BACKGROUND: Ambulance nurses have an important role in early recognition and treatment often being the first medical contact for patients with acute chest pain. However, there is sparse knowledge on the experiences of ambulance nurses with regard to use of Prehospital Guidelines for patients with Acute Chest Pain.

AIM: To explore ambulance nurses' experiences of using prehospital guidelines for patients with acute coronary syndrome.

METHOD: A qualitative descriptive study design. Semi-structured interviews with 22 ambulance nurses recruited through purposive sampling strategy. The material was transcribed and analysed using content analysis.

RESULTS: Two main categories emerged from the results. The first category Sense of professional obligation included experiences of having an important role in caring for patients with acute chest pain. Understanding this role and the collaboration in the chain of care prompted ambulance nurses to adhere to the guidelines. However, not receiving enough feedback on the provided care made them uncertain whether to use guidelines. The second category Clinical difficulties using guidelines consisted of experiences of being surrounded by practical challenges while using guidelines. Ambulance nurses meet these challenges by relying on their clinical experience, which sometimes led to them deviating from the guidelines.

CONCLUSIONS: The ambulance nurses experienced a mixture of feeling secure and insecure when using the guidelines. Foremost, when encountering patients with unspecific chest pain, they felt a lack of feedback and an insufficient collaboration within the chain of care, which made them deviate from guidelines. To increase adherence in guidelines, post-registration education to update the knowledge and skills about guidelines for acute chest pain is needed followed by formal inter-disciplinary feedback on the care provided.

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.

Methods

This study is a qualitative interview study. The authors used the stimulated recall interview (SRI) with nurses working at a children's hospital in southern Sweden for the data collection. In total twelve nurses were interviewed and qualitative content analysis was used for the data analysis.

Results

The results are presented as one theme: Need for higher competencies and evidence, and three categories: Routines can enable pain assessment, Trusting one's own assessment of the whole picture, and Pain assessment scales as an extra workload. The interviewed nurses acknowledged that pain assessment tools are a vital part of the field of pain treatment. They also had trust issues with measuring and estimating pain by means of a tool such as pain scale. Furthermore, their opinion was that too many different tools and methods add up towards a more blurry and stress‐related environment and due to a lack of consistent routines, pain assessment is seen as a work‐related burden in the daily routines.

Conclusion

Results from the present study indicated that nurses need clear routines in combination with continued education regarding pain assessment with pain scales, which might be the key to successful pediatric pain assessment and thus to better pain management within pediatrics.

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.

Currently, there are few studies which examine targeted family-focused support when a family member is diagnosed with breast cancer. Thus, the aim of this study was to explore families' experiences of participating in a family nursing intervention identified as Brief Family Health Conversations (BFamHC) following the diagnosis of breast cancer. Semi-structured family interviews were conducted with nine families (including 29 family members) 2 weeks following the family-focused intervention of three sessions of BFamHC. Thematic analysis was used to analyze the data. Families reported the BFamHC as positive and as a unique kind of family health conversation, one that afforded them the opportunity to communicate and share their experiences as a family group. A family conversation, even one as time-limited as BFamHC, offered a sense of relational sharing and togetherness, thus preventing feelings of isolation and vulnerability. Therapeutic family-focused conversations, such as BFamHC, hold promise as a useful family nursing intervention following the diagnosis of breast cancer.

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.

Background Colonoscopy plays a crucial role in the diagnosis of paediatric inflammatory bowel disease (IBD), adolescents comprise 25% of all cases of IBD. Several studies have found that a safe, informative, and effective colonoscopy, performed in a child-friendly atmosphere with minimal distress to the child, is difficult to achieve. The aim of this study was to describe nurse’s experiences of the pre-colonoscopy procedure prior in children. Methods A qualitative design with a thematic content analysis approach was used. Fifteen nurses at a children’s hospital participated in interviews regarding their experiences of the bowel cleansing procedure with PEG in children. Results Four key themes were extracted from the nurses’ experiences; lack of knowledge, challenges surrounding information, responsibility without control and assembly line- like procedure.. Conclusions This study shows that nurses feel that they need more time and education opportunities before involved in paediatric colonoscopies.

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.

The paediatric care’s primary priority is the best interest of children. For this to be possible necessitates both the children’s and parent’s perspective before planning different medical procedures which the child must undergo. The study´s aim was to compare children’s and parents’ experiences of the Child undergoing bowel cleansing prior to a colonoscopy. The interviews with children who have undergone a colonoscopy for the first time and parents who were present when their child underwent a colonoscopy were analysed used latent content analysis. Children (n=17) of both genders (12 girls and five boys) of an age ranging from 10-17 years and parents (n=12) were involved in this study. The findings were presented as one theme: The children’s and parent’s perspective of bowel cleansing. The results of the present study show both similarities and differences between children’s and parents’ experiences of a child’s bowel cleansing prior to colonoscopy using polyethylene glycol with electrolytes as a laxative. The conclusion drown from this study is necessity to use both child and child´s perspective to find strategies to help those children when bowel cleansing prior to colonoscopy.

This thesis focuses on children aged 10-18 years with symptoms of, ordiagnosed with, inflammatory bowel disease (henceforth referred to as IBD).Before the disease can be diagnosed, a child must undergo several procedures,with colonoscopy as an established investigation, including bowel cleansing,which is crucial for the safe examination of the intestine. The prevalence ofpaediatric IBD is increasing worldwide, which will augment the number ofpaediatric colonoscopies. When the recommended laxative polyethylene glycol(PEG) was used for bowel cleansing, the children and their accompanyingparents experienced the procedure as difficult due to the large volume of badtastingPEG. Once IBD is diagnosed, the children must undergo lifelongmedical treatment, which entails several follow-up colonoscopies.Furthermore, IBD is a chronic illness with an unpredictable activity patternthat can have a negative impact on the children’s quality of life. One of theaims of this thesis was to explore a child/child’s perspective of going through acolonoscopy and child’s perspective of living with IBD. A further aim was toinvestigate whether sodium picosulphate (NaPico) can be used as an adequatealternative when the bowel is cleansed prior to colonoscopy in children.Three of the studies were interview studies (Papers I, II, & IV) with childrenand parents as participants. The data from 17 children and 12 parents (PapersI & II) was analysed using content analysis, and a phenomenologicalhermeneutic method was used when 7 children (Paper IV) were interviewed.The children’s experiences prior to colonoscopy (Paper I) were identified asbelonging to an overall theme, A private affair, which could be divided intofour categories: Preparing yourself, Mastering the situation, Reluctantlyparticipating, and Feeling emotional support. The result from the parents’ experiences when their child is undergoing an elective colonoscopy wasstructured into one theme, Charged with conflicting emotions, with threecategories: Being forced to force, Losing one’s sense of being a parent, andStanding without guidance (Paper II). The initial findings from these empirical studies undertaken served as apreparation for another study, aimed at comparing the quality of bowelcleansing using either PEG or sodium picosulphate (NaPico) in relation to thetolerability and acceptance of the laxatives among children and theiraccompanying parents (Paper III). This study was a randomised controlledtrial (RCT) that was conducted as an investigator-blinded study within theDepartment of Paediatrics at a university hospital in Sweden(www.clinicaltrials.gov, identifier NCT02009202). A total of 72 children wererandomly placed into one of two groups (PEG or NaPico). The Ottawa BowelPreparation Quality Scale (OBPQS) was used to evaluate the quality of thebowel cleansing. Two different questionnaires were used to evaluate both theacceptability and the tolerability of the laxatives. In total, 67 protocols wereanalysed according to the OBPQS. No significant difference in bowelcleansingquality was detected between the two groups. However, rates ofacceptability and tolerability were significantly higher in the NaPico group than in the PEG group, according to both the children and the parents. Finally, in order to illuminate the meaning of children’s lived experience ofIBD, an interview study with seven children was conducted. The meaning oftheir lived experience of IBD was interpreted as A daily struggle to adapt andto be perceived as normal. This interpretation was discussed in relation toIngmar Pörn’s theory of adaptedness (Paper IV). The findings point to the conclusion that both children’s and parents’perspectives are important, in order to improve the paediatric colonoscopy.The children (10-18 years) with symptoms of, or diagnosed with, IBD werereluctant to talk about their problems, including colonoscopy. However, theywere willing to share their experiences in order to help other children withsimilar problems, or in order to influence and improve paediatric care. Itemerged that both children and parents need to feel confident in their dealingswith healthcare professionals and to feel that healthcare professionals taketheir opinions seriously when preparing the child for colonoscopy. It is also important that the children have the opportunity to choose thebowel-cleansing protocol. NaPico can be recommended as the option forbowel cleansing in children aged 10 years and older. The meaning that can beextracted from the children’s experience of IBD is that they are struggling toadapt and to be perceived as normal. This is a conscious process entailing aconfrontation with various problems, such as ambitions and goals that arehard to achieve, due to reduced abilities resulting from the illness or from aninsufficiently adapted environment.

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

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.

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