To Örebro University

Background: Many patients who receive palliative home care wish to die at home, even when the symptom of the disease deteriorates. Despite this, large number of patients die in hospital. 

Aim: To map the occurrence of patients receiving specialized palliative home care being transported to hospital near death in Sweden. 

Methods: A national retrospective cross-sectional study based on data from the Swedish Register of Palliative Care. Patients ≥18 years of age enrolled in specialized palliative home care with dates of death 2015 11 01 – 2022-10-31 were included (n= 39,698). Descriptive statistics were used to compare patients who were transported to hospital and died there within seven days of arrival, and patients who were not transported or transported earlier than seven days before death.

Results: Of the total study population, 7,383 patients were identified as dying in hospital/other care unit within 7 days of transport from specialized palliative home care. The majority (74%) were admitted to a specialized palliative care unit, 23% to a non-specialized palliative care unit and 3% to additional care units. Most patients died 1-2 days after arriving at the hospital. No clinical relevance differences were noted regarding sex, age, or diagnosis when comparing transported patients with non-transported patients, whereas the transported patients had more frequent dyspnea (31% vs. 23%, p <0.001) and anxiety (60% vs. 57%, p<0.001). Presence of several simultaneous symptoms was significantly more common in the transported group (27% vs. 25%).

Conclusion: Many patients enrolled in specialized palliative home care were transported and died in hospital. Most died 1-2 days after arrival. They had complex symptoms and not all patients were admitted to a specialist palliative care unit. Some common denominators, such as symptoms and symptom burden, can be noted in the patients who are transported, but more studies are needed to identify the causal relationship of these transports.

The aim of this study was to investigate Swedish children’s and parents’ attitudes and knowledge about human papillomavirus (HPV) vaccination a year after gender-neutral HPV vaccination was introduced in Sweden’s national immunization program (NIP). Additional information about HPV and vaccine was provided in the extended immunazation program. In total, 276 parents and 206 children from 22 School Health Services responded to a web-based survey. Results showed that half of the children and about a third of the parents received additional Public Health Agency information about HPV vaccination, and a majority were satisfied. Parents considered HPV vaccination being important for their children’s health, and both children and parents considered it important to vaccinate all genders against HPV. Both children and parents rated school nurses as most reliable source of HPV vaccination information. Teachers were also a common source of HPV and HPV vaccination information for children. Further research among teachers in Sweden is needed to explore their knowledge and abilities to inform students and parents about HPV and vaccination.

AIM: To explore and compare the didactic approaches to practical skills learning at simulation centres in Scandinavian universities and university colleges.

BACKGROUND: Academic simulation centres are an important arena for learning practical nursing skills which are essential to ensure competent performance regarding patient safety and quality of care. Knowledge of didactic approaches to enhance learning is essential in promoting the provision and retention of students' practical nursing skills. However, research on didactical approaches to practical nursing skills learning is lacking.

DESIGN: A qualitative comparative design was used.

METHODS: During November and December 2019, interviews were conducted with a total of 37 simulation centre directors or assistant directors, each of whom possessed in-depth knowledge of practical skills in teaching and learning. They represented bachelor nursing education in Denmark, Norway and Sweden. A qualitative deductive content analysis was conducted.

RESULTS: The results revealed all five predetermined didactical components derived from the didactical relationship model. Twenty-two corresponding categories that described a variation in didactic approaches to practical skills learning in Scandinavian nursing simulation centres were identified. The didactical components of Learning process revealed mostly similarities, Setting mostly differences and Assessment showed only differences in didactic approaches.

CONCLUSION: Although various didactic approaches were described across the countries, no common approach was found. Nursing educational institutions are encouraged to cooperate in developing a shared understanding of how didactic approaches can enhance practical skills learning.

IMPLICATIONS FOR PROFESSION AND/OR PATIENT CARE: Cross-country comparisons of practical nursing skills learning in Scandinavian countries highlight the importance of educator awareness concerning the impact diverse didactic approaches may have on competent performance in nursing education. Competent performance is pivotal for ensuring patient safety and the provision of high-quality care.

PATIENT OR PUBLIC CONTRIBUTION: No Patient or Public Contribution.

REPORTING METHOD: This study followed the Consolidated Criteria for Reporting Qualitative Research reporting guidelines.

Background: Changes in demographics with an older population, the illness panorama with increasing prevalence of non-communicable diseases, and the shift from hospital care to home-based care place demand on primary health care, which requires multiprofessional collaboration and team-based organization of work. The COVID-19 pandemic affected health care in various ways, such as heightened infection control measures, changing work practices, and increased workload.

Objectives: This study aimed to investigate the association between primary care practices’ organization, and quality and safety changes during the COVID-19 pandemic.

Design: Data were collected from 38 countries in a large online survey, the PRICOV-19 study. For this paper, the participating practices were categorized as “Only GPs”, comprising practices with solely general practitioners (GPs) and/or GP trainees, without any other health care professionals (n = 1,544), and “Multiprofessional,” comprising practices with at least one GP or GP trainee and one or more other health professionals (n = 3,936).

Results: Both categories of practices improved in infection control routines when compared before and during the COVID-19 pandemic. A larger proportion of the multiprofessional practices changed their routines to protect vulnerable patients. Telephone triage was used in more “Multiprofessional” practices, whereas “Only GPs” were more likely to perform video consultations as an alternative to physical visits. Both types of practices reported that the time to review new guidelines and scientific literature decreased during the pandemic. However, both had more meetings to discuss directives than before the pandemic.

Conclusions: Multiprofessional teams were keener to introduce changes to the care organization to protect vulnerable patients. However, practices with only GPs were found to be more aligned with video consultations, perhaps reflecting the close patient-doctor relationship. In contrast, telephone triage was used more in multiprofessional teams.

BACKGROUND: The aim of this study was to compare and describe different professionals' experiences of workplace psychological and social factors in occupational health (OH) organizations in Sweden.

METHODS: This cross-sectional study with a descriptive and comparative design included 472 respondents with common professions in the occupational health service (OHS) in Sweden. Data were collected with "The General Nordic Questionnaire for Psychological and Social Factors at Work" (QPSNordic). The professions have been compared pairwise using the Independent Samples Kruskal-Wallis test, adjusted by Bonferroni correction for multiple tests on subscales and single items and these are presented descriptively.

RESULTS: The experience of the psychological and social work environment on job task measurement level differed between the professionals. Experiences on social and organizational as well as on individual measurement levels are similar between the professionals who perceive them as satisfactory. Out of the 472 respondents, 7% reported that they had seen someone being subjected to harassment and bullying at the workplace during the last six months.

CONCLUSIONS: The experience among the professionals differs most in the Job task measurement level. The results indicate that although different OH professionals experience psychological and social factors at work in different ways, their experiences are generally satisfactory even though harassment and bullying do exist. The research about occupational health professionals and their work environment is sparse. Further applied research is needed for the planning and development of occupational health services in Sweden.

Aim: Dignity in older persons is a goal of palliative care. This study aimed to perform a process evaluation of the Swedish Dignity Care Intervention (DCI-SWE) in municipal palliative care in Sweden, focusing on implementation, context, and mechanism of impact.

Methods: This study had a process evaluation design. The Knowledge to Action framework supported the implementation of the DCI-SWE. The intervention was used by community nurses with older persons (n = 18) in home healthcare and nursing homes. Data were collected by focus groups- and individual interviews with community nurses (n = 11), health care professionals (n = 5) and managers (n = 5), reflective diaries, and field notes.

Results: Grasping the DCI-SWE was challenging for some community nurses. Enhanced communication training and increased engagement from managers were requested. However, the DCI-SWE was perceived to enhance professional pride in nursing. In terms of fidelity, dose and reach the project was not fully achieved. Regarding mechanism of impact the DCI-SWE contributes to address older persons' loneliness and existential life issues, as it put conversations with older persons on community nurses' agenda.

Conclusions: The DCI-SWE provided opportunities to maintain older persons' dignity and quality of life. However, with refinements of design and the DCI-SWE, the sustainability in the context may increase.

OBJECTIVE: The aim of this study was to describe perceived health problems among disaster responders after the earthquake in eastern Turkey/Syria in February 2023.

METHODS: A non-probability cross-sectional study was conducted using an online survey.

RESULTS: A total of 525 local (18%) and international disaster responders (81%) participated in the study. Of these responders, 46% reported physical or mental health problems during or after their deployment, 15% required medical care during the mission, and 7% required medical evacuation. The most common health problems during the field mission were feeling scared or unsafe, sleeping problems, and headache. After the mission, fatigue, sleeping problems, and feeling depressed were the most frequently reported health problems. The local responders perceived significantly more health problems than did the international responders. Approximately 11% of the participants could not return to their ordinary work after deployment because of infections or mental health issues.

CONCLUSIONS: Physical and mental health problems are commonly perceived by disaster responders and may reduce the effectiveness of disaster response. Raising awareness of health risks among disaster response workers and employers is essential to ensure proper duty of care and should include reparations and medical support during and after disaster response operations.

BACKGROUND: The professional role of a nurse anaesthetist involves taking a pedagogical approach towards students, including supervision during clinical practice. Although supervisors are facilitators of student learning, they are offered little training in adult learning principles. The aim of this study was to describe supervisors' experience of student nurse anaesthetist learning during clinical practice in the operating room.

METHOD: In this qualitative interview study, 12 semi-structured individual interviews were carried out with clinical supervising nurse anaesthetists. The data were analysed inductively using thematic analysis.

RESULTS: The results are illustrated with one theme and five sub-themes. The clinical learning situation of student nurse anaesthetists is described as a reflection of different cultures coming together. The operating room environment is a new context to students, and students enter with different clinical background and experiences. There is tension in facilitating student learning due to demands for productivity; supervisors suggest the use of separate operating rooms with a special focus on learning in the future.

CONCLUSION: Clinical practice facilitates student learning and is a parallel process to routine care. Thus, it requires the cultures of higher education and healthcare organizations to co-exist. This is illustrated with the theme "Contributing to students' future professional roles by bridging the hospital and university cultures". In the operating room, student learning is challenged by a new context and time pressure as shown by subthemes. To overcome challenges and support student learning in the operating room from a supervisors' perspective, interprofessional student teams are suggested as a future approach and need to be further investigated.

BACKGROUND: Cervical cancer is a global disease and it is well established that cervical cancer is caused by human papillomavirus (HPV). In Sweden self-sampling for HPV is now used as a complement to sampling performed by a midwife. However, there is a lack of knowledge on how older women perceive the self-sampling compared to the sampling performed by a midwife. Therefore, the aim of the study was to describe how women, aged 64 years and older, perceived the process of self-sampling and sampling performed by a midwife for HPV-testing.

METHODS: Eighteen women were included in a qualitative interview study, and a phenomenographic approach was used for the analysis of the interviews.

RESULTS: Three descriptive categories emerged: Confidence in sampling, Facilitating participation and Being informed. Within the categories, eight conceptions emerged describing the variation relating to how the women perceived the process of self-sampling and sampling performed by a midwife.

CONCLUSIONS: Women in this study describe confidence in self-sampling for HPV-testing and that the self-sampling was saving time and money, both for themselves and for society. Information in relation to an HPV-positive test result is of importance and it must be kept in mind that women affected by HPV may feel guilt and shame, which health care professionals should pay attention to. This knowledge can be used in education of health care staff.