Background: Telenursing is an expanding part of healthcare, staffed with registered nurses whose work environment is typical of a call centre. Work-related stress has been shown to be a major problem in nurses’ work environments and of importance to the outcome of care, patient safety, nurse job satisfaction and burnout. Today, however, we have a limited understanding of and knowledge about the work environment for telenurses. The aim of the present study is to explore and reach consensus on perceived important obstacles and prerequisites in telenurses’ work environment.

Methods: A modified Delphi design, using qualitative as well as quantitative data sequentially through three phases, was taken. Data were initially collected via semi-structured interviews (Phase I) and later using a web survey (Phase II-III) between March 2015 and March 2016.

Results: The findings present a consensus view of telenurses’ experiences of important obstacles and prerequisites in their work environment. Central to the findings are the aspects of telenurses having a demanding work, cognitive fatigue and having no opportunity for recovery during the work shift was ranked as important obstacles. Highly ranked prerequisites for managing were being able to focus on one caller at a time, working in a calm and pleasant environment and having technical support 24/7.

Conclusions: Managers need to enable telenurses to experience control in their work, provided with possibilities to control their work and to recover during work; shortening work time could improve their work environment. Limited possibilities to perform work might contribute to feelings of stress and inability to perform work. 

The number of landfills in Sweden is not exactly known, but the number of closed landfills containing organic waste is estimated to be between 4000 and 8000. Some of these are close to large and growing cities and are of interest to exploitation. Urban air quality affects people's health and well-being, real-time measurement and modelling of gases in the air is important for planning future cities. In this paper, we present a cost-effective method for monitoring methane and CO2 based on gas sensors mounted on an unmanned aircraft (UAV, drone). A drone-based wireless system is developed with MOS sensors (MQ2, MQ4 and TGS2611), Arduino-nano, XBee wireless communications modules and the interface to a base station's computer is written in Python. The system was tested in real field measurements with good results.

In many countries, most organic waste is usually placed in landfills, which generates public concern about the health effects of emissions pollutants. The natural bacterial decomposition of organic waste produces landfill gases, about half of the methane, with the remainder mainly carbon dioxide and minor amounts of other gases. Real-time measurement and modeling of emissions gases in landfills are essential. This work develops a low-cost wireless measurement system using MOS gas sensors (MQ4, MQ5, and MQ9), a 32 bits microcontroller, an XBee module, and HC-12 wireless communications modules. The system can be mounted on an uncrewed aerial vehicle (UAV, drone) or deployed as a wireless sensor network. Experiments have been carried out near a closed landfill, and measurement results show high methane concentrations.

The overall aim was to describe how persons with dementia (PwDs) reflecton being outdoors and to investigate the support provided by a passivepositioning alarm (PPA) in making daily life safer for PwDs and theirspouses.

Repeated conversations were held with 11 PwDs living in their own homesregarding their reflections on being outdoors (Study I). Interview study with14 spouses to a person with dementia (PwD) with their reflections on differentkinds of information and communication technology (ICT) devicesthat were used or can be used in the daily care of PwDs (Study II). An ethnographicapproach with participant observations and conversations withfive couples, a PwD and his/her spouse, describing and exploring their useand experiences of using a PPA, over time, in daily life (Study III). An experimentalsingle-case ABAB-design with three cases, a PwD and hisspouse, investigating the effects of using tracking technology on independentoutdoor activities and psychological well-being (Study IV).

In summary, the results of the thesis show that being outdoors was describedby the PwDs as a confirmation of their identity, the `Self´. The useof ICT in daily care of PwDs was described by the spouses as shifting betweentheir own needs for safety and security and the perceived need forsafety and security from the perspective of the PwD. The use of a PPA indaily life among PwDs living in their own homes can give a sense of freedom,support and strengthen the feeling of independence for both PwDsand their spouses as well as give a feeling of safety and security for themboth. Use of the PPA may also increase PwDs’ independent outdoor activitiesand decrease spouses’ worries.

It is important to support older adults' independence after hospitalization and, thus, to increase their perceived quality of life. The present descriptive study took a qualitative approach and aimed to describe older adults' experiences of their life situation after hospital discharge. Fifteen individuals (≥65 years) from two regional hospitals in central Sweden were interviewed between October 2015 and January 2016 in their own home following hospital discharge. The interview data were analyzed using manifest and latent qualitative content analysis. The analysis revealed one theme: "Longing to be independent again" based on four categories: `Dependent on other people and aids´, `Obstacles, impediments and limitations in daily life´, Adapt to the situation´ and `Psychological and physical values´. Understanding older adults' experiences of life after hospitalization is also a prerequisite for being able to provide person-centered care.

Objectives: To investigate the effects of using tracking technology on independent outdoor activities and psychological well-being in 3 persons with dementia (PwDs) and their spouses.

Methods: Three experimental single-case studies with an A1B1A2B2 design. The intervention entailed access to a passive positioning alarm and technical support. Continual daily measures of independent outdoor activities among PwDs’ and spouses’ worries about these activities were made during all phases.

Results: Access to a tracking technology consistently increased the independent outdoor activities of 2 PwDs. One of the spouses consistently reported decreased worry during B phases, another’s worry decreased only in B2, and the third showed little variability in worrying across all phases.

Conclusion: Tracking technology may support PwDs to engage in independent outdoor activities and decrease spouses’ worries; however, randomized controlled group studies are needed to investigate whether these results can be replicated on a group level.

This study aimed to describe the wayfinding strategies used during outdoor walks by people with Alzheimer’s disease. Inspired by an ethnographic approach, observations and conversations during repeated outdoor walks with five people with Alzheimer’s disease living in their own homes were conducted. Data were analyzed using qualitative content analysis. The wayfinding strategies the participants described were: (1) landmarks, (2) used their senses, (3) stopped, looked around, and thought, (4) walking the same way or loop and in familiar areas, and (5) only walked in places and on routes where they could see other people and houses. Using wayfinding strategies might help people with Alzheimer’s disease to be independent during outdoor walks, and discussing these strategies with relatives and nursing care staff may help finding people with Alzheimer’s disease if lost outdoors. Wayfinding during the winter might be facilitated if temporary and changeable objects are avoided in people with Alzheimer’s disease’s walking route.

Objectives:The aim of this study was to describe how persons with early-stage dementia reflect on being outdoors.

Method: Data were collected through repeated interviews with a purposive sample of 11 persons with early-stage dementia in Sweden during the period 2009–2010 and were analysed using qualitative content analysis.

Results: Informants described being outdoors as a confirmation of the self. Confirmation of their ability to maintain desired activities, despite the dementia disease, was important to the informants. However, some confirmations were not positive; the realisation that one could no longer perform certain activities could be devastating. Two sub-themes emerged: shifting between ‘still being part of it all’ and a sense of grief and loss and striving to keep on despite perceived barriers. Past, but no longer possible, outdoor activities were greatly missed and the informants longed to be able to perform these activities once again. To resolve possible difficulties associated with being outdoors, the informants used various adaptation strategies. Despite the described barriers, being outdoors was of great value to them.

Conclusion: Independent outdoor activities seem to contribute to the well-being and feelings of self-worth among persons with early-stage dementia who want to be and are able to be outdoors. If a person with dementia, despite cognitive limitations, wants and is able to engage in outdoor activities, it is important for relatives and health-care staff to encourage and facilitate this, for example, by discussing adaptation strategies to deal with orientation problems.

Objective: To map areas of discussion about use of seclusion and restraint in healthcare, as expressed in motifs posted on Twitter.

Materials and method: We adopted a qualitative approach with an archival and cross-sectional observational design. 188 images from Twitter postings were analyzed.

Results: Five categories were identified: Informative and educational messages; Equipment as artifacts; Spatiality; The restrained subjects; Sociopolitical connotations of restraint.

Conclusions: Based on our results we conclude that restraint and seclusion images posted on Twitter included several aspects; the intention to educate others, show the spatiality in relation to restraint, imagining characterized by objects and persons, and a sociopolitical connotation. This in turn means that Twitter posts offer nurses a chance to engage in social marketing and connoting an ethical dimension to a person associated with measures used to exert power over others. This is because communication surrounding certain controversial issues in healthcare is free from hierarchies on Twitter.

AIM: To describe intensive care nurses' reflections on being part of interdisciplinary emergency teams involved in in-hospital cardiopulmonary resuscitation.

DESIGN: A qualitative descriptive design.

METHODS: Eighteen intensive care nurses from two regions and three hospitals in Sweden were interviewed. The data were analysed with General Inductive Analysis.

RESULTS: The work for intensive care nurses in the emergency team was reflected in three phases: prevention, intervention and mitigation-referred as before, during and after the CPR situation.

CONCLUSIONS: The findings describe the complexity of being an intensive care nurse in an interdisciplinary emergency team, which entails managing advanced care with limited and unknown resources in a non-familiar environment. The present findings have important clinical implications concerning the value of having debriefing sessions to reflect on and to talk about obstacles to and prerequisites for performing successful resuscitation.

Background

Problems with memory and decline in cognitive abilities are common during development of dementia. Different kinds of technologies may be useful in supporting persons with dementia and their relatives in daily life. Tracking technologies have the potential to improve independence among persons with dementia. Consequently, the aim of the present study was to describe perceptions of a passive positioning alarm (PPA) among persons with mild dementia.

Methods

A repeated interview study was conducted in Sweden with a strategic sample of 11 persons with mild dementia. Roger’s Diffusion of Innovation Theory was used to deductively analyse the data.

Results

Regarding the advantages of the PPA, participants described perceived safety and security for, both themselves, and their relatives, as well as freedom and independence. However, they also expressed concern about the cost of the PPA, reflected on who might be the receiver of the alarm from the PPA, emphasized the importance of opportunities to test the device before becoming a user and early introduction before their problems start, thus allowing them to decide for themselves.

Conclusions

Supporting persons with dementia in their own homes using, e.g., a PPA may enable them and their relatives to remain longer in their own homes and be safer in their own neighbourhoods.

Abstract: Aim To describe how complexity science has been integrated into nursing.

Design: A scoping review. Data source/review method Academic Search Elite, Scopus, PsycINFO, Cumulative Index to Nursing and Allied Health Literature, PubMed and Web of Science were searched November 2016, updated in October 2017 and January 2020. The working process included: problem identification, literature search, data evaluation, synthesizing and presentation. Results Four categories were found in the included 89 articles: 1) how complexity science is integrated into the nursing literature in relation to nursing education and teaching; 2) patients? symptoms, illness outcome and safety as characteristics of complexity science in nursing; 3) that leaders and managers should see organizations as complex and adaptive systems, rather than as linear machines; and 4) the need for a novel approach to studying complex phenomena such as healthcare organizations. Lastly, the literature explains how complexity science has been incorporated into the discourse in nursing and its development.

Conclusion: The review provided strong support for use in complexity science in the contemporary nursing literature. Complexity science is also highly applicable and relevant to clinical nursing practice and nursing management from an organizational perspective. The application of complexity science as a tool in the analysis of complex nursing systems could improve our understanding of effective interactions among patients, families, physicians and hospital and skilled nursing facility staff as well as of education.

Impact: Understanding complexity science in relation to the key role of nurses in the healthcare environment can improve nursing work and nursing theory development. The use of complexity science provides nurses with a language that liberates them from the reductionist view on nursing education, practice and management.

Communication in healthcare extends beyond patient care, impacting the work environment and job satisfaction. Interprofessional communication is essential for fostering collaboration, but challenges arise from differences in training, roles, and hierarchies. The study aimed to explore psychiatric outpatient clinicians’ experiences of interprofessional communication and their perceptions of how the communication intersects the organizational and social work environment of healthcare. Qualitative research involved focus group interviews with clinicians from five psychiatric outpatient units in Central Sweden, representing diverse professions. The authors analyzed semi-structured interview data thematically to uncover clinicians’ perspectives on interprofessional communication. An overarching theme, “Adjustment of communication,” with subthemes “Synchronized communication” and “Dislocated communication,” emerged. Clinicians adapted communication strategies based on situations and needs, with synchronized communication promoting collaboration and dislocated communication hindering it. Communicating with each other was highly valued, as it contributed to a positive work environment. The study underscores the importance of an open, supportive environment that fosters trust, and respect among healthcare clinicians. Consistent with prior research, collaboration gaps underscore the urgent need to improve interprofessional communication.

Background

Communication in healthcare has been extensively studied, but most research has focused on miscommunication and the importance of communication for patient safety. Previous research on interprofessional communication has mainly focused on relationships between physicians and nurses in non-psychiatric settings. Since communication is one of the core competencies in psychiatric care, more research on interprofessional communication between other clinicians is needed, and should be explored from a broader perspective. This study aimed to explore and describe interprofessional communication in a psychiatric outpatient unit.

Method

During spring 2022, data consisting of over 100 h of fieldwork were collected from observations, formal semi-structured interviews and informal conversations inspired by the focused ethnography method. Data was collected at an outpatient unit in central Sweden, and various clinicians participated in the study. The data analysis was a back-and-forth process between initial codes and emerging themes, but also cyclical as the data analysis process was ongoing and repeated and took place simultaneously with the data collection.

Results

We found that a workplace’s history, clinicians´ workload, responsibilities and hierarchies influence interprofessional communication. The results showed that the prerequisites for interprofessional communication were created through the unit’s code of conduct, clear and engaging leadership, and trust in the ability of the various clinicians to perform new tasks.

Conclusion

Our results indicate that leadership, an involving working style, and an environment where speaking up is encouraged and valued can foster interprofessional communication and respect for each other´s professional roles is key to achieving this. Interprofessional communication between different clinicians is an important part of psychiatric outpatient work, where efficiency, insufficient staffing and long patient queues are commonplace. Research can help shed light on these parts by highlighting aspects influencing communication.

Background

Depression is a common disorder in old age and increases with hospitalisation. The aim was to investigate whether improvement in depressive symptoms after hospitalisation is associated with education level, age, gender, living situation, self-efficacy, activities in daily living and quality of life by (1) examining the prevalence of depressive symptoms at baseline and at 1st and 2nd follow-up (2) examining different factors? association with depressive symptoms at baseline and (3) examining different factors? association with improvement in depressive symptoms at baseline and at 1st and 2nd follow-up.

Methods

The study consisted of 145 patients, 65 years and older. Data were collected between February 2015 and September 2016 through interviews conducted using structured protocols. The instrument used was Katz index of ADL, Geriatric Depression Scale-20, Life Satisfaction Questionnaire and the General Self-Efficacy Scale. The participants were interviewed before discharge from hospital, after 1.5 month and after 3 months.

Results

The prevalence of depressive symptoms in older persons was high after hospitalisation. Factors associated with improvement of depressive symptoms after hospitalisation were higher educational level, improvement in activities in daily living and quality of life. Non-significant results were found for improvement of depressive symptoms and gender, age, living situation or self-efficacy.

Conclusions

Depression is a common health problem in older persons, especially after hospitalisation. It is therefore important that healthcare staff screen older persons for depression during hospitalisation, as this allows identification of those in need and a possibility to help them in an appropriate manner. Persons with lower educational level and depressive symptoms need special attention.

Background: The Perceptions of Restraint Use Questionnaire measures perception of restraint in a 17-item questionnaire. The aim of this study was to assess the test-retest reliability of the PRUQ as a measure of staff attitudes to restraint in elderly older persons care for people with dementia from two different nursing homes, and its ability to produce reliable results.

Methods: Twenty-six staff members from two different nursing homes completed the 17-item PRUQ twice with 14–21 days between time points. As the questionnaire has already been translated in another study, the current study evaluated total item scores, mean, internal consistency, and intraclass correlation for reliability purposes.

Results: The internal consistency Cronbach’s Alpha were ˃ ≥0.726. The Intraclass correlation (ICC) between test and retest was moderate to good for the three subscales, with ICC (A,1) and ICC (C,1) values approximately equal and in the range 0.480–0.962. A Bland-Altman plot of the PRUQ total mean scores illustrates no systematic change in the mean.

Conclusions: The Swedish version of the PRUQ shows mainly good reliability. Therefore, we suggest that researchers continue to develop the PRUQ to be an even higher reliable questionnaire of health care professionals’ perceptions of measure for restraint use in nursing homes for persons with dementia

Background

Older people hospitalized for COVID-19 are a vulnerable group due to the disease itself, aging and often loss of hearing and vision. Person-centered care, where patients have opportunities to communicate and participate in their own care, is important. However, because healthcare staff needed to wear personal protective equipment during the pandemic, to protect the patients and themselves, providing person-centered care was often difficult. This study aims to describe older hospitalized patients’ experiences both of being cared for, while having COVID-19, and of the care provided by healthcare staff wearing PPE.

Methods

Fourteen older patients, over 65 years of age, were interviewed, and the data were analyzed using qualitative content analysis. The study adhered to Consolidated criteria for reporting qualitative research guidelines.

Results

Three subthemes and one overall theme, “The desire for survival overshadows difficulties”, emerged in the analysis. The main findings revealed that the older hospitalized patients experienced the care they received from the healthcare staff as satisfactory. The older patients reported understanding and accepting that the pandemic situation meant that their ability to participate in their own care and communicate with healthcare staff were given lower priority.

Conclusions

Older hospitalized patients need to be provided person-centered care, and situations such as a pandemic are no exception. Care tasks that are not acute in nature, e.g., planning for patients’ return home, could be conducted by healthcare staff not required to wear PPE.