Twenty-first century transformations have taken place within the framework ofglobalisation of the economy, the spread of information technology and global migrationresulting in increased cultural diversity in many societies. This qualitative studyinvestigated perspective transformation in 18 research students, from Australia, HongKong SAR, and Sweden, participating in an international online course by using Mezirow’stheory of perspective transformation and Kiely’s six forms of transformativechange (intellectual, moral, political, cultural, personal, and spiritual). The approach tolearning facilitated global networking and a commitment to support growth in thestudents’ research practice. Validating the link between research students’ learningexperiences and perspective transformation theory encourages educators to developfuture online educational materials to promote cognitive flexibility and reflexivity andincrease students’ cultural awareness to inform their research practices.

BackgroundIn endoscopic care, favourable patient experiences before, during and after a colonoscopy are essential for the patient's willingness to repeat the procedure. To ensure that significant experiences are measured, patients should be involved in creating the measurement instruments. Thus, the aim of the present study was to develop a colonoscopy-specific PREM by (1) operationalising patient experiences before, during and after a colonoscopy procedure and (2) evaluating its content validity.MethodsThe colonoscopy-specific PREM was developed in two stages: (1) operationalisation with item generation and (2) content validity testing. A previously developed conceptual model, based on a systematic literature review that illustrates patients' (n = 245) experiences of undergoing a colonoscopy, formed the theoretical basis. To assess the degree to which the PREM reflected patients' experiences before, during and after a colonoscopy procedure, content validity was tested-through face validity with healthcare professionals (n = 4) and cognitive interviews with patients (n = 14) having experienced a colonoscopy. Content validity index (CVI) was calculated to investigate the relevance of the items.ResultsThe Patient Experience Colonoscopy Scale (PECS) is a colonoscopy-specific PREM consisting of five different constructs: health motivation, discomfort, information, a caring relationship and understanding. Each construct was defined and generated into a pool of items (n = 77). After face-validity assessment with healthcare professionals, a draft 52-item version of the PECS was ready for content validity testing by the patients. During cognitive interviews the patients contributed valuable insights that led to rewording and removal of items. Results from the CVI suggest that the PECS and its content are relevant (I-CVI range 0.5-1, S-CVI/Ave = 0.86). The final PECS consists of 30 items representing a colonoscopy-specific PREM.ConclusionThe PECS is a new 30-item PREM instrument designed for adult elective colonoscopy patients after they have undergone the procedure. Each item in the PECS derives from a conceptual model based on a systematic literature review. Patients and healthcare professionals were involved in developing the PECS, which measures colonoscopy-specific patient experiences before, during and after the procedure. The content validity testing positively contributed to the development of the PECS. Psychometric properties need to be evaluated further.

BACKGROUND: Thoracoabdominal aortic aneurysms (TAAA) pose significant risks of morbidity and mortality. Considering the evolving techniques for TAAA intervention and the growing interest in quality of life (QoL) outcomes for decision-making, we aimed to evaluate the impact of patient and perioperative characteristics on short-, medium-, and long-term post-operative QoL in TAAA repair patients.

METHODS: A systematic search was conducted in CINAHL, APA PsycINFO, EMBASE, Medline and Cochrane to identify primary research studies evaluating QoL post TAAA surgery, published in English or Swedish between 01 January 2012 and 26 September 2022. A narrative synthesis was reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement. The quality of evidence was assessed using the Critical Appraisal Skills Programme and Joanna Briggs Institute checklists.

RESULTS: Eight studies of low or moderate quality with 455 patients were included. Preoperative QoL in TAAA patients was lower compared to the general population. While there is an initial short-term improvement in post-operative QoL, patients fail to reach baseline levels even after seven years, with physical activity and functioning domains being particularly affected. Experiencing post-operative complications, including paraplegia and cardiovascular events, negatively impacts post-operative QoL. Patients with uncomplicated postoperative status had improved QoL. Prolonged hospital stay negatively affects physical functioning.

CONCLUSIONS: Individuals with TAAA are likely to have lower baseline QoL compared to the general population. Following TAAA repair, post-operative QoL may remain lower than baseline levels, persisting over the long-term. Comorbidities, post-operative complications, and hospitalisation duration appear to exert adverse effects on post-operative QoL.

Introduction: An increasing population and a shortage of identified potential organ donors are causing the waiting list fororgan transplants to grow continuously. Donation after circulatory death (DCD) is a method aimed at meeting the demandfor transplantable organs. However, it presents new challenges in nursing care, and there is a lack of studies investigatingnurses’ attitudes and knowledge of DCD.Objective: The objective of this study was to determine and describe intensive care nurses’ (ICNs’) knowledge, attitudes,and views on DCD before a national implementation in Sweden.Method: This study utilized a cross-sectional mixed-method design. A convenience sampling method was employed, targetingICNs working in four intensive care units in Sweden. A study-specific tool comprising fixed and free-text questions was developed.Fifty-one ICNs participated. Data were analyzed descriptively, and correlation analysis was performed using Spearman’scorrelation. Free-text answers were qualitatively assessed and analyzed. An integrated analysis was conducted to synthesizethe quantitative and qualitative findings.Results: Fifty-three percent reported limited knowledge about DCD. Nurses with previous education on DCD had significantlyhigher knowledge (r=.380, p=.006), were more engaged with the public debate on organ donation (r =.423, p=.002),and considered the ethical aspects of DCD more thoroughly (r=.386, p=.022). The qualitative analysis identified four keycategories: The importance of the team, the need for ethical discussions, increased knowledge of DCD, and unanswered questions andunmet needs. The integrated analysis underscored the need for targeted education, clear guidelines, and ongoing ethical discussionsto prepare ICU nurses for DCD.Conclusion: Nurses educated in organ donor care had better knowledge and a more positive attitude toward DCD implementation.The study also highlights the importance of interprofessional teamwork in DCD implementation. The findings suggest that education on DCD could improve the identification and implementation of DCD donors, addressing the globalshortage of transplantable organs.

Introduction: To minimize the risk of developing foot-ulcers, persons with diabetes are given the advice to daily inspect their feet and to apply skincare formulations. However, commercially available skincare products have rarely been developed and evaluated for diabetes foot care specifically. The primary aim of this randomized controlled trial (RCT) is to evaluate the effects in reducing foot xerosis in persons with diabetes without footulcers using two skincare creams containing different humectants (interventions) against a cream base nonhumectant (comparator). Secondary outcomes are to evaluate differences on skin barrier integrity, lowmolecular weight biomarkers and skin microbiota, microcirculation including transcutaneous oxygen pressure, degree of neuropathy, and HbA1c between intervention-comparator creams. Methods: Two-armed double-blind RCT, registered in ClinicalTrials.gov Identifier: NCT06427889. With 80 % power, two-tailed significance of 2.5 % in each arm, 39 study persons is needed in each arm, total 78 persons, 98 including dropouts, to be able to prove a reduction of at least one category in the Xerosis Severity Scale with the intervention creams compared to the comparator. In one arm, each participant will treat one foot with one of the intervention creams (Oviderm (R) or Canoderm (R)), while the opposite foot will be treated with the comparator cream (Decubal (R) lipid cream), twice a day. If needed, participants are enrolled after a wash-out period of two weeks. The participants will undergo examinations at baseline, day 14 and day 28. Discussion: This RCT evaluate the potential effects of humectants in skin creams against foot xerosis in persons with diabetes.

Aim: The aim was to identify planned and completed preventive interventions among older persons with oral health problems receiving municipal health care. A further aim was to determine the correspondence between oral health problems and planned preventive interventions among older persons with oral health problems receiving municipal health care. Design: Cross-sectional register study. Methods: Oral health data from the Swedish national quality registry, Senior Alert, were extracted for 4,024 older persons (>= 65 years) receiving municipal health care in a county in Southern Sweden. Data were statistically analysed. Results: A large majority of older persons (97.4%) with assessed oral health problems had at least one planned preventive intervention, and approximately three quarters of the planned interventions were completed. There seemed to be a mismatch between type of oral health problems and preventive interventions as not all older persons had a planned preventive intervention related to their specific oral health problem.

BackgroundAlthough dietary adjustments are recommended frequently for bowel symptoms, evidence of diet's impact on bowel function is lacking. The aim was to develop a patient-reported outcome instrument, for children with and without Hirschsprung's disease (HD), to explore experiences of dietary effects on bowel function.MethodsChildren with and without HD and their parents participated. Questionnaire items regarding the impact of diet on bowel function originated from focus group discussions. Specific food items, reported in the literature or in focus groups to cause bowel functional effects, were listed requesting each item's effect size and effect type. Content validity was tested within two separate semistructured interviews. A pilot test was performed. Assessing comprehension, relevance and wording clarity structurally, revisions were made accordingly. Children's bowel function was assessed through the validated Rintala Bowel Function Score.ResultsA total of 13 children with and without HD, median age 7 (range 2-15) years, and 18 parents participated in the validation. Each question's relevance had been ranked highly early in the validation process but most questions needed refining for improving clarity and comprehension. Wordings regarding bowel symptoms and emotions connected to food in particular were perceived to be sensitive and complex. Specifically wording regarding some bowel symptoms (gases, pain) and parental stress emotions (guilt, ambivalence) were, consistent with participants' opinions, subjected to multiple step revisions. Following the validation process, which included two semistructure interviews with different participants and then a pilot test with a third cohort, a full track overview of changes and rewording made in all steps of the validation process was presented. The final questionnaire then comprised 13 questions assessing foods' significance for bowel function, emotions, social impact and 90 specific food items' possible effects and effect sizes on bowel function.ConclusionsThe Diet and Bowel Function questionnaire, enabling answering by children, was developed and the content validated qualitatively. This report presents insights into the whole validation process, declaring reasons for the selected question- and answering options, and their wordings. The Diet and Bowel Function questionnaire can be used as a survey questionnaire to enhance understanding of dietary effects on bowel function in children, and its results can be supportive in improving dietary-treatment programs.

AIM: Identify and describe areas of concern focusing on day-to-day variations during the first month after surgery for patients recovering from colorectal cancer surgery.

DESIGN: A multi-method design was applied using diaries and interviews.

METHOD: Data was collected using semi-structured diaries kept 1 month after surgery by seven patients recovering from colorectal cancer surgery. Also, face-to-face interviews were conducted 1 month after surgery. Data from the diaries constituted a framework for the following directed content analysis of interviews.

FINDINGS: Low levels of pain were experienced but caused reduced mobility and tiredness. Practical matters in daily living were restricted, while social life could be hampered by a frequent need to defecate. Appetite and consequently the ability to eat and drink was the most prominent concern, due to changes in taste and ability to tolerate food. Worries were mainly related to changes in bowel movements. No Patient or Public Contribution.

Background: Patients with intermittent claudication need lifelong treatment with secondary prevention to prevent cardiovascular events and progression of atherosclerotic disease. Illness perception, health literacy, self-efficacy, adherence to medication treatment, and quality of life are factors influencing patients' self-management. Knowledge of these factors could be important when planning for secondary prevention in patients with intermittent claudication.

Aim: to compare illness perception, health literacy, self-efficacy, adherence to treatment, and quality of life in in patients with intermittent claudication.

Methods: A longitudinal cohort study was conducted with 128 participants recruited from vascular units in southern Sweden. Data were collected through medical records and questionnaires regarding illness perception, health literacy, self-efficacy, adherence to treatment, and quality of life.

Results: In the subscales in illness perception, patients with sufficient health literacy reported less consequences and lower emotional representations of the intermittent claudication. They also reported higher self-efficacy and higher quality of life than patients with insufficient health literacy. In comparison between men and women in illness perception, women reported higher illness coherence and emotional representations associated with intermittent claudication compared to men. A multiple regression showed that both consequences and adherence were negative predictors of quality of life. When examining changes over time, a significant increase in quality of life was seen between baseline and 12 months, but there were no significant differences in self-efficacy.

Conclusion: Illness perception differs in relation to level of health literacy and between men and women. Further, the level of health literacy seems to be of importance for patients' self-efficacy and quality of life. This illuminates the need for new strategies for improving health literacy, illness perception, and self-efficacy over time. For example, more tailored information regarding secondary prevention could be provided to strengthen self-management to further improve quality of life in patients with intermittent claudication.

Introduction: Social determinants of health impact health, and migrants are exposed to an inequitable distribution of resources that may impact their health negatively, leading to health inequality and social injustice. Migrant women are difficult to engage in health-promotional activities because of language barriers, socioeconomic circumstances, and other social determinants. Based on the framework of Paulo Freire, a community health promotion program was established in a community-academic partnership with a community-based participatory research approach.

Aim: The aim of this study was to describe how a collaborative women's health initiative contributed to migrant women's engagement in health promotion activities.

Materials and methods: This study was part of a larger program, carried out in a disadvantaged city area in Sweden. It had a qualitative design with a participatory approach, following up on actions taken to promote health. Health-promotional activities were developed in collaboration with a women's health group, facilitated by a lay health promoter. The study population was formed by 17 mainly Middle Eastern migrant women. Data was collected using the story-dialog method and the material was analyzed using thematic analysis.

Result: Three important contributors to engagement in health promotion were identified at an early stage of the analysis process, namely, the group forming a social network, the local facilitator from the community, and the use of social places close to home. Later in the analysis process, a connection was made between these contributors and the rationale behind their importance, that is, how they motivated and supported the women and how the dialog was conducted. This therefore became the designated themes and were connected to all contributors, forming three main themes and nine sub-themes.

Conclusion: The key implication was that the women made use of their health knowledge and put it into practice. Thus, a progression from functional health literacy to a level of critical health literacy may be said to have occurred.

OBJECTIVES: To describe the development of a codesigned complex intervention intended to prevent the risks of pressure ulcers, malnutrition, poor oral health and falls among older persons in nursing homes.

DESIGN: : Nursing homes in the municipality in southern Sweden.

PARTICIPANTS: End users (n=16) in nursing homes (n=4) codesigned the intervention together with the research group in workshops (n=4) in March-April 2022. Additionally, stakeholders (n=17) who were considered to play an important role in developing the intervention participated throughout this process. Data were analysed using reflexive thematic analysis.

RESULTS: Four workshops were conducted with end users (n=16) and 13 meetings with stakeholders (n=12) were held during the development process. The intervention aims to bridge the evidence-practice gap regarding the preventive care process of the risks of pressure ulcers, malnutrition, poor oral health and falls among older persons in nursing homes. The intervention is aimed at end users, lasts for 3 weeks and is divided into two parts. First, end users obtain knowledge on their own by following written instructions. Second, they meet, interact and discuss the knowledge acquired during part 1.

CONCLUSION: The intervention is robustly developed and thoroughly described. The study highlights the extensive process that is necessary for developing tailored complex interventions. The description of the entire development process may enhance the replicability of this intervention. The intervention needs to be tested and evaluated in an upcoming feasibility study.

TRIAL REGISTRATION NUMBER: NCT05308862.

Background: Intermittent claudication requires treatment with secondary prevention to reduce disease progression and the risk of cardiovascular events and to improve quality of life. Health literacy and self-efficacy are important preconditions for the health behaviour changes necessary for adhering to secondary prevention.

Aim: Evaluate health literacy in patients with intermittent claudication regarding clinical characteristics, demographics, self-efficacy and quality of life.

Methods: A cross-sectional study evaluating health literacy, self-efficacy and quality of life using questionnaires. Patients with intermittent claudication from vascular units in the south of Sweden were included.

Results: In total, 158 patients were included, of which, 52.5% reported “inadequate” (0-8 points) or “problematic” (9-12 points) health literacy with no differences between men and women. A significant higher proportion of patients living alone reported “inadequate” or “problematic” health literacy than “sufficient” (13-16 points) health literacy. Patients with “sufficient” health literacy reported significantly higher self-efficacy and quality of life and were more physically active than patients with “inadequate” or “problematic” health literacy. Also, patients with a university degree reported a significantly higher ability to “access” (seek, find and obtain) and “understand” (comprehend the accessed) information relevant to health.

Conclusion: The majority of patients with intermittent claudication have “inadequate” or “problematic” health literacy. Also, an “inadequate” or “problematic” health literacy level is more common among patients living alone, and education level appears to be more important when “accessing” and “understanding” information relevant to health. This illuminates the importance of not only the patients’ health literacy but also demographics when planning for secondary prevention.

PURPOSE: The COVID-19 pandemic revealed a global urgency to address health care provision disparities, which have largely been influenced by systematic racism in federal and state policies. The World Health Organization recommends educational institutions train clinicians in cultural competence (CC); however, the mechanisms and interacting social structures that influence individuals to achieve CC have received little attention. This review investigates how postgraduate health and social science education approaches CC and how it accomplishes (or not) its goals.

METHOD: The authors used critical realism and Whittemore and Knafl's methods to conduct a systematic integrated review. Seven databases (MEDLINE, CINAHL, PsycINFO, Scopus, PubMed, Web of Science, and ERIC) were searched from 2000 to 2020 for original research studies. Inclusion criteria were: the use of the term "cultural competence" and/or any one of Campinha-Bacote's 5 CC factors, being about postgraduate health and/or social science students, and being about a postgraduate curriculum or a component of it. Thematic analysis was used to reveal the mechanisms and interacting social structures underlying CC.

RESULTS: Thirty-two studies were included and 2 approaches to CC (themes) were identified. The first theme was professionalized pedagogy, which had 2 subthemes: othering and labeling. The second theme was becoming culturally competent, which had 2 subthemes: a safe CC teaching environment and social interactions that cultivate reflexivity.

CONCLUSIONS: CC conceptualizations in postgraduate health and social science education tend to view cultural differences as a problem and CC skills as a way to mitigate differences to enhance patient care. However, this generates a focus on the other, rather than a focus on the self. Future research should explore the extent to which insight, cognitive flexibility, and reflexivity, taught in safe teaching environments, are associated with increasing students' cultural safety, cultural humility, and CC.

Patient experience is defined as a major quality indicator that should be routinely measured during and after a colonoscopy, according to current ESGE guidelines. There is no standard approach measuring patient experience after the procedure and the comparative performance of the different colonoscopy-specific patient-reported experience measures (PREMs) is unclear. Therefore, the aim was to develop a conceptual model describing how patients experience a colonoscopy, and to compare the model against colonoscopy-specific PREMs. A systematic search for qualitative research published up to December 2021 in PubMed, Cochrane, CINAHL, and PsycINFO was conducted. After screening and quality assessment, data from 13 studies were synthesised using meta-ethnography. Similarities and differences between the model and colonoscopy-specific PREMs were identified. A model consisting of five concepts describes how patients experience undergoing a colonoscopy: health motivation, discomfort, information, a caring relationship, and understanding. These concepts were compared with existing PREMs and the result shows that there is agreement between the model and existing PREMs for colonoscopy in some parts, while partial agreement or no agreement is present in others. These findings suggest that new PREMs for colonoscopy should be developed, since none of the existing colonoscopy-specific PREMs fully cover patients' experiences.

Aim To establish outcomes of a priority setting partnership between participants with diabetes mellitus and clinicians to identify the top 10 research priorities for preventing and treating diabetic foot ulcers (DFUs). Methods Due to the COVID-19 pandemic, the James Lind Alliance Priority Setting Partnership process was adapted into a digital format which involved a pilot survey to identify understandable uncertainties with high relevance for participants tested by calculating the content validity index; a main survey answered by 53 participants living with diabetes and 49 clinicians; and a final digital workshop to process and prioritise the final top 10 research priorities. Results The content validity index was satisfactory for 20 out of 25 uncertainties followed by minor changes and one additional uncertainty. After we processed the 26 uncertainties from the main survey and seven current guidelines, a list of 28 research uncertainties remained for review and discussion in the digital workshop. The final top 10 research priorities included the organisation of diabetes care; screening of diabetes, impaired blood circulation, neuropathy, and skin properties; vascular surgical treatment; importance of self-care; help from significant others; pressure relief; and prevention of infection. Conclusion The top 10 research priorities for preventing and treating DFUs represent consensus areas from persons living with diabetes and clinicians to guide future research. These research priorities can justify and inform strategic allocation of research funding. The digitalisation of James Lind Alliance methodology was feasible.

The number of older people needing care is increasing, and care is often provided by informal caregivers. The mission of family care advisors (FCAs) is to provide them with support; however, whether and how support in existential matters such as existential loneliness is provided is unclear. Therefore, the aim of this study was to describe FCAs’ views on existential loneliness, and existential support provided to relatives who act as informal caregivers to older people. A national survey was distributed to 349 FCAs in Sweden, response rate n = 120 (36%). The STROBE checklist was followed when presenting the study. Existential loneliness was viewed as thoughts about life and meaning (78%). Existential support was provided by dialogues (87%), visits (75%) and support groups (73%); 45% of FCAs stated that they had time to provide existential support and 27% reported having knowledge of how to encounter existential loneliness. FCAs provide existential support, but often lack experience, knowledge and time. Time and knowledge are important prerequisites for acknowledging existential needs. 

Interprofessional Education (IPE) is essential to prepare future health-care professionals for collaborative practice, but IPE requires evaluation. One psychometrically sound instrument is the Interprofessional Education Collaborative Competence Self-Efficacy Tool consisting of nine items (IPECC-SET 9). This tool does not, to date, exist in a Swedish version. Therefore, the aim of this study was to translate and validate the Swedish version of the IPECC-SET 9. The English version was translated into Swedish and tested among 159 students in the 3-year Bachelor Programs in Nursing and in Biomedical Laboratory Science. The psychometric analysis was guided by a Rasch model, which showed that the items functioned well together, confirming unidimensionality, and that the person misfit was also lower than the set criterion. The separation index was 2.98, and the Rasch-equivalent Cronbach-alpha measure was estimated to .92, supporting internal consistency. No systematic differences on item level in IPECC-SET 9 further supported fairness in testing. The Swedish IPECC-SET 9 demonstrates sound psychometric properties and has the potential to be used as a measure of self-efficacy for competence in interprofessional collaborative practice among health profession students. However, the IPECC-SET 9 is recommended to be further tested in larger samples representing the entirety of health-care teams.

Background Migrants are often more vulnerable to health issues compared to host populations, and particularly the women. Therefore, migrant women's health is important in promoting health equity in society. Participation and empowerment are central concepts in health promotion and in community-based participatory research aimed at enhancing health. The aim of this study was to identify conditions for health promotion together with women migrants through a community-based participatory research approach. Methods A community-based participatory research approach was applied in the programme Collaborative Innovations for Health Promotion in a socially disadvantaged area in Malmo, Sweden, where this study was conducted. Residents in the area were invited to participate in the research process on health promotion. Health promoters were recruited to the programme to encourage participation and a group of 21 migrant women participating in the programme were included in this study. A qualitative method was used for the data collection, namely, the story-dialogue method, where a process involving issue, reflections and actions guided the dialogues. The material was partly analysed together with the women, inspired by the second-level synthesis. Results Two main health issues, mental health and long-term pain, were reflected upon during the dialogues, and two main themes were elaborated in the process of analysis: Prioritising spare time to promote mental health and Collaboration to address healthcare dissatisfaction related to long-term pain. The women shared that they wanted to learn more about the healthcare system, and how to complain about it, and they also saw the togetherness as a strategy along the way. A decision was made to start a health circle in the community to continue collaboration on health promotion. Conclusions The community-based participatory research approach and the story dialogues constituted an essential foundation for the empowerment process. The health circle provides a forum for further work on conditions for health promotion, as a tool to support migrant women's health.

BACKGROUND: Patients with chronic diseases create their own subjective beliefs about their conditions based on their illness perceptions. In the common-sense model, illness perceptions constitute personal beliefs about illness with regard to five components: identity, timeline, cause, control/cure, and consequences. Patients' illness perceptions affect both their management of their disease and their adherence to treatment. Since patients with peripheral arterial disease need life-long treatment for secondary prevention, generating knowledge about illness perceptions in patients with peripheral arterial disease is essential.

OBJECTIVES: To systematically review and synthesise the literature on illness perceptions in patients with peripheral arterial disease.

DESIGN: A systematic review DATA SOURCES: PubMed, CINAHL, and PsycINFO.

REVIEW METHODS: A systematic search strategy was conducted in December 2017, with an update in July 2019. Two team members independently screened all titles and abstracts. A relevance and quality appraisal of the studies was performed. The references from the included studies were evaluated for additional studies. The data from 14 studies were extracted and synthesised using a "best-fit" approach to framework analysis. A deductive analysis was conducted using the common-sense model. The data not suitable for the framework were analysed separately using inductive conventional content analysis, yielding an additional component representing the retrospective consequences of peripheral arterial disease.

FINDINGS: The findings showed diversity in illness perceptions in each of the five components of the framework as well as in the additional component. The findings showed participants' lack of understanding of the chronic nature of the disease, i.e., about the timeline, the identity of the symptoms and the cause of the disease. The patients' beliefs about control and cures varied from having high motivation to engage in physical activity to thinking that walking could make their situations worse. There was fear about the future, as patients perceived disease progression and decreasing control to be consequences of their illness. Living with the disease, the emphasis in the additional component, was a process for regaining control and adapting to their situations.

CONCLUSIONS: Patients with peripheral arterial disease shape their own understandings of their conditions. These beliefs may influence their management of their disease and adherence to treatment. Therefore, the current study suggests that illness perceptions should be addressed when planning secondary prevention for patients with peripheral arterial disease.

Although colonoscopy is a common examination, there is limited research focusing on how patients experience this procedure. It is important that a colonoscopy is tolerated, as it may lead to lifesaving diagnostics and treatment. This study aims to explore adult patients' experience of undergoing a colonoscopy regarding the time prior to, during, and after the procedure. This was a qualitative study with individual interviews (n = 24) and a purposeful sample that was analyzed using thematic analysis. The analysis revealed four themes. The first, "making up one's mind," describes how the participants gathered information and reflected emotionally about the forthcoming procedure. The hope of clarification motivated them to proceed. In the theme "getting ready," self-care was in focus while the participants struggled to follow the instructions and carry out the burdensome cleansing. The next theme, "going through," illuminates' experiences during the colonoscopy and highlights the importance of feeling involved and respected. The last theme, "finally over," is characterized by experiences of relief, tiredness, and a desire for clarity. The healthcare professionals' ability to meet the participants' needs is vital, given that the experiences are highly individual. These findings contribute to a variegated image of how patients experience the process of undergoing a colonoscopy.

BACKGROUND: Although pressure ulcers, malnutrition, poor oral health and falls are common among older persons, causing deteriorated health status, they have not been studied altogether among older persons receiving different types of municipal health care. The aim of this study was to determine the prevalence of risk for pressure ulcers, malnutrition, poor oral health and falls among older persons aged ≥65 years receiving municipal health care in southern Sweden.

METHODS: A retrospective cross-sectional study (n = 12,518 persons aged ≥65 years) using data from the national quality registry Senior Alert was conducted. The prevalence of risk for pressure ulcers, malnutrition, poor oral health and falls was calculated based on categorical data from the instruments available in Senior Alert. T-tests, chi-square test, the Mantel- Haenszel test and logistic regression models were performed.

RESULTS: The prevalence of risk for pressure ulcers, malnutrition, poor oral health and falls was 27.9, 56.3, 34.2 and 74.5% respectively. Almost 90% of the older persons had at least one health risk. The prevalence of risk for pressure ulcers, poor oral health and falls was significantly higher in dementia care units compared to short term nursing care, home health care and nursing homes. The prevalence of risk for malnutrition was significantly higher among older persons staying in short term nursing care compared to other types of housing. The odds of having a risk for malnutrition were higher in short term nursing care compared to other types of housing. The oldest age group of 95-106 years had the highest odds of having a risk for falls. The presence of multiple health risks in one subject were more common in dementia homes compared to nursing homes and home health care but not compared to short term nursing care.

CONCLUSION: The prevalence of risk for pressure ulcers, malnutrition, poor oral health and falls was high, implying that these health risks are a great concern for older persons receiving municipal health care. A comprehensive supporting preventive process to prevent all the investigated health risks among older persons receiving municipal health care is recommended.

Background: Despite available knowledge how to prevent the risk of pressure ulcers, malnutrition, poor oral health and falls among older persons in nursing homes, these risks still frequently occur and cause a major burden for older persons; furthermore, for the health care system, they are extremely costly. One way to combat these risks is to register the prevention process in quality registries. However, the increasing older population worldwide is going to put high demands on those working with this group of people. Objective: To explore how nurse aides, registered nurses and managers in nursing homes experience working with the prevention of pressure ulcers, malnutrition, poor oral health and falls in general and according to the quality register Senior Alert care process. Methods: A qualitative study was conducted in nursing homes in a municipality in southern Sweden. We purposively sampled nurse aides, registered nurses and managers (n = 21) working in nursing homes registered in the quality register Senior Alert, who then participated in one of five focus group semistructured digital interviews held between February and April 2020. The interviews were audio recorded. Data were analysed using reflexive thematic analysis. Results: Our findings explore how nurse aides, registered nurses and managers experience working with the prevention of pressure ulcers, malnutrition, poor oral health and falls in nursing homes both in general and according to Senior Alert. The following four themes were generated during the analysis: (1) is included in the everyday work, (2) requires team effort, (3) requires handling many challenges and (4) requires finding strategies. Conclusion: The prevention of pressure ulcers, malnutrition, poor oral health and falls among older persons in nursing homes is complex. There is a commitment and responsibility among nurse aides, registered nurses and managers regarding preventive work and team effort, and finding useful strategies is necessary for the work to be successful. However, challenges, both at the individual and organizational levels, are involved, which implies that smoother organizational routines facilitating this preventive work are needed. Although nurse aides, registered nurses and managers are good at finding strategies that facilitate this work, one of the main challenges seems to lie in the variety of knowledge found among those working in nursing homes, particularly among nurse aides. This challenge was voiced by all the professionals, which suggests the need for a tailored educational intervention aimed at increasing the related knowledge among those working in nursing homes to enhance preventive work.

BACKGROUND: Despite healthcare scholars valuing diversity, current cultural awareness training does not address mechanisms that drive societal patterns, that generates cultural insensitivity and reinforces stereotypes of minority groups. The influence of culture on thinking is an important issue because of potential ethnocentric biases on the design, data collection, analysis, and dissemination of research.

OBJECTIVES: Using internationalization-at-home activities to explore the mechanisms that enhance the development of cultural awareness in postgraduate health and social science research students.

DESIGN AND METHODS: A pragmatic critical realist study, qualitatively dominant, using mixed-methods to integrate and analyze qualitative and quantitative data. Data were collected pre- and post-internationalization-at-home activities. Qualitative data were collected from online discussion forums and focus groups, and quantitative data were collected from a pre-test and post-test measure of cultural awareness.

SETTING AND PARTICIPANTS: Eighteen research students in postgraduate health and social science programs from three universities (Australia, Hong Kong, and Sweden) participated in five formal internationalization-at-home webinars and informal international group activities.

RESULTS: Participants reported four mechanisms counteracting structures (i.e., ethnocentric biases) toward the emergence of cultural awareness: 1. awareness of cultural issues motivating people toward achieving a common goal; 2. reflexivity within psychological safety; 3. deliberations that challenge the veracity of individual assumptions; 4. courage coupled with curiosity. When some or all the mechanisms occurred, properties of enhanced cultural awareness emerged, as confirmed by the quantitative data.

CONCLUSIONS: Cultural awareness training should emphasize social relations to allow cultural safety to develop for postgraduate health and social science research students. Without skills revealing unconsciously held ethical values, this study argues that postgraduate health and social science students may inadvertently reconstitute and reinforce in their research the discrimination of underserved groups.

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

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

DESIGN: Qualitative descriptive design.

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

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

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

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

BACKGROUND: Cultural awareness and cultural competence have become important skills in higher education as populations continue to grow in diversity around the world. However, currently, there are few instruments designed to assess student awareness of the aspects of culture, and the existing instruments need further development and testing for use with different target populations. Therefore, the aim of this study was to test the psychometric properties of a modified version of the Cultural Awareness Scale (CAS) for use in higher education within the health and social care fields.

METHODS: A modified version of the CAS was developed, which was tested psychometrically using cross-sectional data. In total, 191 undergraduate students from different health and social care undergraduate programs in Sweden and Hong Kong responded to a call to test the modified instrument.

RESULTS: The results showed that the modified CAS is a four-factor measure of cultural awareness and possesses satisfactory internal consistency. Results also support the use of the modified CAS as a generic tool to measure cultural awareness among students in higher education within the health and social care fields.

CONCLUSION: The modified CAS showed satisfactory psychometric properties and can be recommended as a generic tool to measure cultural awareness among students in higher education within the health and social care fields. However, further psychometric testing on the effectiveness of the modified CAS as a tool to evaluate the efficacy of cultural awareness interventions is required.

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

Objectives: The aim of this study was to establish the top 10 research uncertainties in aortic dissection together with the patient organization Aortic Dissection Association Scandinavia using the James Lind Alliance concept. Methods: A pilot survey aiming to identify uncertainties sent to 12 patients was found to have high content validity (scale content validity index = 0.91). An online version of the survey was thereafter sent to 30 patients in Aortic Dissection Association Scandinavia and 45 caregivers in the field of aortic dissection. Research uncertainties of aortic dissection were gathered, collated and processed. Results: Together with research priorities retrieved from five different current guidelines, 94 uncertainties were expressed. A shortlist of 24 uncertainties remained after processing for the final workshop. After the priority-setting process, using facilitated group format technique, the ranked final top 10 research uncertainties included diagnostic tests for aortic dissection; patient information and care continuity; quality of life; endovascular and medical treatment; surgical complications; rehabilitation; psychological consequences; self-care; and how to improve prognosis. Conclusion: These ranked top 10 important research priorities may be used to justify specific research in aortic dissection and to inform healthcare research funding decisions.

Objective: This study aimed to review, summarise, and assess the available evidence regarding the impact on the quality of life (QoL) of men undergoing screening for abdominal aortic aneurysm (AAA) and attending regular follow ups. Methods: PubMed, MEDLINE, CINAHL, and PsycINFO were used for searching. The search was performed from April to July 2016, with an update in February-March 2018. The quality of the studies was appraised with respective checklists from the Critical Appraisal Skills Programme. A narrative synthesis of the included studies was performed. The analysis included studies evaluating QoL in relation to one or more of the following concepts: physical function, psychological impact and social life in men undergoing AAA screening, but excluded studies evaluating QoL in AAA patients diagnosed outside a screening program. Results: The initial results from the search were 128 articles. Duplicates were removed, titles and abstracts were screened, and 22 full text articles were collected. Based on the inclusion criteria, 11 quantitative studies were included. Inferior quality of life among men with detected AAA was identified compared to those without the diagnosis and the general population in the included studies. The self-perceived health decreased over time for the participants with AAA. Assessments after surgery showed that the participants returned to similar health as before the screening. A wide variety of factors regarding the methodologies, designs, measurements, sample sizes, and the time for the assessment were noted in the included studies. Conclusion: Quality of life is an important outcome for AAA screening and studies have been conducted in an attempt to address the imbalance between benefits and harm. However, it is still difficult to draw clear conclusions, possibly due to the heterogeneity of the original studies. Nevertheless, it is important to identify men with an AAA who develop conditions influencing their health and QoL in order to understand their care needs to further support them and improve their situation.

BACKGROUND: People with intellectual disabilities in staffed group homes often need lifelong support and dependency on others. Thereby, special demands are placed on staff and service managers to ensure opportunities for participation in everyday life. This study aims to explore how service managers promote participation in Swedish group homes for adults with intellectual disabilities. METHOD: A qualitative research design involving individual interviews with 14 service managers was used to gain an understanding of how the participation of adults with intellectual disabilities can be promoted in Swedish group homes. RESULTS: The results comprise two main themes; Creating preconditions for participation and Barriers for promotion of participation. CONCLUSIONS: Service managers experienced that promoting service user participation in group homes was an important part of their responsibility. The findings indicate that structural strategies such as coaching, supervision and reflection are important and should be further developed.

Aim: The aim was to explore planned nursing interventions and evaluations of such interventions, in older people at risk for malnutrition living in municipal residential care homes. Designs: A registry study. Methods: The study was conducted using data from the Swedish national quality registry Senior Alert. Data on all persons assessed and registered in Senior Alert living in municipal residential care homes in a mid‐sized town between January and December 2014 were subjected to statistical analysis. Results: In total, 677 nutritional risk assessments were performed among the participants (N = 587), who were between 65‐109 years. A larger proportion of women were estimated as being at risk for malnutrition compared with men. The three most common prescribed nursing interventions were nutritional treatment, dietary support and weight control; however, interventions were not prescribed for all participants at risk for malnutrition. Lesser than 50% of the interventions were evaluated, with dietary support, pharmaceutical review and weight control the three most likely to be evaluated. Further, planned interventions for participants at risk of malnutrition were implemented more often for men than for women.

Self-management programs require a range of indicators to evaluate their outcomes. The Health Education Impact Questionnaire (heiQ) was developed to meet this need. The heiQ contains 40 items with 4 response categories, representing eight scales. We developed a Swedish version of the heiQ that was tested by cognitive interviews (n = 15) and psychometrically (n = 177) using classical test theory (CTT) and Rasch measurement theory (RMT). The Swedish heiQ was easily understood by interviewees and met CTT criteria, with supported scaling assumptions (corrected item-total correlations, 0.37) and reliability (ordinal alpha 0.78). General support was demonstrated for the measurement properties of the eight heiQ scales by acceptable RMT fit. However, there were signs of malfunctioning response categories for four items in two scales, and of suboptimal item coverage of the measurement continua. The Swedish heiQ appears comparable to other available language versions. Further efforts may be needed to optimize response categories and measurement precision.

BACKGROUND: Falls are a common and often a devastating health hazard for older people, causing suffering, morbidity and mortality. Falls are costly for society in terms of both resources and direct medical costs. Although knowledge about falls and fall prevention is well known, falls among older people are still a major problem. AIM AND OBJECTIVES: The aim was to estimate the prevalence of the risk of falls among older people receiving municipal health care. A further aim was to investigate the consistency between fall risk factors and preventive nursing interventions. DESIGN: A cross-sectional register study. METHODS: Data containing risk assessments based on the Downton Fall Risk Index (DFRI) and planned interventions by the municipal health care were collected from the Swedish national quality registry, Senior Alert. Data were analysed using descriptive and analytic statistics. RESULTS: In the sample of 5,427 older people, the prevalence of the risk of falling was 79%. There was a difference in prevalence between the different types of municipal health care, sex and age. The most common preventive intervention was environment adjustments, and the least planned intervention was information/education about falls. Physical activity as an intervention was planned among 13.2% of the participants. Approximately 27% of the older people did not have any planned interventions despite being at risk of falling. Planned interventions did not always correspond with the risk factors; for instance, only 35.4% of those at risk of falling due to medication obtained pharmaceutical reviews as a preventive measure to decrease the risk. CONCLUSION: The risk of falling is common among older people, and the preventive interventions do not sufficiently follow current evidence. This implies that systematic implementation of fall-prevention guidelines is needed in municipal care. IMPLICATION FOR PRACTICE: A better match between identified risk factors and preventive interventions is warranted.

Background: Of various chronic diseases, low back pain (LBP) is the most common and debilitating musculoskeletal condition among older adults aged 65 years or older. While more than 17 million older adults in the USA suffer from at least one episode of LBP annually, approximately six million of them experience chronic LBP that significantly affects their quality of life and physical function. Since many older adults with chronic LBP may also have comorbidities and are more sensitive to pain than younger counterparts, these older individuals may face unique age-related physical and psychosocial problems. While some qualitative research studies have investigated the life experiences of older adults with chronic LBP, no systematic review has integrated and synthesized the scientific knowledge regarding the influence of chronic LBP on the physical, psychological, and social aspects of lives in older adults. Without such information, it may result in unmet care needs and ineffective interventions for this vulnerable group. Therefore, the objective of this systematic review is to synthesize knowledge regarding older adults’ experiences of living with chronic LBP and the implications on their daily lives. Methods/design: Candidate publications will be sought from databases: PubMed, CINAHL, and PsycINFO. Qualitative research studies will be included if they are related to the experiences of older adults with chronic LBP. Two independent reviewers will screen the titles, abstracts, and full-text articles for eligibility. The reference lists of the included studies will be checked for additional relevant studies. Forward citation tracking will be conducted. Meta-ethnography will be chosen to synthesize the data from the included studies. Specifically, the second-order concepts that are deemed to be translatable by two independent reviewers will be included and synthesized to capture the core of the idiomatic translations (i.e., a translation focusing on salient categories of meaning rather than the literal translation of words or phrases). Discussion: This systematic review of qualitative evidence will enable researchers to identify potential unmet care needs, as well as to facilitate the development of effective, appropriate, person-centered health care interventions targeting this group of individuals. Systematic review registration: PROSPERO 2018: CRD42018091292

Purpose: To describe patients' experiences undergoing a carotid endarterectomy (CEA) under local anesthesia. Design: Explorative qualitative design. Methods: Semistructured interviews with 15 participants who had undergone CEA under local anesthesia, analyzed by content analysis. Findings: Undergoing CEA under local anesthesia entails enduring stress with no possibility of withdrawal. Patients' lack of understanding of local anesthesia and experiencing pain and discomfort caused feelings of stress. The surgery resulted in a loss of control; patients had to surrender their autonomy to someone else. The nurse anesthetist was the link to the world outside the operating room (OR), and that nurse conveyed feelings of safety and security during the surgery. Conclusions: Patients' experiences ranged from being pleased with the surgical procedure and local anesthesia to vowing never to undergo such a procedure again. It is important to focus on the patients' experiences and feelings when choosing a method of anesthesia.

Objectives: Patient reported outcomes are increasingly used to assess outcomes after peripheral arterial disease (PAD) interventions. VascuQoL-6 (VQ-6) is a PAD specific health-related quality of life (HRQoL) instrument for routine clinical practice and clinical research. This study assessed the minimum important difference for the VQ-6 and determined thresholds for the minimum important difference and substantial clinical benefit following PAD revascularisation. Materials and methods: This was a population-based observational cohort study. VQ-6 data from the Swedvasc Registry (January 2014 to September 2016) was analysed for revascularised PAD patients. The minimum important difference was determined using a combination of a distribution based and an anchor-based method, while receiver operating characteristic curve analysis (ROC) was used to determine optimal thresholds for a substantial clinical benefit following revascularisation. Results: A total of 3194 revascularised PAD patients with complete VQ-6 baseline recordings (intermittent claudication (IC) n ¼ 1622 and critical limb ischaemia (CLI) n ¼ 1572) were studied, of which 2996 had complete VQ-6 recordings 30 days and 1092 a year after the vascular intervention. The minimum important difference 1year after revascularisation for IC patients ranged from 1.7 to 2.2 scale steps, depending on the method of analysis. Among CLI patients, the minimum important difference after 1 year was 1.9 scale steps. ROC analyses demonstrated that the VQ-6 discriminative properties for a substantial clinical benefit was excellent for IC patients (area under curve (AUC) 0.87, sensitivity 0.81, specificity 0.76) and acceptable in CLI (AUC 0.736, sensitivity 0.63, specificity 0.72). An optimal VQ-6 threshold for a substantial clinical benefit was determined at 3.5 scale steps among IC patients and 4.5 in CLI patients. Conclusions: The suggested thresholds for minimum important difference and substantial clinical benefit could be used when evaluating VQ-6 outcomes following different interventions in PAD and in the design of Clinical trials.

The prevalence of abdominal aortic aneurysm (AAA) is reported to be 2.2%-8% among men >65 years. During recent years, screening programs have been developed to detect AAA, prevent ruptures, and thereby saving lives. Therefore, most men with the diagnosis are monitored conservatively with regular reviews. The objective of the study was to describe how men diagnosed with abdominal aortic aneurysm <55 mm discovered by screening experience the process and diagnosis from invitation to 1 year after screening. A total of eleven 65-year-old men were included in three focus groups performed in a University Hospital in Sweden. These were qualitatively analyzed using manifest and latent content analysis. The experience of the screening process and having an abdominal aortic aneurysm in a long-term perspective revealed three categories: "trusting the health care system," emphasizing the need for continual follow-ups to ensure feelings of security; "the importance size," meaning that the measure was abstract and hard to understand; and "coping with the knowledge of abdominal aortic aneurysm," denoting how everyday life was based mostly on beliefs, since a majority lacked understanding about the meaning of the condition. The men want regular surveillance and surrendered to the health care system, but simultaneously experienced a lack of support thereof. Knowing the size of the aorta was important. The men expressed insecurity about how lifestyle might influence the abdominal aortic aneurysm and what they could do to improve their health condition. This highlights the importance of communicating knowledge about the abdominal aortic aneurysm to promote men's feelings of security and giving space to discuss the size of the aneurysm and lifestyle changes.

Cultural skills are fundamental to developing global academic scholars. Internationalization at home can facilitate the acquisition of these skills without students having to go abroad. However, research on the effect of internationalization of higher education is scarce, despite apparent benefits to incorporating cultural sensitivity in research. Further, little is known about the role information and communication technology plays. In this pilot study, we describe the experience of doctoral students with an internationalization‐at‐home program, and its impact on developing an understanding about different research cultures. Eight doctoral nursing students from Sweden and Hong Kong participated in five webinars as “critical friends”. The study followed a descriptive, qualitative design. The results demonstrated that students observed cultural differences in others' research training programs. However, while cultural differences reinforced friendship among local peers, they challenged engagement with critical friends. Challenges led to the perception of one another not as critical friends but as “distant” friends. We discuss the possible reasons for these outcomes, and emphasize a need to nurture connectivity and common goals. This would prepare students to identify, translate, and recognize cultural differences to help develop knowledge of diverse research cultures.

Patients may suffer from a wide range of postoperative symptoms after coronary artery bypass grafting. In-depth knowledge of the recovery process is a prerequisite for nursing interventions. However, we found no specific instrument covering the entire range and duration of postoperative symptoms related to this procedure. We therefore modified and extended the 19 items, generic Postoperative Recovery Profile questionnaire for the specific evaluation of the recovery after coronary artery bypass grafting. We here report on the development process of the new questionnaire. Procedure-specific symptoms were identified by a literature review and by experts. The content validity was assessed by healthcare professionals (n = 15), inpatients (n = 12) and outpatients (n = 4). A test run was done with inpatients (n = 10), which was followed by a test-retest reliability evaluation with inpatients (n = 24). We identified 15 new symptoms in the literature review and six in the content validity assessment. Only three of the 35 items had an acceptable content validity index, but all 35 items in the test run were reported by at least two patients. The questionnaire took 4-9 minutes to complete and was considered easy to use. The final instrument used in the reliability test included 22 new items, and 25 of the 35 items were satisfactory stable. To conclude, we developed a 35 items, procedure-specific questionnaire that was easy to use and may aid systematic assessment of the recovery after coronary artery bypass grafting.

Predictors for postoperative recovery after colorectal cancer surgery are usually investigated in relation to length of stay (LoS), readmission, or 30-day morbidity. This study describes patient characteristics and surgery-related factors associated with patient-reported recovery 1 and 6 months after surgery. In total, 153 consecutively included patients who were recovering from colorectal cancer surgery reported their level of recovery using the Postoperative Recovery Profile. Multiple logistic regression analysis was used to calculate associations with recovery, defined as good or poor, divided into five recovery dimensions: physical symptoms, physical functions, psychological, social and activity. Better preoperative health predicted good recovery regarding three dimensions 1 month after surgery. Regarding all dimensions 1 month after surgery, poor recovery was predicted by a poor recovery on the day of discharge within corresponding dimensions. Higher age was associated with good recovery 6 months after surgery, while chemotherapy showed negative associations. Overall, a majority of factors had a negative impact on recovery, but without any obvious relation to one specific dimension or point in time. Those factors were: high Body Mass Index, comorbidity, abdominoperineal resection, loop ileostomy, colostomy and LoS. This study illustrates the complexity of postoperative recovery and a need for individualised follow-up strategies.

Aims and objectives To explore experiences of negative pressure wound therapy at home, in patients with deep perivascular groin infection after vascular surgery and management in daily life. Background Deep surgical site infection after vascular surgery with exposed vessels often requires long-term treatment with negative pressure wound therapy, and continued therapy at home has become routine. Design An explorative qualitative study. Methods Nine men and six women with a deep surgical site infection in the groin after vascular surgery, treated in their home with negative pressure wound therapy, were interviewed. The interviews were analysed using manifest and latent content analysis. Results Undergoing negative pressure wound therapy at home meant a transition from being a dependent patient to a person who must have self-care competence and be involved in their own care. A need to feel prepared for this before discharge from hospital was expressed. Lack of information and feelings of uncertainty prolonged the time before feeling confident in managing the treatment. The informants gradually accepted the need to be tied up to a machine, became competent in its management and found solutions to perform everyday tasks. Overall, it was a relief to be treated at home. Conclusions Several benefits of negative pressure wound therapy at home were expressed. However, unnecessary stress and anxiety were experienced due to a lack of information on the treatment and instruction concerning the equipment. Adequate information and education must therefore be provided to facilitate the transition from a patient to a person with self-care competence and ability to manage this treatment at home. Relevance to clinical practice The findings revealed a need for more support and knowledge in their transition from hospital care to home care with negative pressure wound therapy. Routines must be established that ensure patient safety and security in treatment at home.

Screening for abdominal aortic aneurysm (AAA) has proven to reduce AAA-related mortality, but how the knowledge of having an untreated AAA affects health and daily life requires further clarification. The aim was to investigate the psychosocial consequences and sense of coherence (SOC) in 65-year-old men diagnosed with AAA and participating in a national screening program during a 6-month follow-up compared with men with no AAA. The single-center cohort study included 52 men with AAA and 118 men without AAA. A questionnaire including the Short Form 36 Health Survey, Hospital Anxiety and Depression Scale, SOC, questions concerning stress, and questions related to AAAwere answered at baseline and after 6 months. Men with AAA reported more problems with physical functioning, pain, and general health than men with a normal aorta at baseline. After 6 months, men with AAA still reported more problems with physical functioning and stress in relation to disease than men with normal aortic diameter. No differences were observed between groups in SOC, anxiety, and depression. A significantly higher satisfaction with information from the physician and desire to learn about the AAA diagnosis was reported at baseline compared with that at follow-up. Having knowledge about the AAA diagnosis may moderately impact physical health and perceived stress, and in combination with the increased prevalence of other cardiovascular diseases, may lead to impaired perceived health for men diagnosed with AAA.

AIMS AND OBJECTIVES: To describe the lived experience of recovery during the first 6 months after colorectal cancer surgery. BACKGROUND: Colorectal cancer is the third most common cancer diagnosis worldwide. Early discharge places demands on healthcare professionals to prepare patients for their return home and to provide them with appropriate support throughout the recovery process. This requires knowledge of what it is like to recover from colorectal cancer surgery. DESIGN: A qualitative phenomenological design was used to describe the structure of recovery after colorectal cancer surgery. METHODS: Ten patients recovering from colorectal cancer surgery were interviewed at one month and six months after surgery. The descriptive phenomenological method by Giorgi was used throughout the study. RESULTS: Postoperative recovery was described as a progressive process. This process was accompanied by experiences of physical powerlessness, difficulties with food intake, altered bowel function and dependency on others. The experiences were most intense at the beginning of the recovery but disappeared as time went by and normality in life returned. CONCLUSION: While recovering from colorectal cancer surgery, patients experience obstacles that impede their ability to live life as normal. Six months after surgery, those experiences disappear or become adjusted to being part of normal life. RELEVANCE TO CLINICAL PRACTICE: Patients should be provided with information about the expected postoperative recovery before discharge from hospital. The need for professional support appears to be most frequently needed in early recovery, but it should be considered on an individual basis.

Background: Many existing patient-reported outcome measures are extensive regarding both patient burden and administration, and in terms of analysing and reporting results. The VascuQoL-6 (VQ6) – a short version of the original Vascular Quality of Life Questionnaire (VascuQoL), a disease-specific instrument for peripheral arterial disease – was recently developed. However, the VQ6 has not yet been empirical tested with regard to content validity, construct validity and test retest reliability. Our aim was, therefore, to explore both the validity and the reliability of the VQ-6 in a target population with established peripheral arterial disease. Methods: Two hundred patients treated at two vascular centres were consecutively recruited for the survey. Administered questionnaires included VQ6 and the Short Form Health Survey-36 (SF-36). Out of the 200 patients, 150 also received a second VQ6 questionnaire for a test-retest assessment. Further, a purposive sample of 22 patients consented to participate in cognitive interviews. All included patients suffer from peripheral arterial disease. The questionnaire data was tested by both Rasch analysis and traditional psychometric methods, while the cognitive interviews were analysed descriptively. Results: The validity and reliability of the VQ6, as tested in a target population without the surrounding 19 items from the original VascuQoL, was high, in general, and a good fit to the Rasch model was observed. Further, an excellent internal consistency and significant correlations between comparable dimensions in SF-36 were demonstrated. In the test-retest analysis, the percentage agreement was somewhat poor (<70%) in the six items. However, no systematic disagreements between the two assessments were seen in any of the six items, and the test-retest assessment for the VQ6 sum score showed an acceptable intraclass correlation coefficient (0.86). Finally, all items in the VQ6 were considered as both understandable and relevant by the interviewed patients. Conclusions: The VQ6 has acceptable to good psychometric properties with regard to data quality, scale assumptions, targeting, validity and reliability. Further, VQ6 seems to be easy to use and comprehend within the target population of patients with PAD.

AIM: To describe and compare general health and state anxiety before surgery and up to 6 months after surgery in patients with colorectal cancer undergoing elective rectal resection, abdominoperineal resection or colonic resection in an enhanced recovery context. BACKGROUND: Little is known about patient-reported health and anxiety after colorectal cancer surgery in an enhanced recovery context. DESIGN: A prospective cohort study. METHODS: Data were collected from October 2011-February 2013. The questionnaires - EuroQol 5-Dimensions 3-Levels and State-Trait Anxiety Inventory - were answered before surgery, at discharge and 1 and 6 months after surgery. Data were analysed using inferential statistics to describe differences between groups of patients (Kruskal-Wallis test) and between assessments within groups (Friedman's anova). RESULTS: Patients (N = 105), divided into three groups based on surgical procedure, showed a high health index and a low state anxiety in all assessments without differences between the groups. Patients considered for abdominoperineal resection rated their pre-operative health as significantly higher than patients after rectal and colonic resections did. Within groups, patients recovering from abdominoperineal resection and rectal resection deteriorated significantly in health index 1 month after surgery. However, after 6 months they had improved again. After colonic resection, patients improved significantly in self-rated health and anxiety 1 month after surgery with no further discernible improvement after 6 months. CONCLUSION: The study showed that patients generally had a high level of health and a low level of anxiety throughout the study period. Only a few differences occurred between assessments within groups.

AIM: To explore improvement facilitators' experiences of handling their commission to implement evidence-based practice in elderly care for frail older persons. BACKGROUND: Improvement facilitators were put in place across Sweden in a time-limited project by the government, with one part of the project being to evaluate the model before establishing this facilitation of evidence-based practice in elderly care. METHOD: Two focus groups were interviewed twice. Each group comprised three respondents. The interviews were analysed using qualitative content analysis. FINDINGS: A main theme, 'Moving forward by adjusting to the circumstances', described how the improvement facilitators handle their commitment. Five subthemes emerged: identifying barriers, keeping focus, maintaining motivation, building bridges and finding balance. CONCLUSION: The improvement facilitators' commitment is ambiguous because of unclear leadership of, and responsibility for the national investment. They have to handle leaders' different approaches and justify the need for evidence-based practice. The improvement facilitators did not reflect on the impact of programme adaptations on evidence-based practice. IMPLICATIONS FOR NURSING MANAGEMENT: The findings emphasise the need for collaboration between the improvement facilitator and the nurse manager. To fully implement evidence-based practice, negotiations with current practitioners for adaptation to local conditions are necessary. Furthermore, the value of improving organisational performance needs to be rigorously communicated throughout the organisation

Background: Peripheral arterial disease is a chronic illness, and patients with peripheral arterial disease should receive advice about lifestyle changes and medical therapies to reduce further atherosclerotic complications. Previous research has indicated that patients with peripheral arterial disease lack information about their disease and secondary prevention measures. The aim was to elucidate how patients with peripheral arterial disease communicate their knowledge about their illness and treatments. Methods: During 2009, seven focus group interviews were conducted with twenty-one patients (50–81 years old) with peripheral arterial disease and were analysed using content analysis. Results: When respondents with PAD communicate their knowledge about the illness and its treatments they “Navigate through uncertainty, believes and facts about PAD, displaying an active or passive information-seeking behaviour”. After discharge, they felt a feeling of relief at first, which was later exchanged into uncertainty from their restricted knowledge about the illness and how to behave following revascularisation. For example, during the discussions about risk factors, smoking was noted as a major risk factor, that triggered feelings of guilt. Thus, the respondents needed to consult other sources of information to manage their everyday lives. Conclusions: Following endovascular treatment, the short amount of time spent with peripheral arterial disease patients requires innovative guidance in clinical practice to meet individuals’ needs regardless of whether the patient actively or passively understands and manages their peripheral arterial disease.

AIMS AND OBJECTIVES: The aim was to describe the experience of living with varicose veins classified according CEAP (clinical class, aetiology, anatomy, pathophysiology) as C4 (eczema or thrombophlebitis) and management of the disease in daily life. BACKGROUND: Primary chronic venous insufficiencies with varicose veins are a relatively common condition among both men and women. Several studies have shown that quality of life improved after treatment of varicose veins compared to before treatment. This suggests that patients with a milder form of varicose veins such as C4 experience a negative influence on their quality of life before treatment. DESIGN: This is an explorative qualitative study with a phenomenological approach. METHOD: A purposive sample was used, and 12 in-depth interviews were conducted with persons having superficial venous insufficiency classified C4. A descriptive phenomenological analysis was performed. RESULTS: The essence of the phenomenon of living with varicose veins classified C4 and management of the disease in daily life meant adapting to a life with varicose veins and relieve discomfort from legs with an unfavourable appearance. Coping with discomfort involved dealing with the disease emotionally and finding strategies that helped to relieve symptoms; however, living with 'repulsive' legs was seen as embarrassing, and many found the need to hide their condition. CONCLUSION: Patients with varicose veins classified C4 had notable symptoms of the disease that affected daily living. This in turn required the use of different coping strategies to manage symptoms, and significant adjustments related to activities and social life were made. RELEVANCE TO CLINICAL PRACTICE: It seems desirable that patients with varicose veins receive treatment at an earlier stage of the disease and are familiar with the tools and solutions available to alleviate symptoms and avoid a negative impact on daily life