Due to the unfamiliarity of the surroundings, children having surgery endure worry and tension. Untreated anxiety in children impairs postoperative healing and causes changes in postoperative behavior. The purpose of this review was to determine the efficacy of distraction therapies on anxiety in children undergoing surgery. The systematic review was reported in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses standards. PubMed via MEDLINE, CINAHL, ProQuest, Web of Science, and the Cochrane Central Register of Controlled Trials were used to find relevant trials. Full-text papers published in English from January 1, 2000 to December 31, 2021 were included. Children undergoing surgery aged 1 to 18 years were included. A data extraction form was created to extract data from the selected studies. According to the Cochrane risk of bias assessment tool, studies were classified as "low risk, " "high risk, " or "unclear risk. " Review Manager software was used to do a quantitative meta-analysis. Thirteen studies looked at the effect of distraction intervention on children. Nine of them were selected for meta-analysis. The distraction interventions included in this review were: handheld video game, play dough and play with blocks and puzzles, tablet-based interactive distraction, animated video, painting and storytelling, age-appropriate video, distraction with video glasses, watching a movie, and bringing favorite toy during hospital stay. Meta-analysis showed that distraction interventions are effective on preoperative anxiety in children (standardized mean difference = -17.07, 95% confidence interval: 27.11-7.02, p = 0.0009).

A hospitalized child experiences anxiety more frequently as compared to non-hospitalized children. Surgery can be emotionally distressing for children, and subsequently their parents and caregivers, this distress can cause profound adverse impacts on children. We aimed to identify the effect of non-pharmacological interventions on children’s (1–18 years) anxiety undergoing surgery. The following databases: Medical Literature Analysis and Retrieval System Online (MEDLINE), Cumulative Index of Nursing and Allied Health Literature (CINAHL), Proquest, Web" of Science, and Cochrane Central Register of Controlled Trials were systematically searched for full-text articles. The review included 15 randomized controlled trials. The risk of bias was assessed using Cochrane Risk of Bias tool. The interventions included in the study were preoperative education, puppet play, therapeutic play, distraction activities, parental presence, and clown therapy. The review presents a narrative reporting of the findings. This review identifies that non-pharmacological interventions are effective in reducing anxiety among children undergoing surgery. There are a limited number of studies from developing countries. Further research is required to underpin the use of these interventions with children before surgery. 

Introduction: The World Health Organization has reported that one fifth of all children in the world suffer from poor mental health regardless of cultural differences. Previous studies have shown that working with mental health is an important part of the duties of school nurses in Sweden.

Objective: The aim of the present study was to describe the experiences of school nurses regarding the identification of mental illness among pupils in primary school.

Methods: In this inductive qualitative study, interviews were conducted with 11 school nurses in southern Sweden and analyzed using content analysis.

Results: The results indicate three major themes: (1) the need for shared responsibility, (2) feelings of uncertainty and inadequacy in school nurses, and (3) the importance of establishing relationships.

Conclusion: This study indicates that school nurses feel responsible for their pupils' well-being, but also feel that they need support. A lack of guidance in identifying mental illness emerged from the interviews.

Aim: This study aimed to investigate mothers’ levels of satisfaction with distraction as a post-operative pain management intervention for their child.

Background: Although the number of studies on paediatric pain management has increased over time, research into non-pharmacological post-operative pain management remains inadequate, indicating that more research is required.

Design: A posttest-only control group design was adopted to measure mothers’ levels of satisfaction with distraction as a non-pharmacological post-operative pain management intervention for their child.

Methods: The study included 160 mothers and their children undergoing elective surgery in a paediatric surgical unit. Mothers and children were randomly allocated to intervention and control groups (80 intervention, 80 control). The children in the intervention group received age-appropriate distraction interventions for three post-operative days along with the usual care. Children in the control group received only usual care. Data on parental satisfaction with pain management interventions was assessed on the day of discharge using a parental satisfaction questionnaire.

Results: In the intervention group 48 mothers (60%) were ‘very satisfied’ and 22 mothers (40%) were ‘moderately satisfied’ with pain management interventions for their child. In the control group 27 mothers (34%) were ‘very satisfied’ and 53 (66%) were ‘moderately satisfied. The mean and standard deviation of mother’s satisfaction in the intervention group and control group was 42 ±5.23 and 34 ± 6.64 respectively. The present study identified that there was a significant difference in the level of mother’s satisfaction between the intervention and control groups (p<.05).

Conclusion: The level of satisfaction with pain management intervention for their child was higher for mothers in the intervention group that the control group. The distraction intervention provided for the children during the postoperative period improved the mothers’ satisfaction level.

Backgroud: To become a parent of a child who is born small for gestational age can lead to challenges in addition to the newly accuried parenting role. There is currently a lack of knowledge regarding parents´experiences if having a child born small for gestional age. Purpose: The purpose of this study was to describe the experienve of becoming a parent of a child small for gestional age. Design and method: A qualitativ inductive approach was chosen with grounded theory as a method, a stratagic selection was used and individual interviews wiht open questions were performed. Results: The results showed that the parents expressed quilt over the childs´size and focused on the aility to nourish their child to keep their unexpectedly small child alive. An experienced concern about the childs´food intake could be seen throughout the entire interview material and the need for information was great. A common experience of the parents was that constant feeding of the child dominates their lived. Conclusion: The conclusion is that the unexpectedly small size of the child awakens the parent´s instinct to provide life-sustaining care and the parents need increased support and more information around the child´s condition. This requires well-trained professionals, because parents to children born SGA often harbour feelings of unpreparedness and guilt. Practice implications: Increased understanding and knowledge about parents´experience of having a child born SGA, healthcare sevices can optimize the potential for better attachment between parent and child as well as offer appropritae support.

Sex education can be described as an important part of health education in school and one way of strengthening health education could be a collaboration between different professionals in the school team. The aim of this study was to describe teachers' and school nurses' experiences and perspectives with regard to sex education among students aged 11-12 years and to explore potential influencing factors. We employed a qualitative design, and the teachers and school nurses were interviewed individually. A thematic analysis was conducted on the interviews and the results showed that the classroom was considered to be the teacher's arena. Tradition and attitudes between professionals could be obstacles that affect collaboration between teachers and nurses and the study showed that there remains much to be done before collaboration at the same level between the groups can be established.

BACKGROUND: With rapidly ageing population worldwide, loneliness among older adults is becoming a global issue. Older migrants are considered being a vulnerable population and ethical issues are often raised in care for elderly. A deeper sense of loneliness, existential loneliness is one aspect of loneliness also described as the ultimate loneliness. Making oneself understood or expressing emotions, have shown to be particularly challenging for older migrants which could lead to experience of existential loneliness. Ageing and being a migrant are potential triggers for experiencing existential loneliness. There appears to be, however, little known about being a migrant experiencing existential loneliness in old age.

AIM: This study explored older migrants' experience of existential loneliness.

RESEARCH DESIGN: Qualitative study.

PARTICIPANTS AND RESEARCH CONTEXT: Data were collected through interviews (n = 15) with older (>65) migrants' in Swedish nursing homes or senior citizen centres. A thematic analysis was performed to analyse the data.

ETHICAL CONSIDERATIONS: The study was conducted in accordance with the principles of research ethics.

FINDINGS: The result was described in terms of three themes: (1) Choices made in life, (2) seeking reconciliation with life and (3) thoughts about death and dying in a foreign country.

DISCUSSION: Ethical reflection and knowledge about how older migrants' life story can lead to experiencing existential loneliness, could be of use in care for older migrants'.

CONCLUSION: This study indicates that the experience of existential loneliness derived from being a migrant is a long-term and significant process. Migration was a hope of creating a meaningful life, the experience of existential loneliness occurred as migrants sought reconciliation with life, reflected upon their past choices, and thought about death and dying in a foreign country.

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.

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.

This proposal reports from a pilot study where primary teachers and school nurses were interviewed concerning their collaboration in sex education. These primary teachers and school nurses do not traditionally collaborate around sex education in Swedish schools. Albeit different projects where collaboration between them has been encouraged, earlier research demonstrates problems between the two groups of professionals to act jointly. The new Swedish school law from 2011 prompts such collaboration and asks for school health teams increased participation in sex education in compulsory school. In this pilot study, five primary teachers and five school nurses were interviewed about their collaboration. The purpose of the pilot study was to describe and analyse the teachers and school nurses’ experiences and perspectives of their collaboration concerning sex education among pupils aged 10-12 years. The interviews were analysed with thematic analysis. One overall theme emerged; The classroom is the teacher’s arena, and three sub themes; A collaboration needs two parts; Attitudes is a barrier and Organisation as a facilitator, were found. The results indicate a prevailing distance between the two groups. The nurses claim that the classroom is the teacher’s arena, an arena which is difficult for nurses to enter. The collaboration is usually initiated by teachers not nurses. The teachers assert that the school nurses are professional resources in school and experts on different health issues, such as menstruation. While the school nurses regard the head master as important for how sex education is facilitated and implemented in school, the teachers claim to manage sex education without the head master’s influence. The results indicate that the new school law where school health team is involved in the science education has not been implemented at the schools in the present study.

The study comprised a prospective, comparative, cross-sectional survey in 143 children undergoing tonsil surgery. Parents answered the Post Hospitalization Behavior Questionnaire for Ambulatory Surgery (PHBQ-AS), and children answered the questionnaire Postoperative Recovery in Children (PRiC). The PHBQ-AS had positive correlation with the PRiC and with general health. On day 10 after surgery, up to 1/3 of the children still reported physical symptoms (PRiC). No gender or age differences concerning the items of behavior (PHBQ-AS) were found. The quality of postoperative recovery (PRiC) in girls were lower, with higher levels of nausea, dizziness, coldness, and headache compared to boys. Children

Problem: Childrens wellbeing should always be considered but during hospital stay, many children experience pain due to medical procedures such as inserting a peripheral venous catheter. In order to prolong the time in situ and to avoid the necessity to change the catheter frequently, it can be flushed with either heparin or sodium chloride. Since heparin has negative side effects, the aim of this study was to examine whether or not there is any scientific support for intermittent flush with heparin being more efficient in extending the time in situ as compared to intermittent flush with sodium chloride. Eligibility Criteria: A systematic review structured according to PICO was performed. The databases used were PubMed, CINAHL and Cochrane Library, and eligible study designs were systematic reviews and randomized controlled double-blinded trials. The studies were critically appraised and synthesized, after which an evidence grading was performed. Sample: Two systematic reviews and four randomized controlled double-blinded trials were included. Results: The systematic reviews were assessed as high quality and the randomized controlled double-blinded trials assessed as moderate quality. The results showed both significant differences, and no significant differences between heparin groups and sodium chloride groups regarding time in situ. Conclusions: Our conclusion is that heparin might not be necessary but no guidelines are possible to develop. Implications: Since heparin has negative side effects among children and no significant result in favour of heparin was found, more studies are needed in order to provide evidence-based care.

Background: The World Health Organization recommends exclusive breastfeeding as the main source of nutrition for infants during their first six months of life. However, despite this well-known recommendation, not all mothers breastfeed, whether partly or fully, during this time. Objective: The aim of this systematic literature review was to compile evidence regarding sociodemographic, physical, mental, and social factors that influence breastfeeding mothers to stop breastfeeding before the infant reaches six months. Search method: A systematic search was conducted in four databases. Selection criteria: Studies with quantitative research were included. Data collection and analysis: Totally, 186 abstracts were read, 83 seemed relevant but 18 were found to be duplicates. Finally, 27 articles met the inclusion criteria and were included. The quality assessment was done with a quality assessment template from the Swedish Council on Technology and Assessment and the grading of the result was carried out according to GRADE Results: The association of breastfeeding cessation between the mother`s young age, low level of education, return to work within 12 weeks postpartum, caesarean birth and inadequate milk supply was found to have a low level of evidence. The link found between depressions among the mothers with the cessation of breastfeeding was found to have a very low level of evidence. Conclusions: Sociodemographic factors appeared to have caused cessation of breastfeeding in some of the included articles. The preventive work should focus on how to improve the knowledge of health-care professionals and targeted interventions must address mothers who are at risk of ceasing breastfeeding before the recommended time. Keywords: breast feeding, review, risk factors, weaning

Inflammatory bowel disease (IBD) is increasing in children. When this lifelong illness is diagnosed in childhood, especially during adolescence, it may have a negative impact on children's quality of life. The aim of the present study was to illuminate the meaning of children's lived experience of ulcerative colitis. Seven children aged between 10 and 18 years were recruited from University Hospital South Sweden and interviewed about the phenomenon under scrutiny. Data were analyzed by means of a phenomenological hermeneutical method. The meaning of the children's lived experience of ulcerative colitis was summed up as a main theme. A daily struggle to adapt and be perceived as normal consisted of 4 subthemes: being healthy despite the symptoms, being healthy despite being afraid, being healthy despite a sense of being different, and being healthy despite needing support. The children strove to perceive themselves as healthy, and they needed to be perceived as healthy, especially when experiencing symptoms of inflammatory bowel disease. Children with inflammatory bowel disease confront various problems, such as ambitions and goals that are hard to achieve, due to reduced abilities as a result of the illness or an insufficiently adapted environment.

Since 2010, vaccination against human papilloma virus (HPV) has been offered free of charge for all girls in Sweden. The school nurse administer the vaccination when the girls are 10-12 years old. The transmission of HPV is primarily connected to an active sex life, something that normally not has started in this age. Therefore, it is interesting to investigate if, and how the introduction of HPV-vaccination has influenced sex education in school. We have in a pilot study individually interviewed 5 primary teachers and 5 school nurses concerning infor-mation about the vaccination, sex education and their cooperation. The results demonstrate how the teach-ers see themselves mainly as distributor and collector of information and agreement documents about the vaccination. The vaccination information has not been integrated into sex education. Some of the teachers act as support when the pupils have questions connected to the vaccination. The school nurses described that they perform information about puberty, sexual life and HPV vaccination in groups of girls only, but also in the whole class. They experienced that there were limited cooperation between the teachers and themselves although they expressed that they wanted to collaborate. Most nurs-es felt that they were waiting for “an invitation” from the teachers to visit the classroom. One interviewee described how the principal of the school did not allow the school nurse and the teacher to share groups since the head master did not want to risk that the parents would not approve related to religion. The nurs-es did not have full insight concerning the teachers’ lectures but they had a feeling that the teachers fo-cused on biology and the nurses handled practical things like menstruation and also discussed psychologi-cal issues with the pupils. During the presentation we will present the results, but also some possible explanations to and implications of our results.

Introduction: When a child is diagnosed with Type 1 diabetes, it involves extensive lifestyle changes for the whole family. There is limited knowledge of the impact the initial care has for children and parents over time. The aim was to compare children’s diabetes-specific health-related quality of life (HRQOL) in hospital-based care and hospital-based home care (HBHC), 12 and 24 months after the onset of Type 1 diabetes. The aim was also to compare the children’s and parents’ proxy-report of the children’s diabetes-specific HRQOL after 12 and 24 months, regardless of the form of care. Method: The trial took place at a university hospital in Sweden and had a randomised controlled design evaluating the hospital-based care and HBHC, referring to specialist care in a home-based setting. Children aged 5–16 and their parents answered the PedsQLTM 3.0 Diabetes Module, 12 months and 24 months after the onset of the illness. Results: The results showed no difference regarding the children’s diabetes-specific HRQOL. However, 12 months from diagnosis, the children and parents who received HBHC experienced more worry than those who had received hospital-based care at diagnosis (p = .012). Irrespective of the form of care, children reported more discomfort of the disease than their parents reported that the children would have (p = .017). Conclusion: Overall, the result indicates that both hospital-based care and HBHC provide equivalent outcomes in terms of the children’s diabetes-specific HRQOL. However, a more home-based model of care might put more strain on some families. Those families need to be identified and the routines should be flexible in order to meet each family’s need.

OBJECTIVES Tonsil surgery is associated with significant morbidity during recovery. Patient-reported outcome measures (PROM) are the golden standard for the planning and follow-up of delivered care, which should also be an axiom for children. The current aims were to describe self-reported postoperative recovery in children after tonsil surgery, and to compare tonsillotomy and tonsillectomy in this respect. METHODS In total, 238 children (4-12 years old) with a history of obstructive problems and/or recurrent tonsillitis, and undergoing tonsil surgery were included. Forty-eight per cent were operated with partial tonsil resection/tonsillotomy (TT) and 52 % with total tonsillectomy (TE), all in day surgery. Postoperative recovery was assessed on days 1, 4, and 10 using the validated self-rating instrument PRiC, Postoperative Recovery in Children. This includes 23 items covering different aspects of recovery after tonsil surgery. A higher score indicates worse status in the respective items. RESULTS Daily life activities (sleeping, eating, and playing), physical symptoms (e.g. headache, stomach ache, sore throat, otalgia, dizziness, nausea, defecation, urination), and emotional aspects (sadness, frightening dreams) were affected during the recovery period. The TE-girls showed higher scores then boys regarding stomach ache, defecation, and dizziness. Children above 6 years of age reported higher values for the physical comfort variables, while the younger group showed worse emotional states. Postoperative recovery improved from day 1 to 10 in all surgical groups. The TE-group showed lower recovery compared to the TT-groups (p=<0.01-0.001) in most items. CONCLUSION The goal of postoperative management is to minimize or eliminate discomfort, facilitating the recovery process and avoiding complications. Children are able to describe their recovery, and thus, PRiC seems to be able to serve as a PROM to obtain patient-centered data after tonsil surgery. The recovery process after TT causes less postoperative morbidity and a quicker return to normal activity compared to TE.

Most injuries to young children happen in the home. Therefore, this study aimed to investigate if extended individual information to mothers´ related to injury to children in the home and possible preventative actions has any effect on their awareness of the problem and if Sense of Coherence has any influence. This was a quasi-experimental designed intervention study with a comparison group. Extended individual information with empowerment as the approach was used. Ninety-nine mothers of children under the age of 7 months participated. A questionnaire with sociodemographic data and questions regarding awareness towards prevention was used. Mothers who took part in the intervention significantly increased their awareness of the fact that child injuries take place at home when compared with the mothers in the comparison group, [OR 2.3, CI 1.3-4.3]. However, no significant improvement of awareness towards prevention was noted, neither any association to the mothers SOC-scores. This study showed that the intervention had a positive effect on the mothers´ awareness towards the fact that child injuries are taking place at home, but it did not increase the mothers´ awareness towards prevention of child injury.

Objectives: The purpose of this randomised study was to compare the quality of bowel cleansing using either polyethylene glycol (PEG) or sodium picosulphate (NaPico) (primary outcome) in relation to the tolerability and acceptance of these laxatives among children and their caregivers (secondary outcome). Methods: The study was a randomised controlled trial that was conducted as an investigator-blinded study within the Department of Paediatrics of Ska°ne University Hospital in Malmo¨ , Sweden. A total of 72 children (10–18 years of age) were randomly placed into 1 of 2 groups (PEG or NaPico). The Ottawa Bowel Preparation Quality Score was used to evaluate the quality of bowel cleansing. A total of 2 different questionnaires were used to evaluate both the acceptability and tolerability of the laxatives. Results: In total, 71 children completed the bowel cleansing. Of these 71 cleanses, 67 protocols were analysed according to the Ottawa Bowel Preparation Quality Score. No significant difference in bowel cleansing quality was detected between the 2 groups. Rates of acceptability and tolerability were significantly higher in the NaPico group than in the PEG group. Conclusions: In the present study, both laxatives were found to be satisfactory in terms of aiding the performance of an uncomplicated and successful colonoscopy. NaPico was, however, more tolerable to the children than PEG, and both, the children and their caregivers, were more accepting of NaPico than of PEG. Consequently, NaPico can be recommended as the option for bowel cleansing in children ages 10 years and older. Key Words: bowel cleansing, children, colonoscopy, randomised controlled trial

Abstract Rationale, aims, and objectives: According the United Nations (1989), children have the right to be heard and to have their opinions respected. Since postoperative recovery is an individual and subjective experience and patient-reported outcome measures are considered important, our aim was to develop and test an instrument to measure self-reported quality of recovery in children after surgical procedures. Methods: Development of the instrument Postoperative Recovery in Children (PRiC) was influenced by Quality of Recovery-24, for use in adults. Eighteen children and nine professionals validated the items with respect to content and language. A photo questionnaire was developed to determine whether the children’s participation would increase compared to the text questionnaire. The final instrument was distributed consecutively to 390 children, ages 4–12 years, who underwent tonsil surgery at four hospitals in Sweden. Results: A total of 238 children with a mean age of 6.5 years participated. According to the parents, 23% circled the answers themselves and 59% participated to a significant degree. However, there was no significant difference in participation between those who received a photo versus a text questionnaire. Psychometric tests of the instrument showed that Cronbach’s alpha for the total instrument was 0.83 and the item-total correlations for 21 of the items were >0.20. Conclusion: Our results support use of the PRiC instrument to assess and follow up on children’s self-reported postoperative recovery after tonsil operation, both in clinical praxis as well in research.

ABSTRACT FOR CROATIA CONFERENS OCTOBER 2016 To publish a scientific article Many of you have probably some idea how to increase the quality of care or have perhaps already conducted some quality work. This workshop aims to inspire you to perform a study or to decide to publich work you already has conducted. In 2014, a study by Eiken et al concluded that nurses education and work load was related to the mortality of their patients. This results indicate that nurses actions are valuable and therefore, should nurses publish their work so that others can get benefit of it. In order to develop the scientific skills we need to strategies and during this workshop we shall discuss obstacles and possibilities and share our experiences.

Aims and objectives. To illuminate children’s experiences prior to colonoscopy. Background. It is well known that children need to be well prepared before undergoing stressful medical procedures, and the goal of such preparations should focus on minimising their level of anxiety. The clinical investigation of children with suspected inflammatory bowel disease involves several steps, with colonoscopy being routinely used to investigate the colon and the lower part of the small intestine. To minimise children’s anxiety during various medical procedures, it is important that information about their experiences is obtained directly from the children themselves. Design. A qualitative study. Method. The study was designed as a qualitative interview study involving 17 children aged 10–17 years undergoing colonoscopy at a children’s university hospital in Sweden. Verbatim transcripts were analysed using content analysis. Results. The children’s experiences prior to colonoscopy were identified as belonging to an overall theme, a private affair, and to four categories: preparing yourself, mastering the situation, reluctantly participating and feeling emotional support. Conclusion. This study shows that children’s experiences prior to colonoscopy are a private affair and that the preparation needs to be individually adapted for the ‘preprocedural’ preparation to be comprehended. Relevance to clinical practice. The children’s experiences ascertained in this study can contribute to a greater understanding of children’s needs prior to a colonoscopy and may provide professional care staff with the basis for future nursing assessments.

Aim. The aim of this study was to investigate if nurses change a child´s peripheral intravenous catheter when clinically indicated. Background. Today, inserting a peripheral intravenous catheter is a common procedure in hospital care, but this can be a painful and traumatic for children. There are guidelines when to change the peripheral catheter in adults, but no similar guidelines was found concerning children. A Cochrane review from 2010 concludes that the policy should be to change the peripheral intravenous catheter when clinically indicated. This includes phlebitis, but also pain, redness, infiltration swelling, leakage and blockage. Method. The design was prospective and observational. Daily observations were made at the hospital by one of the researchers and notes were made in a protocol. Findings. Thirty-three children with a total of 47 peripheral intravenous catheters participated, and 104 observations were made. Of the children, 42 % (14/33)developed complications. Among the children with phlebitis grad 2 and 3 the nurses did not change the peripheral intravenous catheter when clinically indicated. Conclusion. This study shows that phlebitis occurs in children with a peripheral intravenous catheter and the PIC were not changed when clinically indicated. It is the professional´s responsibility to reduce the painful experiences for children during hospital care, and more research concerning nurses´ clinical decisions needs to be conducted

Purpose. The purpose was to illuminate parents’ experiences when their children are undergoing an elective colonoscopy performed using polyethylene glycol-based regimes for bowel preparation. Design and Methods. Individual interviews with 12 parents were performed and analysed using content analysis. Results. The parents’ experiences were structured into one theme: “Charged with conflicting emotions” with three categories: “Being forced to force,” “Losing one’s sense of being a parent” and “Standing without guidance.” Practice Implications. Understanding parents’ experiences can help healthcare staff guide parents in helping their children undergo a colonoscopy

More than 90% of children born with congenital heart disease survive into adulthood due to successes of cardiac surgery and medical management. Interviews with 16 young adults with congenital heart disease to explore their experiences of transfer from pediatric to adult care were performed. The analysis identified five themes; Feeling secure during the transfer process, Experiencing trust in the care, Expecting to be involved, Assuming responsibility for one's health is a process and Lack of knowledge leads to uncertainty. In conclusion; a structured and gradual transfer process was necessary to enable the informants to shoulder the responsibility for self-care.

Over the last twenty years, the National Board reports have shown an increase when it comes to launch, inducing childbirth. Statistics show that births started with induction has increased in Sweden from 8.1% in 1990 to 13.2% in 2007. For pregnancy more than 42 weeks of gestation or more, is the most frequent cause of inducing childbirth. This means an increased risk of complications and may result in cesarean uterus ruptures and or low Apgar Score for the child. The purpose of this report was to describe the incidence of labor induction, its indications and obstetric outcomes in women's clinic in Malmö. The report is based on retrospective medical record review. Data were processed in SPSS. The results show that induced births has increased, but no statistical difference over time could be shown. However, it turned out spontaneous birth that ended with vacuum extraction after induction was significantly elevated relative to spontaneous deliveries without induction. Induced women are at risk and require increased monitoring because of the risk of uterine rupture, over stimulation and the effect on the fetus. In several studies, it appears that induction leads to painful latensfaser and increased pain relief was needed. Midwives and doctors should be well aware that the indication for induction must be done to justify the increased risk for mother and child, choice of induction should be based on an overall assessment of the mother's and the child's condition and ability to cope with an induced labor. It should clearly state the cause of the induction, method and dosage of any medicine so that no doubt exists, either in the journal or on the drug list.

Cardiovascular disease is one of the West's most common diseases. Diagnosis and treatment of constricted coronary arteries can be performed with contrast imaging and percutaneous coronary intervention (PCI). Studies have shown that puncture through the radial artery reduces complications such as bleeding and decreased cardiac events compared with a punction of arteria femoralis. A follow-up regarding local complications of trans-radial procedure is important. The aim of this study was to retrospectively evaluate the incidence of local complications after trans-radial coronary intervention after discharge. A total of 139 patients were contacted by telephone after 2-4 months. Inquiry was made according to a questionnaire concerning local symptoms related to the area around the wrist for trans-radial coronary intervention and whether the pulsations in arteria radialis were palpable or not. In this study, 91.4% of patients had no local complications after trans-radial coronary intervention. All patients had palpable pulsations in arteria radialis, and one of them had a weak radial pulse which had to be verified by Doppler. Twelve patients (8.6%) reported local symptoms of any kind. Seven patients (5%) had various problems such as pain, numbness, swelling and hematoma from the hand. Two patients (1.4%) had symptoms of wrist and another two had symptoms from the forearm and one had pain in the shoulder. Eight patients (6%) reported different persistent symptoms. The conclusion is that a punction of arteria radialis in coronary intervention has benefits such as bleeding complications and preventing decreased cardiac death versus a punction of femoral which has been shown in several other studies. The results of this study showed that nearly 10 % experienced mild local complications, especially in the hand. Furthermore, since the patients reported increased well-being postoperatively trans-radial procedures should be first choice in coronary intervention.

Overweight and obesity in younger children could better be brought in focus through a deeper understanding of how Child Health Care nurses (CHC-nurses) perceive their work with the problems of overweight at the CHC Centers. The aim of this study was to elucidate the CHC-nurses conceptions of their preventive work with childhood overweight and obesity in Child Health Care. A qualitative study, based on open-ended interviews, involving 18 CHC-nurses strategically selected from 17 CHC Centres in the southern part of Sweden using a phenomenographic approach. Two categories of description emerged from the data: (i) Internal obstacles to the CHC- nurses' work with overweight in children and (ii) External obstacles to the management of overweight in children. The CHC-nurses conceived their work with overweight in Child Health Care to be complicated and constrained by several obstacles depending on the nurses' personal priorities, knowledge, responsibility and the absence of resources and cooperation, as well as the lack of uniform guidelines for preventing and managing childhood overweight and further a deficient management organisation. Nurses' attention to monitoring overweight in children, and their initiative for prevention, is based on their conceptions of the obstacles that hinder them in their efforts. An increased awareness of the CHC-nurses conceptions of the priorities, their sense of responsibility and prevention practices is warranted. If measures in this direction are not taken there is a growing risk that overweight children will pass through the CHC without any formal recognition of their situation. There is an indication that the present level of the CHC-nurses' preventive work with childhood overweight has room for improvement in several areas. It is suggested that the specialist education of these health care professionals should be supplemented and that organisation of the management of childhood overweight should be also revised at the primary health care level.

1. Nurses´ attitudes towards pain in children. Previous research has shown a lack of knowledge in pain treatment among nurses working with children. Children express pain different compared to adults and research has shown that nurses´ attitudes are important to pain assessment in children. The present study aimed to explore nurse’s attitudes towards pain in children. The study was conducted as a questionnaire study on nurses working with children at a pediatric ward at a university hospital in the south of Sweden. The questionnaire ”Views and knowledge about pain in children” was selected and translated into Swedish. A total of 357 surveys were handed out and 153 were answered, which provided a response frequency of 43 % of the total population. Data was analyzed descriptively and comparisons between groups were conducted The results showed that a majority of nurses don’t think that a child less than one month of age may be intubated without narcotics or pain medication but 22 % answered that they did not know. They also express the importance of total elimination of pain when treating post-operative and chronic pain. Some nurses´ believed that minor procedure can be carried out without pain medication. Advanced education and experience affect attitudes to some point. Place of work didn’t affect nurses attitudes towards pain in children. 2. Childrens´s pain from the children and parents perspective. Pain management is important for the child in many aspects and may lead to long term problems and affect quality of life for the child. Sweden is lacking optimal management of acute and chronic pain in children and adolescents. The aim of this study was to describe children´s and parent´s perception of pain in hospital be performing a prevalence study using a questionnaire containing seven questions. Totally 182 questionnaires were administrated and 146 were returned. The results showed that 68 % of children have experienced pain during hospital stay and rating scales concerning pain are not used in particularly high degree. "Did the staff ask you or your child about pain?" - 82 % ( 79/97) answered yes. Did you or your child during the last 24 hours had the possibility to assess pain with a scale e.g. VAS?" Only 23 % (22/97) have had the possibility. These results can provide increased knowledge of pain and pain assessment by health professionals, which may provide a basis for further discussion and increase quality of pain management for children in hospital.

Aim. This literature study highlights patients with diabetes mellitus and / or peripheral vascular disease and their experiences of changes in life after a leg or lower extremity amputation. Background. Living with a chronic disease such as peripheral vascular disease and / or diabetes, can lead to strains and affect daily life, including pain, sleep difficulties, problems with ulcers and fear of amputation. Being amputated can lead to shock and grief postoperatively. The mental preparation preoperatively is important for how the patient's experience life postoperatively. Patients need support and encouragement from the nursing staff and relatives in order to increase well-being and for greater autonomy in the postoperative phase. Method. A systematic literature review, based on review and compilation of qualitative studies, was chosen in order to answer the research question. Three articles were found relevant to the purpose of the study, one study was found to be of high quality and two studies of medium quality. Two of the studies were conducted in Western and one in the Asian context. The authors used the SBU's manual in the selection process of literature. Results. After compilation of the three studies two overall third-level themes were identified: Suffering and to regain hope. Conclusion. There is scientific evidence that a leg or lower extremity amputation alters a patient’s situation in life. This may cause distress in different dimensions. In this study emotional, psychosocial and physical suffering were identified. There is also evidence that patients who has time can develop some acceptance and adjustment to their new situation. Support from family and friends are important for the motivation to fight and regain hope for the future. Similar experiences / experiences identified despite different cultural backgrounds.

Historically, the clinical decision regarding whether a child experience pain or not has been based on professional’s perception rather than on scientific evidence. A common misunderstanding has been that children do not experience pain to the same extent as adults. However, the definition of pain is that it is an unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in terms of such damage. In spite of this, many children are going through painful procedures during hospital stay without any pain relief medication. A literature review from 1985 based on 40 articles showed that 77 % of newborns only received muscle relaxantia before heart surgery and no pain medication. In 1994 it was shown that, even in utero, invasive procedures are painful since the fetus respond with increased level of stress hormones. Furthermore, in 1997 research revealed that a child who has been exposed to pain early in life show a stronger pain response later during childhood. Yet, in 2003 it was shown that newborns at a neonatal intensive care unit were exposed to more than 14 painful procedures per day. Research has shown that nurses´ attitudes are important to pain assessment in children. Others have shown that nurses show a lack of knowledge in pain treatment for children. A recent study showed that nurses believed that minor procedure can be carried out without pain medication. In addition, advanced education for nurses and experience in working with children affect attitudes to some extent. Children are a vulnerable group and nurses have, or should have, an important impact on pain management among children. How do we get there?

Abstract Background: Registered Sick Children’s Nurses and District Nurses employed at Child Health Care centres are in a position to help prevent childhood overweight and obesity. Prevention of this challenging public health threat could be improved through having a better understanding of how this group of nurses perceives childhood obesity. The aim of this study was to elucidate the conceptions of childhood overweight, including obesity, among nurses working in Child Health Care. Method: A qualitative study using a phenomenographic approach, based on open-ended interviews with 18 Child Health Care nurses (CHC-nurses) strategically selected from 17 Child Health Care Centres in the southern part of Sweden. Results: Four categories of description emerged from the data: Perception of childhood overweight changes, Overweight in younger children a neglected concern, Overweight a delicate issue and Importance of family lifestyle. The participating CHC-nurses conceived overweight in children, primarily obesity in children to be an extensive and serious problem which affects children, families and the surrounding society. Overweight in children was further perceived as a consequence of their parent’s lifestyle and their awareness of the problem, which was considered by the CHC-nurses as a sensitive and a provoking issue. It was also perceived that overweight in children is not taken seriously during the pre-school period and that concerns regarding overweight in younger children were mainly about the appearance and not the health of the child. The CHC-nurses perceived that the proportion of overweight children has increased, which Swedish society and the CHC-nurses have adapted to. This adaptation makes it difficult for CHC-nurses to define those children who are overweight. Conclusion: CHC-nurses provide a comprehensive and complex picture of childhood overweight, which includes several difficulties dealing with this issue. Attention to CHC-nurse’s conceptions of overweight in children is important since it can affect the parent-nurse relationship and thereby the nurse’s, as well as the parent’s efforts to influence the children’s weight. It is suggested that CHC- nurses should work with person centered counseling and empowerment concerning parent to child relations in cases involving overweight. Keywords: Child, Conceptions, Nurses, Overweight, Perceptions, Primary health care, Qualitative research

Information and education are important components in the care of patients before colorectal surgery. In order to optimize a quick recovery after surgery sufficient and evidence based information is essential. The aim was to describe and review scientific articles regarding the importance of the preoperative patient information given before colorectal surgery from a patient perspective. The method was a literature study, with a systematic approach, in order to find evidence concerning patient information before colorectal surgery. The results showed that patients describe experiences of anxiety, insecurity, and the fear of the unknown. They needed healthcare givers which provide a feeling of security and continuity. If the patients receive multidimensional, written and verbal information, they are less anxious and have higher self-control postoperatively. They also experience less pain and can be mobilized earlier. If patients who should receive a stoma met a stoma therapist preoperative expressed less anxiety, fewer stoma complications and better mental well-being. This means that the patients can manage their colostomy earlier. Accurate preoperative information enhances understanding of the postoperative recovery phase and makes patients more involved. This leads to earlier recovery and discharge. The conclusion is that patients undergoing colorectal surgery are in great need of preoperative information. When this is given due to a standard care program, with regard to the individual needs, the patients will be better prepared for their surgery and postoperative care. Patients will participate in their care actively and take responsibility early, reducing complications and accelerate the post-operative recovery. Through good cooperation in the team around the patient, the individual needs of the patient are optimized. If the patient is assigned a patient charge nurse, the individual needs is identified earlier and if necessary followed up postoperatively after discharge.

Aims and objectives.  To describe possible social, nutritional and biological factors influencing iron intake and iron status among healthy one-year-old children in southern Sweden. Background.  Iron deficiency is one of the most important nutritional disorders and increases the risk of delayed mental and motor development. Children are at risk because of rapid growth, which entails relatively high requirements of iron. Design.  A prospective study using survey methods. Method.  Randomly selected one-year-old children (n = 90) and their parents participated. Parents answered a questionnaire enquiring about demographic data and the child's feeding and health during the first year. The child's total food intake and blood samples (haemoglobin, mean corpuscular volume, S-ferritin and transferring receptor) were obtained. Results.  Twenty-seven per cent of the children had an iron intake below the Nordic Nutrition Recommendations of 8 mg/day (NNR 2004). Follow-on formula and iron-fortified porridge contributed to 64% of the child's total iron intake. Partial breastfeeding and low maternal education correlated negatively with iron intake from complementary food. In total, 10·3% (n = 9) of the children were found to be iron-depleted (S-ferritin ≤12 μg/l), and 2·3% (n = 2) had iron deficiency with or without anaemia (Hb ≤100 g/l). Conclusions.  One-year-old children in Sweden may be at risk of developing iron deficiency, but information about iron-rich food can improve iron status. Relevance to clinical practice.  Knowledge about factors influencing children's iron intake and iron status may improve the nutritional advice and education from the Child Health Services to prevent or detect iron deficiency.

AIM: The aim of this study was to investigate to what extent individual-based extended information given to mothers from city parts of low education can improve precautions taken by them to prevent burn and scald injuries involving young children in the home and further to compare the results with a group of mothers who had not received extended information. METHODS: This intervention study, with a comparison group, has a quasi-experimental design. Individual-based information, with an empowerment approach, was given to a group of mothers living in two separate areas of a city in southern Sweden with a low level of education. In total, 99 mothers of children under the age of 7 months participated. The mothers were selected through the local child healthcare authorities. Observations were made and bivariate analyses were established. RESULTS: The results showed that the intervention had a significant impact on improving the precautions the participating mothers introduced to protect their children against burn and scald injuries in the home and further, in relation to a comparison group. CONCLUSIONS: Through empowerment, workshops, and home visits aimed to increase their consciousness and knowledge, the participating mothers' precautions taken against child injuries in the home improved. It is of great importance that a framework for considering the problem of burn and scald injuries to children is presented from a preventive perspective which, in combination with evidence-based interventions, may enable the creation of injury prevention programmes for implementation by the community health care.

In the county of Scania, Sweden, antibiotic use among small children is among the highest in the country. The aim of this study was to investigate the associations between antibiotic use among 8-month-old children in Malmö and characteristics of the child as well as parental sociodemographic characteristics, lifestyle factors, and psychosocial support. The study was a population-based cross-sectional survey. The study population consisted of children who visited the Child Health Care (CHC) centres in Malmö for their 8-month health checkup during 2003–2006 and whose parents answered a self-administered questionnaire (n = 7266 children). The questionnaire was distributed to parents of children registered with the CHC and invited for an 8-month checkup during the study period. The odds of using antibiotics increased as parental educational level decreased. Using high educational level as a reference group, low maternal educational level was associated with an increased antibiotic use for the child, odds ratio (OR) = 1.61 (95% CI: 1.34–1.93). Furthermore, children whose parents were born outside Sweden showed higher antibiotic use, OR = 1.43 (95% CI: 1.24–1.65), in comparison with children whose parents were born in Sweden. Exposure to environmental smoking, parental experience of economic stress, and a low level of emotional support increased the odds for antibiotic use. Boys had higher odds of use of antibiotics than girls, OR = 1.40 (95% CI: 1.25–1.57). Having a low birth weight, having an allergy and having siblings also increased the odds for early antibiotic use, while breastfeeding seemed to have a protective role. Conclusion There were clear associations between parental factors such as sociodemographic, psychosocial and lifestyle factors and antibiotic use at this early stage of life. Several characteristics of the child also affected the use of antibiotics.

AIM: The aim of the study was to describe parents' experiences concerning feeding situations and their contact with the nurse at the Child Health Service (CHS). BACKGROUND: Some of the most important tasks for the nurse at the CHS are to monitor growth, detect feeding difficulties and give advice concerning food intake and feeding practices. METHOD: Eighteen mothers differing in age, education, ethnicity and number of children and recruited from different CHS were interviewed. The narratives were transcribed verbatim and analysed by content analysis at manifest and latent levels. RESULT: All mothers' described that food and feeding were essential parts of their lives requiring a great deal of time and involvement. Two major categories of mothers' attitudes in feeding situations were identified - a flexible attitude and a controlling attitude. Mothers with a flexible attitude were sensitive to the child's signals and responded to them in order to obtain good communication. Mothers who expressed a need for control established rules and routines regarding the feeding situations. Mothers with a controlling attitude expressed receiving inadequate support from the nurse at the CHS. CONCLUSION AND CLINICAL IMPLICATION: This study shows that some mothers experience inadequate support from the nurse at the CHS. Knowledge about mothers' experiences of feeding situations and their different attitudes towards the child during feeding might improve the CHS nurses' knowledge and help them understand and more adequately support mothers who experience feeding difficulties.

Aim: This study compared transferrin receptor (TfR) concentrations with iron parameters relative to a child´s intake of cow´s milk and follow-on formula. Methods: TfR, β-Haemoglobin, serum ferritin and mean corpuscular volume (MCV) of red blood cells were analyzed in a study population of 263 children aged 2.5 y. The amount of cow´s milk and follow-on formula consumed were recorded. Results: There was a significant difference of TfR/log. ferritin between children whose milk intake was < 500 ml and those with a milk intake of > 500 ml (p=0.003). There were significantly higher values of TfR/log. ferritin in children whose MCV of red blood cells was < 75fL than those with > 75fL (p=<0.0001). The TfR concentrations were significantly lower after iron treatment. Conclusion: Higher concentrations of TfR were correlated with lower concentrations of haemoglobin and MCV of red blood cells. Milk consumption increases the risk of higher ratio of TfR/log. ferritin. TfR concentrations were significantly lower after iron treatment.

Aim. The objective of the study was to investigate iron status in children in relation to intake of cow's milk and follow-on formula. Methods. In all, 367 healthy 2.5-y-old children were enrolled in the study. The amounts of cow's milk and formula consumed were recorded. B-haemoglobin, S-ferritin, S-iron, total iron binding capacity and mean corpuscular volume were analysed. Results. Seven percent of the children had iron deficiency anaemia (Hb <110 g/l) and 10% had S-ferritin <12 μg/1. Furthermore, 10% of the children were iron deficient, with or without anaemia. Children with iron deficiency had a higher intake of cow's milk (382 ml, 95% confidence interval (CI) 294-496, vs. 257 ml, CI 232–272, p< 0.0001), and fewer consumed follow-on formula (11% vs. 43%, p = 0.0002) compared to those with sufficient iron. Conclusion. Iron deficiency is still common during childhood in Sweden. Intake of cow's milk is significantly higher in children with iron deficiency. In contrast, iron deficiency is less frequent among those consuming follow-on formula.