Background: Compassion is seen as a core professional value in nursing and as essential in the effort of relieving suffering and promoting well-being in palliative care patients. Despite the advances in modern healthcare systems, there is a growing clinical and scientific concern that the value of compassion in palliative care is being less emphasised. Objective: This study aimed to explore nurses’ experiences of compassion when caring for palliative patients in home nursing care. Design and participants: A secondary qualitative analysis inspired by hermeneutic circling was performed on narrative interviews with 10 registered nurses recruited from municipal home nursing care facilities in Mid-Norway. Ethical considerations: The Norwegian Social Science Data Services granted permission for the study (No. 34299) and the re-use of the data. Findings: The compassionate experience was illuminated by one overarching theme: valuing caring interactions as positive, negative or neutral, which entailed three themes: (1) perceiving the patient’s plea, (2) interpreting feelings and (3) reasoning about accountability and action, with subsequent subthemes. Discussion: In contrast to most studies on compassion, our results highlight that a lack of compassion entails experiences of both negative and neutral content. Conclusion: The phenomenon of neutral caring interactions and lack of compassion demands further explorations from both a patient – and a nurse perspective. © The Author(s) 2019.

Bakgrund: Omkring 100 000 svenskar beräknas lida av bensår vilka kräver långa behandlingstider och medför ekonomiska kostnader för samhället. Olika sjukdomstillstånd såsom trauma och försämrad blodcirkulation anses som riskfaktorer. Att leva med bensår kan ha negativ inverkan på människors dagliga liv. Det är viktigt för sjuksköterskor att informera patienterna kring behandlingen, ge stöd samt ha förmågan att bemöta dem med respekt och empati. Syfte: Syftet med föreliggande studie var att beskriva hur patienter med bensår upplever sin livskvalitet samt att beskriva undersökningsgrupperna som ingick i de inkluderade artiklarna. Metod: Beskrivande litteratur studie som inkluderade tolv vetenskapliga artiklar som söktes fram i databasen Cinahl. Huvudresultat: Patienterna beskrev smärta som påverkade deras dagliga liv både fysiskt och psykiskt. Sömnproblem påverkade det psykiska måendet negativt. Rädslan för att skada sig begränsade patienterna fysiskt och man beskrev även känslan av skam, missmod, ensamhet, oro, ångest, depression och förlust av hopp. Bensår upplevdes tidssamt energikrävande och brister i kunskap hos sjukvårdpersonalen hade negativ påverkan på patienternas livskvalité. Undersökningsgrupperna varierade i antal från 5 till 247 deltagare, majoriteten var kvinnor, åldern var mellan 18 till 99 år. De flesta deltagarna hade haft venösa bensår, vilka varade mellan 6 veckor till 43 år. Slutsats: Att leva med bensår påverkade livskvaliteten. Relationen mellan sjuksköterska – patient hade stort betydelse för sårläkningen och välbefinnande. Det är viktigt att sjuksköterskor har tillräcklig kunskap om denna patientgrupp samt att ge ett professionellt bemötande, stöd och information om en egenvård. 

OBJECTIVE: The aim of this study was to investigate levels of perceived family cohesion during childhood, teenage years, and young adulthood in cancer-bereaved youths compared with non-bereaved peers.

METHODS: In this nationwide, population-based study, 622 (73%) young adults (aged 18-26) who had lost a parent to cancer 6 to 9 years previously, when they were teenagers (aged 13-16), and 330 (78%) non-bereaved peers from a matched random sample answered a study-specific questionnaire. Associations were assessed using multivariable logistic regression.

RESULTS: Compared with non-bereaved youths, the cancer-bereaved participants were more likely to report poor family cohesion during teenage years (odds ratio [OR] 1.6, 95% CI, 1.0-2.4, and 2.3, 95% CI, 1.5-3.5, for paternally and maternally bereaved youths, respectively). This was also seen in young adulthood among maternally bereaved participants (OR 2.5; 95% CI, 1.6-4.1), while there was no difference between paternally bereaved and non-bereaved youths. After controlling for a number of covariates (eg, year of birth, number of siblings, and depression), the adjusted ORs for poor family cohesion remained statistically significant. In a further analysis stratified for gender, this difference in perceived poor family cohesion was only noted in females.

CONCLUSION: Teenage loss of a parent to cancer was associated with perceived poor family cohesion during teenage years. This was also noted in young adulthood among the maternally bereaved. Females were more likely to report poor family cohesion. Our results indicate a need for increased awareness of family cohesion in bereaved-to-be families with teenage offspring, with special attention to gender roles.

Det övergripande syftet med denna avhandling är att utifrån unga människors berättelser få en ökad förståelse för hur det är att leva som ung och vara arbetslös. Ytterligare ett syfte är att utforska och beskriva hur unga arbetslösa människors erfarenheter av att ha deltagit i ett stödprojekt för arbetslösa kan förstås ur ett vårdande perspektiv. Avhandlingens övergripande frågeställningar är: Vad innebär det för en ung människa att leva som arbetslös? På vilket sätt kan ett resurscenter för unga arbetslösa vara vårdande? Avhandlingen, som är en sammanläggningsavhandling bestående av fyra vetenskapliga artiklar; har en deskriptiv design och en hermeneutisk forskningsansats. Avhandlingen tar sin utgångspunkt i de fyra vårdvetenskapliga metabegreppen; människa, hälsa, vårdande och världen. Dessa metabegrepp utgör avhandlingens grundpelare samtidigt som de ger forskningens tematik dess vårdvetenskapliga inramning. Informanterna bestod av 15 unga arbetslösa finska män i åldrarna 18-27 år samt 12 unga arbetslösa finska kvinnor i åldrarna 18-26 år som samtliga varit arbetslösa mellan två till sex månader. Data samlades in genom semistrukturerade intervjuer. Intervjuerna bearbetades dels med hjälp av innehållsanalys och dels genom hermeneutisk tolkning. För att öka förståelsen för avhandlingens vårdvetenskapliga tematik så kopplades empirinära resultat från de fyra delstudierna samman med vårdvetenskapliga teorifragment hämtade från Katie Erikssons caritativa vårdteori. Sammantaget kan resultaten vad gäller de unga männens och kvinnornas erfarenheter av arbetslöshet liknas vid ett slags lidande eller en livsleda. I verksamheten på resurscentret för unga arbetslösa framkom de av Eriksson uttalade vårdande begreppen ansa, leka och lära. Ansandet visade sig i form av att de unga människorna fick känna sig uppskattade och accepterade för dem de var och är. Leken och lärandet visade sig i form av att de unga arbetslösa kunde få uttrycka framtidsdrömmar och våga se andra perspektiv. På resurscentret kunde man identifiera goda vårdande krafter som samverkade för att möjliggöra färden från livsleda och lidande till livslust och livsmod. Sammanfattningsvis kan konstateras att arbetslöshet påverkar den unga människans hälsa. Det borde vara värdefullt; inte bara för den arbetslöse enskilde individen; utan också för samhället i stort, att tidigt upptäcka de arbetslösas vardag och verklighet, slussa in dem i ett vårdande kontext för att därigenom i bästa fall kunna ersätta livsledan med livsmod.

Purpose: Our aim was to describe Swedish Healthcare Direct (SHD) and its features as a complex system.

Methods: Qualitative interviews were conducted with 20 SHD telenurses, covering their experiences and skills when encountering and advising callers with mental illness. Complexity science was used as an a priori theoretical framework to enhance understanding of the complex nature of telenursing.

Results: SHD was described as a complex system as nurses were constantly interacting with other agents and agencies. During these interactions, dynamic processes were found between the agents in which the nurses adapted to every new situation. They were constantly aware of their impact on the care-seekers, and perceived their encounters with callers with psychiatric illness as "balancing on a thin line". SHD was also described as both an authority and a dumping ground. The openness of the system did not give the nurses possibility to control the number of incoming calls and the callers' intentions.

Conclusions: These new insights into SHD have important implications for organization developers and nursing management in terms of overcoming linear thinking.

Background: How patients preserve their sense of dignity in life is an important area of palliative care that remains to be explored. Aims: To describe patients' perspectives of what constitutes a dignified life within a palliative care context. Methods: Twelve palliative care patients were interviewed about their views on living with dignity. Data were analysed using qualitative content analysis. Results: What constitutes a dignified life during end-of-life care was captured by the theme 'I may be ill but I am still a human being' and presented under the categories 'preserving my everyday life and personhood', 'having my human value maintained by others through 'coherence' and 'being supported by society at large'. Conclusion: Patients' sense of dignity can be preserved by their own attitudes and behaviours, by others and through public support. Health professionals need to adopt a dignity-conserving approach, for which awareness of their own attitudes and behaviours is crucial. 

BACKGROUND: In most parts of the world, nursing historically has been considered an occupation for women. Gender stereotypes are associated with the nursing profession.

AIM: The aim was to describe and compare the self-reported competence in female and male nursing students. The students were also compared according to their different background college educations. The theoretical framework of hegemonic masculinity and femininity was used.

DESIGN: A cross-sectional design with a questionnaire was used at two points in time, 2012 and 2017.

METHODS: Nursing students completed a questionnaire on graduation from a three-year university nursing program from 12 universities/university colleges in Sweden. In total, 1,810 students were participating, 1577 female and 227 male students. The Nurse Professional Competence scale was used for data collection.

RESULTS: There were statistical significant differences in the self-reported competence between female and male students (t-tests and ANOVAs). These differences are in agreement with the patterns of hegemonic masculinity and femininity. Female students estimated their competence in giving value-based nursing care as higher than male did. Male students estimated their competence in development and leadership higher than female did.

CONCLUSION: The pattern of hegemonic masculinity and femininity could be identified. This indicates a difference in power between female and male students.

IMPACT: The study addresses the self-reported competence of female and male nursing students. The results indicated that male students possibly looked on themselves as superior to the female students. In order to change the image of nursing as a woman's work, the self-images should be discussed in nursing education as well as in college education. Women interested in development, research and leadership and men interested in nursing care and administration must feel that nursing is a suitable profession for them. The stereotypical image of nursing as a women's work is a barrier to nurses' professional development.

The healthcare sector is fast-growing and knowledge-intensive, and to meet the demands associated with it, nursing students must have high levels of self-regulated learning (SRL), metacognition, and general self-efficacy (GSE). In this cross-sectional, correlational study, data were collected from 216 nursing students through a questionnaire. The aims were: 1) to describe the levels of SRL ability, metacognitive ability and GSE among second- and third-year nursing students; 2) to explore the relationships between the SRL ability, metacognitive ability and GSE of second- and third-year nursing students; 3) and to compare SRL ability, metacognitive ability and GSE between second- and third-year nursing students. Nursing students had moderate levels of SRL ability and metacognitive ability, but lower levels of GSE. Positive relationships between SRL ability, metacognitive ability, and GSE were observed. Third-year nursing students had a higher level of SRL ability but lower levels of GSE, compared to second-year students. In terms of metacognitive ability, no significant differences were observed between the student batches. Interventions are required for the improvement of nursing students’ SRL ability, metacognitive ability, and GSE.

Aim

To describe the gardens and their use by individuals living at residential care facilities (RCFs) with high ratings on restorative values.

Background

Being outdoors has been described as important to older people's well‐being. Use of outdoor gardens may increase residents’ well‐being through experiences of restorative qualities such as being away and fascination. Thus far, there has been little research on restorative experiences of gardens in the care of older people.

Design

A descriptive design using behaviour mapping observations integrated with qualitative field notes and recorded conversations.

Methods

A criterion sampling of two gardens (out of a total of 87) was made based on residents’ ratings of restorative values; the two with the highest values were chosen. Eleven residents at the two RCFs took part. Data were collected through behaviour mapping observations, field notes and conversations on five occasions in the respective facilities during residents’ visits to the garden.

Results

The observations revealed that the main uses of the gardens were to socialise and relax. The conversations also showed that the garden stimulated residents’ senses and evoked memories from the past. These restorative values were interpreted as a sense of being away and fascination. Not having opportunities for outdoor visits was reported to result in disappointment and reduced well‐being.

Conclusions

The findings showed that two basic gardens with different characteristics and views could stimulate residents’ senses and evoke memories from the past; this supports the call for residents to be able to spend time in gardens to promote their well‐being.

Implications for practice

First‐line managers, nurses and healthcare staff in the care of older people should consider that regular opportunities to spend time outdoors may promote older people's well‐being through feelings of being away and fascination.

Currently, women comprise about ten percent of those sentenced to psychiatric forensic clinics in Sweden. Those who are sentenced to forensic care because of offending and violent behaviour have already taken a step away from the usually expected female behaviour. On the other hand, there are many women in forensic care who have not committed crimes, but who instead self-harm. Studies have identified a gender bias in diagnosing and care in psychiatric settings, but there are few studies conducted on women in forensic care. The present study therefore examined how the situation of women patients and female norms are expressed in the staff's talk about these women during verbal handovers and ward rounds at a forensic clinic in Sweden. The aim was to explore how psychiatric staff, in a context of verbal handovers and ward rounds, talk about women who have been committed to forensic psychiatric care, and what consequences this might have for the care of the patients. The content of speech was examined using audio recordings and a method of analysis that was inspired by thematic analysis. The analysis identified that the staff talked about the women in a way that indicates that they expected the women to follow the rules and take responsibility for their bodies in order to be regarded as acceptable patients.

Background

Knowledge concerning nursing students’ experiences of the clinical learning environment and how supervision is carried out is largely lacking. This study compares nursing students’ perceptions of the clinical learning environment and supervision in two different supervision models: peer learning in student-dedicated units, with students working together in pairs and supervised by a “preceptor of the day” (model A), and traditional supervision, in which each student is assigned to a personal preceptor (model B).

Methods

The study was performed within the nursing programme at a university college in Sweden during students’ clinical placements (semesters 3 and 4) in medical and surgical departments at three different hospitals. Data was collected using the Clinical Learning Environment, Supervision and Nurse Teacher evaluation scale, CLES+T, an instrument tested for reliability and validity, and a second instrument developed for this study to obtain deeper information regarding how students experienced the organisation and content of the supervision. Independent t-tests were used for continuous variables, Mann-Whitney U-tests for ordinal variables, and the chi-square or Fischer’s exact tests for categorical variables.

Results

Overall, the students had positive experiences of the clinical learning environment and supervision in both supervision models. Students supervised in model A had more positive experiences of the cooperation and relationship between student, preceptor, and nurse teacher, and more often than students in model B felt that the ward had an explicit model for supervising students. Students in model A were more positive to having more than one preceptor and felt that this contributed to the assessment of their learning outcomes.

Conclusions

A good learning environment for students in clinical placements is dependent on an explicit structure for receiving students, a pedagogical atmosphere where staff take an interest in supervision of students and are easy to approach, and engagement among and collaboration between preceptors and nurse teachers. This study also indicates that supervision based on peer learning in student-dedicated rooms with many preceptors can be more satisfying for students than a model where each student is assigned to a single preceptor.

Aims and objectives. To describe the partners’ experiences of living with a person with chronic illness and how they manage everyday life.

Background. The number of partners providing informal care for their chronically ill spouse is rising, and they describe their daily life as demanding.

Design. A descriptive design with a qualitative approach was used.   

Methods. A purposive sample of 16 partners with a chronically ill spouse were interviewed. The interviews were recorded, transcribed, and analyzed using qualitative content analysis.

Results Four main themes were identified: ‘Living with challenges caused by the spouse's disease,’ ‘Seeking support for living with the spouse’s illness,’ ‘Appreciating the good parts of life’ and ‘Adapting to constant changes and an uncertain future.’ The participants rated their health as rather good and had great confidence in their own ability to cope with daily life. Their experiences of support from formal care providers varied; they expressed the need for more assistance from the health care sector.

Conclusions. The partners experienced many challenges in everyday life when providing informal care for their chronically ill spouse. This affected both their physical and psychological health, as they had limited time for themselves. The partners seemed to receive more support from their informal network than from formal care providers. In handling daily life, the partners balanced demands and resources to identify possibilities to move forward and find meaning in life.

Relevance to clinical practice. Formal care providers must acknowledge partners' needs, develop evidence-based assessment guidelines, and provide efficient support to partners with a chronically ill spouse. 

Aims

To identify clusters based on graduating nursing students’ self‐reported professional competence and their achievement on a national examination. Furthermore, to describe and compare the identified clusters regarding sample characteristics, students’ perceptions of overall quality of the nursing programme and students’ general self‐efficacy.

Design

A cross‐sectional study combining survey data and results from a national examination.

Methods

Data were collected at two universities and one university college in Sweden in January 2017, including 179 students in the final term of the nursing programme. The study was based on the Nurse Professional Competence Scale, the General Self‐Efficacy scale and results from the National Clinical Final Examination. A Two‐Step Cluster Analysis was used to identify competence profiles, followed by comparative analyses between clusters.

Results

Three clusters were identified illustrating students’ different competence profiles. Students in Cluster 1 and 2 passed the examination, but differed in their self‐assessments of competence, rating themselves under and above the overall median value respectively. Students in Cluster 3 failed the examination but rated themselves at the overall median level or higher.

Conclusion

The study illustrates how nursing students’ self‐assessed competence might differ from competency assessed by examination, which is challenging for nursing education. Self‐evaluation is a key learning outcome and is, in the long run, essential to patient safety.

Impact

The study has identified clusters of students where some overestimate and others underestimate their competence. Students who assessed their competence low but passed the exam assessed their general self‐efficacy lower than other students. The findings illuminate the need for student‐centered strategies in nursing education, including elements of self‐assessment in relation to examination to make the students more aware of their clinical competence.

Sammanfattning: Bakgrund: Den vanligaste dödsorsaken för barn i åldrarna 1-14 år är barncancer. Det är cirka en tredjedel av cancerdrabbade barn som insjuknar i leukemier och en tredjedel som drabbas av hjärntumörer. Den sista delen utgör de övriga diagnoserna. Det är viktigt att veta hur man ska bemöta föräldrars tankar och känslor av att leva med ett barn med cancer då vårdpersonal måste individanpassa vården av barnet efter föräldrarnas behov. Syfte: Syftet med denna litteraturstudie var att beskriva föräldrars erfarenheter av att leva med barn med cancer. Metod: En litteraturstudie som utgår från 11 artiklar med kvalitativ ansats med sökorden barn, barndomscancer, cancer, familjens erfarenheter, föräldrars erfarenheter, pediatrik. Databasen CINAHL användes för att söka artiklar. Huvudresultat: Det har varit genomgående i resultatet att föräldrarna upplevde ångest, depression, ilska och brist på sömn. Livet påverkas hos föräldrarna efter barnets cancerdiagnos då det blir brist på vardagliga rutiner och normaliteter. Vid en cancerdiagnos hade föräldrarna svårt att se en framtid med det cancersjuka barnet vilket visar att föräldrarna längtar till det ögonblick barnet blir botat. Slutsats: Det framkom tydligt att föräldrar till barn med cancer upplevde ett stort behov av stöd och vikten av att få rätt information. Föräldrar isolerar sig från omgivningen, men kan hitta andra föräldrar på sjukhuset med samma erfarenheter.

Aim: The aim of this thesis was to study the working life of first-line managers and their subordinates in elderly care from an empowerment perspective. Methods: Paper I and II used a qualitative approach, and semi-structured interviews were conducted with 14 male and 14 female first-line managers. Data were analyzed using qualitative content analysis. Paper III and IV used a quantitative approach with a longitudinal, correlational and multilevel design. 78 first-line managers and 1398 subordinates filled in the questionnaire at T1 and 56 first-line managers and 769 subordinates at T2. Data were analyzed using descriptive statistics, multivariate analyses (III & IV) and multilevel modelling (IV). Results: In Paper I and II, the first-line managers reported having a challenging and complex work situation. Although the first-line managers sometimes expressed a need for better access to structural empowerment in terms of information, resources and support, they experienced psychological empowerment in their work. In Paper III, the results indicated that the more access the first-line managers had to structural empowerment over time, the more likely they were to feel psychologically empowered over time, resulting in lower ratings of their stress symptoms and higher ratings of their own self-rated leadership-management performance over time. Another finding in Paper III was the influence the number of subordinates per first-line manager had on the first-line managers’ ratings of structural empowerment and the subordinates’ ratings of structural empowerment and stress symptoms. In Paper IV, the results indicate that the more access the first-line managers had to structural empowerment at T1, the more access the subordinates had to structural empowerment at T2, and the higher the subordinates rated their first-line manager’s leadership-management performance at T2, when controlling for psychological empowerment. Conclusions: The working life of first-line managers in elderly care is complex and challenging, and they seem to need better access to structural empowerment (Paper I-IV). However, although deficiencies in access to structural empowerment were reported, the first-line managers experienced their work as a positive challenge (Paper 1) and felt that, though the work was not easy, it was worth it (Paper II).

BACKGROUND:

The work situation for first-line managers in elderly care is complex and challenging. Little is known about these managers' work situation from a structural and psychological empowerment perspective.

AIM:

To describe first-line managers' experiences of their work situation in elderly care from a structural and psychological empowerment perspective.

METHOD:

Interviews from 14 female first-line managers were analysed using qualitative content analysis.

RESULTS:

The theme described the managers' work situation as "It's not easy, but it's worth it." In the four subthemes, the managers described their work in terms of "Enjoying a meaningful job," "A complex and demanding responsibility that allows great authority within set boundaries," "Supported by other persons, organisational preconditions and confidence in their own abilities" and "Lacking organisational preconditions, but developing strategies for dealing with the situations."

CONCLUSION:

The managers described having various amounts of access to structural empowerment and experienced a feeling of meaning, competence, self-determination and impact, that is, psychological empowerment in their work.

IMPLICATIONS FOR NURSING MANAGEMENT:

It is vital that first-line managers have access to organisational support. Therefore, upper management and first-line managers need to engage in continuous dialogue to customize the support given to each first-line manager.

Aim: The aim was to describe individuals’ experiences of living with long-term illness.

Methods: A qualitative approach with a descriptive design was used. Semi-structured interviews were conducted with 16 persons (50–80 years). They were also asked to self-rate their perceptions of their current health status and confidence in their ability to cope with everyday life.

Results: One main theme was identified: new insights and access to resources change the perspective on life. Personal characteristics and support from others were advantageous in finding ways to deal with limitations related to the illness. Most of the persons experienced a changed approach to life, in that they now valued life more than they had before. However, some persons also experienced lost values and found it difficult to accept medications. The persons rated their current health status as slightly above average, but their confidence in their ability to cope with everyday life as high.

BACKGROUND: Autonomy and participation are threatened within the group of older people living in nursing homes. Evidence suggests that healthcare personnel act on behalf of older people but are still excluding them from decision-making in everyday care.

OBJECTIVE: The purpose was to describe registered nurses' experience of caring for older people in nursing homes to promote autonomy and participation.

RESEARCH DESIGN: A descriptive design with a phenomenological approach was used. Data were collected by semi-structured individual interviews. Analysis was inspired by Giorgi's method. Participants and research context: A total of 13 registered nurses from 10 nursing homes participated. Ethical considerations: Ethical approval was obtained from the Regional Research Ethics Committee. Informed consent was achieved and confidentiality guaranteed.

FINDINGS: The essence of caring for older people in nursing homes to promote autonomy and participation consisted of registered nurses' awareness of older people's frailty and the impact of illness to support health and well-being, and awareness of acknowledgement in everyday life and trusting relationships. Paying attention to older people by being open to the persons' wishes were aspects that relied on registered nurses' trusting relationships with older people, their relatives and surrounding healthcare personnel. The awareness reflected challenges in caring to promote older people's right to autonomy and participation in nursing homes. Registered nurses' strategies, hopes for and/or concerns about development of everyday life in nursing homes were revealed and mirrored their engagement in caring for older people.

DISCUSSION AND CONCLUSION: Awareness of older people's frailty in nursing homes and the importance of maintained health and well-being were described as the main source for promoting autonomy and participation. Everyday life and care in nursing homes needs to be addressed from both older people's and healthcare personnel's perspectives, to promote autonomy and participation for residents in nursing homes.

Background: In 2018, 22,400 sexual offenses were reported in Sweden, of wich 96% of them were against women. The Council of Europe had started in 2014 and the Convention on the Prevention and Control of Violence against Women and Domestic Violence. At the same, the Swedish Higher Education Ordinance (SFS 2017: 857 and 2018: 1135) made a change and from 1 July 2018, it became a requirement for nures to have knowledge of women who are subjected to violence.

Purpose: The aim of this study was to describe nurse´s experiences of meeting abused women.

Method: A descriptive literature study. The result is based on 11 scientific articles which were reviewed and analyzed. The articles are both of quantitative and qualitative approach.

Main Results: Knowledge and guidelines are essential for nurses in providing care for sexually, mentally and physically abused women. If the nurses received adequate education, knowledge of resources in the hospital but also in society, it resulted in a safer care and environment for the women and the nurses, they felt mor secure in asking and talking about partner violence. 

Conclusion: The nurse´s encounter with violent subjwomen aroused many strong feelings, and they were affected both during working hours and in private life. More training and knowledge in the subject are required for the nurses to be able to meet and care for women who are subjected to violence in a professional manner, which means more quality assured care. 

Bakgrund: Komplementär och alternativ medicin (KAM) är ett samlingsnamn som innefattar en annan typ av medicin och behandling än den konventionella behandlingen. KAM baseras på en helhetssyn av människan där man anser att både kropp och själ är en helhet och detta grundas på den holistiska synen. Patienter som har diagnostiserats med cancer söker ofta hopp och botemedel för sin sjukdom. Vissa för att bli botade, andra för att förlänga livet samt förbättra sitt psykiska och fysiska välbefinnande. Via egenvård söker patienten sig till KAM för att finna metoder som antingen ett komplement eller alternativ till den konventionella behandlingen.

Syfte: Att beskriva cancerdiagnostiserade patienters erfarenheter av Komplementär och Alternativ Medicin (KAM).

Metod: Litteraturstudie av en beskrivande design som omfattar totalt 12 artiklar varav alla är med kvalitativ ansats. Sökningarna genomfördes i PubMed och Cinahl. 

Huvudresultat: Patienter som diagnostiserats med cancer sökte sig ofta till KAM i hopp om att hitta en metod som kunde förlänga livet eller få dem att må bättre, till exempel lindra symtom. Upplevelserna och erfarenheterna av KAM-metoderna var till största del positiva där patienterna blivit hjälpta med både fysiska och psykiska besvär. Det framkom att vårdpersonalens bemötande gällande KAM var bristfällig och det berodde på bristande intresse och kunskap.

Slutsats: Patienter uppger att erfarenheterna av KAM-användandet överlag är positiva där känslan av kontroll och självbestämmande ökar. Det framgår dock att patienter upplever ett bristande stöd från vårdpersonalen inom den konventionella sjukvården, till exempel när de vill diskutera KAM. Detta visar sig genom ett ointresse och en bristande kunskap om metoderna.

District nurses are preceptors of district nurse students at the postgraduate level. These district nurse students are already registered nurses who have graduated and are now studying to become district nurses; this training is at the postgraduate level. As preceptors at the postgraduate level, district nurses play an important role in helping these students to achieve the learning outcomes of the clinical practice part of their education. However, there is a lack of studies on precepting at this level. Thus, the aim was to describe district nurses' experiences of precepting district nurse students at the postgraduate level. The study was descriptive in design and used a qualitative approach. Purposive sampling was used and nine district nurses from seven primary health care units in Sweden were interviewed. Data were analysed using qualitative content analysis. An overall theme ”Fluctuating between transferring knowledge and striving for reflective learning” and two subthemes emerged. The preceptors’ views on precepting and performance varied depending on the situation. The conclusions is that given the current learning outcomes for clinical practice education at the postgraduate level, district nurses need to bemore influenced by preception focused on reflective learning.

Timely access to care services is crucial to support people with dementia and their family carers to live well. Carers of people with dementia (N = 390), recruited from eight countries, completed semi-structured interviews about their experiences of either accessing or not using formal care services over a 12-month period in the Access to Timely Formal Care (Actifcare) study. Participant responses were summarised using content analysis, categorised into clusters and frequencies were calculated. Less than half of the participants (42.3%) reported service use. Of those using services, 72.8 per cent reported timely access and of those not using services 67.2 per cent were satisfied with this situation. However, substantial minorities either reported access at the wrong time (27.2%), or feeling dissatisfied or mixed feelings about not accessing services (32.8%). Reasons for not using services included use not necessary yet, the carer provided support or refusal. Reasons given for using services included changes in the condition of the person with dementia, the service's ability to meet individual needs, not coping or the opportunity to access services arose. Facilitators and barriers to service use included whether participants experienced supportive professionals, the speed of the process, whether the general practitioner was helpful, participant's own proactive attitude and the quality of information received. To achieve timely support, simplified pathways to use of formal care services are needed.

Women in prostitution are often disrespected and subject to health risks. The aim of this study is to explore how women formerly engaged in prostitution in Sri Lanka position themselves in relation to gendered norms of respectability, and to discuss the possible implications for their sexual and reproductive health and rights (SRHR). Semi-structured qualitative interviews were conducted with fifteen women formerly engaged in prostitution. Discourse analysis was used to identify and describe interpretative repertoires and four repertoires were identified: Victimhood, Resistance, Responsibility, and Independence. The first three were drawn upon to construct their identities in line with norms of female respectability, as the women emphasised being victims of unfortunate situations, resisting sexual disrespectability and taking responsibility for their children and others. The last repertoire deviated from the respectability norm as it conveyed a picture of the women as independent, strong and courageous subjects, characteristics more in line with male respectability in Sri Lanka. Despite marginalised and oppressive circumstances, the women drew on interpretative repertoires to enhance access to respect, dignity and resources. However, their vulnerability to violence, SRHR risks and virtual absence of rights leave them with little access to resources that could enable a healthier and better life. © 2019, © 2019 The Author(s). Published by Informa UK Limited, trading as Taylor & Francis Group.

Purpose - The purpose of this paper is to 1) describe Lean maturity in primary care using a questionnaire based on Liker’s description of Lean, complemented with observations, and 2) determine the extent to which Lean maturity is associated with quality of care measured as staff-rated satisfaction with care and adherence to national guidelines. High Lean maturity indicates adoption of all Lean principles throughout the organization and by all staff.

Design/methodology/approach - Data were collected using a survey based on Liker’s four principles, divided into 16 items (n = 298 staff in 45 units). Complementary observations (n = 28 staff) were carried out at four units.

Findings - Lean maturity varied both between and within units. The highest Lean maturity was found for ‘adhering to routines’ and the lowest for ‘having a change agent at the unit’. Lean maturity was positively associated with satisfaction with care and with adherence to national guidelines to improve healthcare quality. 

Practical implications - Quality of primary care may benefit from increasing Lean maturity. When implementing Lean, managers could benefit from measuring and adopting Lean maturity repeatedly, addressing all Liker’s principles and using the results as guidance for further development.

Originality/value - This is one of the first studies to evaluate Lean maturity in primary care, addressing all Liker’s principles from the perspective of quality of care. The results suggest that repeated actions based on evaluations of Lean maturity may help to improve quality of care.

Background

Lean is commonly adopted in healthcare to increase quality of care and efficiency. Few studies of Lean involve staff-related outcomes, and few have a longitudinal design. Thus, the aim was to examine the extent to which changes over time in Lean maturity are associated with changes over time in care-giving, thriving and exhaustion, as perceived by staff, with a particular emphasis on the extent to which job demands and job resources, as perceived by staff, have a moderated mediation effect.

Method

A longitudinal study with a correlational design was used. In total, 260 staff at 46 primary care units responded to a web survey in 2015 and 2016. All variables in the study were measured using staff ratings. Ratings of Lean maturity reflect participants’ judgements regarding the entire unit; ratings of care-giving, thriving, exhaustion and job demands and resources reflect participants’ judgements regarding their own situation.

Results

First, over time, increased Lean maturity was associated with increased staff satisfaction with their care-giving and increased thriving, mediated by increased job resources. Second, over time, increased Lean maturity was associated with decreased staff exhaustion, mediated by decreased job demands. No evidence was found showing that job demands and job resources had a moderated mediation effect.

Conclusion

The results indicate that primary care staff may benefit from working in organizations characterized by high levels of Lean maturity and that caregiving may also be improved as perceived by staff.

This paper reports on qualitative data from the Actifcare study investigating experiences, attitudes, barriers and facilitators concerning access to and use of formal care. A total of 85 semi-structured in-depth interviews were conducted in eight European countries. Results were analysed with a deductive content analysis, first within country and then integrated in a cross-national analysis. Overall, analysis of the in-depth interviews revealed two major themes with five subcategories. The results can be summarised in an optimal pathway for access to dementia care. This pathway includes fixed factors such as disease-related factors and system-related factors. In addition there are personal factors that are subject to change such as attitudes towards care. An important finding consisted of the necessity of having sufficient information about the disease and available care and having a key contact person to guide you through the process of finding suitable care while monitoring your needs. In addition, it is important to involve your social network as they can take on care-giving tasks. It is helpful to have a diagnosis (in most countries). Concerning decision-making, the person closest to the person with dementia is in the majority of cases the one who makes the ultimate decision to access and use services and he/she should therefore be supported in this process. These results provide insight into the factors that influence the pathway to formal care use and help professionals to enhance access to formal dementia care by focusing on factors that can be modified.

Objective: The increased attempted suicide rate is one of the main problems healthcare systems face in many societies. Social meaning is one of the main fields of studying suicide attempts. The main aim of the present study was to investigate the motives of suicide attempts among Iranian women.

Method: To explore suicide motives, history of medical or psychological issues, family relationships, and environmental conditions, participants were interviewed individually. The present study comprised semi-structured interviews involving 52 women who had attempted suicide and subsequently been hospitalised. Finally, the data were transcribed, categorised and narrated.

Results: The study identified two types of suicide meanings: escape and appeal. Escape suicide attempts were motivated by a desire to run away from intolerable situations in the family or social life. Escape suicide attempts were characterised by flight from grief, loss of honour, shame, infamy or memories of failure incidents. In appeal suicide attempts, participants experienced high pressure or control from husbands or other heads of families and the suicide attempts were used as a strong request to make her husband or family change. Other participants attempted suicide when their honours or masteries were threatened, or when they had committed deeds associated with great shame. The results also showed that several participants provided clear examples of patriarchic oppression as a strong underlying mechanism for suicide motivation.

Conclusions: As the results of our study revealed that family and gender structures play integral roles in motives of suicide attempts, future research among Iranian men is suggested. 

Objectives: Previous research found that burdens are put on relatives to patients with serious mental illness. A majority of the studies have described the situation of being a husband/wife or parent of someone who is mentally ill. However, little is known about the perspective of childhood experiences and the effect on adult life from having a parent with mental illness. Hence, the purpose of this review was to investigate experiences of having a parent with serious mental illness.

Methods: We used a qualitative interpretive meta-synthesis. Five relevant databases were chosen: Cumulative Index to Nursing and Allied Health Literature, MEDLINE, PsycINFO, PubMed and Psychology and Behavioral Sciences Collection. We found 4302 studies in our initial search. Fourteen met the inclusion criteria and the quality assessment.

Results: The findings are presented in four themes: (1) Growing up in a dysfunctional home environment; (2) The child’s feelings and thoughts; (3) The need of support; and (4) The lingering effects in adult life.

Conclusions: We found that experiences of growing up in a dysfunctional home can result in relational issues later in life and that the need for support can persist into adult life. This has implications for clinical practice when encountering these patients. 

The aim of the study was to describe nursing students' reflections on caring for end-of-life patients in a youth volunteer service. A purposive sample of 11 nursing students in one province in China were interviewed and diaries were collected. The data were analysed using qualitative content analysis. The students described the service as “an empowering care that makes a difference – but not without challenges on different levels”. The service was said to provide devoted caring adjusted to the person's need, condition and wishes. According to the students, the service had an impact on them; the internal and/or external support was stimulating and rewarding, whereas deficient support was frustrating and made them feel helpless. They emphasized the need for improvements at different levels. In conclusions, the youth volunteer service empowers both patients and students and can be seen as person-centred care. The students' professional knowledge, skills and ability improved, while these aspects were still perceived as deficient. Appropriate curriculum and training for nursing students are necessary and should be tailored to improving students' caring ability and confidence. Expanding the service was emphasized and suggestions for improvements were identified.

Background

The shortage of registered nurses is a global concern. Motives to become registered nurses can be to help others, altruism, personal development and career security. Motives in combination with student expectations regarding the role are not explored.

Objective

To describe students' motives to become registered nurses and their expectations regarding their future profession.

Design

A longitudinal descriptive design with a qualitative approach was used to follow nursing students in the beginning, during and at the end of their education.

Participants and setting

A purposive sampling of a group with initially 75 students starting a three-year nursing program at a university in Sweden.

Methods

A study specific questionnaire with open-ended questions was used in the beginning, during and the end of the students' education. At data collection two and three, a copy of the earlier answers was attached. Data were analysed using manifest and latent content analysis.

Results

An important profession with career opportunities, interesting duties and team work were described. Students expected diversified duties, possibilities for development and work satisfaction. Increased concerns regarding their upcoming work life was described at the end of the education.

Conclusion

The students had a positive understanding of the profession and perceived their forthcoming role as interesting. The leading role of coordinating patient care was more comprehensive than expected. Supportive conditions and well planned transition periods could strengthen newly graduated nurses in their professional role and could be an important aspect in the future retention of RNs.

Aim: To explore the perceptions of infection control practices among healthcare personnel and evaluate the use of authentic vignettes as a means to alter infection control behavior.

Method: Four authentic vignettes were used as a part of reflective dialogues with healthcare personnel. An evaluation of the dialogues was performed with six healthcare personnel using the focus group technique. Qualitative content analysis was used to analyze the data.

Results: The mind-set to help one another and do one’s best in every situation was described as a core aspect in preventing the transmission of microorganisms. Having support, taking personal responsibility, being knowledgeable about infection control practices, and having a reasonable workload were seen to play decisive roles in controlling the spread of infection. Discussing authentic comprehensible vignettes with colleagues during the allotted time was considered a valuable method for improving infection control practices.

Conclusion: Meaningful insights on how best to use vignettes as a means to improve infection control practice were gained. These findings should be considered when designing theory-driven interventions in different contexts, which are aimed at improving infection control practices in health care.

Assessment of students' learning and achievement requires active involvement of participating students, preceptors and lecturers. The lecturers have overall responsibility for both the content of the assessment and students' learning. The aim of the present study was to investigate lecturers' reflections on the mid-course discussion and final assessment that are part of nursing students' clinical practice education. The design was descriptive and had a qualitative approach. Repeated group discussions were undertaken with 14 lecturers at two university campuses in Norway. Five categories were identified: preparing for the three-part discussion, creating a collaborative atmosphere, facilitating student learning, verifying student learning, using the assessment tool to create the assessment discussion; one theme emerged: ‘being able to see and justify students’ learning processes'. Lecturers' reflections on both assessment discussions and students' learning proceeded from a clear pedagogical viewpoint.

Objective: Quality of life of people with dementia and their family carers is strongly influenced by interpersonal issues and personal resources. In this context, relationship quality (RQ) and sense of coherence (SOC) potentially protect and promote health. We aimed to identify what influences RQ in dyads of people with dementia and their carers and to examine differences in their perspectives.

Methods: Cross-sectional data from the Actifcare cohort study of 451 community-dwelling people with dementia and their primary carers in eight European countries. Comprehensive assessments included the Positive Affect Index (RQ) and the Orientation to Life Questionnaire (SOC).

Results: Regression analyses revealed that RQ as perceived by people with dementia was associated with carer education, stress and spouse caregiving. RQ as perceived by carers was associated with carer stress, depression, being a spouse, social support, reported neuropsychiatric symptoms of dementia and carer SOC. Neuropsychiatric symptoms and carer stress contributed to discrepancies in RQ ratings within the dyad. The only factor associated with both individual RQ ratings and with discrepancies was carer stress (negative feelings sub-score). No significant differences in the overall perception of RQ were evident between spouses and adult children carers, but RQ determinants differed between the two.

Conclusions: In this European sample, carer SOC was associated with carer-reported RQ. RQ determinants differed according to the perspective considered (person with dementia or carer) and carer subgroup. A deeper understanding of RQ and its determinants will help to tailor interventions that address these distinct perspectives and potentially improve dementia outcomes.

Bakgrund: Transpersoner och icke-binära är en stigmatiserad grupp i samhället. Många lever i en känsla av utanförskap och denna grupp är enligt statistik överrepresenterad inom psykisk ohälsa. Det finns kunskapsbrist om hur sjuksköterskan som tillhandahåller vård i dessa situationer på hur ett korrekt sätt kan bemöta transpersoner och icke-binära inom hälso-och sjukvård.

Syfte: Syftet med denna studie var att beskriva transpersoners och icke-binäras erfarenheter och upplevelser av hälso-och sjukvården.

Metod: Detta är en litteraturstudie med beskrivande design. Studiens databassökning identifierade tio kvalitativa artiklar som överensstämde med studiens syfte och inklusionskriterier. Resultatet som analyserades presenterades i två huvudteman och sju underteman.

Huvudresultat: Resultatet visade att majoriteten av transpersoner och icke-binära någon gång känt sig kränkta inom hälso- och sjukvården. Personer som identifierade sig som icke-binär kände ofta att de var tvungna att passa in i en mall som de ej var bekväma med. Resultatet visade att språket som användes av hälso- och sjukvårdspersonal var viktigt i mötet med transpersoner och icke-binära. Genom att använda korrekt språk och pronomen i mötet gav det en känsla av acceptans.

Slutsats: På grund av den okunskap som fanns kunde sjuksköterskor ha svårigheter att veta hur de skulle bemöta transpersoner och icke-binära. Det framgick att brist på kunskap oavsiktligt kunde påverkade mötet negativt för personer med könsöverskridande identitet. Därför bör utbildning om denna urvalsgrupp vara mer tillgänglig för hälso- och sjukvårdspersonal.

Sammanfattning

Bakgrund: Anestesisjuksköterskan har omvårdnadsansvaret för patienter under sekundärtransport i Sverige och har därför en viktig roll. Nuvarande forskning beskriver att anestesisjuksköterskor upplever bristande kommunikation och svårigheter med att vårda i ambulans. Forskning som belyser just anestesisjuksköterskors upplevelser av att vårda patienter under sekundärtransport är sparsam och därmed önskvärd.

Syfte: Syftet med studien var att beskriva anestesisjuksköterskors upplevelser av att vårda patienter under sekundärtransport.

Metod: Studien genomfördes med en beskrivande design och kvalitativ ansats. Data samlades in genom semistrukturerade intervjuer med tio anestesisjuksköterskor på två sjukhus i Mellansverige. En kvalitativ innehållsanalys tillämpades för att transkribera och analysera intervjuerna.

Resultat: Studiens resultat delades in i fyra olika kategorier, Att vara steget före, Yrkesroll och ansvarsförhållanden, Att vårda under specifika omständigheter och Teamarbete samt åtta underkategorier. Dessa underkategorier var; Att ha en handlingsplan, Att vara förberedd, Ansvar och personlig utveckling, Yrkeserfarenhet och kompetens, Att vårda unga patienter, Att vårda i ambulans, Stöd från kollegor samt Kommunikation och information.

Slutsats: Att ha en handlingsplan, tidigare yrkeserfarenhet, kommunikation samt stöd från kollegor var faktorer som påverkade anestesisjuksköterskornas upplevelser av att vårda patienter under sekundärtransport. Dessa faktorer var avgörande för om anestesisjuksköterskorna upplevde vårdandet som positivt eller negativt. Studiens resultat tyder på behov av tydliga rutiner samt gemensamma utbildningstillfällen för alla involverade yrkesgrupper.

Nyckelord: anestesisjuksköterska, sekundärtransport, upplevelser

Objectives: To determine whether work ability and well-being predict return to work (RTW) among women with long-term neck/shoulder and/or back pain at a 1-year follow-up, and to assess the ability of the Work Ability Index (WAI) and Life Satisfaction questionnaire (LiSat-11) to discriminate between those who did RTW and those who did not RTW. 

Methods: A survey was sent to 600 women receiving time-loss benefits from the Swedish Social Insurance Agency. In total, 208 women responded at baseline, and 141 at a 1-year follow-up. To identify whether work ability and well-being predicted RTW, multiple logistic regression analyses were performed with and without adjustment for type of work and pain intensity. To assess the discriminative ability of the WAI and LiSat-11 for women who did RTW and those who did not RTW, Receiver Operating Characteristic curves were fitted.  

Results: Work ability predicted RTW, and the results remained significant after adjusting for type of work and pain intensity (OR 1.12, 95% CI: 1.04-1.22). Well-being was not significant. The WAI at baseline adequately discriminated between RTW and no RTW after one year (AUC 0.78, 95% CI 0.70-0.86), but the LiSat-11 did not.

Conclusions: Our results indicate that work ability is an important factor for RTW among women on SL for long-term neck/shoulder and/or back pain. The WAI has adequate discriminatory ability in this population, but the LiSat-11 has not.  

Keywords: Life satisfaction, Musculoskeletal pain, Sickness absence, Work status

Objective: The aim of this study was to identify predictors of return to work (RTW) among women on sick leave due to long-term neck/shoulder and/or back pain.

Methods: The study was a prospective survey with a 1-year follow-up. Data on predictors and outcome were collected using a self-administrated questionnaire containing eight instruments – Coping Strategies Questionnaire, General Self-Efficacy scale, Sense of Coherence, Multidimensional Pain Inventory, Hospital Anxiety and Depression Scale, Demand-Control-Support Questionnaire, Work Ability Index, and Life Satisfaction questionnaire, as well as a set of background questions. A total of 208 women, aged 23-63 years, were included at baseline, and 141 responded at the 1-year follow-up. Multiple logistic regression analyses were performed to identify predictors of RTW.

Results: Of the 141 women, 94 had RTW and 47 had not at the 1-year follow-up. Women who engaged in more coping by increasing behavioral activities, such as leisure activities, reading and socialization, (OR 1.12, 95% CI 1.02-1.22) and those who more strongly believed they would return to the same work within 6 months (OR 1.24, 95% CI 1.12-1.38) had an increased probability of RTW. Getting more social support outside work (OR 0.49, 95% CI 0.26-0.90) decreased the odds of RTW at the 1-year follow-up.

Conclusions: The findings suggested that behavioral activities, belief in returning to the same work and social support were predictors of RTW at the 1-year follow-up. Healthcare professionals should consider these predictors in efforts to prevent prolonged sick leave and to promote RTW among women with long-term neck/shoulder and/or back pain.

Key terms: Follow-up study, musculoskeletal pain, prognostic factors, sickness absence, return to work.

Frontotemporal dementia (FTD) is a neurodegenerative disease with symptoms that differs from other dementias. Commonly early symptoms in FTD are changes in personality and behavior, which can be interpreted as psychiatric disease. The delay in FTD diagnosis contributes to the burden of family caregivers. Therefore, it is important to have more knowledge about the pre-diagnostic stage. In this qualitative interview study, we explored fourteen family caregiver's experiences of the pre-diagnostic stage of frontotemporal dementia (FTD). Our findings suggest that the family caregivers experienced the pre-diagnostic stage of FTD as changes in the interpersonal relationship with their loved one. These changes were often subtle and difficult for family caregivers to explain to others. The findings from our study illuminate the importance of medical staff paying attention when a next of kin is concerned about subtle changes in a loved one. The findings also illuminate that awareness of FTD should be raised.

The purpose of the present study was to extend the knowledge offunctional linkages between visual and mental load, performance, and prefrontalcortex (PFC) activity, during forestry forwarding work. Eleven healthy participants,range 21–51 years old, with a minimum of 1-year work experience,carried out the task of loading logs along a standardized path in a machinesimulator during two counterbalanced test conditions: (i) conventional cranecontrol, and; (ii) semi-automated crane control. Mental load was assessed byquantification of oxygenated hemoglobin (HbO2) concentration changes overthe right dorsolateral prefrontal cortex (dlPFC) via non-invasive functional nearinfrared spectrometry (fNIRS). Visual, autonomic, and motoric control variableswere measured and analyzed in parallel along with the individual level of performance.Linear Mixed Models (LMM) analysis indicated more mental loadduring conventional crane work. Collectively, our data suggest that fNIRS is aviable tool which can be used in neuroergonomic research to evaluate physiologicalactivity levels in PFC.