AIM: To explore the patients´ experiences of pain when being cared for in the intensive care.

DESIGN: An exploratory, qualitative design was chosen.

METHOD: Interviews were performed with patients (October 2015-March 2017) within a week of post-intensive care (N = 16). Thematic analysis was used as method for analysis.

RESULTS: The findings generated two themes - a lack of control and to struggle for control. Pain was described as overwhelming, both in body and mind and generating the experience of a lack of control, with feelings of incapacitation, isolation, and having their needs unmet. Feeling in control of the pain and thus in control of the situation was experienced as a constant struggle. Well-planned care, finding ways to handle the pain and good communication were all helpful in this struggle.

CONCLUSION: The participants recalled their experience of pain in the ICU and control seems to be crucial for how pain is experienced. They experienced a lack of control due to not only the pain but also the treatment, which can be avoided by the nurse continuously evaluating and individualising the care. Balanced care, meeting the patients' needs and good communication helps the patient feel more in control when experiencing pain.

IMPACT: The experience of pain is dependent on control for the intensive care patient. The nurse may help them gain control and thereby handle the experience of pain through including the patient, striving for better communication and implementing individualised care that continuously assesses and treats pain.

INTRODUCTION: A cancer diagnose, for example, colorectal cancer, not only affects the cancer-person stricken, but also the surrounding family. Thus, this scoping review intends to identify appropriate models of support that will guide the development of a model of support to family members during the trajectory of colorectal cancer.

METHODS AND ANALYSIS: , and described by the Joanna Briggs Institute. All the stages will be conducted iteratively and reflexively. First, a search strategy will be developed with a librarian and applied in the following peer-reviewed databases: PubMed, Cumulative Index to Nursing and Allied Health Literature and PsycINFO. Additional searches will be performed in Google Scholar and SwePub for identification of grey literature and hand searched in the reference lists. Searches will be conducted from December 2019 to February 2020. A draft of the preliminary search strategy was performed in PubMed in November 2019. Subsequently, three members of the research team will independently screen all abstracts for relevance, as well as the full-text articles. Studies meeting the inclusion criteria will be critically evaluated using the Joanna Brigg Institute Critical Appraisal Tools. A descriptive summary of study characteristics and of the scoping review process will be presented, including a visual flow diagram. Lastly, a thematic analysis as presented by Braun and Clarke will be conducted. To enhance validity, contact nurses of persons with colorectal cancer will be provided an overview of the preliminary results.

ETHICS AND DISSEMINATION: Being a secondary analysis, ethical approval is not needed for this study. The findings of the analysis will be used to inform the design of a future study aiming to develop a model of support and an upcoming scoping review, which will be published in a scientific journal and presented at relevant conferences.

BACKGROUND: Moving into a long-term care facility (LTCF) can reduce the ability for older adults to engage in meaningful roles and activities and the size of their social network. These changes and losses can lead them to experience existential loneliness (EL)-the intolerable emptiness and lack of meaningful existence resulted from the losses they have experienced. While EL has often been understood as a universal human experience, it has primarily been studied in people from Western cultures; little is known about how EL may be experienced by and manifested in people from Eastern cultures. Hence, this qualitative study aimed to describe the experience and coping of EL in Hong Kong Chinese and Swedish older adults living in LTCFs.

METHODS: A qualitative study using Thorne's (2004) interpretive description was conducted. Thirteen Chinese and 9 Swedes living in LTCFs in Hong Kong, China and Malmo, Sweden, respectively were interviewed about their experience of EL in two series of semi-structured interviews. Data were analyzed using thematic analysis.

RESULTS: The core theme of "overcoming EL" described the participants' experience of EL, which came about through the combined process of "Feeling EL" and "Self-Regulating". Both Chinese and Swedish participants had similar experience with EL. Realizing that they did not want to living with EL anymore, they coped by reframing their experience and identifying new meaning in their life.

CONCLUSIONS: The study findings suggested that early and clear counselling support that help older adults to define new meaning in life may help them cope. In addition, more opportunities should be available at the LTCFs to promote quality relationships, enable older adults to reflect on their lives with pride, and support their ability to do the things they enjoy.

BACKGROUND: The presence of low or hypo glycaemia in children upon admission to hospital in low income countries is a marker for poor outcome. Fasting during illness may contribute to low blood glucose and caretakers' feeding practices during childhood illnesses may thus play a role in the development of low or hypo glycaemia. This study aims to describe the caretaker's feeding practices and association of fasting with low or hypo glycaemia in sick children in Malawi.

METHODS: A mixed method approach was used combining quantitative cross-sectional data for children aged 0-17 years admitted to Queen Elizabeth Central Hospital (QECH), a tertiary hospital in Malawi, with qualitative focus group discussions conducted with caretakers of young children who were previously referred to QECH from the five health centres around QECH. Logistic regression was used to analyse the quantitative data and thematic content analysis was conducted for qualitative data analysis.

RESULTS: Data for 5131 children who were admitted through the hospital's Paediatric Accident and Emergency Department (A&E) were analysed whereof 2.1% presented with hypoglycaemia (< 2.5 mmol/l) and 6.6% with low glycaemia (≥2.5mmoll/l - < 5 mmol/l). Fasting for more than eight hours was associated with low glycaemia as well as hypoglycaemia with Adjusted Odds Ratios (AOR) of 2.9 (95% Confidence Interval (CI) of 2.3-3.7) and 4.6, (95% CI 3.0-7.0), respectively. Caretakers demonstrated awareness of the importance of feeding during childhood illness and reported intensified feeding attention to sick children but face feeding challenges when illness becomes severe causing them to seek care at a health facility.

CONCLUSION: Results suggests that caretakers understand the importance of feeding during illness and make efforts to intensify feeding a sick child but challenges occur when illness is severe leading to fasting. Fasting among children admitted to hospitals may serve as a marker of severe illness and determine those at risk of low and hypoglycaemia.

Children with cancer require repeated hospitalizations and the family's everyday life and routines undergo change. Concrete descriptions of how nurses act when caring for children with cancer throughout the various phases of care and treatment are sparsely highlighted in the literature. The aim of this study was to describe young children with cancer and their parents' experiences of nurses' caring practices over a 3-year period, from diagnosis to follow-up. This study is based on semistructured interviews with 25 children newly diagnosed with cancer, aged 1 to 6 years, and their parents, connected to a pediatric oncology unit in Sweden. Child and parent data were analyzed with a deductive content analysis using Swanson's theory of caring. The result shows that nurse care practices directed toward young children with cancer and their parents are to some extent similar across a 3-year period from diagnosis to follow-up but also differ in some ways. Nurses' caring practices aim to support children and parents in the transition to a "new normal." Child- and family-friendly care processes include the following: creating hope and a trustful relationship, asking rather than assuming, providing knowledge and information, performing tasks skillfully, displaying an interest in the child's and parents' life outside the hospital, and helping the family to trust in the future and other health care providers. Based on these results, we recommend the development of a standardized and structured nursing care plan or clinical guideline with detailed information on how to carry out clinical nurse care practices in the different phases.

AIM: To describe partners' experiences of living with men with a screening-detected abdominal aortic aneurysm (AAA).

BACKGROUND: Diagnosis of a chronic life-threatening disease affects the patients' as well as their partners' lives in different aspects. AAA, with rupture as the major consequence, is a life-threatening disease that can affect the whole family. Screening programmes for AAA have been introduced in several countries to reduce the mortality rate. Although the awareness of having an AAA influences the individuals' quality of life and well-being, it is still unclear how it affects their partners.

DESIGN: Qualitative descriptive design.

METHODS: . The data were analysed using qualitative content analysis. The study conforms to the COREQ checklist.

RESULTS: Three categories were identified: (a) experiencing the unexpected; (b) being reminded of fragility; and (c) balancing a changing relationship. The partners had a positive attitude towards the screening process and were pleased that their husbands were under surveillance. Nevertheless, at the same time, the diagnosis caused worries and questions. The AAA diagnosis was constantly in the minds of the partners, which sometimes affected and limited daily activities. Furthermore, ambivalent feelings towards surgical treatment were described. The partners tried to support their men and encouraged them to achieve a healthy lifestyle.

CONCLUSION: The partners' well-being and daily lives were impacted by the awareness of the screening-detected AAA. Different degrees of worry were the most common reaction and were pervasive in all three categories.

RELEVANCE FOR CLINICAL PRACTICE: The result highlights the need to review routines or develop new strategies to include the partners in the process of screening and offer supplementary support and information.

Background: The voices of those who have grown up in a family with maternal intellectual or developmental disability (IDD) are valuable for gaining an understanding of their situation, which is essential in order to be able to support these families and avoid potentially detrimental situations.

Aim: The study aim was to describe the experience of having grown up in a family where the mother has an IDD, with a focus on everyday life and perceived health consequences in adult life.

Method: A qualitative method with retrospective narrative interviews and narrative content analysis was chosen. In-depth interviews were performed with four women who had experiences of a childhood with maternal IDD.

Findings: Four themes emerged: Living under adverse circumstances; Dealing with one’s everyday life situation; Receiving insufficient support and wishing for more; and The echo from childhood into adult life. The findings revealed a distressing childhood, characterized by neglect, abuse, anxiety, and overburdening responsibilities, and also endeavors to keep the family situation a secret, while at the same time wanting the adult world to react.

Discussion: The findings can hopefully stimulate occupational therapists and other professionals to more effectively identify the situation of these children and provide support to prevent adverse future health conditions and poor well-being.

Background Studies have highlighted deficiencies in the information given by nurses to surgical patients. Studies also show that the role of the nurse in connection with the discharge of patients after surgery is unclear. The aim of the study was therefore to elicit and to explore registered nurses' conceptions of the phenomenon ofnursing care information given to surgical patients in connection with hospital discharge. Method Semi-structured interviews were conducted with fifteen nurses at surgical unites at the southern parts of Sweden. The interviews were transcribed and then analysed according to the phenomenographic approach. Result The analysis resulted into three descriptive categories which conjointly may be said to express the general conceptions of the informants. Thus, according to the informants, the provision of nursing care information in connection with the discharge of surgical patients is: (i) not a nursing priority, (ii) adapted to the context of care, and (iii) a possible enhancement of the nursing process and the quality of care. Conclusion The result of the study implies that the discharge conversation may be seen as an opportunity for the nursing profession to formalise and to enhance the quality of care in connection with the discharge of surgical patients.

BackgroundMental healthcare is an important component in societies' response to mental health problems. Although the World Health Organization highlights availability, accessibility, acceptability and quality of healthcare as important cornerstones, many Europeans lack access to mental healthcare of high quality. Qualitative studies exploring mental healthcare from the perspective of people with lived experiences would add to previous research and knowledge by enabling in-depth understanding of mental healthcare users, which may be of significance for the development of mental healthcare. Therefore, the aim of the current study was to describe experiences of mental healthcare among adult Europeans with mental health problems.MethodIn total, 50 participants with experiences of various mental health problems were recruited for separate focus group interviews in each country. They had experiences from both the private and public sectors, and with in- and outpatient mental healthcare. The focus group interviews (N=7) were audio recorded, transcribed verbatim and analysed through thematic analysis. The analysis yielded five themes and 13 subthemes.ResultsThe theme Seeking and trying to find help contained three subthemes describing personal thresholds for seeking professional help, not knowing where to get help, and the importance of receiving help promptly. The theme Awaiting assessment and treatment contained two subthemes including feelings of being prioritized or not and feelings of being abandoned during the often-lengthy referral process. The theme Treatment: a plan with individual parts contained three subthemes consisting of demands for tailored treatment plans in combination with medications and human resources and agreement on treatment. The theme Continuous and respectful care relationship contained two subthemes describing the importance of continuous care relationships characterised by empathy and respect. The theme Suggestions for improvements contained three subthemes highlighting an urge to facilitate care contacts and to increase awareness of mental health problems and a wish to be seen as an individual with potential.ConclusionFacilitating contacts with mental healthcare, a steady contact during the referral process, tailored treatment and empathy and respect are important aspects in efforts to improve mental healthcare. Recommendations included development of collaborative practices between stakeholders in order to increase general societal awareness of mental health problems.

Ageism is discrimination against individuals or groups based on their age. In the Swedish healthcare context, the term isuncommon, despite the fact that older people are a significant class of users. One of every five individuals in Sweden is 65 yearsof age or older, and the proportion of older people in the population is rising. Therefore, ageism in healthcare warrants moreawareness and focus. In three recent articles that we have published relating to nutritional, depression and continence care forolder people, we found indications of ageism even though we did not aim to study it. There is a need to identifythe manifestations of ageism and label them, and to become alert to both the visible and invisible expressions of ageism.This will help in the development of interventions and policies to eliminate ageism in healthcare. With health inequalitiesgrowing and seemingly becoming the norm rather than the exception in Sweden and other European countries, it has becomeimperative to address and eliminate health inequalities through a range of initiatives and mechanisms. Fighting ageism in differentsettings must be a part of this larger goal.

In today's world, nurses increasingly care for individuals from different cultures. Because culturally sensitivecare can improve patient satisfaction in care, nurses need to develop cultural competence in their practice. Todevelop cultural competence, one option is to build cultural awareness by exposing students to nursing practicesin other cultures through online internationalization-at-home activities. However, little is known about theprocess of cultural awareness development through internationalization activities. Therefore, this qualitativestudy aimed to identify the development process of cultural awareness in nursing students, who participated in aseries of internationalization-at-home activities. A total of 31 nursing students from Australia, Hong Kong, andSweden volunteered to participate in student-led learning groups. Groups consisted of two to four students fromeach university, who engaged in four weekly webinars and online reflections about nursing practice based on acase scenario. Data were collected from participants' ongoing reflective journal entries, and after the webinarsended, from three focus groups. A semi-structured interview guide was used to understand how the internationalization-at-home activities impacted their cultural awareness and knowledge of nursing. Data wereanalyzed using interpretive description. Following four levels of thematic analysis (i.e., comprehension,synthesis, theorizing, reconceptualization), we identified four themes in the development of cultural awareness:1) nurturing reciprocity through comparisons of nursing culture; 2) discovering common ethical values of thenursing profession; 3) developing cultural awareness in nursing ideology and practice; and 4) transformingunderstanding of nursing in the context of their healthcare systems. By the end of the internationalizationactivities, students appeared to have developed relational skills to facilitate their own inner dialogue aboutethical ideals of “self” and “other” in the context of being part of the global nursing community. Future researchshould develop and assess teaching strategies that can further facilitate the four themes in cultural awarenessdevelopment.

BACKGROUND: The health-promoting qualities of participation as an opportunity for social and cognitive engagement are well known. Use of Everyday Technology such as Smartphones or ATMs, as enabling or disabling factors for out-of-home participation is however under-researched, particularly among older people with and without dementia. Out-of-home participation involves participation in places and activities outside of a person's home, in public space. Situated within the context of an increasingly technological society, the study investigated factors such as perceived risks, access to a concession travel pass and use of Everyday Technologies, and their relationship with out-of-home participation, among older people in the UK.

METHODS: One hundred twenty-eight older people with and without dementia in urban and rural environments in the UK, were interviewed using the Participation in ACTivities and Places OUTside Home (ACT-OUT) Questionnaire and the Everyday Technology Use Questionnaire (ETUQ). Associations between Everyday Technology use, perceived risk of falling, functional impairment, access to a concession travel pass and out-of-home participation were investigated using ordinal regression.

RESULTS: A higher probability of Everyday Technology use (Odds Ratio [OR] = 1.492; 95% Confidence Interval [CI] = 1.041-1.127), perceived risk of falling outside home (OR = 2.499; 95% CI = 1.235-5.053) and, access to a concession travel pass (OR = 3.943; 95% CI = 1.970-7.893) were associated with a higher level of out-of-home participation. However, other types of risk (getting lost; feeling stressed or embarrassed) were not associated with out-of-home participation. Having a functional impairment was associated with a low probability of a higher level of out-of-home participation (OR = .470; 95% CI = .181-1.223). Across the sample, 'outside home' Everyday Technologies were used to a higher degree than 'portable' Everyday Technologies which can be used both in and outside home.

CONCLUSIONS: The study provides insights into perceived risks, access to a concession travel pass and use of Everyday Technologies, and their relationship with out-of-home participation, among older people in the UK. Increased knowledge about factors associated with out-of-home participation may help to guide targeted health and social care planning.

= 0.033). The content analysis and graphical joint display revealed motivators, considerations that require extra attention, and strategies for managing social participation. The results underline how Everyday Technology use can be assistive to social participation but also the need to consider social deprivation of the living environment, especially among people with dementia.

Background: Though workplace violence (WPV) is a global problem for healthcare professionals, research within in-hospital care has mainly focused on WPV in emergency healthcare settings. Thus, the number of qualitative studies that explores experiences of WPV in general hospital wards with a longer length of stay is limited.

Aim: The aim of this study was to explore how healthcare professionals in surgical hospital wards experience and manage WPV perpetrated by patients or visitors.

Method: . Exposure to WPV is a problem for healthcare professionals in surgical wards and has consequences for the patients. Preventive strategies, guidelines, and action plans are urgently needed to minimise the risk of WPV and to ensure a safe work and care environment.

BACKGROUND: Fatigue is a common symptom associated with a wide range of diseases and needs to be more thoroughly studied. To minimise patient burden and to enhance response rates in research studies, patient-reported outcome measures (PROM) need to be as short as possible, without sacrificing reliability and validity. It is also important to have a generic measure that can be used for comparisons across different patient populations. Thus, the aim of this secondary analysis was to evaluate the psychometric properties of the Norwegian 5-item version of the Lee Fatigue Scale (LFS) in two distinct patient populations.

METHODS: The sample was obtained from two different Norwegian studies and included patients 4-6 weeks after stroke (n = 322) and patients with osteoarthritis on a waiting list for total knee arthroplasty (n = 203). Fatigue severity was rated by five items from the Norwegian version of the LFS, rating each item on a numeric rating scale from 1 to 10. Rasch analysis was used to evaluate the psychometric properties of the 5-item scale across the two patient samples.

RESULTS: Three of the five LFS items ("tired", "fatigued" and "worn out") showed acceptable internal scale validity as they met the set criterion for goodness-of-fit after removal of two items with unacceptable goodness-of-fit to the Rasch model. The 3-item LFS explained 81.6% of the variance, demonstrated acceptable unidimensionality, could separate the fatigue responses into three distinct severity groups and had no differential functioning with regard to disease group. The 3-item version of the LFS had a higher separation index and better internal consistency reliability than the 5-item version.

CONCLUSIONS: A 3-item version of the LFS demonstrated acceptable psychometric properties in two distinct samples of patients, suggesting it may be useful as a brief generic measure of fatigue severity.

TRIAL REGISTRATION: Clinicaltrials.gov: NCT02338869; registered 10/04/2014 (stroke study).

Patients' life history is of primary interest in psychiatric nursing care. Our aim was to illustrate how we used time geography as a method to identify individuals' patterns in relation to certain situations in place. We have used interviews and diaries to construct life charts by hand and with a computer software program. By using time geography, we provide a rich amount of information, which can generate a broader picture of a person's life, to identify stressful as well as social aspects of a person's life. Patients with mental ill health need and value the therapeutic relationship using time geography.

HRQoL problems as perceived by children with RVOT anomalies are best identified with the PedsQL Cardiac Module and relate mostly to cognitive and physical functioning. The agreement findings suggest the need to take into account both child- and parent reports in the assessment of HRQoL.

Background. In Sweden, both glucose analyzers in accredited laboratories and point-of-care glucose devices are used for gestational diabetes mellitus (GDM) diagnosis. The aim of this study was to compare the diagnostic performance of the HemoCue Glucose 201+ (HC201+) and RT (HC201RT) systems with that of the hospital central laboratory hexokinase method (CL) based on lyophilized citrate tubes, using the isotope dilution gas chromatography-mass spectrometry (ID GC-MS) as reference. Methods. A 75 g oral glucose tolerance test was performed on 135 women screened positive for GDM. Diagnosis was based on the World Health Organization 2013 diagnostic thresholds for fasting (n=135), 1 h (n=52), and 2 h (n=135) glucose measurements. Bland-Altman analysis and surveillance error grids were used to evaluate analytical and clinical accuracy. Results. Significantly more women were diagnosed with GDM by HC201+ (80%) and CL (80%) than with the reference (65%, P<0.001) based on fasting and/or 2 h thresholds, whereas the percentage diagnosed by HC201RT (60%) did not differ significantly from the reference. In Bland-Altman analysis, a positive bias was observed for HC201+ (4.2%) and CL (6.1%) and a negative bias for HC201RT (-1.8%). In the surveillance error grid, 95.9% of the HC201+ values were in the no-risk zone as compared to 98.1% for HC201RT and 97.5% for CL. Conclusions. A substantial positive bias was found for CL measurements resulting in overdiagnosis of GDM. Our findings suggest better performance of HC201RT than HC201+ in GDM diagnosis. The results may have possible implications for GDM diagnosis in Sweden and require further elucidation.

Background: Everyday technologies (ET) such as smart phones, and internet banking are increasingly incorporated into daily activities. Therefore, valid assessments are needed to identify ability in ET use and to design and evaluate interventions.

Aims: To evaluate and compare the stability over time (test-retest reliability) of measures generated with the short version of the Everyday Technology Use Questionnaire (S-ETUQ) in older adults with cognitive impairment or mild dementia.

Materials and Methods: Data was collected with S-ETUQ at two occasions (m = 20.9 days in between) in a sample of (n = 73) older adults with cognitive impairment of different origin (n = 38) or mild dementia (n = 35). Stability of each participant’s S-ETUQ measure was examined using standardised difference z-comparisons. The test-retest reliability coefficient of the S-ETUQ measures was determined by Intraclass Correlation Coefficients. Comparisons were performed using Mann-Whitney u-tests.

Results: The S-ETUQ measures were statistically stable between the two occasions. Hence, the group of persons with cognitive impairment demonstrated slightly higher stability and fewer differences compared to the group with mild dementia. The ICCs (0.82–0.90) indicated good to excellent agreement.

Conclusions: S- ETUQ can be used with older people with cognitive impairments of varying degree to gather reliable and precise information regarding their use of ET.

In this study, we aim to contribute to the field of critical health communication research by examining how notions of mental health and illness are discursively constructed in newspapers and magazines in six European countries and how these constructions relate to specific understandings of mental health literacy. Using the method of cluster-agon analysis, we identified four terminological clusters in our data, in which mental health/illness is conceptualized as "dangerous," "a matter of lifestyle," "a unique story and experience," and "socially situated." We furthermore found that we cannot unambiguously assume that biopsychiatric discourses or discourses aimed at empathy and understanding are either exclusively stigmatizing or exclusively empowering and normalizing. We consequently call for a critical conception of mental health literacy arguing that all mental health news socializes its audience in specific understandings of and attitudes toward mental health (knowledge) and that discourses on mental health/illness can work differently in varying contexts.

OBJECTIVES: Inequalities in oral health have been on the rise globally. In Sweden, these differences exist not between regions, but among subgroups living in vulnerable situations. This study aims at understanding behavioural change after taking part in participatory oral health promotional activity among families living in socially disadvantaged neighbourhoods in Southern Sweden.

SETTING: The current study involved citizens from a socially disadvantaged neighbourhood in Malmö, together with actors from the academic, public and private sectors. These neighbourhoods were characterised by high rates of unemployment, crime, low education levels and, most importantly, poor health.

PARTICIPANTS: Families with children aged 7-14 years from the neighbourhood were invited to participate in the health promotional activities by a community representative, known as a health promoter, using snowball sampling. Between 8 and 12 families participated in the multistage focus groups over 6 months. Data were analysed using qualitative content analysis.

RESULTS: Three main themes emerged from the analysis, providing an understanding of the determinants for behavioural change, including meaningful social interactions, family dynamics and health trajectories. The mothers in the study valued the social aspects of their participation; however, they believed that gaining knowledge in combination with social interaction made their presence also meaningful. Further, the participants recognised the role of family dynamics primarily the interactions within the family, family structure and traditional practices as influencing oral health-related behaviour among children. Participants reported having experienced a change in general health owing to changed behaviour. They started to understand the association between general health and oral health that further motivated them to follow healthier behavioural routines.

CONCLUSIONS: The results from this study show that oral health promotion through reflection and dialogue with the communities, together with other stakeholders, may have the potential to influence behavioural change and empower participants to be future ambassadors for change.

Introduction

A new-born with congenital heart disease requires care that involves numerous specialists. Such care can be provided at tertiary referral hospitals and transportation is often needed. A crucial factor is the handover process, when the child is born at a distance, with transfer of both professional responsibility and continued care from one healthcare professional to another.

Aim

The aim of this study was to identify crucial factors for the receiving healthcare professionals that influence the handover process of the new-born with congenital heart disease.

Method

A cross-sectional questionnaire study with 53 receiving healthcare professionals at a paediatric intensive care unit at a tertiary referral university hospital in Sweden. The response rate was 48/53. Numerical variables were computed and a content analysis was performed.

Findings

The handover process of the new-born with heart disease transferred to a tertiary referral hospital is complicated. A clear majority of the respondents identified one or more flaws in this process. Crucial factors identified were: relevant and structured information, clear communication, adequate patient knowledge and an enabling environment.

Conclusion

A standardised procedure in the different phases of the handover process could improve communication, the working situation for healthcare professionals and thereby increase patient safety.

Background: Older adults manage increasing numbers of everyday technologies to participate in home and community activities. Purpose: We investigated how assessing use of everyday technologies enhanced predictions of overall needed assistance among urban older adults. Method: We used a cross-sectional design to analyze responses from 114 participants completing the Everyday Technology Use Questionnaire, the Montreal Cognitive Assessment, and a sociodemographic questionnaire. We estimated overall needed assistance based on definitions in the Assessment of Motor and Process Skills. We created logistic regression models and receiver operator characteristic curves to analyze variables predicting overall needed assistance. Findings: With high specificity and sensitivity, the Everyday Technology Use Questionnaire and the Montreal Cognitive Assessment were the strongest predictors of overall needed assistance.

Background: The changing technological environment is reflected in regular updates made to the everyday technology (ET) use questionnaire (ETUQ). Newly added ETs may not present comparable challenges across countries and diagnoses.

Aims: To identify whether country context, or dementia diagnosis, impact ETs’ challenge level.

Material and methods: 315 older adults from three countries were included; Sweden (n = 73), United States (n = 114), England (n = 128), and had a confirmed diagnosis of mild dementia (n = 99) or no known cognitive impairment (n = 216). Differential Items Functioning (DIF) analysis was performed on 88 ETs included in the ETUQ by country and diagnosis. The impact of DIF was evaluated in a Differential Test Functioning (DTF) analysis.

Results: Nine items (10.2%) in the ETUQ showed statistically significant DIF between countries; five of which were public space ETs and none of which were information and communication technologies (ICTs). Three ICT items, and no others, showed significant DIF by diagnosis. The items’ DIF was shown to have no impact upon person measures of ability to use ET in the DTF.

Conclusions and significance: The utility of the ETUQ in occupational therapy practice and research internationally is highlighted through the stability of the challenge hierarchy and lack of impact on person measures.

BACKGROUND: Victimisation of women is encountered in all countries across the world, it damages the mental and physical health of women. During pregnancy and the postpartum period, women are at a greater risk of experiencing violence from an intimate partner. The aim of this study was to explore childbirth outcomes in a Swedish population of women reporting a history of violence including domestic violence during pregnancy.

METHODS: A longitudinal cohort design was used. In total, 1939 pregnant women ≥18 years were recruited to answer two questionnaires, both questionnaires were administered in the early and late stages of their pregnancy. The available dataset included birth records of 1694 mothers who gave birth between June 2012 and April 2014. Statistical analyses included descriptive statistics, T-test and bivariate logistic regression.

RESULTS: Of 1694 mothers 38.7% (n = 656) reported a history of violence and 2% (n = 34) also experienced domestic violence during pregnancy. Women who were single, living apart from their partner, unemployed, smoked and faced financial distress were at a higher risk of experiencing violence (p = 0.001). They also had significant low scores on the SOC-scale and high EDS-scores ≥13 (p = 0.001) when compared to women without a history of violence (p = 0.001). Having a history of violence increased the woman's risk of undergoing a caesarean section (OR 1.33, 95% CI 1.02-1.70). A history of emotional abuse also significantly increased the risk of having a caesarean section irrespective of whether it was a planned or an emergency caesarean section (OR 1.50, 95% CI 1.09-2.06). Infants born to a mother who reported a history of violence, were at significant risk of being born premature < 37 weeks of gestation compared to infants born by mothers with no history of violence (p = 0,049).

CONCLUSIONS: A history of violence and/or exclusively a history of emotional abuse has a negative impact on childbirth outcomes including caesarean section and premature birth. Therefore, early identification of a history of or ongoing violence is crucial to provide women with extra support which may have positive impact on her birth outcomes.

PURPOSE: The aim of this study was to describe the phenomenon of undergoing colonoscopy as experienced by adolescents.

DESIGN: This study was a qualitative study in which data were collected and analyzed in accordance with the methodological principles of Reflective Lifeworld Research with a phenomenological approach.

METHODS: Face-to-face interviews were performed with 17 adolescents after undergoing the first colonoscopy.

RESULTS: The phenomenon of undergoing colonoscopy as experienced by adolescents can be described as a collision between emotions and a desire to obtain answers to questions about the examination, as well as concerns about its result and the meaning of undergoing colonoscopy. The essential meaning is additionally described through its constituents: a sense of vulnerability, an opportunity for symptom explanation, and sensibility regarding information.

CONCLUSIONS: The results can be concluded in terms of the knowledge that for adolescents a colonoscopy means more than an examination. Although colonoscopy is not experienced as painful, it evokes different emotions that affect adolescents. Therefore, a psychological preparation, on an individual level, is required before the colonoscopy. Our results showed that adolescents need to understand the connection between their symptoms, their body, and the colonoscopy.

OBJECTIVE: The aim of this study was to describe the experience of polyethylene glycol (PEG) bowel preparation in adolescents undergoing colonoscopy.

RESULTS: 32 adolescents, 10-18 years of age self-reported a minimum of complications 1 week after colonoscopy when PEG was used for bowel preparation. 17 adolescents, 10-18 years were also interviewed about bowel preparation with PEG. Using qualitative content analysis, two categories were extracted from the data: "Being decisive makes it manageable" and "Be prepared for a horrible experience." The adolescents reported PEG intake difficulty; the intake was, however, manageable if they received appropriate information.

BACKGROUND: Improved survival rates of preterm infants and critically ill children has resulted in an increasing number of children growing up on HPN. However, how the child and the child's family experience HPN is sparsely studied.

PURPOSE: Thus, this study aims to elucidate the everyday life experiences of children with intestinal failure on HPN from the perspective of the child and the child's family.

DESIGN AND METHODS: We used a qualitative inductive study that included semi-structured interviews from 13 family members in six families, and we analyzed them using content analysis.

RESULTS: The family members' experiences had an overall theme, having to take on a full-time (nursing) responsibility, and fell into three categories: family restrictions, family adjustments, and family uncertainty.

CONCLUSION: Families on HPN had to shoulder an in-home round-the-clock (nursing) responsibility that came with a daily logistical challenge. The complexity of HPN complicates the possibility of external support, so the families choose to keep the burden within the family; consequently single-parent households have limited possibilities for relief and recovery.

PRACTICE IMPLICATIONS: To minimize the intrusion of the treatment in family's everyday life and, thereby, support the families, health care professionals might find it beneficial to obtain an inventory of the everyday life needs of each specific family when first introducing HPN. Further, by encouraging close kin to participate in the HPN education these families may be unburdened some more. In addition, it is essential that professionals follow the families protocol for management and not the other way around.

Background: The mental healthcare treatment gap (mhcGAP) in adult populations has been substantiated across Europe. This study formed part of MentALLY, a research project funded by the European Commission, which aimed to gather qualitative empirical evidence to support the provision of European mental healthcare that provides effective treatment to all adults who need it.

Methods: Seven focus groups were conducted with 49 health professionals (HPs), including psychologists, psychiatrists, social workers, general practitioners, and psychiatric nurses who worked in health services in Belgium, Cyprus, Greece, the Netherlands, Norway and Sweden. The focus group discussions centered on the barriers and facilitators to providing quality care to people with mild, medium, and severe mental health problems. Analyses included deductively and inductively driven coding procedures. Cross-country consensus was obtained by summarizing findings in the form of a fact sheet which was shared for triangulation by all the MentALLY partners.

Results: The results converged into two overarching themes: (1) Minding the treatment gap: the availability and accessibility of Mental Health Services (MHS). The mhcGAP gap identified is composed of different elements that constitute the barriers to care, including bridging divides in care provision, obstacles in facilitating access via referrals and creating a collaborative 'chain of care'. (2) Making therapeutic practice relevant by providing a broad-spectrum of integrated and comprehensive services that value person-centered care comprised of authenticity, flexibility and congruence.

Conclusions: The mhcGAP is comprised of the following barriers: a lack of funding, insufficient capacity of human resources, inaccessibility to comprehensive services and a lack of availability of relevant treatments. The facilitators to the provision of MHC include using collaborative models of primary, secondary and prevention-oriented mental healthcare. Teamwork in providing care was considered to be a more effective and efficient use of resources. HPs believe that the use of e-mental health and emerging digital technologies can enhance care provision. Facilitating access to a relevant continuum of community-based care that is responsive coordinated and in line with people's needs throughout their lives is an essential aspect of optimal care provision.

Background: A dysfunctional use of coping strategies has repeatedly been linked to suicidal behaviour in non-psychiatric populations. However, data regarding association between coping strategies and suicidal behaviour in psychiatric populations are limited. Aims: The aim of the study was to investigate the possible relationship between self-reported suicide risk, suicidal ideation and coping strategies in three psychiatric cohorts. Method: Three cohorts of psychiatric patients were involved in the study; recent suicide attempters (n = 55), suicide attempters at follow-up 12 years after a suicide attempt (n = 38) and patients with ongoing depression without attempted suicide (n = 72). Patients filled in the self-rating version of The Suicide Assessment Scale (SUAS-S) from which items no. 17–20 addressing current suicidal ideation were extracted. To investigate coping strategies, the Coping Orientation of Problem Experience Inventory (COPE) was used. Results: In all cohorts, regression analyses showed that only avoidant coping was significantly correlated with the scores of SUAS-S adjusted for covariates. The items no. 17–20 correlated significantly to avoidant coping but not with other coping strategies in all cohorts. Conclusion: The results of this study indicate that among coping strategies only avoidant coping may be associated with suicide risk in psychiatric patients independently of history of attempted suicide.

Background This case control study aimed to investigate whether symptoms of sexual dysfunction are more common in males from infertile couples than in the general population and to explore whether symptoms of sexual dysfunction are associated to hypogonadism. Objectives Participants were 165 subfertile men in infertile heterosexual relationships, 18-50 years of age, with sperm concentrations < 15 x 10(6)/mL. The controls were 199 men from a population-based group, matched for age. Material and methods Logistic regression was applied in order to calculate odds ratios (ORs) for seven different symptoms of sexual dysfunction. In a multivariate model, we tested independent effects of infertility and primary as well as secondary hypogonadism. Results Statistically significant association between subfertility and symptoms of sexual dysfunction was found for lack of ability to control ejaculation (OR 2.2, 95% CI: 1.2-4.2). For hypogonadism, statistical significance was seen both in relation to low sexual interest/desire for sex (OR 2.3, 95% CI: 1.0-5.5) and for being worried about the size or shape of the penis (OR 3.6, 95% CI: 1.3-9.5). These associations remained statistically significant in males with primary but not those with secondary hypogonadism. Discussion Our study showed that men from infertile couples have an increased risk of symptoms of sexual dysfunction and this risk is linked to androgen deficiency. Conclusion Assessment of reproductive hormone levels and sexual function should routinely be done in this group of males.

Purpose: Spouses are in a vulnerable situation when caring for a frail partner late in life. Exploring their existential loneliness can be a way to understand more about their existential needs. Method: A hermeneutic approach was used. Multistage focus group interviews were conducted with two groups consisting of five spouses, respectively, who met three times each. To work with the text, an approach was adapted where quotations are converted into poems in a linguistic manner. Results: Existential loneliness can be understood as the following: 1) being in a transition from us to merely me, 2) being forced to make decisions and feeling excluded, 3) navigating in an unfamiliar situation and questioning oneself, and 4) longing for togetherness but lacking the energy to encounter other people. The main interpretation is that existential loneliness emerges when one is in moments of inner struggle, when one is forced to make impossible choices, when one is approaching and is in limit situations, and when one is experiencing the endless loss of the other. Conclusion: For health care professionals to achieve a holistic picture, person-centeredness can be a way to make the spouses' existential needs visible and to provide support based on their needs.

Purpose: A decline in the ability to perform activities of daily living (ADL) and ability to use everyday technology can pose threats to independent living, healthcare management and quality of life (QOL) of patients suffering from chronic obstructive pulmonary disease (COPD). Evidence of the relationship between these variables remains limited. The dual aim of this study was, first, to investigate if health-related QOL (HRQOL) was associated with quality in ADL performance and everyday technology use; second, to examine whether lung function, years with COPD diagnosis, living status or educational level affected physical and mental domains of HRQOL. Methods: This cross-sectional study included (N=80) participants aged 46-87 years recruited at healthcare centres in the Northern Region of Denmark using a convenience sampling procedure. Data were gathered through standardized assessments and analysed using multiple regression analysis. Results: The regression model explained 50.6% (R2=0.506) of the variation in HRQOL-physical. The following four variables were statistically significantly associated with HRQOL - physical: years since COPD diagnosis (p=0.023), ability to use everyday technology (p=0.006), amount of relevant everyday technologies (p=0.015) and ADL motor ability (p<0.01). The regression model explained 22.80% (R-2=0.228) of HRQOL - mental. Only the variable ability to use everyday technology was statistically significantly associated with HRQOL - mental (p=0.009). Conclusion: Quality of ADL performance and everyday technology use seem to be associated with HRQOL in people living with COPD. The only demographic variable associated with HRQOL was years with COPD. This indicates that healthcare professionals should enhance their attention also to ADL-performance and everyday technology use when striving to increase the HRQOL of persons living with COPD.

Background Little is known whether children experience pain during hospital stay from the child's own perspective or not. The existing studies tend to be based on a small number of children and therefore have limitations concerning the generalisability of the results. Aim The aim of this study was to describe children's self-reported pain and experience concerning pain management during hospital stay. Methods This study has a quantitative cross-sectional design with descriptive statistics as data analysis. Results A total of 786 questionnaires, Pain in Children in Hospital, were distributed in four countries with the response rate of 75% which was almost equal between countries. Our result showed that 87% (503/579) children at hospital self-reported pain during the past 24 h. Nearly 63% of the children reported a pain score of > 5 the last 24 h. Most of children reported that they had received a question about pain from the hospital staff, and that the staff observed and assessed their pain. Totally 95% reported that they were satisfied with their pain relief during the last 24 h. Conclusion Our study showed that when children were given the possibility to self-report pain, nearly 2/3 expressed that they had experienced pain during hospital stay. However, most of them reported satisfaction with pain management and their pain relief.

Background: Despite numerous interventions aiming to improve physical activity in socially disadvantagedpopulations, physical inactivity remains to be a rising challenge to public health globally, as well as, in Sweden. Inan effort to address this challenge, a community-based participatory intervention was developed through activecommunity engagement and implemented in a socially disadvantaged neighborhood in Sweden. The current studyaims to present the development and initial evaluation of a participatory research driven physical activityintervention.Methods: Fifteen participants (11 females and 4 males) aged 17–59 years volunteered to participate in the physicalactivity intervention program. The intervention program was evaluated using a longitudinal mixed methods designmeasuring health impact changes over time through focus group discussions and quality of life surveys. Furtheradditional biomedical health parameters such as levels of glycosylated hemoglobin, blood pressure, levels ofoxygen saturation and body mass index were monitored before and after the intervention. Focus group data wereanalyzed using content analysis with an inductive approach. The pre-and post-test scores from the survey-basedquality of life domains, as well as the health parameters were compared using non-parametric and parametricstatistics.Results: Four themes emerged from the analysis of the focus group discussions including sense of fellowship,striving for inclusion and equity, changing the learner perspective and health beyond illness. The scores for thedomains Physical Health, Psychological Health, Social Relationships and Health Satisfaction where significantlyhigher after participation in the physical activity intervention program compared to the pre-test scores (p < .05)s.There were however, no significant changes in the scores for the environmental domain and overall quality of lifeafter intervention compared to that prior to intervention start. Overall, the biomedical health parameters remainedstable within the normal ranges during intervention.Conclusion: The focus group discussions and results from the surveys and biomedical measures reveal importantfindings to understand and further develop the intervention program to promote health equity among citizens indisadvantaged areas. Evaluating the feasibility of such an intervention using multiple approaches contributes toeffective implementation of it for larger communities in need.

INTRODUCTION: Applying critical thinking is essential for nursing students both in an academic and clinical context. Particularly, as critical thinking is a vital part of nurses' everyday problem-solving and decision-making processes. Therefore, regardless of the topic taught or the setting in which it is taught, it requires teaching strategies especially targeting students' critical thinking skills and abilities. One challenge with the latter is the difficulties to assess and evaluate the impact of such teaching strategies on the students' critical thinking disposition. Hence, our objective will be to review published literature on; existing teaching strategies and outcomes assessments targeting nursing students' critical thinking skills and abilities.

METHODS AND ANALYSIS: Our scoping review will be conducted in accordance with Arksey and O'Malley's framework for scoping studies. Search strategies will be developed in cooperation with an experienced librarian, and adjusted to each individual database for example, CINAHL, PubMed, PsycINFO, ERIC and ERC. A preliminary search in CINAHL was conducted on the 17^th of July 2019. Peer-reviewed published studies conducted with a qualitative, quantitative or mixed method design and focussing our objectives, will be eligible for inclusion. Included studies will be quality assessed in accordance with their study design. Data will be charted using a standardised extraction form. The qualitative data will be presented through a thematic analyses, and the quantitative data by descriptive numerical analysis. Lastly, nurse educators and nursing students will be consulted for validation of the findings from the scoping review.

ETHICS AND DISSEMINATION: Under the Swedish Ethical Review Act (2003:460) this study does not need ethical clearance by a Regional Ethical Review Authority as it not includes any primary empirical data on biological material or sensitive information. The findings will be used to inform the design of a future study aiming to develop an, and subsequently evaluate it, educational intervention targeting teaching strategies focussing on nursing students' critical thinking skills and abilities.

Background

Forced migration is a trying and difficult experience to endure. Several supplementary challenges in relation to the establishment process await almost immediately after arrival. The process of establishing into a new society is often a long and challenging process. Both learning the language and understanding the society are the first immediate barriers for entering the Swedish labour market, as well as the authorization of diplomas and qualifications. A common challenge is also finding stable and adequate housing. A prerequisite for being able to take on these challenges is the health capital/status of recently arrived migrants (RAM). Health approached in a wide-ranging manner includes all factors that are in one way or another affecting the life of a human being. In order to enhance the establishment and inclusion of RAM it is important to have the fundamental understanding of the situation that this group are facing in relation to their health, as well as different health related risk factors.

Aim

The aim of the survey was to evaluate health and health related factors for RAM adults included in the establishment process in the southern region of Sweden, Skåne.

Material and methods

All recently arrived Arabic speaking individuals that currently participated in civic- and health communication through Partnership Scania were invited to participate in the study. The period of data collection was between May 2018 and March 2019. The questionnaire was initially developed in Swedish and translated into Arabic. It contains questions addressing different diseases, care needs, migration specific questions, housing, social relations, violence, living habits and sexual health among other things. The questionnaire was distributed in a paper format in civic and health communication classes through civic and health communicators. In total, 315 questionnaires were received resulting in an approximate response rate of 25,3%.11

Conclusion

The study found that a large percentage of RAM reported being either overweight or obese, with many of them considering that they gained weight since their flight to Sweden. Almost one in ten RAM participants reported their health status as bad or very bad. A third of participants reported their health as fairly good. Almost half of the respondents experienced an improvement in self-reported health status after receiving the residence permit, but almost one fifth experienced a change for the worse. Almost half the participants had been in a need for health care during the last three months from the date of answering the questionnaire without seeking care. Furthermore, almost a third of the RAM was at risk for their mental ill-health. A higher proportion of men as compared to women reported being at risk for their mental ill-health. More than half of the respondents were not physically active or were active less than 30 minutes per week. The majority of the respondents reported distrust for humans beings. A considerable proportion were lacking social networks in relation to finding jobs. Half of the respondents were missing any contact with employers and a third experienced difficulties having their qualification validated.

Background

It is often a long and time-consuming process for migrants i.e. refugees to establish themselves into a new society. This includes adapting to the new society within which they find themselves, learning the local language as well as trying to access the labour market. To facilitate this, in 2010 Sweden adopted a mandatory 24 months structured and individually based public support system for to facilitate migrants establishment in the country (once a residence permit has been granted). This research questions how well the group of newly arrived migrants i.e. refugees from Syria and Iraq is equipped to take on the challenges that await them after the mandatory period of establishment has ended. For example, has their situation improved? How is their physical and mental health status? How do they consider the establishment period? Are they employed or what are their thoughts on the possibility of becoming so? This understanding is crucial in order to ensure that there is a solid empirical foundation upon which to base an assessment of, and were necessary adapt, the establishment procedure in Sweden.

Aim

The aim of the survey has been to map health and health related factors among adult newly arrived migrants from Iraq and Syria in Skåne that received the public support for their establishment. In addition to this the research sought to determine if this support has contributed to increased participation in society as well as increased access to the labour market.

Material and methods

The survey was conducted using a broad questionnaire in Arabic which focused on different health related questions, care needs, living conditions, social relations, violence , migration specific questions, employment, participation in society as well as questions related to sexual health. The selection of respondents is based on a random sample containing 10 000 individuals living in Skåne who were born in Iraq and Syria. The research looked at those who had received a residence permit between 01.09.2012 and 31.08.2016. The age of the respondents was between 20 and 64 years when receiving the residence permit. The survey was conducted during the autumn of 2018. The questionnaire was sent out to the respondents as a paper questionnaire with the possibility to answer the13questionnaire online. In total, 3208 questionnaires were received resulting in a response rate of 33%.

Conclusion

The survey found the following. The time period for receiving residence permit was usually within one year of arrival. A good level of Swedish language proficiently was only reported by a few respondents. The self-reported health status is in line with the rest of the population in the region. In addition, the participants recognised that the maintenance of their health was largely their responsibility, and was important. There were also some reports of unmet health needs as well as unmet dental care needs. Health related living conditions, such as smoking and physical inactivity, is more common amongst this group than the rest of the population. Lack of trust for different institutions is a challenge as it is more prevalent amongst this group than the general population. However, in contrast to this, there were high level of trust reported with regard to child health care centres. Almost all participants reported that they participated in the public support for establishment, including civic and health communication. The majority reported that the activities included in the establishment programme as being relevant. However, the observed challenges were not being sensitive to the various situations of the participants, quality as well as that, the activities overlap. Loss of social network as well as language barriers are considered by many as an obstacle for entering the labour market. Access to the Swedish labour market was reportedly a significant ongoing challenge for the participants.

BackgroundMigration in general is a factor that could lead to increased stress-levels among migrants, which is often caused by different circumstances that have occurred before the migration. After their arrival in a host country, a period of uncertainty occurs for asylum seekers. This results from waiting for their asylum claim to be assessed. Prolonged waiting for permission to stay correlate negatively in relation with mental health. In Sweden, all newly arrived migrants are invited to participate in an establishment process, which means individually developed support for the newly arrived persons to settle and begin to integrate. However, a foundation for being able to actively participate in the establishment process is a good health as well as stable and safe housing. A special vulnerable group among the newly arrived are families with children. This results from challenges that this group face with health and secure and stable housing in contrast to other newly arrived persons that are without a partner and children. Further on, newly arrived women are also a vulnerable group to consider. Therefore, there is a great need to illuminate the newly arrived families and especially women, and how they consider their health as well as their situation during their establishment process.

Aim

The aim was to shed light on the newly arrived families experience of health, with a focus on female newly arrived migrants health during their establishment.

Material and methods

The present report consists of two qualitative research studies that employed interviews. The interviews were carried out using semi-structured guides and consisted of several questions and themes. 26 interviews were carried out in total. 15 of these focused on families and 11 focused on the situation for newly arrived women. In the first study the data was analyzed by the method by Attride-Stirling and thematic network and in the second study with Burnard`s method for content analysis. Authorized translators were used. All interviews were conducted within the county of Scania.

Conclusion

Newly arrived families within the establishment process are fighting the asylum application as well as being challenged to find stable housing for their families. The children enjoyed school and the parents were driven by a determination to learn the Swedish language as well as being able to enter the Swedish labor market, although the later was considered to be a challenge for them. Some of the parents were suffering from stress due to having family12members left in home countries. Further to this the participants highlighted challenges with regard to integration in to Swedish society. When we do consider the situation of the newly arrived women, they were also seeing that family reunification is of importance and crucial for their mental well-being. The women in the present study, were eager to learn the language and to enter the labor market.In conclusion, it is of great importance to be sensitive to determinants of health such as unemployment, participation, the social life in Sweden as well as safe housing conditions with looking at certain vulnerable groups experiences of the establishment process in Sweden.

Background: Phenomenological empathy and sense of coherence are two researched communication approaches used to improve therapeutic connections with patients in a variety of nurse related settings. The aim of this study is to evaluate students' feedback concerning how this event has enabled that understanding, development and refinement of skill-sets in PE and SoC when managing the acutely ill during simulation. Methods: 114 third year bachelor degree-nursing students were given the opportunity to complete an evaluation, developed for the specific purpose of this study. The evaluation contained six closed questions on a four point Likert-scale and three open questions, handed out upon completion of the standardised patient simulation of the acutely ill. Comments written in response to the open questions were analysed using manifest content analysis and closed questions using SPSS to produce descriptive frequencies. Results: 100 students completed the evaluation. Student nurses', regardless of previous experience or age, indicated the need for more education and practice in phenomenological empathy and sense of coherence to enhance their ability to build therapeutic connections with the acutely ill. Conclusions: Teaching phenomenological empathy and sense of coherence, as an integral part of standardised patient simulation is necessary to motivate student nurses ability to build therapeutic relationships with the acutely ill to enhance person centred care.

Previous research findings suggest that insomnia could be related to decreased health status and that it could also be affected by traumatic life experiences, such as war. Good health is important for newly arrived refugees for an effective integration process. The aim of the present study is, therefore, to investigate the association between self-perceived health and sleep quality among newly arrived refugees in Sweden. The results are based on 681 migrants who participated in a survey between 2015 and 2016. There was a significant odds ratio (OR) after adjustment for confounders for newly arrived refugees that were experiencing bad self-perceived health to also experience bad sleep: OR 8.07 (4.34-15.00). Furthermore, the OR remained significant but lower after adjustments for confounders for newly arrived refugees that had bad self-perceived health to be suffering from anxiety during sleep, with OR 3.83 (2.11-6.94).

INTRODUCTION: Colorectal cancer (CRC) is one of the most common cancer diagnoses among both sexes. Sweden has not yet implemented any CRC screening programme, but a study, Screening of Swedish Colons (SCREESCO), is ongoing. The movement within the health care sector towards a more participatory perspective has led to the increased importance of shared decision making (SDM), and this is suggestively applied when deciding upon screening participation. There is no Swedish questionnaire for assessing the level of SDM in relation to CRC screening. Therefore, the CRC screening module of the National Survey of Medical Decisions was translated and culturally adapted into a Swedish context: the SCREESCO questionnaire. AIM: The SCREESCO questionnaire requires further evaluation, and therefore, the aim, by using the Rasch approach, was to evaluate the psychometric properties of the SCREESCO questionnaire. METHODS: A Rasch partial credit model was chosen to investigate the psychometric properties. The sample consisted of individuals invited to the SCREESCO programme, who have answered the SCREESCO questionnaire. RESULTS: Rating scale structures indicated stability for the response structure used. Satisfactory evidence for validity of internal structure was also shown for the whole questionnaire and two of three concepts/subscales, after deletion of a few items. Validity in response processes indicated acceptable, or close to acceptable, findings, while the results for unidimensionality and differential item functioning (DIF) were somewhat mixed. Separation index revealed less satisfactory results, both for the whole questionnaire and the concepts/subscales. CONCLUSION: This Rasch analysis of the SCREESCO questionnaire revealed that the questionnaire in its current form has difficulties to assess the level of SDM in relation to CRC screening. The achieved results will guide further evaluation and development with the long-term goal of having a Swedish questionnaire, to be used in the health care sector, assessing the level of SDM in relation to CRC screening.

The clinical environment is a vital component of nurse education, constantly changing due to constraints of the current health care systems such as increasing number of students and a limited number of preceptors. Peer learning, is gaining momentum as an educational model highly suitable for clinical placements. The peer learning model incorporates structured learning activities that support student activity, but little is reported of the actual structure and content of those activities. Thereby, the aim of this study was to explore precepting nurses’ experience of using structured learning activities as part of the peer learning model during clinical placement. We used a qualitative research approach, using two open self-administered global questions. The result is based on the analysis of the written responses from 62 preceptors. Four categories followed the analysis: An opportunity for collaboration, An occasion for reflection, A new educational structure, and Recommendations for development. The preceptors perceived the structured learning activities as beneficial for increased collaboration and reflection among students. Moreover, utilizing the structured learning activities was perceived to be time saving for the preceptors, however this is an area where further research is needed.

Aims: The Swedish public support system for integration and establishment of newly arrived refugees includes an individualized introduction plan, containing language, civic and health information classes. As the plan requires active involvement, the simultaneous establishment of childcare and school start for children risks creating additional challenges and frustrations. The aim of the study was to explore the experience of adjustment among newly arrived refuge parents in the resettlement process, so as to understand how this risk may be mitigated. Methods: A qualitative study conducted with 24 Syrian refugee parents participating in the resettlement process and having received asylum status. Results: Parents experienced stress due to long waiting times for residence permits and the struggle to find stable housing. The parents established themselves by enrolling in language studies and looking for employment. They also faced challenges adjusting socially since they were mainly meeting people from their own country and therefore felt excluded from the Swedish society. Conclusions: The parents describe the experiences of having escaped from a war-torn country and arrived in new surroundings as mainly challenging for their current situation. Feelings of uncertainty arise as families struggle with daily life while waiting for residence permits, finding stable housing, learning a language and adjusting to new social circumstances. Having this in mind, we conclude that this group of refugees is exposed to health risks in the near future and as such is in need of additional support.

Aim: This study aimed to illuminate nurses’ experience of continence care for older people receiving home care, either in their own home or in an assisted living facility. Background: Registered Nurses (RNs) have a major role to play in identifying and establishing appropriate actions regarding continence care for older people. However, the crucial nursing care pathway for continence care is commonly described as poor. Methods: Interviews were conducted with 11 RNs providing home care, and the transcribed texts were analysed using inductive content analysis. Result The impressions of RNs were categorised according to four themes: perceptions of continence care, an open approach to continence care, the need for personalised aid fittings and the importance of teamwork in continence care. Key findings were the importance of teamwork; the need for nurses to embrace leadership at the point of care and be more visible in terms of the provision of direct care; substantiation that evidence‐based interventions, such as scheduled toileting and prompted voiding, should constitute the norm in continence care within the context of home care; and the need for nurses to support the right of older persons to receive an assessment of their continence problems, deemed to be the minimum standard of quality care. Conclusion: The provision of continence care that is based on key nursing standards, such as evidence‐based and person‐centred care, as well as individualised continence care that is based on evidenced‐based guidelines, would ensure an improvement in the continence care that is presently on offer to older people.

The overall aim of the thesis was to explore healthcare professionals’ and volunteers’experiences of encountering older persons’ existential loneliness, the significance ofthe care context, and first-line managers’ view of support. Three of the studies werequalitative with a descriptive design (studies I–III) and the fourth was quantitativewith a cross-sectional design (Study IV). The data collection for studies I and II wasbased on focus group interviews with healthcare professionals (i.e., nurse assistant,registered nurse, physician, occupational therapist, physiotherapist, social counsellor,and social worker) in home care, residential care, hospital care, palliative care,primary care, and pre-hospital care. The data collection for Study III was based onfocus group interviews and individual interviews with volunteers from variousorganisations. Study IV was based on a questionnaire sent to first-line managers inmunicipal care, examining their views of support for staff and volunteers encounteringexistential issues among older persons.

The findings of Study I indicated that, during the everyday care of older people,healthcare professionals experienced existential loneliness in various ways andsituations related to ageing, illness, and end of life. The professionals’ stories aboutencountering older persons’ existential loneliness revealed that they often felt insecureabout how to talk about existential issues. They also felt inadequate and frustratedwhen encountering barriers such as the older person’s bodily limitations, demands andneeds (perceived as insatiable), personal privacy, or fear and difficulty in encounteringexistential issues. Study II was a multiple case study of the care contexts of homecare, residential care, hospital care, and palliative care. The findings indicated that thecare context matters regarding professionals’ views and interpretations of the originof existential loneliness. In home care and residential care, these views andinterpretations concerned life, the present, and the past. In hospital and palliative care,existential loneliness mainly concerned the older person’s forthcoming death.Professionals considered creating relationships an important part of their role in allcare contexts, although the meanings, purposes, and conditions of these relationshipsdiffered (Study II). Study III showed that being a volunteer meant being a fellowhuman being, alleviating others’ and one’s own loneliness. Becoming a volunteer was a way of finding meaning, and volunteering made the volunteers feel rewarded andsimultaneously emotionally challenged. Encountering loneliness, includingexistential loneliness, required sensitivity to others’ needs for both closeness anddistance. The findings of Study IV, based on a questionnaire, indicated that 88% ofthe first-line managers found that older persons sometimes or often expressedexistential loneliness. They also reported that staff insecurity was the major obstacleto talking about existential issues with the older persons. Support was provided in theform of structured reflection, but provision of systematic supervision was reported byonly 6% of first-line managers. The managers reported that most support was providedby themselves or by registered nurses. Almost half of the managers (44%) reportedthat, at their units, volunteers were engaged in activities such as everydayconversations and/or music/entertainment. In addition, they also reported a desire forvolunteers to be more involved in both everyday and existential conversations. Inconclusion, one of the most important findings of this thesis was the insecurity of theprofessionals, manifested in a fear of discussing existential issues. This was revealedin the interviews with the professionals and confirmed by the first-line managers.According to both professionals and volunteers, the relationship with the older personwas important when encountering existential issues. The thesis demonstrates theimportance of helping professionals focus on existential issues about life and death and of the potential of volunteers as an important complement in the care of olderpeople.

Diabetic peripheral neuropathy is a diabetes-related complication with vague and progressive symptoms with few available treatments. The aim of this study was to describe the experiences of diabetic peripheral neuropathy among adults living with type 1 diabetes. Twelve interviews were performed and qualitative content analysis was used. The overarching theme ‘living with challenges in the shadow of diabetes’ substantiated by the categories ‘pay attention to changes over time’, ‘frequent needs to facilitate living’ and ‘burdens to manage’ represents a daily awareness of the complication where autodidactic strategies were implemented. The conclusion indicates that it might be beneficial if nurses in diabetes care initiate an open-minded dialogue with adults with diabetic peripheral neuropathy to highlight their experiences and to discuss further strategies to facilitate living.

There are great health disparities in the world today, both between countries and within them. This problem might be seen as related to the access to various kinds of capabilities. It is not fully clear, however, what the exact relation is between health and capabilities. Neither Amartya Sen nor Martha Nussbaum has explicitly formulated a theory of health to go with their theories of capabilities. This paper attempts to present a clarification of the conceptual relation between health and capabilities. Health, it is argued, should be seen as a holistic multi-dimensional phenomenon, made up of basic abilities and subjective well-being, and of fundamental states and processes. Using this theory, the paper shows how health is related to Nussbaum's ten capabilities. It is argued that health, in the senses described, is a necessary part of all ten capabilities. Moreover, some of the capabilities on Nussbaum's list, such as thinking and imagining, and practical reasoning, refer to health. Finally, it is shown that even though health is part of all capabilities, health cannot itself primarily be seen as a capability. An acceptable degree of health is required as a functioning for any theory of human flourishing to be reasonable.