Background: Pregnant women are often faced with having to decide about prenatal screening for Down’s syndrome. However,the decision to participate in or refrain from prenatal screening can be seen as an important decision not only for the pregnant woman but also for both the partners.

Objective: The aim of this study was to explore the couples’ processes of decision making about prenatal screening.

Methods: A total of 37 semi-structured interviews conducted at two time points were analysed using the interpretive description.

Setting: The study was carried out in Maternal health-care centres,Örebro County Council, Sweden.

Participants: Fifteen couples of different ages and with different experiences of pregnancy and childbirth were interviewed.

Results: Three different patterns of decision making were identified. For the couples in The open and communicative decision-making process’, the process was straightforward and rational, and the couples discussed the decision with each other. ‘The closed and personal decision-making process’ showed an immediate and non-communicative decision making where the couples decided each for themselves. The couples showing ‘The searching and communicative decision-making process’ followed an arduous road in deciding whether to participate or not in prenatal screening and how to cope with the result.

Conclusions: The decision-making process was for some couples a fairly straightforward decision, while for others it was a more complex process that required a great deal of consideration.

Objective: A two-step model on information on prenatal screening consists of brief information at the first visit at the Maternal Health Care Centre and an offer of extended information at a separate visit. There is a lack of knowledge why some pregnant women and their partners refrain from the extended information visit. The aim of this study was to explore their reasons

Method: Eight qualitative interviews were analysed using Interpretive Description.

Results: In the first theme “From an individual view”, the interviewees saw the invitation from their own points of view. They refrained because they did not want to receive any more information or had taken an individual position against chromosomal testing. In the theme, “From a societal view”, the interviewees perceived the offer as part of a societal view on prenatal screening that they could not support.

Conclusion: The findings shows that these interviewees' reasons of declining an extended information visit are multidimensional and influenced by different views, from both an individual perspective and a more societal one. Health care professionals should be aware that some persons could have a different view on health care services and could be reluctant to accept offered services.

The overall aim of this thesis was to describe pregnant women's and partners' views and experiences on early prenatal screening with the combined test, with special focus on the two-step information model.

Interviews were performed with 15 couples who had taken part in the extended information visit about prenatal screening, describing their perceptions of the information model (I) and ten couples or women of those, for a follow-up interview exploring their decision-making process (II). Seven couples, who had not taken part in the extended information visit, were interviewed describing their views and experiences about prenatal screening (III). A questionnaire was answered by 295 women and by 223 partners about their satisfaction about the decision whether or not to participate in the combined test, and their assessment of whether or not this choice had been difficult (IV).

The results showed that different opinions were expressed about the offer of the extended information visit. The separate visit was welcomed by most couples (I). The decision-making process regarding whether to take part in the test or not was described by most couples as a fairly straightforward decision, while for others it was a more complex process that required a great deal of consideration (II). An apprehension of the test, by some of those who had refrained the extended information visit, was that it was an expression of society's involvement in decisions that belong to the expectant parents (III). Ninety-three percent of both women and partners considered the decision about participating in the combined tests as uncomplicated, and well over 90%, of both women and partners were satisfied with their decision (IV).

The conclusions in this thesis, are that the decision whether or not to participate in the combined test is multidimensional and influenced by different views. The two-step information model helped the pregnant woman and the partner to make a decision in a fairly straightforward process or a more complex process with mixed feelings.

Background: The role of the registered nurse (RN) in the municipality regarding medication management in care for the elderly is rarely discussed. Organizational issues related to medication management often contribute more to the management than needs of the patients, nursing skills, and collaboration with the physician in primary care.

Objective: The aim of this study was to describe RNs’ perceptions of their professional role, especially regarding medication management in nursing of the elderly.

Design: The study is descriptive with a qualitative approach. Interviews with 16 RNs working at nursing homes were analysed by content analysis.

Results: The findings can be grouped into seven categories showing the RN in different roles while performing different aspects of her or his work: as controller, executer, messenger, supervisor, initiator, visionary and solitary worker. These themes were identified in the interviews and characterized the nurses’ own judgements and actions taken, especially regarding drug treatment. Overall, the RNs described nursing in elderly care as an undefined profession lacking leadership regarding medication management.

Conclusions: The study concludes that medication management ought to be promoted in care for the elderly. To handle the challenge and risks of polypharmacy there must be sufficient and adequate reporting based on the RNs’ nursing and skills to monitor and evaluate the drug treatment in teamwork with the physician. This requires leadership with understanding of the integration of services in care for the elderly, and of the medical processes and nursing skills involved.

Objective The combined test for Down syndrome is offered to pregnant women. Qualitative studies have shown that the decision, whether or not to accept the test,is a rational one for most couples, although for some it may be difficult. Little is known about the couples’ satisfaction with the decision afterwards; the aim of this study was to extend that knowledge

Method Pregnant women and their partners were invited to fill out a questionnaire at approximately pregnancy week 20. The questionnaire, which covered aspects of their decision on prenatal testing, was based on the Decision Regret Scale, with additional questions

Results The response rate was 77% (295/359 women and 223/315 partners). The decision whether or not to participate in the combined test was seen as mutual by 95% of the women and 96% of the partners, and was perceived as uncomplicated by 93% of both women and partners. The decision was considered as difficult/very difficult by 6%. With a range of 93% – 99% women and partners were satisfied with their decision afterwards, but 1%–7% were not

Conclusion The majority of the participants were satisfied wither their decision. However, a small minority were not, which is important to recognize.

Objective: Extended verbal information on prenatal screening was given when combined ultrasound and biochemistry screening test was offered at Örebro County Council, Sweden, in 2008. The aim of this study was to describe pregnant women's and her partners' perceptions of this information model.

Method: The interviews were semi-structured, and altogether, 26 interviews were performed with pregnant women and partners. Qualitative content analysis was used to analyze the data.

Results: The result consists of two main categories, ‘form and content’ and ‘managing the information’, to describe the couples' perceptions of the information given. Nine categories describe the information model in: voluntariness, a separate visit, a special midwife, the content, missing information, ethical considerations, a visit on equal terms, communication within the couple, communication with other people, and emotional management.

Conclusion: The information model helps expecting parents to focus on prenatal screening. Only information about prenatal screening and diagnosis was not enough for everybody; some couples want this to be an opportunity to discuss with a professional the pros and cons of prenatal screening as well as ethical considerations. The information visit gives the partner a chance to be involved and an opportunity for the couple to discuss the subject.