Rationale and aims: The importance of evaluating postoperative recovery with consideration to the patient’s perspective has been emphasized. The aim of this study was to demonstrate how the recovery-specific Postoperative Recovery Profile (PRP) questionnaire can be used to evaluate patient-reported outcome measures (PROMs) after hip- and knee replacement in the enhancement of clinical quality and the person-centeredness of clinical services. Method: Patients undergoing primary total knee- and hip replacement were eligible for this longitudinal follow-up study. The participants completed the PRP questionnaire on repeated occasions. In this paper, data from Day 3 and Month 1 after discharge were used. The change in recovery, between the two measurement occasions, on item-, dimensional- and global levels, both for each patient and for the group, were evaluated. Results: A total number of 75 patients were included. One month after discharge the median PRP score was 13 (partly recovered) out of 19. Recovery changes towards lower levels of problems/difficulties were shown in both item-, dimensional- and global levels of recovery month 1 after discharge, as compared with Day 3. The group of patients was homogenous in change. Conclusions: We demonstrated that the PRP questionnaire can be used to evaluate postoperative recovery after hip- and knee replacement surgery on item-, dimensional- and global levels. Data from each recovery level can be useful for quality development and in informing increases in the person-centeredness of clinical services. The global population scores can be used to evaluate treatment effect on a group of patients. It can also be used to define endpoints in follow-up studies.

In this study we investigated whether single nucleotide polymorphisms (SNP) in the genes coding for BDNF (Val66Met) and VEGF(C2578A) may be associated with maladaptive strategies among suicide attempt patients. We found that BDNF Val66Met gene polymorphism probably affect avoidant coping strategies.

Background/Aims: Increasing evidence suggests a link between brain-derived neurotrophic factor (BDNF) and suicidal behaviour (SB). Furthermore, decreased peripheral BDNF levels have been associated with clinical symptoms in various psychiatric disorders as well as with personality dimensions in healthy individuals. However, the relationship between BDNF and psychopathology is poorly investigated regarding SB. Methods: Plasma BDNF concentrations were analysed in 61 recent suicide attempters. Clinical symptoms were evaluated using the Comprehensive Psychopathological Rating Scale. Personality dimensions were assessed using the Marke-Nyman Temperament Scale. Results: Plasma BDNF correlated positively and significantly with the personality dimension Solidity but not with the other personality dimensions or with clinical symptoms. Conclusion: BDNF plays an important role in the regulation of neuroplasticity and neurogenesis in humans. Our results indicate that lower BDNF concentrations are associated with higher levels of impulsiveness and changeability (low scores on the Solidity scale). Furthermore, low plasma BDNF levels may be proposed as a trait marker rather than a state marker for attempted suicide. (C) 2016 S. Karger AG, Basel

The aim of this study was to explore and evaluate managers’ views of a large-scale improvement program, including their experiences and opinions about improvement initiatives and drivers for change. The study is based on a survey used in 2 nationwide mappings of improvement initiatives and developmental trends in Swedish health care. The participants were all managers in a county council in Sweden. Data were analyzed descriptively, and statements were ranked in order of preferences. A majority of the respondents stated that they had worked with improvements since the county council improvement program started. The managers sometimes found it difficult to find data and measurements that supported the improvements, yet a majority considered that it was worth the effort and that the improvement work yielded results. The top-ranked driving forces were ideas from personnel and problems in the daily work. Staff satisfaction was ranked highest of the improvement potentials, but issues about patients’ experiences of their care and patient safety came second and third. The managers stated that no or only a few patients had been involved in their improvement initiatives. Large-scale county council improvement initiatives can illuminate quality problems and lead to increased interest in improvement initiatives in the health care sector.

Background: Quality improvement initiatives have expanded recently within the healthcare sector. Studies have shown that less than 40% of these initiatives are successful, indicating the need for an instrument that can measure the progress and results of quality improvement initiatives and answer questions about how quality initiatives are conducted. The aim of the present study was to develop and test an instrument to measure improvement process and outcome in Swedish healthcare. Methods: A questionnaire, founded on the Minnesota Innovation Survey (MIS), was developed in several steps. Items were merged and answer alternatives were revised. Employees participating in a county council improvement program received the web-based questionnaire. Data was analysed by descriptive statistics and correlation analysis. The questionnaire psychometric properties were investigated and an exploratory factor analysis was conducted. Results: The Swedish Improvement Measurement Questionnaire consists of 27 items. The Improvement Effectiveness Outcome dimension consists of three items and has a Cronbach’s alpha coefficient of 0.67. The Internal Improvement Processes dimension consists of eight sub-dimensions with a total of 24 items. Cronbach’s alpha coefficient for the complete dimension was 0.72. Three significant item correlations were found. A large involvement in the improvement initiative was shown and the majority of the respondents were satisfied with their work. Conclusions: The psychometric property tests suggest initial support for the questionnaire to study and evaluate quality improvement initiatives in Swedish healthcare settings. The overall satisfaction with the quality improvement initiative correlates positively to the awareness of individual responsibilities.

This study evaluated the use of the Breakthrough Series Collaborative methodology in a Swedish county council improvement program, comparing measurements at the beginning and after 6 months. A questionnaire was used, and improvement processes and outcomes were analyzed. The results showed an overall large engagement in improvements, although the methodology and facilitators were seen as only moderately supportive.

The purpose of this study was to evaluate whether an improvement programme can contribute to positive sustainable improvements in an organisation, and whether financial incentives are driving forces for improvements. The material was all projects (n¼232) that applied for funding in a county council improvement programme between 2007 and 2010. The projects were analysed as to whether they received funding (n¼98) or were rejected (n¼95). In addition, a categorisation of the projects’ intentions was analysed. Some projects were still ongoing, but 50 projects were implemented and sustained two or more years after being finalised. Implemented improvements were on different levels, from (micro-level) units up to the entire (macro-level) organisation. In addition, 27 rejected projects were finalised without funding. Eighteen of those 27 were sustainably implemented. This study indicates that there are incentives other than financial at work if an improvement programme contributes to sustainable improvements in the organisation. To encourage practice-based improvements is one way of incentivising the intention and effort to become and perform better.

Background: From a management point of view, there are many different approaches from which to choose to engage staff members in initiatives to improve performance. Objective: The present study evaluated how two different types of improvement strategies facilitate and encourage involvement of different professional groups in health-care organizations. Methods/Design: Empirical data of two different types of strategies were collected within an improvement project in a County Council in Sweden. The data analysis was carried out through classifying the participants' profession, position, gender, and the organizational administration of which they were a part, in relation to their participation. Setting: An improvement project in a County Council in Sweden. Participants: Designed Improvement Processes consisted of n=105 teams and Intrapreneurship Projects of n=202 projects. Intervention: Two different types of improvement strategies, Designed Improvement Processes and Intrapreneurship Projects. Main Outcome Measures: How two different types of improvement strategies facilitate and encourage involvement of different professional groups in healthcare organizations. Results: Nurses were the largest group participating in both improvement initiatives. Physicians were also well represented, although they seemed to prefer the less structured Intrapreneurship Projects approach. Assistant nurses, being the second largest staff group, were poorly represented in both initiatives. This indicates that the benefits and support for one group may push another group aside. Conclusions: Managers need to give prerequisites and incentives for staff who do not participate in improvements to do so. Comparisons of different types of improvement initiatives are an underused research strategy that yields interesting and thoughtful results.

Background: During the last decade fundamental changes have taken place at coronary care units (CCUs) with regard to medical treatment and advanced technology in order to improve care for patients with coronary heart disease. In the past, caring in a coronary care context was described in qualitative studies mostly from the patients’ point of view. Coronary care nurses (CCNs) are considered to play a crucial role in this care although research into nurses’ conceptions of caring in this area is still scarce. Extended knowledge from the CCNs’ perspective could be of help in developing and implementing new, nurse-led interventions in a coronary care context. Aim: This study aims to describe the conceptions of caring among a group of coronary care nurses. Methods: This is an interview study. Phenomenographic interviews with open-ended questions were conducted with 21 purposefully sampled CCNs from CCUs at two different county hospitals. The audio-taped interviews took place between March and May 2013 and the data consist of 365 double-spaced pages. The age of the CCNs ranged from 23 to 63 years, the length of experience working as a registered nurse ranged from 1 to 42 years and experience as a CCN ranged from 0.5 to 27 years. A phenomenographic analysis according to the steps described by åkerlind was used. The interviews were read several times in order to gain an overall impression of the data. The central elements of the CCNs’ responses that focus on ’what’ and ’how’ were identified, condensed and summarised as a preliminary means of understanding a phenomenon. Similar responses were carefully grouped or classified and a comparison of the categories was made in order to establish the borders between them. The descriptive categories were created on the basis of similarities and differences. An iterative process was used throughout the data analysis to check interpretation against the interviews that had been transcribed verbatim and the description categories. The description categories were used to develop an ‘outcome space’ that described the wholeness of the findings. Results: The analysis is ongoing. At the beginning of 2014 we expect to present preliminary results and answer questions about qualitatively different conceptions of caring found among a group of CCNs working in CCUs and how the different conceptions of these individuals can be understood.

Background Suffering a myocardial infarction (MI) is a life-threatening event that impacts not only on the individual concerned but also on the next of kin. However, there seems to be a paucity of naturalistic inquiries that focus specifically on midlife next of kin and their experience of being close to a relative who has suffered an MI. This study aims to elucidate the experience of being a midlife next of kin of a relative who has suffered a myocardial infarction. Method Nine women and four men in midlife participated in the focused interviews, which were conducted and analysed during 2010/2011 using Lindseths and Norbergs' description of the phenomenological hermeneutical method. Findings Four themes – Solely responsible, Lurking unease, Left out of the picture and Life on hold – formed the basis of the core theme Standing alone when life takes an unexpected turn. The core theme was interpreted as a central phenomenon encompassing the experience of being solely responsible for the well-being of their relative and the family, thus putting their own life on hold. The core theme also reflected the next of kin's experience of being left out of the picture when it came to the relative's care before and after the MI. Conclusion The next of kin's negative feelings of standing alone were further intensified by their experience of being left out of the picture by the healthcare professionals concerning their relative's care. As a cardiac nurse, it would seem essential to have knowledge about the experiences of next of kin in connection with a relative's MI event. Such knowledge can facilitate the planning and organisation of nursing care and at the same time address the next of kin's role in the recovery and rehabilitation process.

The aim of this study was to elucidate the meaning of the experience of younger people (younger then 55 years) during their first year following a myocardial infarction. We analyzed 17 interviews using a phenomenological-hermeneutic method. The core theme and central phenomenon was the everyday fight to redress the balance in Life, which encompassed an existential, physical, and emotional battle to regain a foothold in Daily Life. The aftermath of a Life-threatening event involved a process of transition while at the same time creating a new meaning in Life. Lack of energy and its impact on the complex interplay of midlife combined with unreasonable demands from employers and Health care professionelas seemed to color the experince of the informants. The knowledge gained in this study can constitute a valuable contribution to overall quality Assurance in nursing care and the development of nursing interventions for the cardiac rehabilitation of younger patients.

Aim and objectives. To extend nurses' descriptions of how they understood caring, as reflected in the findings of an earlier study (i.e. the hierarchical outcome space) and to gain additional understandings and perspectives of nurses' views of caring in relation to a coronary care patient case. Background. Scientific literature from the 1970s-1990s contains descriptions of caring in nursing. In contrast, the contemporary literature on this topic- particularly in the context of coronary care - is very sparse, and the few studies that do contain descriptions rarely do so from the perspective of nurses. Design. Qualitative descriptive study. Methods. Twenty-one nurses were interviewed using the stimulated recall interview technique. The data were analysed using deductive and inductive qualitative content analysis. Result. The results of the iterative and integrated content analysis showed that the data mainly reproduced the content of the hierarchical outcome space describing how nurses could understand caring; however, in the outcome space, the relationship broke up (i.e. flipped). The nurses' views of caring could now also be understood as person-centredness"lurking" in the shadows; limited "potential" for safeguarding patients' best interests; counselling as virtually the "only" nursing intervention; and caring preceded by the "almighty" context. Their views offered alternative and, at times, contrasting perspectives of caring, thereby adding to our understanding of it. Conclusion. Caring was described as operating somewhere between the nurses caring values and the contextual conditions in which caring occured. This challenged their ability to sustain caring in accordance with their values and the patients' preferences. Relevance to clinical practice. To ensure that the essentials of caring are met at all times, nurses need to plan and deliver caring in a systematic way. The use of systematic structures in caring, as the nursing process, can help nurses to work in a person-centred way, while sustaining their professional values.

BACKGROUND: Nursing has come a long way since the days of Florence Nightingale and even though no consensus exists it would seem reasonable to assume that caring still remains the inner core, the essence of nursing. In the light of the societal, contextual and political changes that have taken place during the 21st century, it is important to explore whether these might have influenced the essence of nursing. The aim of this study was to describe registered nurses' conceptions of caring. METHODS: A qualitative design with a phenomenographic approach was used. The interviews with twenty-one nurses took place between March and May 2013 and the transcripts were analysed inspired by Marton and Booth's description of phenomenography. RESULTS: The analysis mirrored four qualitatively different ways of understanding caring from the nurses' perspective: caring as person-centredness, caring as safeguarding the patient's best interests, caring as nursing interventions and caring as contextually intertwined. CONCLUSION: The most comprehensive feature of the nurses' collective understanding of caring was their recognition and acknowledgment of the person behind the patient, i.e. person-centredness. However, caring was described as being part of an intricate interplay in the care context, which has impacted on all the described conceptions of caring. Greater emphasis on the care context, i.e. the environment in which caring takes place, are warranted as this could mitigate the possibility that essential care is left unaddressed, thus contributing to better quality of care and safer patient care.

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

Patient safety is an important global issue. While it is well known that patients can suffer from adverse events in nursing care, there is a lack of knowledge as to how they experience them. The aim was to examine adverse events in nursing care as they are experienced by patients and relatives. This was a retrospective study taking both a qualitative and quantitative approach. It was based on data regarding 242 adverse events in nursing care, as reported by patients and relatives to Sweden's Medical Responsibility Board, content analysis was used to analys the reports. Patients' and relatives' experiences were analysed into four categories of adverse events, as concerning participation, clinical judgement, nursing intervention and the essentials of care. The reports were classified by the Medical Responsibility Board, without a standardized system. The adverse events reported were few in number and were reported by patients and relatives only. Lack of participation has negative consquences and contributes to adverse events. Adverse events occur through missed care as well as through carer errors. Nurses need to improve their skills that support patient participation. Patient participation needs to be incorporated into nurses' duties. Resources for patients to participate in their own care needs to be a priority underpinning policy-making in health systems. Nursing education systems need to teach students about the value and benefits of involving patients in their care.

Since 2003 clinical guidelines disseminated aimed at the reduction of the rates of amputation and ulceration of the diabetic foot. A guideline has no value until after it has been implemented. This study aimed to explore this implementation in four Nordic countries.

ARTICLE IN FRENCH. Foot problems in people with diabetes are common,expensive and life-threatening. Eightyfive per cent of all amputations in diabetic patients are preceded by an ulcer, deteriorated to a severe infection or gangrene. The complexity of diabetes foot ulcers necesitates an intrinsic knowledge of underlying pathophysiology and a multi-factorial approach to achieve an effective strategy with regard to prevention and treatment. The most important factors related to development of foot ulcers are peripheral neuropathy, minor foot trauma, foot deformity and decreased tissue perfusion. The International Working Group for the Diabetic Foot Consensus Group has suggested a simple risk classification with regard to prevention of diabetes related amputations and foot ulcers. Identification of the high risk patient can only be detected from a history and clinical examination of the feet, as many foot ulcers in diabetes can potentially be prevented by regular foot inspections, access to foot care for non ulcer pathology and use of adequate foot wear. The feet of diabetic patients should be inspected at every visit to primary health care and specialist care providers and also at every visit from home care service. Assessment of the feet, education to the patient to eprform daily inspections, washing the feet daily, use of foot cream, and use of appropriate shoes requires a multidisciplinary approach including appropriate education of involved health care professionals and patients.

Background: Few studies evaluate patients' perspectives when a new drug is introduced to treat chronic diseases such as diabetes mellitus. The clinical role of a new insulin treatment, in terms of the relationship between higher cost and better treatment outcomes (as defined from the patient perspective) has been discussed. We sought to explore patient satisfaction with a new insulin treatment (insulin glargine). At its launch in 2002/3 it was purported to provide constant, peakless insulin release following once- or twice-daily administration, thus leading to fewer hypoglycaemic episodes while providing metabolic control equivalent to that achieved with NPH human basal insulin. Aims: To investigate the indications used for prescription of a new drug and its clinical effects on glycosylated haemoglobin (HbA1c) levels, perceived hypoglycaemic events and patient satisfaction. Methods: The Diabetes Treatment Satisfaction Questionnaire (Status Version, DTSQ-s), which measures satisfaction with treatment regimen, and perceived frequency of hyperglycaemia and hypoglycemia, was circulated to all living patients who had ever started treatment with insulin glargine at the Department of Endocrinology at Malmö University Hospital. Medical records of 913 patients were assessed for HbA1c levels at 0 and 12 months after starting insulin glargine therapy. Results: Completed questionnaires were returned by 615 of 960 patients (64%) who had ever started insulin glargine. The main indications for starting treatment were physicians' or nurses' initiatives, desire for fewer fluctuations and improved metabolic control. HbA1c levels fell by 0.41% for patients with type 1 diabetes and by 0.68% for those with type 2 diabetes. The mean DTSQ-s score was 28.45 for satisfaction, whereas the mean perceived hypoglycaemic/hyperglycaemic events score was 3. Conclusion: Treatment satisfaction was very high and perceived frequency of hypoglycaemia/hyperglycaemia was very low. The indications for treatment of insulin glargine are being followed in accordance with national recommendations..

Summary Diabetes mellitus and foot ulcer increase the risk of amputation, and prevention of foot ulcers are therefore important. Patients with diabetes and other concomitant diseases are often cared for in a home nursing service and the registered nurses (RNs) have the opportunity to practise preventive care to avoid foot ulcers. How prevention of foot ulcer is performed in home nursing settings has not been previously described. The objective of this study was to explore RNs’ professional work with foot ulcer prevention in home nursing settings for patients with diabetes mellitus. Qualitative interviews were analysed, using manifest content analysis. The setting was four municipalities in Sweden (large and small cities, and rural areas). Fifteen RNs actively working in a home nursing service with more than two years’ experience were recruited. The participants were all women, had worked as RNs for 3–41 years (median 25), and in home nursing for 2–18 years (median 8). The results showed that the RNs work through leadership, coordination, education and evaluation. Health care assistants perform most of the nursing actions to prevent foot ulcers such as assessment of feet, off-loading, nutrition and hygiene. The RNs have medical and nursing responsibility but without the formal tools to execute this fully. The RNs’ formal education was some years back and they relied mostly on experience-based knowledge. It was concluded that patient assessment and nursing actions to prevent foot ulcers are mostly performed by health care assistants. The RNs need to be given formal responsibility in their role as leaders and educators, and need more education in pedagogy and leadership. Eur Diabetes Nursing 2013; 10(2): 52–57 Key words diabetes; diabetic foot ulcer; education; elderly; foot care; foot health; nursing; home care; pressure ulcer; prevention

Background: Persons using daily subcutaneous injections to administer medicine perform them in different ways and thereby increase the risk of skin complications related to the injection. It is often part of nurses’ role to administer medicine and educate the patient in injection technique. Course literature in nursing education, commercial patient education pamphlets, and instructional leaflets do not give consistent advice regarding subcutaneous injection technique. Aim: The aim of this review was to identify the scientific foundation for the technical performance of subcutaneous injections. The question to be answered was: How should a subcutaneous injection be administered to achieve the right dose in the right place with minimum complications? Method: The review included a search in three databases, a screening process at abstract level, followed by a quality assessment of included articles. The quality assessment was done independently by two people and followed specific protocols. Result: A total of 38 articles were assessed for quality and covered information on dose, location, and complications of subcutaneous injection. The assessed studies are heterogeneous in design and describe different aspects of the subcutaneous injection technique. Therefore, the scientific foundation for technical performance is weak. However, several studies indicate that the amount of subcutaneous fat and appropriate needle length are of high importance for the drug to reach the target tissue. Conclusion: More research regarding effective subcutaneous injection technique needs to be done.

Background. Occupational therapists sometimes find it challenging to integrate client-centered and occupational therapy specific assessments in practice. The aim of this study was to explore the use of occupational therapy specific assessments such as the Assessment of Motor and Process Skills (AMPS) among occupational therapists in Sweden and Japan. Methods. Interviews and qualitative thematic analyses were utilized. Findings. Four themes are reported: (1) use it or lose it, (2) simply no space until after hours, (3) biggest barriers can be colleagues, and (4) being more specific: communication. Conclusion. In keeping with previous studies, occupational therapists often find it challenging to implement client-centered and occupation-based assessment tools into practice. However, more work is needed to understand how best practices can be incorporated into a changing occupational therapy daily practice.

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

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

Background: Although chronic bronchitis is associated with impaired quality of life, hospitalisations and increased mortality, it has been less in focus after the introduction of the term chronic obstructive pulmonary disease (COPD). There are no recent published data on the prevalence of chronic bronchitis from the Scandinavian countries. Aim: The main aim of the present study was to estimate the prevalence of chronic bronchitis in West Sweden by using data from a large-scale epidemiological study of the general population. A further aim was to identify current risk factors for chronic bronchitis in a population with a major decrease in the proportion of smokers. Methods: From the 18,087 questionnaire responders out of 30,000 invited to participate at the West Sweden Asthma Study, 2,000 subjects were randomly selected and invited to detailed clinical examinations performed during 2009 2013. A total of 1,172 subjects aged 17 79 participated in the examinations which included, among others, spirometry and structured interviews. Chronic bronchitis was defined according to reported symptoms. Results: The overall prevalence of chronic bronchitis was 7.2% (men 7.6%; women 6.8% ns), and it was 8.7% in subjects older than age 60. Chronic bronchitis was strongly associated with smoking, defined both as current smoking status and pack-years. Other risk factors were increasing age, low socio-economic class and urban living. Of those with chronic bronchitis, 22% fulfilled the GOLD criteria of COPD. Conclusion: The prevalence of chronic bronchitis was somewhat lower than found by studies in Sweden in the 1980s and the prevalence was now similar in men and women. Although smoking was still the dominating risk factor for chronic bronchitis, the relative importance of smoking had decreased parallel with a decreasing smoking prevalence, while the relative importance of other factors than smoking had increased compared to previous studies.

Boost self-efficacy for better health outcomes in adult asthmatics! Authors: Axelsson Malin1, Ekerljung Linda 2, Lundbäck Bo2 1Department of Care Science, Faculty of Health and Society, Malmö University, Malmö, Sweden 2Krefting Research Centre, Department of Internal Medicine and Clinical Nutrition, University of Gothenburg, Gothenburg, Sweden Introduction: Self- efficacy i.e. confidence in ability to handle challenges in everyday life could influence how individuals suffering from long-term disease such as asthma manage the disease, the medication treatment and symptoms, which in turn could influence both disease progression and health-related quality of life (HRQL). Aim: to explore the function of concerns with asthma medication and asthma control as mediators between self-efficacy and HRQL. Method: Adult asthmatics (n=479, 60% women) aged between 19 and 78 years selected from West Sweden Asthma Study completed questionnaires on self-efficacy, concerns with asthma medication, asthma control and HRQL. Two path models with self-efficacy as independent variable, mental and physical HRQL as dependent variables and concerns with asthma medication and asthma control as mediators were conducted. Results: In both path models, self-efficacy was negatively associated with concerns with asthma medication (β= -.130, p=0.005) and positively associated with asthma control (β =.100, p=0.027). In both path models, the effect of concerns with asthma medication on both mental and physical HRQL went through that of asthma control (β=-.138, p=0.003). Both concerns with asthma medication and asthma control mediated the effect of self-efficacy on both mental (β =.132, p=0.002) and physical HRQL (β =.455, p=0.001). Conclusion: Adult asthmatics with lower self-efficacy need support to strengthen their self-efficacy and assistance to overcome their concerns with the asthma medication in order to improve their asthma control. Better self-efficacy and reduced concerns with asthma medication will increase asthma control, which in turn most likely will have a positive effect on both mental and physical HRQL in adult asthmatics.

Consider personality, medication adherence and asthma control in efforts to improve health-related quality of life in adult asthmatics! Authors: Axelsson Malin1, Ekerljung Linda2, Lundbäck Bo2 1Department of Care Science, Faculty of Health and Society, Malmö University, Malmö, Sweden 2Krefting Research Centre, Department of Internal Medicine and Clinical Nutrition, University of Gothenburg, Gothenburg, Sweden Introduction: Asthma is a common respiratory disease, which often requires regular medication treatment. In individuals with asthma, assessments of health-related quality of life (HRQL) serve as an essential health outcome as they capture personal perspectives and experiences of everyday life with asthma and the ongoing medication treatment. Personality, adherence to medication treatment and asthma control are important influential factors of HRQL in adult individuals with asthma. However, these factors have rarely been investigated together. Therefore, the aim was to elucidate associations between personality, adherence, asthma control and HRQL in adult asthmatics. Methods: Adult asthmatics (n=337) with prescribed regular asthma medication treatment selected from West Sweden Asthma Study, participated by completing questionnaires on personality, adherence to asthma medication treatment, asthma control and HRQL. Two path models with the personality traits Neuroticism and Conscientiousness as independent variables, HRQL as dependent variable and adherence and asthma control as mediators were tested. Results: In the first path model, Neuroticism was negatively associated with adherence to asthma medication treatment and the mediated effect of adherence on HRQL went through that of perceived asthma control. In the second path model, both adherence and perceived asthma control functioned as mediators between Conscientiousness and HRQL. In this model, the effect of adherence on HRQL also went through that of perceived asthma control. Conclusion: Improving adherence in adult asthmatics scoring higher on the personality trait Neuroticism or lower on the personality trait Conscientiousness would most likely have a positive impact on their perceived asthma control, which in turn would increase their HRQL. In efforts to improve HRQL in adult asthmatics, individual differences, adherence to asthma medication treatment and perceived asthma control need to be taken into consideration

Objective.The aim was to investigate adherence to asthmamedication treatment,medication beliefs, and asthma control in relation to asthma follow-up consultations in asthmatics in the general population. A further aim was to describe associations between adherence, medication beliefs, and asthma control. Method. In the population-based West Sweden Asthma Study, data allowing calculation of adherence for 4.5 years based on pharmacy records were obtained from 165 adult asthmatics. Additional data were collected through questionnaires and structured interviews. Results. The mean adherence value for filled prescriptions for regular asthma medication was 68% (median 55.3%) but varied over the year under study. Adherence to combination inhalers with corticosteroids and long-acting beta2 agonists was higher than adherence to single inhalers with corticosteroids only. More than one-third of participants reported not having seen an asthma nurse or physician for several years. Regular asthma followup consultations were associated with both higher adherence and the belief that asthma medication was necessary but were not associated with asthma control. Conclusions. Adherence to asthma medication treatment was low and varied over the year under study. The current study suggests that quality improvements in asthma care are needed if adherence to asthma medication is to be improved.

Background Health-care professionals have a responsibility to be attentive to patients’ adherence behavior but it could be difficult to identify poor adherence in the context of clinical practice. Assessment of personality could be used to identify individuals who are in need for support with their adherence behavior. To our knowledge, existing adherence questionnaires are not based on individuals reflecting asthmatics in the general population and there is limited research describing adherence with asthma medication in relation to personal goals with the treatment. The aim was to develop and validate an adherence questionnaire in adult individuals with asthma from the general population and to assess adherence in relation to personality traits and goals with the asthma medication using the developed questionnaire. Methods The study was conducted in three phases: 1. A preliminary postal 46-item questionnaire was refined after psychometric testing (n = 157). 2. The questionnaire was validated (n = 104). 3. The developed adherence questionnaire was analyzed in relation to personality traits and achieved goals with the asthma medication. Adult respondents with physician diagnosed asthma using asthma medications were selected from the population-based West Sweden Asthma Study. The respondents completed the Neuroticism, Extraversion and Openness to Experience Five-Factor Inventory and the Medication Adherence Report Scale and stated their goals with the asthma medication. Data were analyzed using t-tests, correlations, multiple regression and principal component analysis. Results A final questionnaire was developed consisting of ten items organized in three subscales - “medication routines”, “self-adjusting the medication” and “concerns about side-effects”. Two of the subscales - “medication routines” and “self-adjusting the medication” – were associated with the Medication Adherence Report Scale. The subscale “medication routines” was associated with the personality traits – Conscientiousness and Neuroticism and unachieved goals with the asthma medication. Conclusions The developed questionnaire appears to be useful for measuring adherence to asthma medication in adult individuals with asthma. The study suggests that both individual differences and personal treatment goals need to be addressed in efforts to promote adherence to asthma medication treatment.

Background: Sleep disturbances and physical inactivity have only sparsely been studied in relation to health related quality of life (HRQL) in adult asthmatics. Aim: to investigate sleep disturbances and physical inactivity in relation to HRQL in adult asthmatics. Method: The sample (n=737), aged between 21 and 85 years, selected from the OLIN-studies participated in structured interviews about respiratory health, sleep, physical activity and questionnaires on mental and physical HRQL. Results: Sleep disturbances were more common in asthmatics than in non-asthmatics: snoring (p=0.018), difficulties falling asleep (p=0.025), many nocturnal awakenings (p=0.001), daytime sleepiness (p=0.001), early awakenings (p=0.002). Lower mental HRQL was found in asthmatics with difficulties falling asleep (p=0.001), in asthmatics reporting daytime sleepiness (p=0.010) than asthmatics without sleep disturbances. Lower physical HRQL was found in asthmatics with daytime sleepiness (p=0.002), early awakenings (p=0.001) and many nocturnal awakenings (p=0.039) than asthmatics without these sleep disturbances. Lower physical HRQL was found in physically inactive asthmatics than in physically active asthmatics (p=0.034). Physical activity (p=0.008) and asthma control (p=0.049) were stronger predictors of low physical HRQL than sleep disturbances. Difficulties falling asleep (p=0.001) and many nocturnal awakenings (p=0.04) were identified as negative predictors of mental HRQL while asthma control was a non-significant predictor. Conclusion: Helping adult asthmatics to improve their sleeping habits and to increase their physical activity will have a positive impact on their HRQL. Malin Axelssona, Mai Leanderb, Helena Backmanc, Linnea Hedmanc, Eva Rönmarkc a Department of Care Science, Faculty of Health and Society, Malmö University, Malmö, Sweden b Department of Medical Sciences, Respiratory Medicine and Allergology, Uppsala University, Uppsala, Sweden c Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine, The OLIN Unit, Umeå University, Umeå, Sweden

Background: Even though respiratory symptoms are common in the adult population, there is limited research describing their impact on everyday life and association with health care consumption. Aim: The main objective of this population-based study was to estimate and compare the prevalence of respiratory symptoms among adults in Finland, Estonia, and Sweden in relation to health care consumption and to identify factors influencing health care consumption. A secondary aim was to assess to which extent the presence of respiratory symptoms affect everyday life. Method: In the population-based FinEsS studies consisting of random samples of subjects aged 20 to 69 years from Finland (n 1,337), Estonia (n 1,346), and Sweden (n 1,953), data on demographics, respiratory health, and health care consumption were collected by structured interviews. Prevalence was compared and multiple logistic regression analyses were performed. Results: Respiratory symptoms were significantly more common in Finland (66.0%) and Estonia (65.2%) than in Sweden (54.1%). Among subjects with respiratory symptoms, the proportion reporting outpatient care during the past year was fairly similar in the three countries, while specialist consultations were more common in Finland (19.1%), and hospitalisations more common in Estonia (15.0%). Finnish and Estonian residency, female sex, and BMI 25 increased the risk for outpatient care consumption. Wheeze and attacks of shortness of breath in the past 12 months, recurrent sputum production, and cough were associated with an increased risk for health care consumption. Increasing number of respiratory symptoms increased the risk for consuming health care. A larger proportion of subjects in Estonia and Sweden experienced their everyday life being affected by respiratory symptoms compared with subjects in Finland. Conclusion: Respiratory symptoms are common in Finland, Estonia, and Sweden and contribute to a negative impact on everyday life as well as increased health care consumption. The observed differences in health care consumption between countries are probably related to national differences in health care structure.

Background: Chronic Obstructive Pulmonary Disease (COPD) is the fourth leading cause of death in the world. COPD is a progressive disease that could lead to chronic hypoxemia, which requires treatment as domiciliary Long-Term Oxygen Therapy (LTOT). There is a need for increased knowledge about self-care strategies used by individuals living with COPD and LTOT. Objective: The aim was to explore experiences and self-care strategies in patients living with both COPD and LTOT. Sample: The sample consisted of five men and five women diagnosed with COPD being prescribed LTOT for more than one year. Method: Ten interviews were undertaken and analyzed for both manifest and latent content. Results: Living with COPD and LTOT was associated with experiences of guilt although there were doubts about what had caused the lung disease. Both the lung disease and the oxygen therapy had a negative impact on their self-image. Anxiety was expressed when thoughts about the remaining time occurred. There was a constant balance between diminishing abilities and increasing restrictions related to the lung disease and the therapy. In order to compensate for arising imbalance, self-care strategies had been initiated aimed at preserving the present state of health, enabling and facilitating physical activity and promoting a positive attitude. Conclusion: The current study suggests that individuals living with COPD and LTOT are encouraged to adopt self-care strategies directed towards maintaining stability with regard to the lung disease, the oxygen therapy, physical capability and emotional reactions.

Objective To investigate the extent to which Danish women attending antenatal care plan their pregnancies and to determine the association between pregnancy planning and the intake of folic acid, alcohol consumption and smoking habits prior to conception and before the 16th week of gestation. Methods A cross-sectional survey of 258 women. Main outcome measures: intake of folic acid, alcohol consumption and smoking. Pregnancy planning was assessed by the London Measure of Unplanned Pregnancy (LMUP) and the five graded Swedish Pregnancy Planning Scale. Results Most (77%) of the participants reported that their pregnancies were very or fairly well planned. Higher median LMUP scores were observed in women taking folic acid (p < 0.001), in those consuming less alcohol, and in women who stopped smoking prior to pregnancy (p = 0.043). However, 43% of the respondents with a high degree of pregnancy planning and 98% of those with a low degree of planning had not taken folic acid prior to pregnancy. Binge drinking during early pregnancy was reported by 20% of women with a high degree of planned pregnancy and 31% of those with a low degree (p = 0.1). Conclusion Pregnancy planning was associated with a healthier lifestyle but still many women could improve their lifestyle in connection to pregnancy. Their level of alcohol consumption is higher than that recommended for best pregnancy outcome.

Promoting Action on Research Implementation in Health Services (PARiHS) asserts that the success of knowledge implementation relates to multiple factors in a complex and dynamic way, and therefore the effects of implementation strategies vary by method and context. An instrument based on the PARiHS framework was developed to help assess critical factors influencing implementation strategies so that strategies can be tailored to promote implementation. The purpose of this study was to use the Evaluation Before Implementation Questionnaire (EBIQ), to describe staff perceptions in one orthopaedic department, and to investigate differences between wards. Staff members in four different wards at one orthopaedic department at a university hospital in Sweden were invited to complete a questionnaire related to planning for the implementation of a clinical practice guideline. The 23 items in the EBIQ were expected to capture staff perceptions about the evidence, context, and facilitation factors that influence the implementation process. Descriptive statistics and differences between wards were analyzed. Although the overall response rate was low (n = 49), two of the four wards accounted for most of the completed questionnaires (n = 25 and n = 12, respectively), enabling a comparison of these wards. We found significant differences between respondents' perceptions at the two wards in six items regarding context and facilitation in terms of receptiveness to change, forms of leadership, and evaluation and presence of feedback and facilitators. The EBIQ instrument requires further testing, but there appears to be initial support for pre-implementation use of the EBIQ as a means to enhance planning for implementation.

Rationale and aims: This study focuses on the development of an instrument for the evaluation of clinical practice guidelines and is one part of a research project about the implementation and use of such guidelines among hospitals in the southern region of Sweden. The aim of the present paper was to investigate the test-retest reliability of a questionnaire. Method: A questionnaire was designed to gather data about guidelines that have been implemented as well as information about factors, which, according to the Promoting Action on Research Implementation in Health Service (PARIHS)-model, influence the success of implementation. Thirty-nine professionals at one of the hospitals included in the survey completed the questionnaire on two occations within a mean time of 5.5 weeks. The test-retest reliability was analyzed by means of Cohen's Kapps and percentage concordance. Results: Eight items had good agreement in terms of strength and high percentage concordance. With regard to the Kappa values 13 items show moderate and two fair agreement. Conclusions: The test-retest reliability scores show mainly acceptable results indicating a reasonable stability, thus suggesting the possibility of further developing the instrument. The factors described in the PARIHS-model seem relevant for use in evaluating implementation and use of guidelines. The instrument could benefit from a revision of the language in order to enhance clarity and make it less abstract.

Irritable Bowel Syndrom (IBS) är en vanlig global funktionell mag- och tarmsjukdom och uppskattningsvis har 12 procent av Sveriges befolkning IBS. Patienterna behandlas av läkare i primärvården eller av specialistläkare. IBS kännetecknas av besvär från mag-tarmkanalen utan någon bakomliggande påvisbar patofysiologisk eller biokemisk orsak och diagnosen baseras på Rom III kriterierna. Patienter med IBS kan beroende på besvär ha diarré- respektive förstoppningsdominerad IBS eller en intermittent avföringsfrekvens som växlar mellan diarré och förstoppning. Orsakerna till patienternas besvär är komplexa och det är flera faktorer som kan ha betydelse för sjukdomens uppkomst. Störningar i tarmmotoriken, ökad känslighet i tarmen s.k. inre hypersensivitet, störningar i kommunikationen mellan tarmen och hjärnan s.k. ”brain-gut axis”, samt störningar i hormoner och peptider har visat sig ha en viss betydelse. Det är fler kvinnor än män som drabbas av IBS och symtomen varierar beroende på kön. Förstoppning till exempel, är vanligare bland kvinnor, medan diarré är vanligare bland män. Patienter med IBS lider också av många andra besvär, såsom gaser, trötthet, illamående och huvudvärk. Patienter som har IBS har en hög sjukfrånvaro och de utsätts för stort lidande, vilket i förlängningen även påverkar deras sociala situation och dagliga liv. Samhällets kostnad för patienter med IBS är stor eftersom de konsumerar mycket sjukvård i sin jakt efter hjälp för sina besvär. Vid läkarbesöket är det patientens uppgifter som får ligga till grund för fortsatt utredning, men någon enhetlig utrednings- och behandlingsstrategi finns inte. Omhändertagandet av patienter med IBS är i huvudsak medicinskt inriktad och syftar till att lindra patientens besvär och öka välbefinnandet, eftersom någon botande behandling inte finns. Omvårdnadsåtgärder saknas vilket kan anses vara en brist, speciellt för denna patientgrupp som har en så komplex sjukdomsbild. Det fanns ett behov av ett kort och enkelt bedömningsinstrument för att få en uppfattning om de besvär som patienter med IBS har och för att följa behandlingseffekten. Därför utvecklades Visual Analogue Scale for Irritable Bowel Syndrome (VAS-IBS) för att fånga patienters subjektiva upplevelse av sina mag- och tarmbesvär. Formuläret består av nio frågor varav sju skall skattas av patienten med hjälp av en visual analog skala (VAS) och två besvaras med JA/NEJ. De psykometriska testerna bekräftade att VAS-IBS har hög tillförlitlighet avseende validitet, reliabilitet och intern samstämmighet. Formuläret är enkelt att använda för patienter såväl som för vårdpersonal.

In Sweden, 25 graduate nursing programmes are offered by different universities. They vary regarding organisation, content and quality. There is also considerable variation in the amount of clinical practice in Sweden and the quality outcomes vary significantly between these. A multi-method strategy is suggested for clinical competence assessment for nursing to be sure that assessment reveals whether or not students have achieved the complex repertoire of knowledge, skills and attitudes required for competent practice. The aim of the Swedish National Clinical Final Examination (NCFE) is to examine third-year nursing students’ clinical competence and ensure that they have the clinical knowledge and skills required as laid out in the legislation. The examination is a tool/model for a safe and equivalent assessment of clinical competence at the national level. The examination is divided into two parts; a written test and a bedside test. The written exam consists of two cases there medical issues and essential information will be added gradually and continuously throughout each of the cases, followed by questions related to the next scenario. The questions are constructed to have limited answers. The students proceed by turning the top page/paper, one at a time and they must only have one page/paper faced up at a time. Upon completion of a page, it should be placed faced down again. It is not permitted to go back and forth between the pages of the exam. Completed and turned pages must stay tuned. The bedside part of the examination is performed after the written part, and is also of four hours’ duration. The student is expected to demonstrate an adequate capacity for reasoning based on theory about issues of relevance for patient care. Feedback from the patient about the student’s performance is obtained by the observing nurse. The final assessment is made by the clinical lecturer, resulting in the decision to pass or fail the student

Elimination av avfallsprodukter i form av avföring är en av de mest grundläggande fysiologiska processerna i varje människas liv. Att råka ut för mag- och tarmbesvär är ofta dolda obehag som inte syns utanpå men är nog så besvärande för den som drabbas. Besvär från mag- och tarmkanalen kan vara kortvariga och av mindre allvarlig karaktär. De kan också orsakas av en sjukdom av kronisk karaktär som patienterna får leva med resten av sitt liv. Vården och omvårdnaden syftar till att patienter med mag- och tarmbesvär ska få den behandling och det stöd som de behöver för att kunna leva ett för dem bra liv. När mag- och tarmkanalen inte fungerar normalt uppkommer fysiska, psykiska och sociala problem för den drabbade. En kronisk sjukdom påverkar vardagen och det sociala livet på många sätt. Det kan ta tid för patient och närstående att lära sig hantera vardagen och hitta en hanterbar strategi. Sjuksköterskans viktigaste uppgift i mötet med dessa patienter är att bekräfta patienten och besvären, förmedla kunskap och stöd samt att göra patienten delaktig i behandlingen.

This paper describes the research process – from planning to presentation, with the emphasis on credibility throughout the whole process – when the methodology of qualitative content analysis is chosen in a qualitative study. The groundwork for the credibility initiates when the planning of the study begins. External and internal resources have to be identified, and the researcher must consider his or her experience of the phenomenon to be studied in order to minimize any bias of his/her own influence. The purpose of content analysis is to organize and elicit meaning from the data collected and to draw realistic conclusions from it. The researcher must choose whether the analysis should be of a broad surface structure (a manifest analysis) or of a deep structure (a latent analysis). Four distinct main stages are described in this paper: the decontextualisation, the recontextualisation, the categorization, and the compilation. This description of qualitative content analysis offers one approach that shows how the general principles of the method can be used.

En portfolio är inte bara en samling alster utan är också en lär-, kommunikationsoch utvärderingsstrategi för att spegla studentens utveckling under utbildningstiden för att säkerställa att lärandemålen uppfylls. Portfoliouppgifter baserade på kursplanens lärandemål skall underlätta för studenten att nå målen med aktuell kurs och utbildning (Biggs & Tang, 1998; Ellmin & Ellmin, 2003). Intentionen med portfoliometodiken är att skapa ett helhetsperspektiv över studentens utveckling och ska vara ett hjälpmedel för både läraren och studenten att på ett strukturerat sätt dokumentera, kommunicera och skapa forum som främjar ett optimalt lärande. Studenten skall se sin utveckling och lärandeprocess under hela utbildningen och inte bara i en enstaka kurs. När utbildningen är klar har studenten en portfolio som visar på den egna utvecklingen och kompetensen som färdig sjuksköterska. Portfoliometodiken ska stimulera till ökat ansvarstagande och genom att formulera egna mål kan studenten öka medvetenheten hos sig själv och belysa de områden som behöver utvecklas (Gannon et al, 2001). Studenter har under sin utbildning behov av olika former av stöd och portfoliometodiken kan möjliggöra att studenten får det stöd som behövs genom att studenten belyser sina speciella behov. I utvecklings- och bedömningssamtalen vars summativa och reflekterande dokumentation kan ingå i portfolion, skall studenten vara en aktiv samtalspartner och genom att leda samtalet får studenten också ett större ansvar för sitt eget lärande (Ellmin & Ellmin, 2003; Van Tartwijk & Driessen, 2009). Portfoliometodiken stimulerar också till reflektion då studenten tittar tillbaka på och analyserar sina tidigare genomförda uppgifter och upplevelser från såväl teoretiska som praktiska moment (Van Tartwijk & Driessen, 2009). På sjuksköterskeutbildningen på Malmö högskolan finns metodiken till viss del implementerad sedan vårterminen 2010. Implementeringen fokuserades initialt på hur portfoliometodiken ska användas i den verksamhetsförlagda utbildningen (VFU) men finns nu även i andra kurser. Denna process har varit komplicerad men utmanande då flera hundra handledare men också många lärare varje termin blir involverade i denna pedagogik (FoU-rapport 2, 2011, http://hdl.handle.net/2043/11938).

Syftet med Nationell klinisk slutexamination för sjuksköterskeexamen är att pröva om studenter i slutet av termin sex har uppnått den kliniska kompetens som krävs hos en nyexaminerad sjuksköterska. Examinationen avser att möta de förväntade studieresultat som framgår av mål för sjuksköterskeexamen enligt högskoleförordningen och högskolelagen samt från verksamhet där sjuksköterskorna ska arbete i. Deltagandet sker enligt avtal för att åstadkomma en nationell kvalitetskontroll med tydlig verksamhetsförankring av sjuksköterskans kliniska kompetens. I dag är 16 lärosäten anslutna till denna examination och ett lärosäte har en pågående försöksperiod. Från start år 2003, då i form av ett projekt, till idag har examinationen utvärderats och förändrats utifrån ett kvalitetssäkringsperspektiv. År 2007 inrättades en styrelse med representanter från anslutna lärosäte. Styrelsen ansvarar för kvalitetssäkring och utveckling av examinationen. Examinationen består av ett skriftligt prov och ett praktiskt prov som ska ses som en helhet. Det skriftliga provet konstrueras sedan år 2011 av en grupp bestående av erfarna lärare med klinisk förankring och styrelsemedlemmar. Provet är baserat på två patientfall som speglar realistiska vårdsituationer som en sjuksköterska kan stå inför. From hösten 2014 kommer det skriftliga provet att omfatta två delar, Delprov I och Delprov II. Delprov I kommer att omfatta 50 poäng (33 poäng för godkänt resultat) och baseras enbart på frågor kring patientfallen och Delprov II kommer att bestå av två frågor om läkemedelsberäkning som måste vara korrekt besvarade för godkänt resultat. Under det praktiska provet ska studenten under överseende av en sjuksköterska från verksamheten vårda en patient under tre timmar. Studenten bedöms utifrån fastställda kriterier. Därefter följer ett uppföljande samtal mellan student, sjuksköterska och lärare från lärosätet, där studenten utvecklar sitt teoretiska resonemang och får återkoppling på sina prestationer. Sedan våren 2013 har bedömningskriterierna och examensmålen förtydligats i det praktiska provet och det avslutande samtalet har fått en tydligare struktur. Examinationen upplevs av bedömningsansvariga sjuksköterskor i verksamheten och lärare på lärosätena vara en bra examinationsform för att säkerställa kvaliteten på utbildning, handledning och studentens kompetens. Hos studenterna ger examinationen innan genomförandet upphov till oro eftersom de ska bli observerade och bedömda. När examinationen väl är genomförd upplever studenterna att de fått bekräftelse på sin kunskap och förmåga att kunna arbeta som sjuksköterskor. Referenser Lilja Andersson P, Ahlner-Elmqvist M, Johansson UB, Larsson M, Ziegert K Nursing students' experiences of assessment by the Swedish National Clinical Final Examination. Nurse Education Today. 2012 Jan 5. http://dx.doi.org/10.1016/j.nedt.2011.12.004 Athlin E., Larsson M. & Söderhamn O. (2011) A model for a national clinical final examination in the Swedish bachelor programme in nursing. Journal of Nursing Management. 2011 20 Sept (1):90-101. doi: 10.1111/j.1365-2834.2011.01278.x Länk till hemsidan för Nationell klinisk slutexamination för sjuksköterskeexamen www.nkse.se

Utgångspunkten för högskolepedagogiken är studentcentrerat livslångt lärande för att dagens studenter ska kunna möta framtida utmaningar och förändringar i samhällsstrukturen. Studenter oavsett vårdprofession vill känna sig förberedda för morgondagens sjukvård. Arbetsformer och examination under utbildningen ska stödja förmågan till bland annat kritiskt tänkande, problemlösning och reflektion. Under utbildningen förbereds studenter för sin nya kommande yrkesroll och skaffar sig relevanta kunskaper. Dessa kunskaper måste under hela utbildningen värderas så att examensmålen i högskoleförordningen kan uppnås i slutet på utbildningen. Men att bli examinerad, det vill säga få sina prestationer bedömda, är en stressfaktor oavsett om examinationen genomförs på campus eller i klinisk verksamhet. Varje students upplevelse av en examination är unik men det finns gemensamma beröringspunkter. Hur utfallet av en klinisk examination blir beror främst på förutsättningarna för examinationens genomförande, vad som krävs under examinationen, vem studenten är och hur studenten agerar i den aktuella situationen. Den sammantagna bedömningen av studentens prestationer resulterar i ett betyg som fastställs av examinator.

Background: Preceptors are expected to have the skills to be able to form an effective learning environment and facilitate a constructive clinical learning experience for students and new employees. Internationally, access to education for preceptors varies, with preceptors worldwide requesting more education in preceptorship. This article is based on a two-part study focusing on both the development and evaluation of a continuous, credit-bearing professional development course. The aim of this part of the study was to investigate and include preceptors’ requests and educational needs when developing a continuous professional development course on an advanced level. Methods: This study used a qualitative research approach. In total, 64 preceptors (62 women and two men) answered one single written, self-administered global question online. The participants were all interested in teaching and had completed an undergraduate training in preceptorship. The collected data was analysed by content analysis inspired by Burnard’s description of themethod. Results: The participating preceptors illuminated two main themes: ‘Tools for effective precepting of students and healthcare professionals’ and ‘in-depth knowledge and understanding of preceptorship in an academic setting’. The results suggest that vital components for preceptor preparation could be a) teaching and learning strategies, b) reflective and critical reasoning, c) communication models, d) the role of the preceptor, and e) preceptorship. Conclusion: Using the results from this study as a guide, a continuous professional development course was designed to assist preceptors in deepening their knowledge of preceptorship in regard to planning, leading and implementing educational activities directed at students, healthcare professionals, patients and their families. The course content focuses on skills needed for preceptorship and is based on adult learning principles. A continuous, credit-bearing professional development course must include an exam by which participants are formally assessed and graded; therefore, a written assignment was included as part of the course.