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The COVID-19 pandemic caused universities worldwide, including those in Sweden, to adopt online distance learning as the primary teaching approach. However, there is limited research on how larger environmental changes affect university students' occupational balance. In this study, 15 university students were interviewed, and their responses were analyzed using qualitative content analysis. The findings suggest that the students had to take more responsibility for maintaining their occupational balance, as the pandemic and shift to online learning limited their social and physical environment and altered their daily activities and routines. [ABSTRACT FROM AUTHOR]

Aim: To explore if and how nurses' perceived organizational support affects their ability to handle and resolve ethical value conflicts. Design: A mixed methods design with a longitudinal questionnaire survey and focus group interviews. Methods: A questionnaire survey in six hospitals in two Swedish regions provided data from 711 nurses responding twice (November–January 2019/2020 and November–January 2020/2021). A cross‐lagged path model tested the mutual prospective influence between the organizational climate of perceived organizational support, frequency of ethical value conflicts, and resulting moral distress. Four focus group interviews were conducted with 21 strategically selected nurses (April–October 2021). Qualitative data collection and analysis were inspired by Grounded Theory. Results: A climate of perceived organizational support was empowering, contributing to role security. It prospectively decreased the frequency of ethical value conflicts but not the moral distress when conflicts did occur. Conclusion: It is important to facilitate the development of perceived organizational support among nurses, but also to reduce the occurrence of ethical value conflicts that the nurses cannot resolve. Implications for the Profession: By ensuring a shared care ideology, good inter‐professional relations within the entire care organization, providing clear and supportive organizational structures, and utilizing competence adequately, healthcare managers can facilitate and support the development of perceived organizational support among nurses. Nurses who are empowered by perceived organizational support are stimulated by and take pride in their work and experience the work as meaningful and joyful. Impact: The study addressed the question of whether healthcare organizations could support nurses to resolving ethical value conflicts, and thus reduce moral distress. Perceived organizational support is related to factors such as ideological caring alignment and supportive organizational preconditions. This study contributes specific knowledge about how healthcare organizations can empower nurses to effectively resolve ethical value conflicts and thereby reduce their moral distress. Patient or Public Contribution: No patient or public contribution. [ABSTRACT FROM AUTHOR]

This paper aims to describe the nature of pediatric cardiology teams (PCTs) based in Sweden through the use of a mixed methods approach. Questionnaires examining issues about the organization/ways of working, functions/tasks and attitudes were answered by 30 PCTs. Focus group interviews were conducted with six PCTs, selected purposefully by size and location, and information on experiences and attitudes on interprofessional teamwork was explored in depth. Results from the quantitative indicated that in 17 of the teams, where the nurse acted as the central coordinator, there was a positive attitude to the value of teamwork. In the interviews, different problems and needs of improvements were mentioned regarding structure, leadership, presence of physicians in the team as well as the team's mandate. All of the participants, however, agreed that interprofessional teams were required to manage the complexity of the children's care. In conclusion, this study suggests that PCTs need further support to develop structure, leadership and coordination of resources to function in a more effective manner. National plans or recommendations that mandate the organization and working methods of PCTs would be helpful for the ongoing development of PCTs in Sweden. [ABSTRACT FROM AUTHOR]

This paper explores the contributions of the Cultural Formulation (CF) interview to an overall understanding of patients, and focuses on the narratives of 23 newly referred patients with migrant backgrounds seeking help at a psychiatric outpatient clinic in Stockholm. Through text content analysis methods we identified five themes: displacement in space and time; mental illness as a physical disability; life events as etiological factors; concealing as a coping strategy; and being lost in a fragmented health care system. Findings indicate the need to contextualize symptoms for an in-depth comprehension of patients’ phenomenology. Both clinical and policy implications are discussed. The findings suggest that a section on migration and acculturation should be added to the cultural formulation in the next edition of DSM. [ABSTRACT FROM PUBLISHER]

Background: Cardiovascular disease and type 2 diabetes are among the largest public health challenges in Sweden. Research indicates that a healthy lifestyle can prevent most cases. The health dialogue is an evidence-based public health programme for primary care with positive results in several regions of Sweden. This study aimed to describe health care professionals' experiences and perceptions of health promotion through the health dialogue intervention during the pilot phase in the Scania region of Sweden. Methods: The study consists of 12 individual interviews with health care professionals educated in the health dialogue method, implementing the intervention in Scania. Qualitative content analysis with an inductive approach was used. Results: The analysis resulted in 10 sub-categories and the four main categories: A more health-promoting mindset would benefit primary care; Empower individuals; Facilitate sustainable lifestyle changes; Challenges, tools and support for the implementation of the health dialogue. One overarching theme emerged: "Health dialogue, a potential start of a paradigm shift in Swedish primary care". Conclusions: Conclusions imply that the health dialogue is a well-structured method with tools to make health promotion and primary prevention an integrated part of primary care. A respectful and motivating approach during the health dialogue is recommended. It is important to have an ongoing discussion about the approach among the health care professionals. Incorporating the Health Belief Model in the health care professionals' education in the method could increase the focus on self-efficacy during counselling, which could favour the participants' change process. [ABSTRACT FROM AUTHOR]

Background: There has been a global increase in the number of people who are dying of old age. This development implies a need for good palliative care among older persons at the end of life. Here nursing homes have an important role to play. However, the principles of palliative care have not been sufficiently applied in nursing homes, and there is a need to increase the implementation of palliative care in these settings. Therefore the project named Implementation of Knowledge-Based Palliative Care in Nursing Homes (the KUPA project, to use its Swedish acronym) was started as a contribution to filling this knowledge gap. The aim of the present study was to investigate the professionals' experiences of readiness for change to knowledge-based palliative care at nursing homes after the educational intervention within the KUPA project. Methods: The focus group method was used to interview 39 health-care professionals with the aid of semistructured questions based on the Organizational Readiness for Change theoretical framework. Six focus groups were formed at six nursing homes in two counties in southern Sweden. The groups included different types of professionals: assistant nurses, nurses, occupational therapists, physiotherapists and social workers. The analysis was conducted with an abductive approach and included deductive and inductive content analysis. Results: The analysis revealed one overarching theme: hopeful readiness for change in palliative care despite remaining barriers. The main categories were increased knowledge facilitating development, enhanced team spirit, uncertainty about future plans connected with hopeful readiness and remaining organizational barriers. Conclusions: This study adds knowledge and understanding concerning professionals' readiness for change palliative care in nursing homes and shows how ready nursing home settings undertake these changes in practice. The Organizational Readiness for Change theory proved suitable for application in nursing homes to assess the professionals' experiences and to evaluate educational interventions regardless of the organization's readiness for change. Trial registration: ClinicalTrials NCT02708498, first registration 15/03/2016. [ABSTRACT FROM AUTHOR]

Dementia causes substantial suffering for affected persons and their family caregivers. Because no cure is available, it is important to investigate how alternative therapies can improve life for these individuals. For the current study, persons with dementia (PwD) were recruited from a specialized Memory Clinic in Sweden to engage in a choral singing intervention for 1 hour per week for four semesters. PwD were encouraged to bring a family caregiver to the sessions; both were interviewed and data were analyzed using qualitative content analysis. The choral singing intervention appeared to become an important social context for PwD and family caregivers and had a positive impact on relationship, mental well-being, mood, and memory. The intervention appeared to act as an enriched environment for all participants. Choral singing interventions for PwD and their family caregivers is a simple means to create a social context and improve general well-being. [ABSTRACT FROM AUTHOR]

Aims and objectives: To investigate healthcare personnel's working conditions in relation to risk behaviours for organism transmission. Background: Healthcare personnel's behaviour is often influenced by working conditions that in turn can impact the development of healthcare‐associated infections. Observational studies are scarce, and further understanding of working conditions in relation to behaviour is essential for the benefit of the healthcare personnel and the safety of the patients. Design: A mixed‐methods convergent design. Methods: Data were collected during 104 h of observation at eight hospital units. All 79 observed healthcare personnel were interviewed. Structured interviews covering aspects of working conditions were performed with the respective first‐line manager. The qualitative and quantitative data were collected concurrently and given equal priority. Data were analysed separately and then merged. The study follows the GRAMMS guidelines for reporting mixed‐methods research. Results: Regardless of measurable and perceived working conditions, risk behaviours frequently occurred especially missed hand disinfection. Healthcare personnel described staffing levels, patient‐level workload, physical factors and interruptions as important conditions that influence infection prevention behaviours. The statistical analyses confirmed that interruptions increase the frequency of risk behaviours. Significantly higher frequencies of risk behaviours also occurred in activities where healthcare personnel worked together, which in the interviews was described as a consequence of caring for high‐need patients. Conclusions: These mixed‐methods findings illustrate that healthcare personnel's perceptions do not always correspond to the observed results since risk behaviours frequently occurred regardless of the observed and perceived working conditions. Facilitating the possibility for healthcare personnel to work undisturbed when needed is essential for their benefit and for patient safety. Relevance for Clinical Practice: The results can be used to enlighten healthcare personnel and managers and when designing future infection prevention work. [ABSTRACT FROM AUTHOR]

Adolescents with Asperger's syndrome (AS), often have handwriting difficulties that affect their academic performance. The purpose of this descriptive multiple-case mixed-method study was to highlight how adolescents with AS experience writing in the school setting when writing by hand and when using a computerized Assistive Technology Device (ATD), for writing. A qualitative content analysis approach was used, including interviews with five adolescents, their parents, and their teachers. This was complemented by asking the adolescents to rate their perceived performance and satisfaction of writing with and without the ATD. All adolescents described handwriting difficulties, but a reduced ability to express oneself in writing was also common. Initiating and completing writing tasks was often so demanding that it caused resistance to the activity. Several advantages when using the ATD were described by the participants and the self-ratings showed higher scores for performance of and satisfaction with writing when the ATD was used. The results show that teachers' encouragement seemed to be important for the initiation and continuation of use of the ATD. [ABSTRACT FROM AUTHOR]

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

This Swedish study investigates how persons living with dementia report their experiences of cognitive and linguistic testing, as well as their perspectives on the communicative resources and barriers they experience in daily interactions. Eight dyads were included in this qualitative exploratory study; eight persons with dementia and eight family members with whom they interact with daily. Semi-structured interviews, with questions focusing on experiences of diagnostic pathways as well as communicative and cognitive function in daily life, were carried out together with standard clinical testing. The data were analysed using qualitative content analysis. The results shed light on the experiences of uncertainty during the dementia assessment process related to the assessment tasks, the consequences of the assessment and receiving a diagnosis. We interpret this as a result of the unfamiliar clinical focus on function as measured in decontextualised tasks, compared to the participants' view based on their abilities in everyday life. The study also reveals that adjustments in daily life that are necessitated by the consequences of neurological change are often developed in collaboration between the person with dementia and their conversation partners. There are, however, reports of conflicting feelings by the persons diagnosed with dementia, and by their families, as well as their views on how to best handle change, while maintaining a sense of being a competent person through the progression of disease. [ABSTRACT FROM AUTHOR]

Background: A relation to stress and stressful triggers is often, but not always, described in patients with Takotsubo syndrome. Few studies have focused on patients' self-rated stress in combination with qualitative experiences of stress in Takotsubo syndrome. Aims: The aim of this study was to describe stress before and after the onset of Takotsubo syndrome. Methods: Twenty patients were recruited from five major hospitals in Stockholm, Sweden between December 2014 and November 2018. A mixed methods design was used containing the validated questionnaire, perceived stress scale (PSS-14) filled in at baseline and at a 6 and 12-month follow-up, respectively. Qualitative interviews were made at the 6-month follow-up. Results: Self-rated stress, measured by the perceived stress scale, showed stress levels above the cut-off value of 25, at the onset of Takotsubo syndrome (median 30.5). Stress had decreased significantly at the 12-month follow-up (median 20.5, P = 0.039) but remained high in one third of the patients. Qualitative interviews confirmed a high long-term stress and half of the patients had an acute stress trigger before the onset of Takotsubo syndrome. The qualitative interviews showed that the patients had reflected on and tried to find ways to deal with stress, but for many this was not successful. Conclusion: Patients with Takotsubo syndrome reported long-term stress sometimes with an acute stress trigger before the onset of Takotsubo syndrome. Stress decreased over time but remained high for a considerable number of patients. Despite reflection over stress and attempts to deal with stress many were still affected after 6 months. New treatment options are needed for patients with Takotsubo syndrome. [ABSTRACT FROM AUTHOR]

Objectives: Interventions during pregnancy and early childhood have been shown to impact dental health. Thus, Antenatal Care and Dental Care collaborated in an intervention called Health Counselling in Dental Care (HCDC). HCDC was offered free of charge to first‐time expectant parents and was aimed at reducing the frequency of dental caries in children and their parents. However, the intervention reached less than 50% of the parents. The aim of this study was to explore facilitators of, barriers to, and suggestions for increased participation in HCDC. Methods: Data were collected through semi‐structured, face‐to‐face interviews with expectant parents. Participants were purposively sampled based on having been invited to HCDC and to achieve a variation in socio‐demographics. Interviews were audio recorded, transcribed verbatim and analysed using conventional qualitative content analysis. Results: In total, 16 interviews were conducted (10 women, 6 men). Six categories representing three facilitators and three barriers for participation emerged. The facilitators were the midwife's crucial role for disseminating information about HCDC and motivating participation, that the parents perceived HCDC as valuable for themselves and their offspring, and a desire for new or more knowledge. The barriers included a shortage of information regarding the counselling, a perceived lack of value for the parents and offspring, and the timing of the counselling during pregnancy. Conclusions: The midwives were crucial in providing information and motivation for HCDC participation. To increase attendance, sufficient information regarding the benefits of counselling is required, and the timing needs to be flexible and family‐centred. [ABSTRACT FROM AUTHOR]

Aim: To describe partners' experiences of living with men with a screening‐detected abdominal aortic aneurysm (AAA). Background: Diagnosis of a chronic life‐threatening disease affects the patients' as well as their partners' lives in different aspects. AAA, with rupture as the major consequence, is a life‐threatening disease that can affect the whole family. Screening programmes for AAA have been introduced in several countries to reduce the mortality rate. Although the awareness of having an AAA influences the individuals' quality of life and well‐being, it is still unclear how it affects their partners. Design: Qualitative descriptive design. Methods: Twenty‐one partners of men with AAA were purposely selected to participate in individual semi‐structured interviews between August 2017–February 2018 in Sweden. Data were transcribed and imported into NVivo‐12®. The data were analysed using qualitative content analysis. The study conforms to the COREQ checklist. Results: Three categories were identified: (a) experiencing the unexpected; (b) being reminded of fragility; and (c) balancing a changing relationship. The partners had a positive attitude towards the screening process and were pleased that their husbands were under surveillance. Nevertheless, at the same time, the diagnosis caused worries and questions. The AAA diagnosis was constantly in the minds of the partners, which sometimes affected and limited daily activities. Furthermore, ambivalent feelings towards surgical treatment were described. The partners tried to support their men and encouraged them to achieve a healthy lifestyle. Conclusion: The partners' well‐being and daily lives were impacted by the awareness of the screening‐detected AAA. Different degrees of worry were the most common reaction and were pervasive in all three categories. Relevance for clinical practice: The result highlights the need to review routines or develop new strategies to include the partners in the process of screening and offer supplementary support and information. [ABSTRACT FROM AUTHOR]

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

Aims and objectives. The aim was to describe the moods experienced by people waiting for day surgery. Background. Except for anxiety, there is a lack of knowledge about the moods experienced by patients while waiting for day surgery, as well as the impact of mood during the perioperative period. Preoperative anxiety is common and has multiple negative effects. A deeper knowledge of preoperative moods and how they are experienced is needed and may be useful for improving perioperative care. Design. Qualitative descriptive design. Methods. Qualitative semi-structured interviews (n = 20) with adults waiting for day surgery in a Swedish university hospital. Data were analysed with inductive content analysis. Results. The informants described a variety of moods and mood-influencing reasons. The main category that emerged was, 'feeling hope about regaining health as a help to balance mood' regardless of mood. This category was abstracted from the generic categories 'experiencing a harmonious mood' and 'experiencing a shifting mood'. The subcategories were 'feeling calm and at ease despite concerns and fear,' 'experiencing expectation,' 'feeling trust and confidence,' 'shifting between expectancy and anxiety,' 'feeling vulnerable and exposed, and 'feeling uncertainty'. Conclusions. The findings contribute to the knowledge about that regardless of mood, feeling hope about regaining health may help patients to balance their mood during the waiting period. Relevance to clinical practice. The results can have implications with respect to developing and improving preoperative care, such as having clinicians extend offers of individual assistance and information during the waiting period to patients experiencing shifting mood. Instilling hopefulness in patients who are waiting for day surgery by means of clinical staff attitudes and interactions may help patients to develop healthy coping strategies and thereby improve their physical and emotional well-being. [ABSTRACT FROM AUTHOR]

Background: Prescribing of antibiotics for common infections varies widely, and there is no medical explanation. Systematic reviews have highlighted factors that may influence antibiotic prescribing and that this is a complex process. It is unclear how factors interact and how the primary care organization affects diagnostic procedures and antibiotic prescribing. Therefore, we sought to explore and understand interactions between factors influencing antibiotic prescribing for respiratory tract infections in primary care. Methods: Our mixed methods design was guided by the Triangulation Design Model according to Creswell. Quantitative and qualitative data were collected in parallel. Quantitative data were collected by prescription statistics, questionnaires to patients, and general practitioners' audit registrations. Qualitative data were collected through observations and semi-structured interviews. Results: From the analysis of the data from the different sources an overall theme emerged: A common practice in the primary health care centre is crucial for low antibiotic prescribing in line with guidelines. Several factors contribute to a common practice, such as promoting management and leadership, internalized guidelines including inter-professional discussions, the general practitioner's diagnostic process, nurse triage, and patient expectation. These factors were closely related and influenced each other. The results showed that knowledge must be internalized and guidelines need to be normative for the group as well as for every individual. Conclusions: Low prescribing is associated with adapted and transformed guidelines within all staff, not only general practitioners. Nurses' triage and self-care advice played an important role. Encouragement from the management level stimulated inter-professional discussions about antibiotic prescribing. Informal opinion moulders talking about antibiotic prescribing was supported by the managers. Finally, continuous professional development activities were encouraged for up-to-date knowledge. [ABSTRACT FROM AUTHOR]

Rationale, aims and objectives Clinical pathways ( CPs) can improve quality of care on intensive care units ( ICUs), but are infrequently utilized and of varying quality. Knowledge regarding factors that facilitate versus hinder successful implementation of CPs is insufficient and a better understanding of the activities and individuals involved is needed. The aim of this study was to explore the implementation process of CPs within the context of ICUs. Methods An exploratory design with a sequential mixed method was used. A CP survey, including all Swedish ICUs, was used to collect quantitative data from ICUs using CPs ( n = 15) and interviews with key informants ( n = 10) were used to collect qualitative data from the same ICUs. Descriptive statistics and qualitative content analysis were used, and the quantitative and qualitative findings were integrated. Results The CP implementation was conceptualized according to two interplaying themes: a process to realize the usefulness of CPs and create new habits; and a necessity of enthusiasm, support and time. Multiple factors affected the process and those factors were organized in six main categories and 14 subcategories. Conclusions Bottom-up initiatives, interprofessional project groups and small ICUs seem to enhance successful implementation of CPs while inadequate electronic health record systems, insufficient support and time constrains can be barriers. Support regarding the whole implementation process from centralized units at the local hospitals, as well as cooperation between ICUs and national guidance, has the potential to raise the quality of CPs and benefit the progress of CP implementation. [ABSTRACT FROM AUTHOR]

Students' engagement and reflection on learning activities are important during interprofessional clinical practice. The contextual activity sampling system (CASS) is a methodology designed for collecting data on experiences of ongoing activities by frequent distribution of questionnaires via mobile phones. The aim of this study was to investigate if the use of the CASS methodology affected students' experiences of their learning activities, readiness for interprofessional learning, academic emotions and experiences of interprofessional team collaboration. Student teams, consisting of 33 students in total from four different healthcare programs, were randomized into an intervention group that used CASS or into a control group that did not use CASS. Both quantitative (questionnaires) and qualitative (interviews) data were collected. The results showed that students in the intervention group rated teamwork and collaboration significantly higher after than before the course, which was not the case in the control group. On the other hand, the control group reported experiencing more stress than the intervention group. The qualitative data showed that CASS seemed to support reflection and also have a positive impact on students' experiences of ongoing learning activities and interprofessional collaboration. In conclusion, the CASS methodology provides support for students in their understanding of interprofessional teamwork. [ABSTRACT FROM AUTHOR]

Aims and objectives To describe registered nurses' reflections on discussing sexuality with patients. Background It is known that many diseases and treatments have a negative impact on sexual health. Despite these facts, registered nurses typically do not address sexual issues with patients. Design A descriptive design and a qualitative approach were used. Methods Interviews were conducted in 2010 with 10 registered nurses. The data were analysed using qualitative content analysis. Results The themes 'Doing the right thing and doing good', 'Could've, would've, should've: a nurse's conflicting feelings' and 'I just don't talk about it: sexuality as a nontopic' confirmed the notion that discussing sexuality in nursing care is still challenging and difficult for nurses, but also revealed that nurses who do talk to patients about sexual issues do so based on their strong sense of wanting to help. They felt a responsibility because of their knowledge in the area, but the topic also brought out conflicting feelings such as fear and embarrassment. Lack of time, support and places to talk to patients in private as well as prejudice were contributing factors to their not addressing sexuality. Some nurses also felt that sexuality was someone else's responsibility and a taboo subject. Conclusions Patients' sexuality is still surrounded by silence. But factors exist that can facilitate discussion of sexuality. Nurses have a key role in detecting ill-health. This study suggests that when nurses use their knowledge and go beyond their comfort zone and address sexuality, they can identify patients' sexual problems. Relevance to clinical practice Nurses need to understand how their knowledge can help patients who are experiencing sexual problems; they also need support from the workplace and to have access to routines that reinforce the notion that sexuality is a topic worth discussing. [ABSTRACT FROM AUTHOR]

Aim To describe patients' experiences of bladder emptying and urinary catheterization in connection with hip surgery. Background The capacity of bladder emptying in connection with hip surgery is affected by pain, medication and confinement to bed. In connection with such surgery urinary catheterization is often performed, either intermittent or indwelling. Hip surgery patients' experiences of urinary catheterization and urination have not been studied before. Design A qualitative study with descriptive design was conducted among hip surgery patients. Methods Thirty face-to-face interviews were conducted from October 2009-March 2010 and analysed with inductive qualitative content analysis. Results The main category 'An issue but of varying impact' illustrated the patients' experiences of bladder emptying and urinary catheterization. Five generic categories were identified: ability to urinate, catheter is convenient, bothersome bladder emptying, intrusion on dignity and concern about complications. Irrespectively of whether the patients were able to urinate or were catheterized, the bladder emptying situation was not as usual. It was described as uncomplicated and experienced as being positive if the patients were able to urinate by themselves or when catheterization was experienced as convenient. Some patients did not want to be catheterized, approving it only reluctantly. Independently of the method for bladder emptying, the patients in our study would choose the same method next time. Conclusions The patients undergoing hip surgery seem to experience bladder emptying as an issue but of varying impact. Both bladder emptying through micturition and bladder emptying through catheterization are described in positive and negative terms. [ABSTRACT FROM AUTHOR]

Purpose The aim of this study was to explore primary healthcare (PHC) professionals' experiences of the sick leave process. Methods This is an explorative study using data from four semi-structured focus group discussions with a purposeful sample of PHC professionals in Östergötland County, Sweden. Content analysis with an inductive approach was used in the analysis. Results Four key themes emerged from the analysis; priority to the sick leave process, handling sickness certifications, collaboration within PHC and with other stakeholders, and work ability assessments. Patients' need for sick leave was handled from each professional group's perspective. Collaboration was considered important, but difficult to achieve and all the competencies available at the PHC centre were not used for work ability assessments. There was insufficient knowledge of patients' work demands and contact with an employer was rare, and the strained relationship with the social insurance officers affected the collaboration. Conclusions This study highlights the challenges physicians and other PHC professionals face when handling the need for sick leave, especially when encountering patients with symptom-based diagnoses, and the influence of non-medical factors. Hindrances to good practice were increased demands, collaboration, and role responsibility. The challenges in the sick leave process concerned both content and consequences related to poor collaboration within PHC and with representatives from various organizations, primarily employers and social insurance officers. Further research on how to develop a professional approach for handling the sick leave process is needed. [ABSTRACT FROM AUTHOR]

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

blomqvist y.t., rubertsson c., kylberg e., jöreskog k. & nyqvist k.h. (2012) Kangaroo Mother Care helps fathers of preterm infants gain confidence in the paternal role. Journal of Advanced Nursing 68(9), 1988-1996. Abstract Aim. This article is a report on a descriptive study of fathers' experiences of providing their preterm infants with Kangaroo Mother Care. Background. During neonatal intensive care, fathers describe the incubator as a barrier and the separation from their infant as stressful. Fathers consider it important to be close to the infant, and performing Kangaroo Mother Care makes them feel an important participant in their infants' care. Method. Individual interviews conducted in 2009 with seven fathers who performed Kangaroo Mother Care were analysed using qualitative content analysis. Results. The fathers' opportunity for being close to their infants facilitated attainment of their paternal role in the neonatal intensive care unit. Kangaroo Mother Care allowed them to feel in control and that they were doing something good for their infant, although the infant's care could be demanding and stressful. As active agents in their infant's care, some fathers stayed with the infant during the whole hospital stay, others were at the neonatal intensive care unit all day long. Despite the un-wished-for situation, they adapted to their predicament and spent as much time as possible with their infants. Conclusion. Fathers' opportunities for Kangaroo Mother Care helped them to attain their paternal role and to cope with the unexpected situation. The physical environment and conflicting staff statements influenced their opportunity for, and experience of, caring for their preterm infants. [ABSTRACT FROM AUTHOR]

Background. Action-oriented study circles (AOSC) have been found to improve nutrition in 24 nursing homes in Sweden. Little, however, is known about the conceptual use of knowledge (changes in staffs' knowledge and behaviours). Methods. Qualitative and quantitative methods, structured questionnaires for evaluating participants' (working in nursing homes) experiences from study circles (n = 592, 71 AOSC) and for comparisons between AOSC participants (n = 74) and nonparticipants (n = 115). Finally, a focus group interview was conducted with AOSC participants (in total n = 12). Statistical, conventional, and directed content analyses were used. Results. Participants experienced a statistically significant increase in their knowledge about eating and nutrition, when retrospectively comparing before participating and after, as well as in comparison to non-participants, and they felt that the management was engaged in and took care of ideas regarding food and mealtimes to a significantly greater extent than non-participants. The use of AOSC was successful judging from how staff members had changed their attitudes and behaviours toward feeding residents. Conclusions. AOSC facilitates professional development, better system performance, and, as shown in previous studies, better patient outcome. Based on a collaborative learning perspective, AOSC manages to integrate evidence, context, and facilitation in the efforts to achieve knowledge translation in a learning organisation. This study has implications also for other care settings implementing AOSC. [ABSTRACT FROM AUTHOR]

Purpose: An organized population-based mammographic screening programme aims for an early detection of potential breast abnormalities so that treatment can commence. Continuous participation and a high attendance rate are vital for an effective programme. It is important to understand the underlying reasons for participation in mammographic screening, should there be factors that are amendable within reason and could be adjusted. Therefore, the invited women are valuable sources of information. This study aimed at describing the experiences and perceptions about mammographic screening of women from three municipalities in a Swedish county. Method: Six semi-structured focus-group discussions, each with four to five participants, were held. Content analysis was then conducted. Results: The screening procedure, such as staff professionalism, was covered. Other people's opinions and the woman's own understanding affected the women's decisions on whether or not to undergo the procedure. Structural conditions, such as travel time and financial issues, were sources of concern. However, the offer to perform mammographic screening was perceived with gratitude. Conclusions: Structural conditions, risk and time perceptions, the screening procedure, attitudes towards undergoing it and appreciation of its benefit may influence the women's continuous willingness to be screened, which in turn may affect public and individual health. [ABSTRACT FROM AUTHOR]

Purpose: Shared decision making, SDM, in psychiatric services, supports users to experience a greater sense of involvement in treatment, self-efficacy, autonomy and reduced coercion. Decision tools adapted to the needs of users have the potential to support SDM and restructure how users and staff work together to arrive at shared decisions. The aim of this study was to describe and analyse the implementation process of an SDM intervention for users of psychiatric services in Sweden. Method: The implementation was studied through a process evaluation utilizing both quantitative and qualitative methods. In designing the process evaluation for the intervention, three evaluation components were emphasized: contextual factors, implementation issues and mechanisms of impact. Results: The study addresses critical implementation issues related to decision-making authority, the perceived decision-making ability of users and the readiness of the service to increase influence and participation. It also emphasizes the importance of facilitation, as well as suggesting contextual adaptations that may be relevant for the local organizations. Conclusion: The results indicate that staff perceived the decision support tool as user-friendly and useful in supporting participation in decision-making, and suggest that such concrete supports to participation can be a factor in implementation if adequate attention is paid to organizational contexts and structures. [ABSTRACT FROM AUTHOR]