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This paper examines caseworkers' efforts to plan and find appropriate interventions for troublesome young people. Strauss's concept of trajectory is applied to analyse how Swedish caseworkers shape and manage the evolving care trajectories using assessments for young people in secure accommodation, i.e. institutional youth assessments. The empirical material consists of surveys to 82 caseworkers concerning 85 institutional youth assessments and interviews with 16 of these caseworkers. The findings reveal ongoing care trajectories that are out of control where the assessments are seen as an opportunity of change for the youths. Diagnoses, confirmations and plans for action are provided through the assessments and used by the caseworkers in negotiations for resources. Three orientations of contributions to the caseworkers' management of care trajectories were found, all reflecting the many uncertainties of child welfare work: child centred, professional and discharge of liability. In conclusion, the caseworkers searched for the right measures to manage change and achieve youth compliance, but it was also a matter of managing professional and organizational contingencies and passing on responsibility. [ABSTRACT FROM AUTHOR]

Background: The use of life stories in dementia care has been described as a way of seeing every person as an individual, looking beyond their dementia. Life stories have become synonymous with high-quality care, while in Sweden their mere existence in dementia care settings is taken to indicate quality in national comparisons. Such life stories are often standardised, generated by a family member answering predetermined questions in a template. Aim and methods: Using a constructionist approach, this study will (1) chart what versions of a person's life story the templates produce, and (2) establish the intended purpose of such life stories, as communicated by the templates. This study departs from the assumption that life story templates communicate something about the conceptions of people living with dementia. The thematic analysis used data comprising 30 blank templates, totalling about 1,700 questions. Findings: The life story templates were found to generate two very different versions of the individual: (1) a person before symptoms of dementia or (2) a patient with dementia. We also found contradictions about what information should be included, whose life story it was, and the intended use. Discussion: Despite strong pressure on dementia care providers to collect life stories from residents, the life story templates they use are without clear direction, ideology, or purpose. The lack of direction is key given that life stories can be considered actants that shape assumptions about people with dementia and construct realities in dementia care settings. We highlight the need to develop ethical guidelines for life story template design, matched with guidelines for their intended use. [ABSTRACT FROM AUTHOR]

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]

Purpose – The aim of this paper is to report results of the impact of the information and communication technology (ICT) platform and telecare services developed by the MonAMI consortium on the quality of life (QOL) of older people in three European communities. Design/methodology/approach – In a three-month trial, the MonAMI technology was installed in the homes of older people with various needs, in the cities of Stockholm, Sweden; Zaragoza, Spain; and Kosice, Slovakia. Evaluation criteria and instrumentation were developed to assess the effects of the services on users' perceived QOL in the domains of independence, physical health, psychological wellbeing, social networking, and physical environment. Findings – A total of 62 users, with a mean age of 79 years, participated in the trial. Results demonstrate that the MonAMI services had some positive, significant effects on users' QOL. For instance, users with a higher number of disabilities at baseline reported greater confidence in keeping intruders from entering their home compared to users with fewer disabilities (OR=2.51, 0.01 p<0.05). However, overall findings show that healthier, more independent users perceived more benefits from the services compared to users who report more health problems and are less independent. Research limitations/implications – The complexities of conducting the MonAMI trial led to a small, heterogeneous sample of users over a short time span. This in turn created difficulties in observing the potential effects of the services and achieving significance on some indicators of QOL. Originality/value – This paper provides quantitative analyses around the impact of telecare services; suggests important directions for further research; and highlights the methodological challenges of evaluating ICT-based care services in a community setting. [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]

The object of this paper was to investigate the experiences of patients with severe mental illness (SMI) living in a community, including their utilization of care and treatment services. Psychiatric care and social services staff members were asked to make an inventory of those they served in two districts of Malmö, Sweden. Participants had to be over 18 years of age and unable to manage their daily lives without help from others. Almost all of the 80 participants (95 %) were under psychiatric care. A majority (86 %) was receiving dental treatment, and 61 % were supported by social services. Fifty-four percent of the participants received somatic care on an ongoing basis. Although the majority reported the care given as sufficient, one-third of this SMI population considered the care and support they received to be insufficient. Satisfying those who are dissatisfied with the care they are being given would be a significant challenge for service providers, since the unsatisfied are shown to have more difficult lives. [ABSTRACT FROM AUTHOR]

Background: Continuity of care is viewed as a hallmark of high‐quality care in the primary care context. Measures to evaluate the quality of provider performance are scarce, and it is unclear how the assessments correlate with patients' experiences of care as coherent and interconnected over time, consistent with their preferences and care needs. Aim: To develop and evaluate a patient‐reported experience measure of continuity of care in primary care for patients with complex care needs. Method: The study was conducted in two stages: (1) development of the instrument based on theory and empirical studies and reviewed for content validity (16 patients with complex care needs and 8 experts) and (2) psychometric evaluation regarding factor structure, test–retest reliability, internal consistency reliability, and convergent validity. In all, 324 patients participated in the psychometric evaluation. Results: The Patient Experienced Continuity of care Questionnaire (PECQ) contains 20 items clustered in four dimensions of continuity of care measuring Information (four items), Relation (six items), Management (five items), and Knowledge (five items). Overall, the hypothesized factor structure was indicated. The PECQ also showed satisfactory convergent validity, internal consistency, and stability. Conclusion/Implications: The PECQ is a multidimensional patient experience instrument that can provide information on various dimensions useful for driving quality improvement strategies in the primary care context for patients with complex care needs. Patient or Public Contribution: Patients have participated in the content validation of the items. [ABSTRACT FROM AUTHOR]

Purpose – The purpose of this paper is twofold: first, to report results from a quasi-experimental study of outcomes of a leaving care project for youth placed in secure unit care and second, based on the (zero) results, to analyse and discuss the interplay between organisational boundaries, social work and the target group when implementing a project such as the one studied. Design/methodology/approach – The outcome study had a quasi-experimental design. The young people in the leaving care programme were compared with a matched reference group who did not get the special leaving care services. Data were collected (structured Adolescent Drug Abuse Diagnosis-interviews) when the young people entered secure units and on follow-up (registered crime and re-entry into care). Findings – The outcome study showed that the leaving care project had no effect on the young people’s situation at follow-up regarding re-offending and re-entry into secure unit care. This is understood and discussed in relation to the poor implementation of the leaving care project along with an inbuilt conflict between state and local municipality that overshadowed the good intentions of the project. Research limitations/implications – The effect study has a quasi-experimental design, and hence differences between the project group and the comparison group at T1 cannot be fully precluded, although nothing is pointing in such a direction. The unclear content of the intervention makes it difficult to decode how the variation in the support given to the young people eventually impacted the results. The zero-results apply to group level, but that may not be valid for each and every one in the project. Practical implications – According to earlier research, a key person following young persons through different phases of the care trajectory may be of importance. Learning from the CoC project, one can conclude that such a key person should preferably take the role of advocate for the young person, and not be an administrator mainly concerned with coordinating other professionals. Further, when planning and financing is split between organisations, that split hinders efforts to actually mobilise support for young people leaving secure unit care. Originality/value – Few leaving care services are designed for youth with severe behavioural problems and hence, the research is scarce. This study contributes with important knowledge about leaving care interventions for the target group. [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]

Aim This paper is a report of the development and psychometric testing of the Swedish version of the Body Awareness Questionnaire to measure bodily focus of attention. Background The Body Awareness Questionnaire has been identified as an instrument with excellent psychometric properties within the concept of body awareness. It has been used in both research and clinical settings in different contexts. However, a validated Swedish version is not available. Method A cross-sectional design was applied for adaptation of the Body Awareness Questionnaire and psychometric validation. Data were collected between autumn 2009 and spring 2011 from 120 patients diagnosed with rheumatoid arthritis, and from 120 students. The 'concurrent think aloud' method was used in a pre-test to determine the usability of the questionnaire. Cronbach's alpha was used to test the internal consistency, and confirmatory factor analysis was performed to test the construct validity. Results According to the confirmatory factor analysis, neither the one-factor model nor the four-factor model tested in this study fulfilled the pre-specified criteria in accordance with the Comparative Fit Index, Standardized Root Mean Squared Residual and the Root Mean Square Error of Approximation. The value of Cronbach's alpha for the Swedish version of the Body Awareness Questionnaire was satisfactory. Conclusion Our results indicate that the two models tested in this study do not provide a good fit to the observed data. Further refinement and testing of the Swedish version of the Body Awareness Questionnaire is therefore required. The concept of body awareness may be useful in the management of chronic disease and can be addressed in nursing. [ABSTRACT FROM AUTHOR]

In this paper, we examine concurrent and prospective links between attachment and the Five-Factor Model (FFM) of personality from middle childhood to young adulthood (n = 66). At age 8.5 years, attachment was measured with the Separation Anxiety Test and at 21 years with the Adult Attachment Interview, whereas the personality dimensions were assessed with questionnaires at both time points. The results showed that attachment and personality dimensions are meaningfully related, concurrently and longitudinally. Attachment security in middle childhood was positively related to extraversion and openness, both concurrently and prospectively. Unresolved/disorganized (U/d) attachment was negatively related to conscientiousness and positively related to openness in young adulthood. U/d attachment showed a unique contribution to openness above the observed temporal stability of openness. As attachment security was also associated with openness, the duality of this factor is discussed together with other theoretical considerations regarding attachment theory in relation to the FFM. [ABSTRACT FROM PUBLISHER]

This paper presents findings on the role of online traveller information services in regional public transport for older people and people with functional limitations. An explanatory mixed methods design was used. A quantitative questionnaire study of the target group's need of traveller information and use of online traveller information services provided the basis for a qualitative focus group study of their attitudes towards online traveller information services in public transport and their perceptions of traveller information's role in their travel habits. The key findings suggest that the essential influence of access to traveller information through online traveller information services on the travel of older people and people with functional limitations is the reassurance that these services offer. This results in confidence that enables secure travel which in turn enables the older traveller or traveller with functional limitations to cope with possible difficulties during the journey. Thus there is a point in offering high quality traveller information to such people through online traveller information services. The point however, is not necessarily that they should undertake more journeys by public transport, but rather that when they travel they can do so confidently. [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]

This paper describes a project with the aim of reducing the risk of injury when using precast concrete shells in the Swedish construction industry by identifying injury risks, developing and implementing solutions. An interactive research approach was used. Three major injury risks were identified and a system consisting of three tools and a handbook was developed, evaluated, and implemented at one company and made available to the construction industry. [ABSTRACT FROM AUTHOR]

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

Background: NHs have been severely exposed during the COVID‐19 pandemic. Little is known about how staff who provide practical daily care of older residents experienced work during the pandemic. The aim of this study was to understand how nursing assistants (NAs) experienced their work at nursing homes (NHs) for older people during the first wave of the COVID‐19 pandemic. Methods: We conducted a qualitative study of focus group discussions with in total 20 participants from four NHs in Stockholm, Sweden. Discussions were held in November 2020. Transcripts were analyzed using inductive thematic analysis. Results: We identified three major themes: 1) We felt abandoned, scared and disrespected, 2) We made sure we made it through, and 3) We can do good work with appropriate resources. NAs felt disregarded as they were often left alone without adequate support from managers, registered nurses and the municipalities. NAs felt distressed and guilty and developed their own strategies to cope and manage their work. Conclusion and Implication for Practice: During the first wave of the COVID‐19 pandemic NAs felt abandoned and burdened due to lack of leadership. Organizational improvements are required to protect the wellbeing of NAs and to ensure sustainability of patient safety. NAs are crucial in the care for vulnerable older people and their experiences should constitute a keystone for development of future policy and practice in NHs. [ABSTRACT FROM AUTHOR]

Aim(s): This study aims to investigate care unit managers' perceptions of how the COVID‐19 pandemic influenced their ability to support the nurses. Background: The COVID‐19 pandemic placed extreme pressure on health care organizations. More knowledge regarding how the pandemic influenced care unit managers' ability to support nurses is central to ensuring high‐quality health care in future crises. Method(s): A mixed‐methods study in Swedish hospitals with a survey (n = 128) and interviews (n = 20) with care unit managers. Results: Approximately half of the managers reported having spent more time available to and supporting the nurses. Availability was positively predicted by their perceived organizational support while negatively by their job demands. These job demands concerned meeting staff anxiety and managing organizational restructuring. Full focus on direct patient care and strong professional and social support were important job resources. Conclusion(s): For care unit managers to effectively support the nurses during a crisis, they need proficient job resources and moderate job demands. Managers' perceived organizational support positively affects the quality of their crisis leadership. Creating arenas in which staff collegiality can form and develop is beneficial for the ability to meet future crises. Implications for Nursing Management: This study specifies important job resources that should be acknowledged and reinforced to strengthen the ability of care unit managers to actively support the nurses during a crisis. [ABSTRACT FROM AUTHOR]

Background: There is evidence that autism spectrum disorders (ASDs) co-occur with bipolar disorder (BD) relatively frequently. Individuals with BD often report symptoms of mania and hypomania during adolescence, prior to the age of onset for BD. It is unknown whether these symptoms are associated with ASDs. We examined whether diagnoses of ASDs and autistic traits were associated with hypomania in a large, population-based Swedish twin sample. Methods: Parental structured interviews assessed autistic traits, and were used to assign screening diagnoses of ASDs, when twins were aged 9 or 12 (N = 13 533 pairs). Parents then completed questionnaires assessing hypomania when the twins were aged 15 and 18 (N = 3852 pairs at age 15, and 3013 pairs at age 18). After investigating the phenotypic associations between these measures, we used the classical twin design to test whether genetic and environmental influences on autistic traits influence variation in adolescent hypomania. Results: Autistic traits and ASD diagnoses in childhood were associated with elevated scores on the measures of adolescent hypomania. Twin analyses indicated that 6–9% of the variance in hypomania was explained by genetic influences that were shared with autistic traits in childhood. When repeating these analyses for specific autistic trait domains, we found a stronger association between social interaction difficulties and hypomania than for other autistic trait domains. Conclusions: These results indicate a genetic link between autistic traits and hypomania in adolescence. This adds to the growing evidence base of genetic factors associated with ASDs showing links with psychiatric outcomes across childhood and into adulthood. [ABSTRACT FROM AUTHOR]

BACKGROUND: The potential of flexible scheduling to alleviate work-family tensions and replace female part-time work has not been thoroughly explored. Specifically, research has not acknowledged that employees' schedule control may be conditioned by organizational demands for availability and commitment. OBJECTIVE: We examine the links between flexibility and gendered patterns of work-family reconciliation by considering how work arrangements balance employer demands and employee control and how they relate to work-family tensions. METHODS: Using mixed-methods, we combine a survey of Swedish parents (n = 2320) with interviews of survey respondents (n = 40). First, we identify clusters of flexible work arrangements and explore differences between mothers and fathers. Second, we analyze the relationship between flexible work arrangements and work-family tensions. Finally, the qualitative data are used to explore how flexibility/lack of flexibility enter into parents' work-family tensions and negotiations. RESULTS: Three types of flexible work arrangements are found. Boundaryless jobs, which combine high levels of control with high requirements for organizational flexibility, are more common among fathers and highly educated. Confined jobs have low levels of both employee- and employer-oriented flexibility, but high demands, and are common among mothers and in female-dominated workplaces. Despite higher levels of control, boundaryless jobs are not associated with less work-family conflict. In malleable jobs, control is relatively high and demands low and work-family tensions are less noticeable. CONCLUSIONS: Employer- and employee-oriented flexibility go hand in hand, but work arrangements differ radically between groups. High flexibility does not alleviate work-family tensions, and part-time work remains an important work-family strategy for mothers. [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]

The scope of this study is women's descriptions of symptoms experienced through persistent pregnancy-related lumbopelvic pain (PPLP) as well as their strategies to cope with the condition. This is a mixed-method study based on questionnaire responses and inductive interviews with 12 Swedish women with self-reported PLP during pregnancy 2002 partaking in a 12-year postpartum follow-up questionnaire cohort. Test of statistical differences between the interview cohort and the total cohort was performed and the interviews were analysed through inductive qualitative content analysis. The questionnaire data showed that the interview sample reported significantly more pain than the questionnaire respondents but resembled the questionnaire respondents on most other characteristics. The theme "Balancing avoidance and activity" and its sub-themes illustrate the strategies the participants used to manage their situation on a daily basis. The pain was a constant reminder that led to evaluation of pros and cons for physical, social, and mental activities as well as the search for therapies and treatments. For the women who participated in the interviews, living with persistent pregnancy-related lumbopelvic pain caused limitations and negatively affected various and major parts of life to a far greater extent than previously known. Persisting pregnancy-related lumbopelvic pain affects various and major parts of life, including working, physical and social activities, and psychological well-being. Rehabilitation should focus on individualized physical activities and effective coping strategies. Effort should be put into helping the patient find fulfilling explanatory reasons for the persisting pregnancy-related lumbopelvic pain. [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]

Objectives: This study aimed to explore staff perspectives of the physical environment in supporting their care practices for residents living with dementia in Canadian and Swedish long-term care facilities. Design: An exploratory, descriptive, qualitative research design based on focus groups was used. Participants: A total of 24 staff members who worked closely with the residents such as nurses or care aides participated in the focus group interviews from four facilities, two in Sweden and two in Canada. Measurements: Focus group interview was held at each selected care facility once and a total of four times were conducted. Broad questions were asked about the effect of physical environment on care practice, job satisfaction, and interaction with residents. Data were analyzed by thematic analysis. Findings: This study identified three environmental themes that have substantial effect on the social interaction and care practice: (i) design ambience enables and limits social and care interaction, (ii) space arrangements facilitate and hinder the effectiveness of care delivery, and (iii) sensory stimuli have direct impact on residents. The findings demonstrate that well-designed environment qualities such as homelike ambience, an open layout, and stimulating courtyard positively stimulate the emotion of staff as well as residents, which also leads to build trust and relationship and to increase job satisfaction. The study found that the appropriate level of sound or familiar music for residents with dementia is a positive stimulus. When the staff felt comfortable and supported by good care unit's ambience, they can be motivated to care for their residents, leading to better care practices. The study also found that the closed floor plan in an institutional setting could increase staff fatigue by obstructing the view of residents' behaviors and movement and by increasing walking loads. Conclusions: This study highlights the complexities of how care was organized and influenced by the physical environment of the setting. The variations in the physical environmental characteristics and quality of care suggest the value of comparative research in identifying and exploring the possible causes and consequences. Future development in long-term care facilities requires a better understanding of staff experiences and staff involvement in the physical design of care settings. [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]

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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]

Occupational therapists in Sweden are expected to use evidence-based practice. To meet this expectation, a helpful tool could be the Model of Human Occupational Screening Tool (MOHOST). The aim of this study was to examine the utility of the Swedish version of MOHOST. Thirty-seven occupational therapists were invited to take part in the examination. A questionnaire covering transferability, feasibility and clinical relevance was developed. The results show that MOHOST-S seems to have suitable utility. The study supports its implementation potential and clinical relevance. It gives a broad picture of the client's occupational participation and it supports the treatment planning process. [ABSTRACT FROM AUTHOR]

Background: Being engaged in activities in places outside the home after a stroke can be challenging. Knowledge about what characterize places outside the home is important to support participation. Objectives: To explore patterns of participation in places for activities outside the home after stroke and whether these patterns were associated with personal and environmental aspects. Material and methods: Sixty-three people with stroke were interviewed using the Participation in Activities and Places Outside Home (ACT-OUT) questionnaire. A two-step cluster analysis was used to identify patterns of participation and non-parametric test was used to explore potential associations to the patterns of participation. Results: Four clusters of patterns of participation, based on frequency, familiarity of the place/the way to the place and perceived distance, were identified. The patterns were significantly associated with type of place, activity domain, retained or abandoned participation, transportation and being accompanied by someone. The severity of disability was significantly associated with groups of individuals with different patterns of participation. Conclusions: Different combinations of aspects facilitated and hindered whether or not participation changed. To support people with stroke in their endeavour to retain or recapture participation, social support is important to consider in relation to transportation, activities and places outside the home. [ABSTRACT FROM AUTHOR]

Background: The McGill Quality of Life Questionnaire - Expanded (MQOL-E) and the Quality of Life in Life-Threatening Illness-Family Carer/Caregiver version (QOLLTI-F) are developed for use with patients facing the end of life and their family carers, respectively. They are also developed for possible use as companion instruments. Contemporary measurement validity theory places emphasis on response processes, i.e. what people feel and think when responding to items. Response processes may be affected when measurement instruments are translated and adapted for use in different cultures. The aim of this study was to translate and examine content validity and response processes during completion of MQOL-E and QOLLTI-F version 2 (v2) among Swedish patients with life-threatening illness and their family carers. Methods: The study was conducted in two stages (I) translation and adaptation (II) examination of content validity and response processes using cognitive interviews with 15 patients and 9 family carers. Participants were recruited from the hemodialysis unit, heart clinic, lung clinic and specialized palliative care of a Swedish county hospital. Patients had life-threatening illness such as advanced heart failure, advanced chronic obstructive pulmonary disease, end-stage kidney disease or advanced cancer. Patients were outpatients, inpatients or receiving home care. Results: Patients and family carers respectively believed that the items of the MQOL-E and QOLLTI-F v2 reflect relevant and important areas of their quality of life. Although some items needed more time for reflection, both instruments were considered easy to understand. Some changes were made to resolve issues of translation. Participants expressed that reflecting on their situation while answering questions was valuable and meaningful to them, and that responding was an opportunity to express feelings. Conclusions: The results of response processes pertaining to the Swedish translations of both MQOL-E and QOLLTI-F v2 contribute evidence regarding content validity, linguistic equivalence and cultural appropriateness of the translated instruments. In addition, results show that the instruments may support conversations on matters of importance for quality of life between patients and/or family carers and health care professionals. Further research is needed to study the psychometric properties of Swedish translations. [ABSTRACT FROM AUTHOR]

Anxiety disorders are among the most persistent mental health syndromes. There is extensive research showing effectiveness of pharmacotherapy and psychotherapy interventions targeting anxiety, while knowledge is still sparse for other treatment options. The aim of this study was to explore how participants with anxiety disorders experience a physiotherapeutic group treatment in psychiatric outpatient care, and their perceived ability to manage anxiety within two months after participating in the treatment. Semi-structured interviews with participants were conducted to explore experiences of the treatment. Data were analyzed using qualitative content analysis, which resulted in one main theme: Reconnecting to the body in the supportive atmosphere of a group. Six categories reflect the main theme: (1) sharing with others supported by the group, (2) grounding oneself in the body, (3) getting to know the body and learning to manage its reactions, (4) learning to tolerate bodily sensations of anxiety, (5) gaining a more compassionate attitude toward oneself, and (6) challenging old patterns to become more active in life. The participants reported that their ability to reconnect to their bodies increased so that anxious sensations became more endurable and acceptable after treatment. The supportive group context was described as valuable, enabling the participants to feel safe enough to start exploring new ways to manage anxiety. In conclusion, this study suggests that a physiotherapeutic group treatment can be a useful add-on treatment to the standard treatment models of anxiety disorders, including psychotherapy and pharmacotherapy, since it targets the embodied, nonverbal domain of anxiety. [ABSTRACT FROM AUTHOR]

Aims and objectives: To develop and evaluate the psychometric properties of a self‐report instrument measuring 6‐ to 12‐year‐old children's own experiences of participation in health care. Background: Validated measures to evaluate children's participation in health care can play a critical role in strategic work towards supporting children's participation at an individual level and in working towards quality improvements at an organisational level. There are, however, no available instruments to achieve this. Methods: An instrument development design was used, together with the TRIPOD checklist. Item construction was based on research about children's perspectives on participation in health care and Shier's model for participation. The face and content validity was evaluated by 14 healthy children, 9 paediatric nurses and 8 children with different diseases. The construct validity, internal consistency and stability reliability were evaluated based on data from 138 children visiting a paediatric clinic. Results: The testing of the face and content validity resulted in an instrument with child‐friendly language, additional instructions and visual attractive presentation. The principle component analysis resulted in the four‐factor solution: "To be included," "To trust professionals," "To take control," and "To understand information." Internal consistency and intraclass correlation coefficients were acceptable. Conclusion: We conclude that the child participation in health care (ChiPaC) instrument has adequate reliability and validity when used to evaluate children's participation in health care. The involvement of children in the development of ChiPaC resulted in a brief, colourful and user‐friendly instrument for use in paediatric health care. Relevance to clinical practice: This new questionnaire, ChiPaC, is adapted for children between 6–12 years measuring participation in health care from a child perspective. ChiPaC can be used in the practical work of supporting individual children's participation in health care as well as in the strategical work towards quality improvements on an organisational level. [ABSTRACT FROM AUTHOR]

Children who have parents with any kind of illness may become young carers who take a responsibility not expected of children for household tasks, or personal or emotional care for parents and siblings. So far, little is known about children in Sweden who are at risk of becoming young carers. The aim of this article is therefore to explore the extent and impact of children's caring activities as reported in a pilot study by a sample of children in Sweden. A number of international questionnaires measuring the amount of caring activities, impact of caring, quality of life, and psychological well‐being were translated and combined into a survey. The pilot survey was completed by 30 children 10–18 years of age. Also, when completing the survey, the children were interviewed concerning their experiences of caregiving. The participants report on a group level emotional symptoms such as fear and nervousness above the clinical cut‐off value. They also rate a lower level of caring compared with findings from the United Kingdom, but they report a higher degree of negative impact of caring than young carers in the United Kingdom. [ABSTRACT FROM AUTHOR]

The aim of this study was to gain a deeper understanding of Swedish social workers' experience of disabled children's participation, to discover in what ways their knowledge about impairment and disability, combined with legal literacy and local context influence children's participation in formal meetings and decision making. Seven focus-group interviews were conducted with 35 municipal social workers from communities in different parts of Sweden. The phenomenological analysis resulted in the overarching theme of elusive participation, in which participation was described as difficult to grasp both in relation to what was supposed to be achieved and what it was meant to result in. Elusive participation entailed a discrepancy between policy and practice, norms and perception of normality, conflicting perspectives and needs, judgment of children's abilities. These findings underline the importance of creating safe spaces in which social workers have the opportunity for critical reflections and shared discussions about social work practice. [ABSTRACT FROM AUTHOR]

Aim: To culturally adapt and evaluate the psychometric properties of the Young Children's Participation and Environment Measure (YC-PEM) for use by caregivers of Swedish children with and without disabilities, aged 2-5 years. Methods: Thirteen cognitive interviews and two focus groups with caregivers of children with and without disabilities were conducted to evaluate the cultural relevance of YC-PEM content for use in Sweden. Per participant feedback, a revised version of the Swedish YC-PEM was created and pilot tested with caregivers of children with disabilities (n = 11) and children with typical development (n = 22). Results: User feedback informed content revisions to 7% of items. Internal consistency estimates of the Swedish YC-PEM pilot version were acceptable and ranged from.70 to.92 for all but two of the YC-PEM scales. Mean percentage agreement between raters ranged from 47% to 93% across YC-PEM scales for inter-rater, and 44% to 86% for test-retest. One of twelve YC-PEM scales revealed significant group differences between young children with and without disabilities. Conclusions: This study contributes preliminary evidence for the use of some scales within a culturally adapted YC-PEM in Sweden. Further validation with larger samples will allow for parametric testing to evaluate its psychometric properties. [ABSTRACT FROM AUTHOR]

Purpose: The aim of the study was to explore the experiences of remote communication (i.e., communication between persons who are not in the same place) among people with communicative and cognitive disabilities.Materials and methods: Eleven adolescents and adults were interviewed using Talking Mats and interview data was analyzed qualitatively with systematic text condensation.Results: The use of remote communication varies between the participants. The participants also value remote communication differently. Having the possibility to choose between different means of remote communication is important. Being able to determine whether to communicate independently or with support from another person is also valued as relevant. Strategies used to manage remote communication include facilitating for the communication partner and preparing for future communication situations. Those who are able to use writing as an alternative to problematic spoken remote communication like phone calls, for example by using chat or text messaging. Decisions regarding means of communication and human support relate to the concept of self-determination.Conclusion: Better access to remote communication trough assistive technology such as speech synthesis and picture symbols would make remote communication easier and facilitate participation for people with communicative and cognitive disabilities. Implications for rehabilitation People with communicative and cognitive disabilities face challenges with access to remote communication.Access to communication technology including remote communication is important for self-determination, for personal safety and for overall participation in society.Communication technology should be considered in the rehabilitation process and training is crucial.To understand the possible benefits of remote communication, people with communicative and cognitive disability need to get the possibility to practice.Professionals play a key role in the assessment and intervention of remote communication for their patients. [ABSTRACT FROM AUTHOR]

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

Objectives: To perform an ergonomic analysis of work and machinery-related risks in a group of Swedish older farmers, investigating farmers’ attitudes and perceptions about: 1) health status and work motivation, 2) physical and cognitive workload and difficulties in the interaction with machinery and technological innovations, and 3) risks and safety practices. Methods: Nine Swedish male farmers aged 65+ were administered a semi-structured interview and a questionnaire. Results: Participants perceived themselves as being in good health and considered farming as a good proxy of their health status. They reported an increased physical workload but did not describe any cognitive workload. Technology was reported to have low usability, and thus its benefits cannot be fully exploited. Older farmers acknowledged the existence of “new risks” related to the aging process and mainly referred to the common sense and previous experience as the best safety practices. Conclusion: Multilevel interventions focused on the capabilities and limits of the older farmers should be developed, involving both training activities and design solutions for the machinery that can support older farmers’ health and safety. [ABSTRACT FROM AUTHOR]

Aims To investigate the associations between the quality of the physical environment and the psychological and social well-being of older people living in residential care facilities. Background Many older people in care facilities have cognitive and physical frailties and are at risk of experiencing low levels of well-being. High-quality physical environments can support older people as frailty increases and promote their well-being. Although the importance of the physical environment for residents' well-being is recognized, more research is needed. Design A cross-sectional survey of 20 care facilities from each of which 10 residents were sampled. As the individual resident data were nested in the facilities, a multilevel analysis was conducted. Methods Data were collected during 2013 and 2014. The care facilities were purposely sampled to ensure a high level of variation in their physical characteristics. Residents' demographic and health data were collected via medical records and interviews. Residents' well-being and perceived quality of care were assessed via questionnaires and interviews. Environmental quality was assessed with a structured observational instrument. Results Multilevel analysis indicated that cognitive support in the physical environment was associated with residents' social well-being, after controlling for independence and perceived care quality. However, no significant association was found between the physical environment and residents' psychological well-being. Conclusion Our study demonstrates the role of the physical environment for enhancing the social well-being of frail older people. Professionals and practitioners involved in the design of care facilities have a responsibility to ensure that such facilities meet high-quality specifications. [ABSTRACT FROM AUTHOR]

Frailty causes disability and restrictions on older people's ability to engage in leisure activities and for social participation. The objective of this study was to evaluate the effects of a 1-year case management intervention for frail older people living at home in Sweden in terms of social participation and leisure activities. The study was a randomised controlled trial with repeated follow-ups. The sample (n = 153) was consecutively and randomly assigned to intervention (n = 80) or control groups (n = 73). The intervention group received monthly home visits over the course of a year by nurses and physiotherapists working as case managers, using a multifactorial preventive approach. Data collections on social participation, leisure activities and rating of important leisure activities were performed at baseline, 3, 6, 9 and 12 months, with recruitment between October 2006 and April 2011. The results did not show any differences in favour of the intervention on social participation. However, the intervention group performed leisure activities in general, and important physical leisure activities, to a greater extent than the control group at the 3-month follow-up (median 13 vs. 11, P = 0.034 and median 3 vs. 3, P = 0.031 respectively). A statistically significantly greater proportion of participants from the intervention group had an increased or unchanged number of important social leisure activities that they performed for the periods from baseline to 3 months (93.2% vs. 75.4%, OR = 4.48, 95% CI: 1.37-14.58). Even though statistically significant findings in favour of the intervention were found, more research on activity-focused case management interventions is needed to achieve clear effects on social participation and leisure activities. [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]

Aim To develop and validate a new instrument measuring patient anxiety during Magnetic Resonance Imaging examinations, Magnetic Resonance Imaging- Anxiety Questionnaire. Background Questionnaires measuring patients' anxiety during Magnetic Resonance Imaging examinations have been the same as used in a wide range of conditions. To learn about patients' experience during examination and to evaluate interventions, a specific questionnaire measuring patient anxiety during Magnetic Resonance Imaging is needed. Design Psychometric cross-sectional study with test-retest design. Methods A new questionnaire, Magnetic Resonance Imaging-Anxiety Questionnaire, was designed from patient expressions of anxiety in Magnetic Resonance Imaging-scanners. The sample was recruited between October 2012-October 2014. Factor structure was evaluated with exploratory factor analysis and internal consistency with Cronbach's alpha. Criterion-related validity, known-group validity and test-retest was calculated. Results Patients referred for Magnetic Resonance Imaging of either the spine or the heart, were invited to participate. The development and validation of Magnetic Resonance Imaging-Anxiety Questionnaire resulted in 15 items consisting of two factors. Cronbach's alpha was found to be high. Magnetic Resonance Imaging-Anxiety Questionnaire correlated higher with instruments measuring anxiety than with depression scales. Known-group validity demonstrated a higher level of anxiety for patients undergoing Magnetic Resonance Imaging scan of the heart than for those examining the spine. Test-retest reliability demonstrated acceptable level for the scale. Conclusion Magnetic Resonance Imaging-Anxiety Questionnaire bridges a gap among existing questionnaires, making it a simple and useful tool for measuring patient anxiety during Magnetic Resonance Imaging examinations. [ABSTRACT FROM AUTHOR]