Aims: To investigate expectations and experiences of internet-based therapy (IBT) in adolescents with temporomandibular disorder (TMD) pain. Methods: Seven adolescents were strategically selected for this study. All patients had received IBT for their TMD pain in a previous randomized controlled trial. Oneon- one interviews were conducted in a nonclinical setting. The interviews were semi-structured, following an interview guide with six domains. The recorded interviews were transcribed, and a qualitative inductive content analysis was then performed. Results: Content analysis indicated that the expectations of the adolescents and their experiences of IBT as a treatment for TMD pain can be understood in light of three main categories: (1) To become better; (2) An ambivalent experience; and (3) A personal challenge. The adolescents expressed expectations of less TMD pain after treatment, but also of improvement in general well-being and everyday life. Although their experiences of IBT varied, adolescents described having mixed feelings about treatment and feeling that it was personally challenging. Conclusion: Gained understanding of expectations and experiences is a necessary basis for revising the IBT program to meet the demands of adolescents and to improve treatment adherence. Furthermore, the content of the three categories clarifies the values of adolescents, and this understanding can in turn contribute to the development of new patient-centered treatment programs.

AIMS AND OBJECTIVES: The aim of this study was to identify the most common serious adverse events that occurred in nursing homes and their most frequent contributing factors to contribute to improvement of safe nursing care. BACKGROUND: There is a need to improve safe nursing care in nursing homes. Residents are often frail and vulnerable with extensive needs for nursing care. A relatively minor adverse event in nursing care can cause serious injury that could have been preventable. DESIGN: This was a retrospective study, with a total sample of data regarding adverse events (n=173) in nursing homes, concerning nursing care reported by health care providers in Sweden to the Health and Social Care Inspectorate. The reports were analysed with content analysis and the frequencies of the adverse events, and their contributing factors, were described with descriptive statistics. RESULTS: Medication errors, falls, delayed or inappropriate intervention and missed nursing care caused the vast majority (89%) of the serious adverse events. A total of 693 possible contributing factors were identified. The most common contributing factors were 1) lack of competence 2) incomplete, or lack of documentation 3) teamwork failure 4) and inadequate communication. CONCLUSIONS: The contributing factors frequently interacted yet they varied between different groups of serious adverse events. The resident's safety depends on the availability of staff's competence as well as adequate documentation about the resident's condition. Lack of competence was underestimated by health care providers. RELEVANCE TO CLINICAL PRACTICE: Registered Nurses and assistant nurses need to have awareness of contributing factors to adverse events in nursing care. A holistic approach to improve patient safety in nursing homes requires competence of the staff, safe environments as well as resident's and relative's participation. This article is protected by copyright. All rights reserved.

AIMS AND OBJECTIVES: To synthesise and interpret previous findings with the aim of developing a theoretical framework for patient autonomy in a high-tech care context. BACKGROUND: Putting the somewhat abstract concept of patient autonomy into practice can prove difficult as when it is highlighted in healthcare literature, the patient perspective is often invisible. Autonomy presumes that a person has experience, education, self-discipline and decision-making capacity. Reference to autonomy in relation to patients in high-tech care environments could therefore be considered paradoxical, as in most cases, these persons are vulnerable, with impaired physical and/or metacognitive capacity, thus making extended knowledge of patient autonomy for these persons even more important. DESIGN: Theory development. METHODS: The basic approaches in theory development by Walker and Avant were used to create a theoretical framework through an amalgamation of the results from three qualitative studies conducted previously by the same research group. RESULTS: A theoretical framework-the control-partnership-transition framework-was delineated disclosing different parts cocreating the prerequisites for patient autonomy in high-tech care environments. Assumptions and propositional statements that guide theory development were also outlined, as were guiding principles for use in day-to-day nursing care. Four strategies used by patients were revealed as follows: the strategy of control, the strategy of partnership, the strategy of trust and the strategy of transition. CONCLUSIONS: An extended knowledge base, founded on theoretical reasoning about patient autonomy, could facilitate nursing care that would allow people to remain/become autonomous in the role of patient in high-tech care environments. RELEVANCE TO CLINICAL PRACTICE: The control-partnership-transition framework would be of help in supporting and defending patient autonomy when caring for individual patients, as it provides an understanding of the strategies employed by patients to achieve autonomy in high-tech care contexts. The guiding principles for patient autonomy presented could be used in nursing guidelines.

We present the findings of our phenomenological interview study concerning the meaning of being an autonomous person while dependent on advanced medical technology at home. This was elucidated in the participants’ narratives as befriending everyday life when bringing technology into the private sphere. We discovered four constituents of the phenomenon: befriending the lived body, depending on good relationships, keeping the home as a private sphere, and managing time. The most important finding was the overall position of the lived body by means of the illness limiting the control over one’s life. We found that the participants wanted to be involved in and have influence over their care to be able to enjoy autonomy. We therefore stress the importance of bringing the patients into the care process as chronic illness will be a part of their everyday life for a long time to come, hence challenging patient autonomy.

Evidensbaserad omvårdnad definieras i denna bok som både ett förhållningssätt och en process. Förhållningssättet innebär en vilja att använda bästa tillgängliga vetenskapliga bevis som underlag för vårdbeslut. Processen består i hur man praktiskt går tillväga för att finna, sammanställa, kritiskt värdera och implementera detta underlag. Evidensbaserad omvårdnad handlar således om en strävan att bedriva omvårdnad på en god och säker grund och att tillgodose samhällets krav på att forskningsresultat utnyttjas på bästa sätt. Denna fjärde upplaga har förtydligats och alla länkar samt webbadresser har uppdaterats. Ett nytt avsnitt om ledarskapets betydelse för implementering av evidens har tillkommit. På bokens webbsida finns en film som visar evidensbaserad omvårdnad i klinisk verksamhet.

Informal care given by family caregivers is an important part of the total care provided to older adults with multimorbidity. The current study aimed to describe how older adults with multimorbidity experienced care from family caregivers. Interviews were conducted with 24 participants (mean age = 86 years). Older adults with multimorbidity felt gratitude toward family caregivers for their willingness to help with everyday life and for representing their interests in contacts with health care providers. Family caregivers also had a significant impact on older adults’ psychological well-being. However, the results also showed that older adults often felt they were a burden to their family caregivers and that their independence might be reduced. Older adults with multimorbidity should have the opportunity to be more involved in and have more influence over their health care so that they do not have to depend on representation by family caregivers.

The aim was to determine the psychometric properties of the Sumpathy-Acceptance-Understanding-Caring Competence (SAUK) model questionnaire for foreign-born parents evaluating nursing encounters in the Swedish Primary Child Health Care (PCHC) services. Multicultural encounters in child health care from the nursing perspectives are challenging and problematic worlwide. A suitable theory-based and validated questionnaire is needed for foreign-born parents to assess the quality of their encounters with nurses. The SAUC questionnaire, modified for use by new, foreign-born parents using the Swedish PCHC services, was evaluated for its congruence with the theory of Confirming Encounter. The study was ethically approved and data were collected between March and August 2009 from 83 new foreign-born parents seen at 50 clinics. Exploratory factor analysis was used to identifiy related factors, and goodness-of-fit tests were used to estimate theoretical consistency. Confirmatory Factor Analysis was used to verify the results. The questionnaire had satisfactory theoretical consistency with the theory of Confirming Encounter. Three factors identified by exploratory factor analysis and confirmed by confirmatory factor analysis - person support, self-support, and self-perspective support - indicated internal consistency and validated the three factors implicit in the Confirming Encounter. In addition, a new factor, concordance, was identified that is compatible with the theory. To conclude, despite the fact that a modified questionnaire have its limitations results demonstrate that the SAUC-model questionnaire seems to be a reliable and valid nursing quality-control measure with which foreign-born parents can evaluate the qualities of a confirming encounter with nurses. However, we suggest the need for testing the questionnaire in a larger population.

Aims: To explore adolescents' explanations of their temporomandibular disorder (TMD) pain, their pain management strategies for TMD pain, and their treatmentseeking behavior. Methods: One-on-one interviews were conducted with 21 adolescents aged 15 to 19 years old who had TMD pain and followed a semistructured interview guide. Subjects were strategically selected from patients referred to orofacial pain clinic. All participants had been examined and received a pain diagnosis based on the Research Diagnostic Criteria for TMD. The interviews focused on the adolescents' experiences of TMD pain, their strategies for handling pain, and how they seek care. The interviews were recorded, transcribed verbatim, and analyzed using qualitative manifest content analysis. Results: Qualitative manifest content analysis revealed two categories: (1) self-constructed explanations, with three subcategories (situation-based explanatory model, physical/bilogic model, and psychological explanatory model); and (2) pain management strategies, with four subcategories (social support, treatment, relaxation/rest, and psychological strategies). Adolescents used physical activities and psychological and pharmacologic treatment to manage pain. Reasons for seeking treatment were to be cured, to obtain explanation for their pain, and because their symtoms bother others. Conclusion: Adolescents living with TMD pain develop self-constructed explanations and pain management strategies. With access to these descriptions, dentists can be better prepared to have a dialouge with their adolescent patients about their own explanations of pain, the nature of pain, and in wich sitations the pain appears. Dentists can also explore adolescent patients' pain management stategies and perhaps also suggest new treatment stategies at an earlier stage.

The aim of this study was to describe and elucidate patient experinces of autonomy in an intensive care context from a caring perspective. Patients in intensive care units (ICUs) are critically ill and in a dependent and vulnerable position. There is thus a risk of staff taking command not only of the patients' vital functions but also of their decision-making. A qualitative design was selected. Individual interviews were conducted with 11 adult patients with an intensive care episode of two days or more at six Swedish ICUs. Data were analysed using Inductive Content Analysis. Patient autonomy in intensive care was shown to be "A trajectory towards partnership in care depending on state of health and mutual understanding". It was experienced through acknowledged dependence, being recognised as a person, invited participation and becoming a co-partner in care. Patients in need of intensive care wanted to be involved in making decisions about their care as this creates a trusting and healthy care environment. Greater awarness is required about the ICU patient not only being a passive care recipient but also an active agent and where involvment in decision-making and participation in care are crucial.

Patient safety is an important global issue. While it is well known that patients can suffer from adverse events in nursing care, there is a lack of knowledge as to how they experience them. The aim was to examine adverse events in nursing care as they are experienced by patients and relatives. This was a retrospective study taking both a qualitative and quantitative approach. It was based on data regarding 242 adverse events in nursing care, as reported by patients and relatives to Sweden's Medical Responsibility Board, content analysis was used to analys the reports. Patients' and relatives' experiences were analysed into four categories of adverse events, as concerning participation, clinical judgement, nursing intervention and the essentials of care. The reports were classified by the Medical Responsibility Board, without a standardized system. The adverse events reported were few in number and were reported by patients and relatives only. Lack of participation has negative consquences and contributes to adverse events. Adverse events occur through missed care as well as through carer errors. Nurses need to improve their skills that support patient participation. Patient participation needs to be incorporated into nurses' duties. Resources for patients to participate in their own care needs to be a priority underpinning policy-making in health systems. Nursing education systems need to teach students about the value and benefits of involving patients in their care.