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Objective: The objective was to describe midwives’ experiences of postpartum haemorrhage (PPH) >1000 ml in connection with childbirth. Design: A qualitative web-based survey with open-ended questions was used and the results were analysed with content analysis. Setting: Participants were recruited through convenience sampling from a national Facebook group for midwives. Participants: The study sample included 24 midwives with varying work experience at different maternity units in Sweden, all of whom had experience of postpartum haemorrhage >1000 ml. Findings: The midwives described that the treatment of PPH is limited by a lack of cooperation, knowledge, and assistance, as well as by staff inexperience. They also described how a high-pressure work environment contributed to feelings of inadequacy. Good cooperation, team training, having colleagues present, embodied knowledge, and good working conditions, led to successful handling of such situations, which contributed to feeling at ease with what had happened. Key conclusions and implications for practice: Good working conditions related to external contextual factors such as total load and support, as well as internal factors such as self-efficacy, can help midwives manage PPH while providing patient-safe care and feeling confident in their ability and at ease with the events. Therefore, midwives need to be given opportunities for emotional support, education, and team-based training to maintain the quality of midwifery care and avoid negative long-term effects for both midwives and patients.

This systematic review aimed to identify how children's right to health, connected to the principles of protection, promotion, and participation, and from the perspectives of children, parents, and professionals in preschool, school, and healthcare has been empirically demonstrated by international scholars between 1989 and 2021. Following the standards of PRISMA-P, two searches, in 2018 and 2020, were conducted in seven databases. In total, 561 studies were found and after the screening process, which entails reviewing titles, abstracts, and full text-versions, 49 studies were finally included. A deductive qualitative content analysis, proposed by Elo and Kyngas, was performed. According to the findings, protection was demonstrated as Being protected from harmful acts and practices and being entitled to special care and assistance. Promotion was demonstrated as Possessing of resources and Receiving of services, and participation as Being heard and listened to and Being involved in matters of concern. Conforming to the findings, although presented separately, protection, promotion, and participation could be understood as interrelated concepts. In summary, children's right to health was demonstrated within two major fields: as the use of their own resources, and trust and as aspects provided by adults as support and safety. This is the first review of studies, published 1989-2021, identifying children's right to health through the perspectives of protection, promotion, and participation. During this period, children's right to health has mainly been demonstrated in studies from a healthcare context. All researchers, policymakers, health workers, and politicians should include children in all decisions that concern them, to increase their participation. As children's health is closely linked to their physical, social, and cognitive development there is a need for more studies exploring children's right to health in preschool and school contexts in which children spen

PURPOSE: This qualitative study describes nurses' experiences and perceptions of how they develop the clinical gaze. METHODS: This qualitative study used an inductive approach and content analysis to assess the experiences of newly graduated nurses, nurse managers, and nursing teachers. Nineteen interviews were conducted. To achieve credibility, the study followed the guidelines of the Consolidated Criteria for Reporting Qualitative research (COREQ). RESULTS: Two themes emerged: nurses' personal abilities and the learning culture. Learning culture was considered the foundation of the development of the clinical gaze. The clinical gaze was found to be developed in relationships with patients and when learning together with colleagues, in which the opportunities for reflection are central. To develop the clinical gaze, structures for learning activities, such as reflection, communication exercises, and simulation, are needed so that they become a natural part of daily work. This can also be achieved through supervision and skills training both at university and in a care context. CONCLUSIONS: Prerequisites for the development of the clinical gaze include physical presence with the patient combined with learning activities such as conscious reflection with others in a safe learning culture.

Objective: The aim of this study was to describe women's experiences before, under, and after a guided internet-based intervention for vulvodynia. Methods: The design was qualitative, based on content analysis. Participants were women who had undergone guided internet-based treatment for vulvodynia based on acceptance and commitment therapy principles (n = 13). Data were collected through in-depth interviews approximately-one month after participants completed treatment. Results: The analysis revealed the women's experiences of internet-based treatment for vulvodynia. Three themes emerged: “dealing with pain alone,” which was related to experiences of living with vulvodynia before internet-based treatment; “finding new ways,” which described the experiences of undergoing an internet-based treatment for vulvodynia and “feeling empowered to take control,” referring to the experiences of living with vulvodynia after the internet-based treatment. The women described a long search for a diagnosis, revealing a negative experience of healthcare. The internet-based treatment helped them find new ways to manage vulvodynia, but difficulties with the treatment were also experienced. After the intervention, the women reported improvements in wellbeing and having better strategies to manage pain, but also stated that the treatment was insufficient to perceive changes in vulvar pain. Conclusions: The guided internet-based treatment program for vulvodynia based on acceptance and commitment therapy principles was perceived as credible, helpful to manage vulvodynia, and could serve as a complement to regular care. Questions regarding the need for more support and optimal length of treatment need to be further evaluated.

Background: The organ donor process is challenging, not at least for intensive care nurses. The situation changesradically, from intensively working to save the patient’s life to instead caring for the donor patient’s organs so thatthose, in turn, can save another patient’s life. The donation process challenges nurses’ view on what dignifiedcaring at end-of-life entails. The inner core of caring comprises love, mercy and compassion. Dignified caring isrelated to treating the patient as a unique human being and respecting human value, rooted in the theory of caritativecaring that is the framework for this study.Aim: The aim was to illuminate intensive care nurses’ experiences of caring during the organ donor process, froma caring science perspective.Methodology: A descriptive research design including inductive qualitative content analysis of interviews withtwelve intensive care nurses in Sweden about their experiences of caring during the donor process.Results: The theme The complexity of caring during the organ donor process with two categories and fivesubcategories was generated. Intensive care nurses experienced caring during the donor process as being complexin relation to the potential donor patient and patient’s family as well as communication, teamwork andorganization. Caring affects not only the patient and families, but also the nurses and receivers of the donatedorgans. Intensive care nurses perceive the other’s life situation as if it were their own and recognize the importanceof shared humanity.Conclusion: The present study can increase knowledge from intensive care nurses and the caring team, in orderto provide better conditions such as the development of effective intervention strategies in the process of organdonor care as well as caring for the families and members of the team.

Background: Nursing faculties??? perceptions influence nursing education. This article describes how nursing faculty perceive nursing students??? development of professional competence by integrating theory and practice, and by examining how this context influences this integration. Method: With a phenomenographic approach, interviews were conducted with nine participants and analyzed into qualitatively different categories of description. Results: The integration of theoretical and practical knowledge is perceived as a challenge or as naturally intertwined in the entire education, focusing mainly on individual prerequisites for learning. Perceptions of a common mission create coherence for students. Evident learning structures are needed, and there is a perceived discrepancy between nurses??? competence and expectations in health care. Conclusion: If the theory and practice gap could be perceived as a driving force for continuous learning, it could become an incentive for closer collaboration by creating structures for competence development that include individuals, teams, and organizations. [J Nurs Educ. 2022;61(5):236-241.]

BackgroundA previous study showed that pregnant women/new mothers especially Somali-born and some Swedish-born had extremely low vitamin D levels and poor physical performance. Our study aimed to examine vitamin D related lifestyle, attitudes and behaviour before and after brief information about vitamin D, with special long-term focus on Somali-born women.MethodsA cohort of 91 pregnant women/new mothers having serum hydroxyvitamin D (S-25-OHD)<= 50nmol/L (n=51 Somali-born with one third <10nmol/L of S-25-OHD) in primary health care in Sweden was targeted for intervention. Brief individual oral and visual information on vitamin D was given by doctors at baseline and after four and ten months. Questionnaires with ordinal scales on vitamin D related lifestyle of food, clothing, and outdoor activities were distributed on all occasions. Focus-group interviews with 15 women from the target-group were performed after two years. A Somali interpreter was available.ResultsVeiled clothing, indoor living, and a low intake of milk, cheese, and fatty fish were common in the target group. Consumption pattern had increased significantly among the Somali-born women at the four-month follow-up but declined to non-significant levels at the ten-month follow-up. The focus-group interviews showed improved understanding of vitamin D deficiency, symptoms and attitudes, but varying applied behaviours related to sun exposure. Sun exposure for the children and increased fish consumption was the most evident positive results.ConclusionsVitamin D related lifestyle, attitudes and behaviour improved in a Somali-born group of pregnant women/new mothers with severe vitamin D deficiency. The preventive measures suggested in our study may have impact on public health in relation to bone and muscle strength and immunity especially in vitamin D deficiency risk groups.Trial registrationClinicalTrials.gov Identifier: NCT02922803. Date of registration: 28 September 2016.

Aim and objectives: To describe perceptions of managers regarding prerequisites for professional competence development of newly graduated nurses following a 1-year residency programme. Background: In general, managers are unsatisfied with the professional competence of newly graduated nurses. Therefore, they have been involved in residency programmes to support the nurses' transition from being nursing students to professional nurses. However, perceptions of managers regarding the professional competence development of nurses have been sparingly studied. Design/Methods: Qualitative, descriptive study with a data-driven inductive approach with content analysis to obtain an understanding of the perceptions of nine managers through interviews. EQUATOR checklist COREQ is used (see FileS1). Results: Three themes emerged: (a) the nurses' relationships with their teams and patients, (b) expectations regarding the development of practical skills and leadership skills and (c) prerequisites for continuing learning by supportive structures and a mutual responsibility between the manager and the nurse. Reflection was perceived by the managers as a cornerstone in the learning and development of professional competence. Learning theory was important, but learning practical clinical skills was essential for the nurses to develop competence and be able to perform their work, including being a leader of the team. Some structures discouraged continued learning in the development of professional competence, indicating a gap between the healthcare settings and the basic nursing programme. Conclusions: There is a gap between the university and the healthcare settings in maintaining a structure for continued learning, which requires cooperation. This gap and tension can be a driving force for the learning process of competence development. Relationships with team members and patients are considered fundamental for developing professional competence. Relevance to clinical practice To ove

Background: The learning process for student and recently graduated nurses during their transition to professional nursing is stressful and challenging. The aim of this study was to describe recent graduates' experiences of developing professional competence in their basic nursing program and during their first year. Method: A qualitative descriptive design with an inductive approach based on interviews with 11 nurses, with a qualitative content analysis. Results: Recently graduated nurses experience shortages and struggle to develop their professional competence. They find that reflection is a fundamental tool in the process of professional competence development. The competence gap is not between theoretical and practical knowledge, but rather between the university and health care organizations. Conclusion: Focusing on the intertwining of theoretical and practical knowledge can bridge the gap between these two organizations and create a foundation for lifelong learning of professional competence. Creating opportunities for reflection is central to the learning process.

Introduction: Most healthcare professionals rarely experience situations of a request for organ donation being made to thepatient’s family and need to have knowledge and understanding of the relatives’ experiences.Objective: To describe relatives’ experiences when a family member is confirmed brain dead and becomes a potentialorgan donor.Methods: A literature review and a thematic data analysis were undertaken, guided by the Preferred Reporting Items forSystematic Reviews and Meta-Analyses reporting process. A total of 18 papers, 15 qualitative and 3 quantitative, publishedfrom 2010 to 2019, were included. The electronic search was carried out in January 2019.Results: The overarching theme When life ceases emerged as a description of relatives’ experiences during the donationprocess, including five subthemes: cognitive dissonance and becoming overwhelmed with emotions, interacting with healthcareprofessionals, being in a complex decision-making process, the need for proximity and privacy, and feeling hope for thefuture. The relatives had different needs during the donation process. They were often in shock when the declaration ofbrain death was presented, and the donation request was made, which affected their ability to assimilate and understandinformation. They had difficulty understanding the concept of brain death. The healthcare professionals caring for the patienthad an impact on how the relatives felt after the donation process. Furthermore, relatives needed follow-up to processtheir loss.Conclusion: Caring science with an explicit relative perspective during the donor process is limited. The grief process isindividual for every relative, as the donation process affects relatives’ processing of their loss. We assert that intensive careunit nurses should be included when essential information is given, as they often work closest to the patient and her or hisfamily. Furthermore, the relatives need to be followed up afterwards, in order to have questions answere

Aims: Parental separations have become more frequent in recent decades. In Western countries, about 25% of children experience parental separation. There is a need to explore the risk factors for separation to give children an optimal childhood. The objective of the present study was to examine parental stress and depressive symptoms during early parenthood and their association with parental separation. Methods: Four hundred and seven couples completed questionnaires on depressive symptoms for 3 months and parental stress for 18 months after childbirth. Total parental stress and five sub-areas were investigated. To study the separation rate, parents' addresses were recorded 9 to 11 years after childbirth. Results: Twenty-nine percent of the parents were separated 9 to 11 years after childbirth. Separation was associated with depressive symptoms at 3 months (mothers p = .002, fathers p = .025) and total parental stress at 18 months after childbirth (mothers p = .010, fathers p = .005). The sub-areas of parental stress, Spouse relationship problems (mothers p = <.001, fathers p = .001) and fathers' Social isolation (p = .005), were associated with separation. In multivariable regression analyses of the parents' separation rate 9 to 11 years after childbirth, the only significant predictor was mothers' Spouse relationship problems (p < .001). Conclusions: The knowledge that parental stress and depressive symptoms are risk factors for separation may simplify professional support for parents in early parenting. Courses for new and expectant parents can use this knowledge to increase parents' awareness.

Aim: The use of simulation-based team training in neonatal resuscitation has increased in Sweden during the last decade, but no formal evaluation of this training method has been performed. This study evaluated the effect of simulation-based team training on the self-assessed ability of personnel to perform neonatal resuscitation. Methods: We evaluated a full-day simulation-based team training course in neonatal resuscitation, by administering a questionnaire to 110 physicians, nurses and midwives before and after the training period. The questionnaire focused on four important domains: communication, leadership, confidence and technical skills. The study was carried out in Sweden from 2005 to 2007. Results: The response rate was 84%. Improvements in the participants self-assessed ability to perform neonatal resuscitation were seen in all four domains after training (p < 0.001). Professionally inexperienced personnel showed a significant improvement in the technical skills domain compared to experienced personnel (p = 0.001). No differences were seen between professions or time since training in any of the four domains. Personnel with less previous experience with neonatal resuscitation showed improved confidence (p = 0.007) and technical skills (p = 0.003). Conclusion: A full-day course on simulation-based team training with video-supported debriefing improved the participants' self-assessed ability to perform neonatal resuscitation.

Aim To determine whether there is an association between depressive symptoms and parental stress among mothers and fathers during early parenthood in Sweden. Methods In this study, 401 mothers and 396 fathers (393 couples) were included; the Edinburgh Postnatal Depression Scale and the Sense of Coherence Scale were measured 3 months after childbirth, and the Swedish Parenthood Stress Questionnaire and the Sense of Coherence Scale after 18 months. Complete data for multivariable analysis were available for 264 mothers and 252 fathers. Results The mothers estimated greater total depressive symptoms and parental stress than the fathers did. Both the mothers and the fathers had the greatest level of stress in the sub-area 'Role restriction'. The mothers had the lowest level of stress in the sub-area 'Social isolation' and the fathers in the sub-area 'Incompetence'. The mothers perceived greater levels of stress than the fathers did in all sub-areas except for 'Social isolation', where the fathers perceived higher stress. There was an association between the parents' depressive symptoms and parental stress. The parents' own depressive symptoms at 3 months and sense of coherence and the partners' parental stress at 18 months were positively associated with the parental stress at 18 months in univariable and multivariable analyses. Conclusions Understanding the relationship between depressive symptoms and parental stress is important for health professionals so they can offer parents adequate support in early parenthood to optimize the conditions for raising a child. This knowledge should also be communicated to the parents.

Aim To examine whether mothers' and fathers' levels of perceived relationship discord at childbirth were associated with postpartum depressive symptoms when the child was 3 months old. Another aim was to examine parents' levels of self-reported depressive symptoms. The hypothesis was that parents with high levels of perceived relationship discord have higher levels of postpartum depressive symptoms than parents with low levels of perceived relationship discord. Method One week after childbirth, 305 couples' perceived level of relationship discord was measured using the Dyadic Consensus Subscale (DCS) of the Dyadic Adjustment Scale (DAS). At 3 months postpartum, the same couples answered the Edinburgh Postnatal Depression Scale (EPDS) questionnaire. The relations between perceived level of relationship discord and postpartum depressive symptoms were analysed using standard non-parametric statistical methods. Results The mothers and fathers partly differed regarding which areas of their relationship they perceived that they disagreed with their partners about. Furthermore, 16.5% of the mothers and 8.7% of the fathers reported postpartum depressive symptoms, and there was a moderate level of correlation between the DCS and EPDS scores. Conclusion These results may be useful for professionals in antenatal care and child health centres as well as for family caregivers who need to be aware that mothers and fathers may have different views on relationship discord and of the high level of depressive symptoms in recent parents. Further research is needed to examine perceived relationship discord and the development of depressive symptoms postpartum over a longer term.