BACKGROUND: Global demographic ageing trends and changes in healthcare require that nursing students are adequately prepared to care for older people in home care settings. However, many students report insufficient knowledge and feel unprepared for this role. The aim of this study was to describe the variation in nursing students' understanding of caring for older people receiving home care. This study forms part of a broader project aiming at developing a tailored educational intervention in collaboration with nursing students to prepare them for this role.

METHODS: A qualitative study with a phenomenographic approach was conducted. Eighteen individual semi structured interviews were conducted with nursing students at three Swedish universities between February and April 2025. The interviews were conducted either via telephone, digitally via Zoom or face-to-face and subsequently analysed.

RESULTS: The results comprise three descriptive categories illustrating the variation in nursing students' understanding of caring for older people: Nurses' collaborative role in tailoring person-centred care for older people receiving home care, Challenges to person-centred care for older people receiving home care and Opportunities to person-centred care for older people in the home care setting. Within these understandings, students emphasised that nurses need to collaborate with older people, their family members and colleagues to tailor person-centred care to older people at home. However, students also identified challenges that could hinder person-centred care for older people, inducing factors related to older people, nurses and the organisation. Despite these challenges, students recognised opportunities inherent in the home care setting, such as the potential to develop deeper relationships with older people, support their family members, and engage with the broader community.

CONCLUSIONS: The results indicate that students recognised the essential collaborative role nurses play in tailored person-centred for older people in this setting, while also identifying challenges that may hinder its full realisation. At the same time, the students pointed to concrete opportunities for strengthening person-centred approaches within home care. These insights deepen our understanding of how nursing students conceptualise care for older people receiving home care and provide insight into how an educational intervention can be developed to better equip them to meet the complex needs of older people in this setting.

AIMS AND OBJECTIVES: To describe first-line managers' (FLMs) views of the challenges faced by staff when encountering older people's existential concerns in home and residential care.

METHODOLOGICAL DESIGN AND JUSTIFICATION: This cross-sectional study uses a combination of qualitative and quantitative methods.

ETHICAL ISSUES AND APPROVAL: The study was approved by the Swedish Ethical Review Authority (ref. number 2014/652 ) and followed the guidelines of the Helsinki Declaration.

RESEARCH METHODS: FLMs in home and residential care were randomly selected and invited to participate. A self-administered questionnaire was distributed online to 467 managers, 136 (29%) of whom completed it.

RESULTS: About 80% of the FLMs reported that their staff members sometimes or frequently had conversations with the older people in their care about existential concerns, including the following topics: thoughts and feelings about meaning in life; losses and longing for meaningful relations; death, fears and uncertainty and supporting meaningful everyday life. About 75% of the managers also reported that their staff sometimes or often had conversations about existential concerns with one another. Major hindrances to existential conversations were reportedly cognitive impairment and aphasia among the older people and insecurity and unwillingness among the staff. Most managers (73%) reported that their staff received support when encountering existential concerns, mostly as individual support from managers or registered nurses.

STUDY LIMITATIONS: The main limitation of this study is its low response rate, which is common for digital surveys. Nevertheless, the sample is considered to be representative; therefore, the study holds exploratory value.

CONCLUSION: Regular conversations among staff, improved conversational skills and the ability to listen reflect on and perceive older people's perspective and life world are needed when encountering older people's existential concerns. FLMs play a crucial role in emphasising and planning staff support on a regular basis.

Background The increasing proportion of older people worldwide is challenging society and the healthcare sector to develop new solutions, such as involving volunteers, especially to combat loneliness among older people. Loneliness is a broad concept comprising, for example existential loneliness - a deep feeling of aloneness in the world. We know little about volunteers' experience of encountering older people's loneliness in general and existential loneliness in particular. Such knowledge is important in order to develop high-quality volunteering. Aim This study aimed to describe volunteers' experience of becoming and being a volunteer, and encountering older people's loneliness in general and existential loneliness in particular. Methods This descriptive qualitative study is based on eight focus group interviews and twelve individual interviews with volunteers from different organisations, analysed using conventional content analysis. Findings Being a volunteer meant being a fellow human being, alleviating loneliness for others and oneself. Becoming a volunteer was a way of finding meaning, and volunteering made the volunteers feel rewarded and simultaneously emotionally challenged. Being a volunteer also meant acting on one's values, challenging boundaries when necessary. Encountering loneliness, including existential loneliness, required sensitivity to others' needs for both closeness and distance. Conclusion Being a volunteer benefitted not only the older persons the volunteers met, but also the volunteers' own sense of meaning, by alleviating their own loneliness. Sharing existential thoughts and having meaningful conversations about life and death are challenging, but can contribute to the personal growth of the volunteers themselves. It is important to remember that not all volunteers are confident in having existential conversations, so it is important to pay attention to each volunteer's prerequisites and needs. In addition, there is a need for support to volunteers' engagement such as clarifying their role and clarifying the responsibility and expectations from health and social care.

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.

AIM: To explore existential loneliness among older people in different healthcare contexts from the perspective of healthcare professionals. BACKGROUND: Professionals meet and care for older people in most care contexts and need to be prepared to address physical, psychological, social and existential needs. Addressing existential loneliness can be both challenging and meaningful for professionals and is often not prioritised in times of austerity. DESIGN: A multiple case study design was used. METHODS: Focus group interviews were conducted with healthcare professionals (n = 52) in home, residential, hospital and palliative care settings. The analysis was performed in two steps: firstly, a within-case analysis of each context was conducted, followed by a cross-case analysis. FINDINGS: Differences and similarities were observed among the care contexts, including for the origin of existential loneliness. In home care and residential care, the focus was on life, the present and the past, compared to hospital and palliative care, in which existential loneliness mainly related to the forthcoming death. The older person's home, as the place where home care or palliative care was received, helped preserve the older person's identity. In hospital and palliative care, as in institutional care, the place offered security, while in residential care, the place could make older people feel like strangers. Creating relationships was considered an important part of the professionals' role in all four care contexts, although this had different meanings, purposes and conditions. CONCLUSIONS: The context of care matters and influences how professionals view existential loneliness among older people and the opportunities they have to address existential loneliness. IMPLICATIONS FOR PRACTICE: Support for professionals must be tailored to their needs, their education levels and the context of care. Professionals need training and appropriate qualifications to address existential loneliness related to existential aspects of ageing and care.

ABSTRACT Purpose: Existential loneliness is part of being human that is little understood in health care, but, to provide good care to their older patients, professionals need to be able to meet their existential concerns. The aim of this study was to explore health care professionals’ experiences of their encounters with older people they perceive to experience existential loneliness. Method: We conducted 11 focus groups with 61 health professionals working in home care, nursing home care, palliative care, primary care, hospital care, or pre-hospital care. Our deductive–inductive analytical approach used a theoretical framework based on the work of Emmy van Deurzen in the deductive phase and an interpretative approach in the inductive phase. Results: The results show that professionals perceived existential loneliness to appear in various forms associated with barriers in their encounters, such as the older people’s bodily limitations, demands and needs perceived as insatiable, personal shield of privacy, or fear and difficulty in encountering existential issues. Conclusion: Encountering existential loneliness affected the professionals and their feelings in various ways, but they generally found the experience both challenging and meaningful.

Health and social care planning in collaboration in older persons’ homes: the perspectives of older persons, family members and professionals Providing health and social care to older persons is challenging, since older persons often have multiple diseases and a complex health situation. Hence many professions and organisations are involved. Lack of interprofessional and interorganisational collaboration leads to fragmented care. Care planning meetings before hospital discharge have long been used to overcome this fragmentation, but meetings conducted at the hospital have limitations in identifying long-term needs at home. A new model for health and social care planning in collaboration (HSCPC) in older persons’ homes was introduced in two Swedish municipalities. The aim of this study was to gain a deeper understanding of the HSCPC-meeting from the perspectives of older persons, family members, and professionals. Ten care planning meetings from two municipalities were consecutively included. Interviews in retrospect with ten older persons, eight family members, and ten groups of professionals who had attended the HSCPC-meeting at home were analysed with a hermeneutic approach. Four themes emerged: unspoken agendas and unpreparedness, security and enhanced understanding, asymmetric relationships, and ambiguity about the mission and need for follow-up. The comprehensive interpretation is that the professionals handled the HSCPC-meeting mainly as a routine task, while the older persons and family members viewed it as part of their life course. Older persons are in an inferior institutional, cognitive and existential position. However, meeting together in the home partly reduced their inferior position. Findings from this study provide some general suggestions for how HSCPC-meetings should be designed and developed: attention of power relations, the importance of meeting skills and follow- up.

Loneliness and thoughts about existential aspects are common among older people and unmet needs to share their thoughts can lead to existential loneliness. Knowledge about how health care staff perceive existential loneliness in older people and what they do to meet their needs is scarce. The aim of the study was thus to explore health care staff’s perception of older persons’ existential loneliness. Ten focus group interviews were performed with staff (n=55) representing different professions, such as nursing aids, nurses, physicians, occupational therapists, physiotherapists, social counselors and social workers. Different care contexts were included to reach variation; home care, nursing homes, palliative care, primary care, hospital care and prehospital care. Data was analyzed using a qualitative content analysis. The results show that existential loneliness appears in various forms depending on the older person, their life experiences and the situation at hand and seems to be connected to issues about time and place. Staff perceived that existential loneliness emerged when physical disabilities became barriers, when they felt excluded by people in their vicinity or when they themselves excluded others from their life-world. Existential loneliness also emerged when they felt alienation, guilt or regret for situations in the past. Preparedness among staff to identify and deal with existential loneliness varied while the care environment seems to hinder or support their possibility to discover and encounter existential loneliness.

Deltagarbaserad Utvärdering: Skl satsning på vårdplanering i samverkan i Norra Skåne. Erfarenheter ur närstående, personalen och patientens perspektiv