Purpose

The number of people with an autism diagnosis is increasing globally. Health-care professionals may encounter these patients in any type of health-care setting, which makes it important that they understand the challenges autistic patients face in relation to health care. The purpose of this study was therefore to analyze autism-related complaints submitted to patient advisory boards in Sweden.

Design/methodology/approach

Eleven patient advisory boards provided patient complaint cases for the years 2022–2024. In total, 407 cases were analyzed both quantitatively (descriptive and comparative statistics) and qualitatively (manifest content analysis). Comparisons were made between physical and psychiatric health care.

Findings

Most complaints were submitted by caregivers of autistic patients and concerned negative staff attitudes; inappropriate or incorrect treatment; long waiting times (especially for neuropsychiatric assessments); insufficient information; poor coordination; limited involvement; and issues related to administration, accessibility, competence and continuity. A few complaints addressed the health-care environment and confidentiality breaches. Complaints about staff attitudes, waiting times, diagnostic processes and staff competence were significantly more frequent in psychiatric health care than in physical health care.

Originality/value

The findings from this unique and comprehensive analysis of patient complaint cases highlight the need for improved staff training, enhanced communication and better coordination in health care for autistic patients, particularly in psychiatric health care where complaints regarding staff attitudes, waiting times, diagnostic processes, and competence were most frequent.

Background: Healthcare management entails navigating considerable complexity, requiring managers to balance diverse and often competing responsibilities such as staff supervision, patient care, and resource allocation within evolving organizational contexts. Traditional measures rarely capture this multifaceted reality of managerial complexity. The Ottawa Hospital Model of Nursing Clinical Practice and Clinical Management Span of Control Decision-Making Indicators tool (TOH-SOC) provides a broad understanding of managerial span of control.

Objective: To evaluate the extent to which the TOH-SOC items provide valid measurement of the latent construct of managerial complexity, and to examine the degree to which the empirical response patterns fit with the a priori specified hierarchical conceptual framework.

Methods: This methodological study uses previously collected data from a convenience sample of 71 first-line healthcare managers, applying items from the TOH-SOC tool. An unrestricted polytomous Rasch model was used to evaluate response category functioning, model fit, targeting, reliability, and empirical item ordering. Polyserial correlation was applied to analyze the concordance between empirical estimates and conceptually expected item hierarchies.

Results: Three items were found to have response categories that did not function as intended. In one case, this could justifiably be addressed by collapsing the response options. Two of the items with problematic response categories, as well as one additional item, were found to show misfit with the assumptions of the Rasch measurement model.

Conclusion: Among first-line healthcare managers, 13 of the 16 items function well in reliably capturing lower levels of managerial complexity. However, further development of the TOH-SOC tool is required to ensure valid and reliable measurement across the full continuum of managerial complexity, and to strengthen its capacity for detecting changes over time.

Aims: To capture nurse anaesthetists' opinions on the use of depth of anaesthesia assessment methods and describe when and how nurse anaesthetists find such technical devices useful in their clinical practice.

Design: Cross-sectional.

Methods: Exploratory web-based survey among (n = 79) nurse anaesthetists who were members of the Swedish National Association for Anaesthesia and Intensive Care.

Results: In total, 25 nurse anaesthetists estimated that they used anaesthesia depth monitoring in up to every fourth case, whereas 20 reported applying monitoring in up to every second patient. Situations in which nurse anaesthetists would use depth of anaesthesia monitoring were during total intravenous anaesthesia, and in previous instances of awareness. There was a divergence of opinion among the nurse anaesthetists regarding whether judgement of clinical signs was equivalent or superior to the use of anaesthesia depth monitoring.

Conclusion: Based on the survey results, there are indications that knowledge regarding depth of anaesthesia assessment methods needs to be enhanced.

Implications for the profession: Anaesthesia depth monitoring is regarded as important in specific clinical situations, rather than as a routine component of all general anaesthesia. Variations in nurse anaesthetists' opinions on the value of clinical signs compared with technological monitoring indicate that these approaches may be best understood as complementary rather than mutually exclusive methods of assessing anaesthetic depth. Furthermore, the findings highlight the need for ongoing professional education and discussion regarding the appropriate indications, interpretation, and application of anaesthesia depth monitoring in nurse anaesthesia practice.

Impact: The findings suggest that anaesthesia depth monitoring is not routinely used by responding nurse anaesthetists. The results further indicate that nurse anaesthetists' opinion and experiences toward this technology vary, highlighting the importance of considering these factors when developing structured guidelines for clinical practice.

Reporting method: Strobe guidelines were followed.

Patient or public contribution: No patient or public contribution.

BACKGROUND:In most Western countries, senior workers have increased their participation in the workforce. However, at the same time, early retirement also increases. The reasons behind this early exit from the workforce are still unclear.

OBJECTIVE:This qualitative study aims to explore the antecedents of and experiences with a voluntary exit from working life before the expected retirement age of 65 in Sweden.

METHODS:Data consist of semi-structured interviews with 18 participants who exited working life between the ages of 61–63. In Sweden, these ages are considered as an early exit from working life since, for many years, the expected retirement age has been 65. Qualitative content analysis with an abductive approach was utilized.

RESULTS:The analysis revealed four sub-themes: 1) Health benefits with an early exit from working life (with the categories: own health status, the possibility for recovery time, and avoidance of strain); 2) Having economic conditions that enable an early exit from working life (with the categories: offers from the employer and financial compromises); 3) Social benefits with an early exit from working life (with the categories: enabling more time with my social network and avoidance of unsatisfying social work environment); 4) Self-fulfillment activities during the senior years (with the categories: enabling time for activities beyond work and avoidance of decreased job satisfaction.

CONCLUSION:This variety of antecedents of and experiences with a voluntary early exit from working life before the expected retirement age highlights that the ongoing increased statutory retirement age also increases the risk for extended inequalities among the aging population.

Background

In Sweden, becoming a registered nurse with a Bachelor of Science degree in nursing requires three years of full-time study, including an independent 15-credit thesis. Nursing undergraduates have limited access to ongoing research projects and clinical settings, which often prioritize master’s students and faculty-led studies. Thus, many nursing programs default to a literature-review norm, which reduces methodological diversity. This study focuses solely on non-traditional approaches, such as blog analyses, autobiographical analyses, and other innovative designs. The study seeks to disclose how these methods contribute to understanding patient experiences and advancing nursing education and research.

Aim

The aim of the study was to systematically map and critically analyze the methodological and theoretical diversity within Swedish bachelor’s theses in nursing that employ alternative research methods.

MethodA scoping review was conducted. Searches were performed in the DiVA portal (title-only list of 22 145 records) and in three university repositories (2 861 records), followed by an abstract-inclusive DiVA search (491 records). Screening and full-text review yielded 380 final inclusions. The national digital science archive was used to access theses completed between 2013 and 2023. Descriptive and inferential statistics were employed to analyze the data.

Results

Autobiographical works were the most frequently used sources (n = 220), followed by blogs (n = 126). Dictionaries, internet forums, and combined sources were rare. Few theses used dictionaries, social media or internet forums. A descriptive research design was employed in most of the theses, and the majority focused on adults, primarily women. The theoretical content mainly covered themes related to existential issues and suffering, but several bachelor’s theses lacked a formal theoretical framework.

Conclusion

Descriptive designs predominated, while exploratory and theory-integrated approaches were rare. Addressing these gaps requires pedagogical reforms that support use of diverse data sources and encourage inclusive research.

Background: Brain natriuretic peptide (BNP) is a hormone secreted from the heart in response to fluid overload. In patients with chronic kidney disease (CKD), inadequate fluid management during haemodialysis may cause fluid overload and overhydration (OH), risk factors for mortality. The aim of this exploratory pilot study was to analyse the relationships between BNP, OH and all-cause mortality in patients with CKD and haemodialysis.

Methods: In this prospective observational study, five-year survival was analysed in 64 patients with CKD and haemodialysis. Bivariate correlations were performed to analyse the relationships between BNP, OH, and all-cause mortality. Cox regression analysis was performed to adjust the relationship between BNP and all-cause mortality for selected clinical and biochemical characteristics, collected at baseline.

Results: By the end of the study, 33 patients (52%) had died. In bivariate correlation analysis age (r = 0.38), BNP (r = 0.48), handgrip strength (r=-0.34), lean tissue index (r=-0.41) and CRP level (r=-0.34, p = 0.007) were significantly associated with all-cause mortality. In a linear regression model, BNP was found to be a significant predictor of all-cause mortality (HR 2.61). However, after adjusting for age, handgrip strength, and CRP, BNP was no longer a statistically significant predictor of all-cause mortality. Instead, age, handgrip strength and CRP were significant predictors of all-cause mortality (HR 1.04; HR 0.95 and HR 2.61, respectively).

Conclusions: In this study, BNP was correlated with all-cause mortality in patients with CKD and haemodialysis, but OH was not. When adjusting for other clinical and biochemical factors, age, inflammation, and handgrip strength were found to be independent and more important predictors of all-cause mortality than BNP.

Background

First-line healthcare managers navigate complex organizational demands to ensure a good work environment and quality care. Key factors such as expanded span of control, leadership and management performance, and work-related stress significantly influence their job satisfaction. However, how these factors evolve over time in organizational settings remains unclear.

Objective

To examine expanded span of control, leadership and management performance, work-related stress, and job satisfaction among first-line healthcare managers and assess whether the relationships between these variables remained stable over time.

Methods

A repeated cross-sectional design was used to collect annual data from 2020 to 2023 among first-line managers in a Swedish healthcare organization. The Ottawa Hospital Span of Control tool, the Leadership and Management Inventory, the Health & Safety Executive stress tool, and a single-item job satisfaction measure were used to collect data. Kruskal-Wallis tests and Spearman correlation analysis were performed.

Results

An expanded span of control negatively impacted job satisfaction in certain years. Leadership and management performance showed a positive but inconsistent association with job satisfaction. Factors in work-related stress, particularly high demands and strained relationships, consistently had a negative relationship with job satisfaction, whereas control and support positively contributed to greater job satisfaction.

Conclusions

Work-related stress, driven by high demands and poor relationships, significantly decreases job satisfaction. Leadership and management performance influence satisfaction, but inconsistently. Reducing workload and improving support structures can enhance job satisfaction and managerial effectiveness.