals need to adjust to the digital era to provide quality and ethical care. Previous research has rarely adopted a healthcare professional's standpoint to describe their perceptions of digital health competence, even though their perspective in how new care practices are designed and implemented is vital. Design: A qualitative descriptive study. Methods: Healthcare professionals (nurses and allied health professionals) from versatile healthcare settings were recruited for individual semi‐structured interviews in Sweden (n = 5) and Finland (n = 15) (spring 2019‐summer 2020). Purposive and convenience sampling was used. Participants' backgrounds were in the public and private sectors. The interviews were transcribed for inductive content analysis. The SRQR guideline guided the study process. Results: Healthcare professionals' perceptions of digital health competence are connected to competence to provide patient‐centric care through digital channels, using technology and digital health systems, interacting with the patient through digital means, evaluating what digital health is and combining digital and traditional methods. Professionals' perceptions of their own digital health competence were divided, with the participants either reporting sufficient competence or perceiving a lack of skills in some specific areas. Conclusions: Healthcare professionals' perceptions of digital health competence focus on the ability to provide patient‐centric care by evaluating the need and possibilities for using digital health services jointly with more traditional methods. This study provides a sound basis for digital health research, but future studies should focus on elucidating factors which affect digital health competence and competence development. Relevance to clinical practice: The results of this study can guide healthcare practices and digital health implementation, as well as function as a basis for instrument or theory development. Health care and nursing leaders should enable the resources to hybrid practices in patient‐centric care provision. [ABSTRACT FROM AUTHOR]

The role of nurses and nursing in CAP inpatient care is unclear, and nurses are at risk of moral distress due to having to deal with complex demands while lacking organizational support. This study aimed to describe nurses' and assistant nurses' experiences working in child and adolescent psychiatric inpatient care. Eight nurses and seven assistant nurses working in a child and adolescent ward in Sweden participated in the study. Data were collected in 2019 using semi‐structured qualitative interviews and subject to qualitative content analysis. Results describe nurses' and assistant nurses' experiences of child and adolescent psychiatric inpatient care in one theme, Constrained nursing, and four categories: Striving to be there for children and parents; Finding a way to manage work; Depending on others; Lacking nursing leadership. Findings suggest that good, person‐centred and recovery‐oriented nursing practice can exist in CAP inpatient care but remain unrecognized and lacking support due to unclear roles and responsibilities and lack of nursing leadership. This study is reported in accordance with the COREQ guidelines. [ABSTRACT FROM AUTHOR]

Objective: The aim of the study was to explore the communication tools that child healthcare nurses can use during home visits to families when language barriers exist. Design: Qualitative study using data collected from focus group sessions. Sample: Six semi‐structured focus group interviews with twenty nurses in child healthcare services. Measurements: The results were analyzed with a thematic content analysis. Results: The analysis resulted in two themes: Using pictures as support in the conversation, with subthemes Not using pictures as support, Wanting to know how to use pictures as support, Pictures as support for invitations, Different types of pictures as support, and Alternative means of communication with the subthemes Possibilities of using an interpreter, Obstacles to using an interpreter, Mixed communication. Conclusion: If language barriers are present during home visits, decision‐making nurses in Child Health Care (CHC) put families in an unequal position when communicating with them. These results point to a need for more education, guidelines and support regarding alternative and augmentative communication (AAC) tools and structures to assist in overcoming language barriers. [ABSTRACT FROM AUTHOR]

Background: Oral nutritional supplements (ONS) are commonly prescribed to patients with malnutrition. Dietitians have been suggested as preferred prescribers but generally lack ONS prescribing rights. How dietitians with prescribing rights experience their professional practice of prescribing ONS remains understudied. Thus, by exploring dietitians' experiences of prescribing ONS, the present study aimed to obtain a deeper understanding of specific aspects that are of importance for dietitians when providing a nutrition therapy including ONS. Methods: Qualitative individual interviews were conducted with 13 dietitians prescribing ONS to free‐living adult outpatients with malnutrition or at nutritional risk in the hospital or primary care setting. Systematic text condensation was used for data analysis. Results: Two main categories signifying important aspects were identified and labelled: 'Shared tailoring of the ONS prescription' and 'Supporting and facilitating ONS use'. First, the dietitians described tailoring the ONS prescription together with the patient, having their acceptance as a prerequisite, and being flexible regarding products and amounts prescribed. Second, they described performing different communication strategies and organising of practical issues (e.g., ONS delivery and support from others) to support and facilitate patients' ONS usage. Conclusions: The present study identifies patient involvement and the role of dietitians as behaviour change facilitators as two important aspects when dietitians prescribe ONS. These findings allow for dietitians' ideals and strategies on how to prescribe ONS to be made more visible, which can inform both clinical practice and clinical trials for future improvements in nutrition therapy to address malnutrition. [ABSTRACT FROM AUTHOR]

Background: The coronavirus pandemic has resulted in an increased number of interhospital transfers of patients with artificial airways. The transfer of these patients is associated with risks and has been experienced as highly challenging, which needs to be further explored. Aims and objectives: To describe critical care nurses' experiences of caring for critically ill patients with artificial airways during interhospital transfers. Design: A cross‐sectional study using a qualitative approach was conducted during spring 2020. Participants were critical care nurses (n = 7) from different hospitals (n = 2). Methods: The data were collected through semi‐structured interviews based on an interview guide. A qualitative content analysis using an inductive approach was performed. Results: The analysis resulted in one main theme, "Preserving the safety in an unknown environment," and three sub‐themes, "Being adequately prepared is essential to feel secure," "Feeling abandoned and overwhelmingly responsible," and "Being challenged in an unfamiliar and risky environment." Conclusions: Critical care nurses experienced interhospital transfers of critically ill patients with artificial airways as complex and risky. It is essential to have an overall plan in order to prevent any unpredictable and acute events. Adequate communication and good teamwork are key to the safe transfer of a critically ill patient in that potential complications and dangers to the patient can be prevented. Relevance to clinical practice: Standardized checklists need to be created to guide the transfers of critically ill patients with different conditions. This would prevent failures based on human or system factors, such as lack of experience and lack of good teamwork. [ABSTRACT FROM AUTHOR]

Aim: To explore older people's experiences of registered nurses' leadership close to them in community home care. Introduction: In Sweden and throughout the world, the number of people 65 years and older is increasing. While older people are living for more years, living longer can bring more diseases and disabilities, which might lead to the need for home care. Registered nurses are responsible for older people's care needs in their leadership in community home care; this is a part of their professional role as registered nurses, and it implies that they must be multi‐artists. Design: An explorative and inductive design was used in two communities in western Sweden. Methods: Individual interviews were conducted with older people (n = 12) with at least one year of experience with community home care. Data were analysed using qualitative content analysis. Results: The results are presented in the theme 'my registered nurse', including five categories – relationship, professional competence, nursing interventions, coordination and collaboration and organisation – and 15 sub‐categories. Conclusions: These findings are based on older people's own experiences. This is specific, as the phenomenon of the RNs leadership is rarely explored from the perspective of older people. Implications for practice: There is a need for organisations to create more opportunities for older people to have their own registered nurses leading close to them. This is because registered nurses have specific competences for meeting older people's individual needs and involving them as competent partners in satisfying their care needs. [ABSTRACT FROM AUTHOR]

Background: While increasingly discussed in somatic care, the concept of patient participation remains unsettled in psychiatric care, potentially impeding person‐centred experiences. Objective: To describe outpatient psychiatric care patients' conceptualization of patient participation. Design: An exploratory survey. Setting and participants: Patients in four psychiatric outpatient care units. Variables: Patients conceptualized patient participation by completing a semi‐structured questionnaire, including optional attributes and free text. Data were analysed using statistics for ordinal data and content analysis for free text. Results: In total, 137 patients (69% of potential respondents) completed the questionnaire. The discrete items were favoured for conceptualizing patient participation, indicating a primary connotation that participation means being listened to, being in a reciprocal dialogue, learning about one's health care and managing one's symptoms. Additional free‐text responses acknowledged the attributes previously recognized, and provided supplementary notions, including that patient participation is about mutual respect and shared trust. Discussion: What patient participation is and how it can be facilitated needs to be agreed in order to enable preference‐based patient participation. Patients in outpatient psychiatric care conceptualize participation in terms of both sharing of and sharing in, including taking part in joint and solo activities, such as a reciprocal dialogue and managing symptoms by yourself. Conclusion: While being a patient in psychiatric care has been associated with a lack of voice, an increased understanding of patient participation enables person‐centred care, with the benefits of collaboration, co‐production and enhanced quality of care. Patient contribution: Patients provided their conceptualization of patient participation in accordance with their lived experience. [ABSTRACT FROM AUTHOR]

Background: Children often report both fear and pain in conjunction with clinical care and treatment. Interventions developed in the field have still not been sufficient to prevent and relieve children's fear and pain. More knowledge, from children's own perspectives, is needed about how they deal with their experiences. Aim: To explore child‐identified strategies that children use to manage fear and pain during needle‐related medical procedures in hospital. Methods: Interviews with children, age 4–12 years, with experience of hospital care were analysed qualitatively using content analysis. Results: Children have self‐identified strategies for dealing with fear and pain during hospital care and treatment. The strategies vary depending on examination or treatment and on how the child felt at that particular day. Children describe what they can do themselves, how adults can empower them and support from surroundings as strategies that give them a choice and a voice. Children wished to have influence, decide when and how information should be given, scream out loud or squeeze something hard, to deal with fear and pain. The results also show that children tried to be brave, gain control and think positively. Something nice to look at and opportunities to play with others also contributed. Conclusions: Strategies vary between children and are used differently on different occasions. Healthcare professionals pose a threat to the child's needs and ability to use their strategies due to lack of knowledge of the child's chosen strategies. [ABSTRACT FROM AUTHOR]

Aim: At present, there is no reliable method to screen for communication difficulties at age 18-months in the Swedish child health care. This study examined the psychometric properties of the Communication and Symbolic Behavior Scales Developmental Profile Infant-Toddler Checklist (ITC) when used at the 18-month visit in the child healthcare setting.Methods: Children aged 16-20 months (n = 679) were screened. Children were referred for an assessment if they screened positive screen or if the parent or nurse was concerned about the child's communicative development. Two groups of positive screens were used in the analysis (n = 78 children), one based on the ITC result, and one combining the ITC with contradicting information from the nurses' informal clinical assessment.Results: The AUC ranged from 0.68 to 0.84. The sensitivity was 0.85, and the specificity was 0.59. When the ITC result was combined with the nurses' information, sensitivity increased to 0.88 and specificity to 0.63. The internal consistency was moderate to high, and fit indices were satisfactory.Conclusion: The results suggest that the ITC can be used to identify children in need of interventions to enhance communication at 18 months of age, especially in combination with the nurse's assessment. [ABSTRACT FROM AUTHOR]

Background: Anorexia nervosa (AN) and autism spectrum disorder (ASD) may be phenotypically and etiologically linked. However, due to the absence of prospective studies, it remains unclear whether the elevation of autistic traits in AN is evident in early childhood. Here, we prospectively investigated autistic traits before and after the first diagnosis of AN. Methods: In a population‐based sample of 5,987 individuals (52.4% female) from the Child and Adolescent Twin Study in Sweden, parents reported autistic traits at ages 9 and 18. AN and ASD diagnoses were retrieved from the Swedish National Patient Register. In addition, AN diagnoses were ascertained by parent‐reported treatment for AN. We compared whether individuals with and without AN differed in autistic traits before the first diagnosis of AN (age 9) and after the first diagnosis of AN (age 18). Results: We did not find evidence for elevated autistic traits in 9‐year‐old children later diagnosed with AN. At age 18, however, there was a marked elevation in restricted/repetitive behavior and interests, but only in the subgroup of individuals with acute AN. A less pronounced elevation was observed for social communication problems. Conclusions: Coping strategies in individuals with ASD and the somewhat different female ASD phenotype may explain why we did not find elevated autistic traits in children who later developed AN. Alternatively, it is possible that elevated autistic traits were not present prior to the onset of AN, thus questioning the previously reported elevated prevalence of ASD in AN. Future studies should use tailored measurements in order to investigate whether autistic traits in individuals with AN are best conceptualized as an epiphenomenon of the acute AN phase or whether these symptoms indeed represent ASD as a clinically verifiable neurodevelopmental disorder. [ABSTRACT FROM AUTHOR]

Shortage and turnover of registered nurses are worldwide challenges, and work motivation is one factor in retaining staff in the healthcare sector. The aim of this study was to explore registered nurses' motivation expressed in daily communication, using the basic needs in self‐determination theory as a framework. A secondary analysis of ethnographic data, collected through participant observations, informal interviews during observations, and individual interviews, was used. A total sample of all registered nurses employed at a hospital unit in Sweden (n = 10) participated. The data were analyzed thematically through the lens of the basic needs in self‐determination theory: autonomy, competence, and relatedness. Self‐regulation of learning, the possibilities to discuss work‐related challenges with colleagues, and having registered nurses lead dialogues with physicians were factors connected to autonomy. Having a registered nurse and physician solve problems together was a factor connected to competence. A sense of belonging and security in a permissive climate between registered nurses was connected to relatedness. This paper has implications for increased awareness of the three basic motivational needs, which could be used in the development of attractive workplaces. [ABSTRACT FROM AUTHOR]

To meet children's needs for information and support when a parent has a mental illness, Beardslee's family intervention was implemented in Swedish psychosis care. The present study aimed to gain understanding of how parents' with psychosis and their children experienced having taken part in Beardslee's family intervention. The study followed COREQ guidelines. Semi‐structured interviews were conducted with 15 participants (8 parents with psychosis and 7 children) who had participated in the family intervention. Data were analysed with content analysis. Results showed that the parents perceived that the intervention had contributed to improved illness knowledge, communication, and understanding in the family. They also appreciated receiving support in finding an age‐adapted way of explaining their illness, but asked for structured follow‐ups in order to maintain communication. However, comparing parents' and children's interviews led to discrepancies in perceptions of the overall benefits of the intervention. In conclusion, parents with psychosis need continual support in talking to their children about their illness. Furthermore, discrepancies between parents' and children's interviews show the importance of multi‐perspective data collection when studying intervention effects. [ABSTRACT FROM AUTHOR]

Aims and objective: To describe telenurses' experiences of monitoring calls in telephone advice nursing to parents of children with gastroenteritis. Background: In previous studies, making monitoring calls is mentioned as a method used by telenurses to assess the need for care. MonitoringTHE terms 'care‐seekers', 'care‐seeker' and 'careseekers' are used inconsistently in the article. Please suggest which one to follow. We suggest Care‐seeker calls in telephone advice nursing have been described as when telenurses call care‐seekers back once or twice after an initial call. Calls from parents of children with gastroenteritis are common, and many of these calls result in telenurses providing self‐care advice. Methods: Nineteen telenurses from two healthcare call centres in Sweden were interviewed. Data were analysed using inductive qualitative content analysis. Results: One main category, four generic categories and eleven sub‐categories emerged. The telenurses described how working with monitoring calls aimed to provide self‐care at home in a patient‐safe way. Their focus on the parents aimed at increasing their feeling of security and focus on the child aimed at ensuring patient safety. Monitoring calls also provided a learning opportunity for parents and telenurses, and the possibility of relieving pressure on healthcare services. The findings indicate that the use of monitoring calls aims to provide a patient‐safe form of telephone advice nursing. Conclusion: This study shows that many parents feel insecure when their child has gastroenteritis, and the use of monitoring calls may be an effective approach to help them feel more secure at home with their sick child. [ABSTRACT FROM AUTHOR]

Background: Patient participation is associated with satisfaction and improved health‐related outcomes. In gastrointestinal endoscopy, patient participation is an underexplored area. Objective: To gain understanding on patients' experiences, attitudes and preferences concerning patient participation in the endoscopy pathway. Methods: Semi‐structured interviews with endoscopy patients (n = 17, female n = 8, male n = 9, ages 19‐80 years) were performed. Interview transcripts were analysed using qualitative content analysis. Participants were recruited by purposive sampling from an endoscopy unit in a Swedish university hospital. Inclusion:≥ 18 years, fluency in Swedish and recent experience of endoscopy at the unit. Results: Five generic categories emerged, two within the area of the patient's role, which was described as active or passive/included or excluded. Another three generic categories related to factors, critical to active participation, including organizational aspects, impressions of staff and individual circumstances were identified. In this context, patient participation described in the interviews was on a low to basic level, although sometimes reaching a higher level when staff 'invited' patients in decision making. Discussion: This study contributes to the understanding of patient participation in endoscopy. Patients are in an inferior position and need support from the staff for an active role in their care. Although there were variations on the perceived importance of different factors, a heavy responsibility lies on the endoscopy staff to acknowledge the patients' individual needs and to facilitate patient participation. Conclusions: Endoscopy staff has a key role in supporting patient participation. In endoscopy settings, patient participation is vulnerable to multiple factors. [ABSTRACT FROM AUTHOR]

Rationale, aim, and objectives: More knowledge is needed regarding the complex factors and perceptions that enable the implementation of change in health care. The study aimed to examine the enabling factors and barriers encountered in the implementation of improvements in health care in order to achieve patient‐centred care (PCC) and to study if there was a correlation in the extent the improvements were perceived to be implemented and the preconditions that were considered to affect them. Methods: Using a mixed method design, data were gathered via a questionnaire and individual interviews with health care personnel, clinic managers, and first‐line managers. The data collection and analyses were based on the framework for Promoting Action on Research Implementation in Health Services (PARiHS). Correlations between PCC improvements and preconditions for improvements were performed. Results: A high level of involvement, knowledge, and adequate resources were considered important to achieve an implementation of PCC with joint responsibility. Leadership and management need to be explicit and promote continuous follow‐up and feedback. Preconditions for improvement had a linear correlation with the perceived level of implementation. Knowledge‐related preconditions had greatest impact on implementation. Conclusions: The PARiHS framework was appropriate to use since the three components of evidence, context, and facilitation present different important preconditions in the implementation process. Evidence was the highest rated contributor since evidence‐based practices in health care are necessary. It is vital that the important role of the context and facilitators is acknowledged in the implementation process to enable a successful implementation of change. There is a need to incorporate a clear strategy involving all levels in the organization. Furthermore, leaders play an important role in the implementation by facilitating communication and support and by having trust in facilitators and health care personnel. The results are applicable to other interventions implementing change in health care. [ABSTRACT FROM AUTHOR]

Background: Caller satisfaction with telephone advice nursing (TAN) is generally high, and the interaction is essential. However, a valid questionnaire exploring caller satisfaction in TAN with focus on perceived interaction is lacking. Objective: To develop and assess content validity and test‐retest reliability of a theoretically anchored questionnaire, the Telenursing Interaction and Satisfaction Questionnaire (TISQ), that explores caller satisfaction in TAN by focusing on perceived interaction between the caller and the telenurse. Methods: The study was performed in three stages. First, variables relevant for patient satisfaction in health care were identified through a literature search. Variables were then structured according to the Interaction Model of Client Health Behavior (IMCHB), which provided theoretical guidance. Items relevant for a TAN context were developed through consensus discussions. Then, evaluation and refinement were performed through cognitive interviews with callers and expert ratings of the Content Validity Index (CVI). Finally, test‐retest reliability of items was evaluated in a sample of 109 individuals using intraclass correlation coefficients (ICC). Results: The TISQ consists of 60 items. Twenty items cover perceived interaction in terms of health information, affective support, decisional control and professional/technical competence. Five items cover satisfaction with interaction and five items overall satisfaction. Remaining items reflect singularity of the caller and descriptive items of the call. The TISQ was found to exhibit good content validity, and test‐retest reliability was moderate to good (ICC = 0.39‐0.84). Conclusions: The items in the TISQ form a comprehensive and theoretically anchored questionnaire with satisfactory content validity and test‐retest reliability. [ABSTRACT FROM AUTHOR]

Aim: We explored physicians' experiences of communicating with families when their child had cancer and a cure was no longer an option, by focusing on barriers and facilitating factors.Methods: Physicians from the six cancer centres in Sweden took part in focus group discussions between December 2017 and May 2018, and the data were analysed using qualitative content analysis. Focus groups enabled us to gather individual and shared perspectives.Results: The 35 physicians (20 male) had a mean age of 47 (range 31-74) and a mean of 11 years' experience in oncology, ranging from under one year to 43 years. They reported communication challenges when a cure was not possible, namely: emotional and mental drain, lack of mutual understanding and uncertainty about communication skills. They also reported facilitating factors: flexibility in complex conversations, the child's position in the conversations, continuity and trusting relationships, support from colleagues and having discussed the potentially life-threatening nature of cancer from the very start of treatment.Conclusion: Training to overcome communication issues could support the early integration of palliative care. [ABSTRACT FROM AUTHOR]

The aim of this study was to explore the influence of characteristics of nurses and older people on emotional communication in home care settings. A generalized, linear, mixed model was used to analyze 188 audio‐recorded home care visits coded with Verona Coding Definitions of Emotional Sequences. The results showed that most emotional distress was expressed by older females or with female nurses. The elicitation of an expression of emotional distress was influenced by the nurses' native language and profession. Older women aged 65–84 years were given the most space for emotional expression. We found that emotional communication was primarily influenced by sex for nurses and older people, with an impact on the frequency of expressions of and responses to emotional distress. Expressions of emotional distress by older males were less common and could risk being missed in communication. The results have implications for students' and health professionals' education in increasing their knowledge of and attentiveness to the impacts of their and others' characteristics and stereotypes on emotional communication with older people. [ABSTRACT FROM AUTHOR]

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

Background: Despite increased attention and knowledge in palliative care, there is still confusion concerning how to interpret the concept of palliative care and implement it in practice. This can result in difficulties for healthcare professionals in identifying patients whom would benefit from palliative care, which, in turn, could lead to a delay in meeting patients' needs. Aim: To explore healthcare professionals' perceptions of palliative care. Method: Data were collected through twelve interprofessional focus group interviews in community care and hospital wards in south Sweden (n = 74). All interviews were analysed with latent content analysis. Results: Three domains were revealed: first, a blurred conceptual understanding as participants described palliative care using synonyms, diagnoses, phases, natural care and holism; second, a challenge to communicate transitions concerned the importance of how and when the transition to palliative care was communicated and documented; finally, a need for interprofessional collaboration was described as well as the consequences for severely ill persons, relatives and healthcare professionals when it was not established. Conclusion: The perceptions about how to interpret palliative care differed as well as when palliative care should be offered and decided, which might have practical consequences. How long a person has left to live is of great significance for decision‐making, caregiving and preparation in palliative care. The challenge is to use interprofessional communication to promote understanding and collaborate across varied care levels. Integrating palliative care across diverse care levels could be one way to reduce the ambiguity of palliative care. [ABSTRACT FROM AUTHOR]

Aim: Studies of children's early ability to communicate have mainly focused on mother-child dyads. That is why this study analysed the long-term effects of triadic interactions involving both parents.Method: This prospective pilot study monitored child-mother-father communication in 19 families from the general population in Sweden using the standardised Lausanne Trilogue Play method in a video studio. The families and their first-born child were initially followed from three months to 48 months of age. Preschool teachers assessed the children at the age of four using the Preschool Behaviour Questionnaire and then their teachers assessed the subjects at the age of 15 using the Strengths and Difficulties Questionnaire. Early communication was analysed in relation to the children's social competence at the age of 15.Results: The child's skills in initiating turn-taking sequences and their parents' responses to this correlated with the child's social competence at the age of four, as reported in a previous study from our group, and at the age of 15, as reported here.Conclusion: The results of this study indicated that stimulating children's capacity to initiate turn-taking sequences in infancy improved their social competence at the age of 15, confirming positive results at four years of age. [ABSTRACT FROM AUTHOR]

The facilitation of quality time between patients and staff in psychiatric inpatient care is useful to promote recovery and reduce stress experienced by staff. However, interventions are reported to be complex to implement and are poorly described in the literature. This multisite study aimed to evaluate the feasibility and effects of the nursing intervention Time Together, using mixed methods. Data consisted of notes from participant observations and logs to evaluate feasibility, and questionnaires to evaluate effects. The primary outcome for patients was quality of interactions, and for staff, it was perceived stress. The secondary outcome for patients was anxiety and depression symptom levels, and for staff, it was stress of conscience. Data were analysed using visual analysis, percentage of nonoverlapping data, and qualitative content analysis. The results showed that Time Together was a feasible intervention, but measurements showed no effects on the two patient outcomes: quality of interactions and anxiety and depressive symptoms and, questionable effects on perceived stress and stress of conscience among staff. Shared responsibility, a friendly approach, and a predictable structure enabled Time Together, while a distant approach and an unpredictable structure hindered the intervention. In conclusion, the intervention proved to be feasible with potential to enable quality interactions between patients and staff using the enabling factors as supportive components. It also had some effects on perceived stress and stress of conscience among staff. Further evaluation is needed to build on the evidence for the intervention. [ABSTRACT FROM AUTHOR]

Objectives: The aim of this study was to investigate public health nurses' experiences of using interpreters when meeting with Arabic‐speaking first‐time mothers. Design and Sample: An inductive qualitative design was used. Individual interviews were conducted with Swedish public health nurses (n = 11) with experience of working in child health care with interpreters when meeting with Arabic‐speaking first‐time mothers. Measures: Data were analyzed using qualitative content analysis. Results: The analysis of the interviews resulted in one overarching theme: Having to accept and learn to incorporate interpreters when meeting with Arabic‐speaking first‐time mothers. Three subthemes were identified: (a) enabling an understanding of the situation of the mothers; (b) contributing to a trustful relationship; and (c) creating disturbing elements in the dialogue. Conclusions: Using interpreters optimized the conversation between the public health nurse and the Arab‐speaking first‐time mother; however, the complexity of using interpreters was also apparent. [ABSTRACT FROM AUTHOR]

Few studies have focused on women's childbirth experiences in relation to patient safety. The aim of this study was to explore the meaning of safety as a process phenomenon by outlining women's positive and negative experiences of safety in childbirth. A descriptive explorative design was chosen and 16 interviews were conducted. Qualitative content analysis was used. One main theme emerged: safe childbirth through involvement and guidance, based on four subthemes. The characteristics of women's experiences of safe childbirth included the need to be informed and involved by sharing and receiving trustworthy information. Women's experiences of unsafe childbirth included lack of meaningful and trustworthy information that resulted in feelings of being misled or lulled into a false sense of security. Not being involved evoked feelings of being ignored. In conclusion, this study highlights issues of importance for safe maternity care. The perspectives of childbearing women can contribute to an understanding of how to achieve meaningful improvements to provide safer maternity care. [ABSTRACT FROM AUTHOR]

Abstract: Background: Respiratory muscle impairment following cervical spinal cord injury (CSCI) may lead to reduced voice function, although the individual variation is large. Voice problems in this population may not always receive attention since individuals with CSCI face other, more acute and life‐threatening issues that need/receive attention. Currently there is no consensus on the tasks suitable to identify the specific voice impairments and functional voice changes experienced by individuals with CSCI. Aims: To examine which voice/speech tasks identify the specific voice and communication changes associated with CSCI, habitual and maximum speech performance of a group with CSCI was compared with that of a healthy control group (CG), and the findings were related to respiratory function and to self‐reported voice problems. Methods & Procedures: Respiratory, aerodynamic, acoustic and self‐reported voice data from 19 individuals (nine women and 10 men, aged 23–59 years, heights = 153–192 cm) with CSCI (levels C3–C7) were compared with data from a CG consisting of 19 carefully matched non‐injured people (nine women and 10 men, aged 19–59 years, heights = 152–187 cm). Outcomes & Results: Despite considerable variability of performance, highly significant differences between the group with CSCI and the CG were found in maximum phonation time, maximum duration of breath phrases, maximum sound pressure level and maximum voice area in voice‐range profiles (all p = .000). Subglottal pressure was lower and phonatory stability was reduced in some of the individuals with CSCI, but differences between the groups were not statistically significant. Six of 19 had voice handicap index (VHI) scores above 20 (the cut‐off for voice disorder). Individuals with a vital capacity below 50% of the expected for an equivalent reference individual performed significantly worse than participants with more normal vital capacity. Completeness and level of injury seemed to impact vocal function in some individuals. Conclusions & Implications: A combination of maximum performance speech tasks, respiratory tasks and self‐reported information on voice problems help to identify individuals with reduced voice function following CSCI. Early identification of individuals with voice changes post‐CSCI, and introducing appropriate rehabilitation strategies, may help to minimize development of maladaptive voice behaviours such as vocal strain, which can lead to further impairments and limitations to communication participation. [ABSTRACT FROM AUTHOR]

Aim: The first nurse practitioners in surgical care were introduced into Swedish surgical wards in 2014. Internationally, organisations that have adopted nurse practitioners into care teams are reported to have maintained or improved the quality of care. However, close qualitative descriptions of teamwork practice may add to existing knowledge of interprofessional collaboration when introducing nurse practitioners into new clinical areas. The aim was to report on an empirical study describing how interprofessional teamwork practice was enacted by nurse practitioners when introduced into surgical ward teams. Methods and results: The study had a qualitative, ethnographic research design, drawing on a sociomaterial conceptual framework. The study was based on 170 hours of ward‐based participant observations of interprofessional teamwork practice that included nurse practitioners. Data were gathered from 2014 to 2015 across four surgical sites in Sweden, including 60 interprofessional rounds. The data were analysed with an iterative reflexive procedure involving inductive and theory‐led approaches. The study was approved by a Swedish regional ethics committee (Ref. No.: 2014/229‐31). The interprofessional teamwork practice enacted by the nurse practitioners that emerged from the analysis comprised a combination of the following characteristic role components: clinical leader, bridging team colleague and ever‐present tutor. These role components were enacted at all the sites and were prominent during interprofessional teamwork practice. Conclusion: The participant nurse practitioners utilised the interprofessional teamwork practice arrangements to enact a role that may be described in terms of a quality guarantee, thereby contributing to the overall quality and care flow offered by the entire surgical ward team. [ABSTRACT FROM AUTHOR]

Abstract: Background: Although teamwork and interprofessional collaboration are critical to patient safety, nursing, medical, and allied health graduates often feel ill‐prepared to confidently communicate and collaborate with other team members. While interprofessional education (IPE) has been advocated as a way of addressing this issue, there are multiple barriers to its systematic and sustained integration in undergraduate healthcare programs. Despite these challenges, examples of effective IPE initiatives have emerged. Innovation: This article profiles seven case studies of innovative interprofessional education activities that have been successfully implemented across five countries, for a variety of learners, using different delivery modalities, and with evaluation results attesting to their success. Conclusions: The case studies demonstrate innovative ideas that have the potential to overcome some of the barriers to IPE through the use of creative and targeted approaches. This article provides a wealth of ideas for the successful design and implementation of IPE initiatives and will be of benefit to educators wishing to expand their repertoire of teaching approaches. Clinical Relevance: A body of research attests to the relationship between interprofessional communication, teamwork, and patient outcomes. IPE is imperative for facilitating the development of nursing graduates’ communication and teamwork skills; however, innovative approaches are needed to overcome the perceived and actual impediments to its implementation. [ABSTRACT FROM AUTHOR]

Background The preoperative education, which occurs in preoperative patient consultations, is an important part of the surgical nurse's profession. These consultations may be the building blocks of a partnership that facilitates communication between patient and nurse. Aim The aim of the study was to describe topics and structure and documentation in preoperative nursing consultations with patients undergoing surgery for colorectal cancer. Method The study was based on analysis of consultations between seven patients and nurses at a Swedish university hospital. The preplanned preoperative consultations were audio-recorded and transcribed verbatim. The structure of the consultations was described in terms of phases and the text was analysed according to a manifest content analysis Results The consultations were structured on an agenda that was used variously and communicating different topics in an equally varied manner. Seven main topics were found: Health status, Preparation before surgery, Discovery, Tumour, Operation, Symptoms and Recovery after surgery. The topic structure disclosed a high number of subtopics. The main topics 'Discovery', 'Tumour' and 'Symptoms' were only raised by patients and occupied only 11% of the discursive space. Documentation was sparse and included mainly task-oriented procedures rather than patients' worries and concerns. Conclusion There was no clear structure regarding preoperative consultation purpose and content. Using closed questions instead of open is a hindrance of developing a dialogue and thus patient participation. Preoperative consultation practice needs to be strengthened to include explicit communication of the consultations' purpose and agenda, with nurses actively discussing and responding to patients' concerns and sensitive issues. The results of the study facilitate the development of methods and structure to support person-centred communication where the patient is given space to get help with the difficult issues he/she may have when undergoing surgery. [ABSTRACT FROM AUTHOR]

Background Due to the current world situation, Sweden has one of the highest asylum applications within the European Union. Immigrant mothers, specifically those who have immigrated during the last ten years and do not speak the language of the new country, are found to be at particular risk of being effected by postpartum depression. Aim In this study, we elucidate Swedish Child Health Services nurses' experiences of identifying signs of postpartum depression in non-Swedish-speaking immigrant mothers. Methods Latent content analysis was used when analysing data material from 13 research interviews. Results Being able to interpret a non-Swedish-speaking immigrant mother's mood required establishing and constant deepening of a transcultural caring relationship, the use of cultural knowledge to perceive signs of postpartum depression from observations and interactions and to rely on intuition. Conclusion There are both challenges and key factors for success in interpreting the mood of non-Swedish-speaking immigrant mothers. Implications This study provides information to healthcare professionals about challenges with adapting the screening with the Edinburgh Postnatal Depression Scale to immigrant mothers not speaking the language of residence. Tacit knowledge and cultural competence among healthcare personnel are invaluable assets when interpreting mental health in this vulnerable group of mothers. [ABSTRACT FROM AUTHOR]

Background The use of traffic risk assessment questions is an understudied area in nursing research. Obstructive sleep apnoea is associated with an increased risk of traffic accidents. Therefore, traffic safety authorities demand adherent continuous positive airway pressure use. Nurses act as coaches to achieve treatment adherence, but they are also obliged to act as state agents by prohibiting obstructive sleep apnoea patients from drowsy driving. Objective To examine how nurses and obstructive sleep apnoea patients manage traffic risk assessment questions in the relation-building context of treatment initiation consultations. Methods To study, in detail, the actual practice of risk assessment, we used conversation analysis of 19 video-recorded initial treatment consultations with nurses and recently diagnosed obstructive sleep apnoea patients. Ethics The study received ethical approval from the Central Ethical Review Board in Linköping (registration number 214/231-32) and follows the ethical guidelines for qualitative research. Results Patients influence how nurses phrase questions about traffic risk by taking a stance to daytime sleepiness prior to the risk question. Nurses ask traffic risk questions in a way that assumes that driving is unproblematic if patients have not previously indicated problems. It may pose a significant problem when nurses, by accepting patients' prior stance when asking about traffic risk, orient to relationship building rather than task focus. Conclusion To clarify the difference between their two potentially conflicting roles, nurses need to refer to existing laws and official guidelines when they raise the issue of risk in treatment initiation consultations. Nurses should also ask risk assessment questions in a problem-oriented communicative environment. Traffic risk assessment is sensitive yet important, as obstructive sleep apnoea is a highly prevalent problem causing excessive sleepiness. It is essential to acknowledge nurses' double roles with regard to coaching continuous positive airway pressure treatment and assessing traffic risk. [ABSTRACT FROM AUTHOR]