To Örebro University

Objectives. In view of declining screening uptake in young women, this review aims to summarise the available evidence relating to interventions designed to increase cervical screening uptake amongst women aged <= 35 years.

Methods. Electronic databases were searched and further articles located by manual searches. Study designs employing a valid comparison group and including women aged <= 35 years published through 2012 were considered. Data was extracted on the uptake from either screening programme statistics or as reported by the study subjects. A narrative synthesis was undertaken for each category of interventions identified.

Results. Ninety-two records were screened with 36 articles retrieved for further assessment. Four studies met the inclusion criteria, two of which evaluated more than one intervention. One of the studies evaluated the use of a modified invitation letter and reported no significant increase in uptake compared to a standard invitation. Three studies investigated the use of a reminder letter, with two reporting a positive effect on screening uptake in women aged 24-34. Three studies were included which supported the use of physician and telephone reminders. One study on HPV self-sampling reported a positive effect when compared with a reminder letter.

Conclusions. There is a lack of randomised controlled trials designed to specifically address falling cervical screening uptake in amongst young women. Cervical screening programmes need to look beyond the use of invitation/reminders letters in this group of women to develop interventions which attempt to overcome as many barriers to uptake as possible.

Aim and objectives: To develop and test feasibility and acceptability of an interactive ICT-platform integrated in a tablet for collecting and managing patient reported concerns of older adults in home care.

Background: Using different ICT-applications, e.g. interactive tablets for self-assessment of health and health issues, based on health monitoring as well as other somatic and psychiatric monitoring systems may improve quality of life, staff and patient communication and feelings of being reassured. The European Commission hypothesize that introduction of ICT-applications to the older population will enable improved health. However, evidence-based and user-based applications are scarce.

Design: The design is underpinned by the Medical Research Council's complex intervention evaluation framework. A mixed-method approach was used combining interviews with older adults and healthcare professionals, and logged quantitative data.

Methods: In cooperation with a health management company, a platform operated by an interactive application for reporting and managing health related problems in real time was developed. Eight older adults receiving home care were recruited to test feasibility. They were equipped with the application and reported three times weekly over four weeks, and afterwards interviewed about their experiences. Three nurses caring for them were interviewed. The logged data was extracted as a coded file.

Results: The older adults reported as instructed, in total 107 reports (mean 13). The most frequent concerns were pain, fatigue and dizziness. The older adults experienced the application as meaningful with overall positive effects as well as potential benefits for the nurses involved.

Conclusions The overall findings in this study indicated high feasibility among older adults using the ICT-platform. The study's results support further development of the platform, as well as tests in full-scale studies and in other populations.

Relevance to practice: An ICT-platform increased the older adults' perception of involvement and facilitated communication between the patient and nurses.

The number of people reaching old age is increasing rapidly, challenging the society and healthcare to promote healthy and meaningful aging. There is, and has been for a few years, a big interest in collecting patient reported outcomes (PROs) as a base for clinical management. Information and communication technology (ICT) and assistive technology in elderly care increase and may facilitate the care of older adults as they are moved from nursing homes to private homes. An ICT-platform for reporting health issues with immediate access to self-care advice and direct communication with healthcare professionals has been developed. The overall aim of this project is to evaluate the effects of the interactive ICT-platform regarding optimal functionality and participatory care. The project will be conducted in three phases: development of the ICT-platform, evaluating feasibility and evaluation of effects. The platform is unique by integrating interactive components for direct clinical management and needs to be thoroughly evaluated before implementation in daily practice. It is hypothesized that by using an interactive ICT-platform, it will promote participatory care and enhance the communication between older adults and their professional carers. The platform will be further developed, as well as test in a full-scale study.

BACKGROUND: Aging is characterized by loss of function and represents a perspective that puts the focus on the negative aspects of aging. Thus, it is fundamental to shift the focus from loss of function to maintaining good health and personal satisfaction through life; in other words, to promote optimal functionality at a level appropriate for older adults. However, it is not yet known what constitutes optimal functionality from the older adult's own perspective.

OBJECTIVE: To explore the concept of optimal functionality in old age from the older adult's perspective (ie, people over 65 years of age) in industrialized Western countries.

METHODS: We undertook a scoping review and searched two electronic databases (PubMed and the Cumulative Index to Nursing and Allied Health Literature [CINAHL]) from January 2002 to July 2013 for scientific studies, using the key search term personal satisfaction. In total, 25 scientific studies were analyzed.

RESULTS: Only six of the included articles applied a qualitative methodology. By analyzing the results of these articles, three major themes were identified as cornerstones in the concept of optimal functionality at old age: 1) self-related factors (eg, mental well-being); 2) body-related factors (eg, physical well-being); and 3) external factors equal to demographic and environmental factors.

CONCLUSION: There is a lack of qualitative studies in the current literature, and hence of what constitutes optimal functionality from the older adult's perspective. The results outlined in this review identify three cornerstones (self-related factors, body-related factors, and external factors) of what constitutes optimal functionality at old age. However, it is vital that these findings are taken further and are evaluated through qualitative studies to reflect older adults' opinions.

Background: Professional competence and continuous professional development is essential for ensuring high quality and safe nursing care, and it might be important for motivating nurses to stay in the profession. Thus, there is a need to identify the developmental process of nursing competency. Assessment of competence and need for further training helps to identify areas for quality improvement, and to design interventions in order to facilitate continuous competence development in different work contexts. The current study aimed to 1) describe registered nurses' self-assessment of clinical competence as well as the need for further training, and 2) explore possible differences between registered nurses with varying lengths of professional experience as a nurse (≤ 0,5 year, > 0,5-5 years, and ≥ 6 years).

Methods: A cross-sectional survey design was applied, using the Professional Nurse Self-Assessment Scale of clinical core competencies II. Registered nurses (n = 266) working in medical and surgical contexts in hospitals in Sweden responded (response rate 51%). Independent student t-test and analysis of variance were carried out.

Results: Registered nurses assessed their competence highest in statements related to cooperation with other health professionals; taking full responsibility for own activities; and acting ethically when caring for patients. They assessed their need for further training most for statements related to assessing patients' health needs by telephone; giving health promotion advice and recommendations to patients by telephone; as well as improving a creative learning environment for staff at the workplace. For self-assessed competence and need for further training, differences between the groups for 35 and 46 items respectively, out of 50 were statistically significant.

Conclusions: Although the registered nurses assessed their competence high for important competence components expected of professionals such as cooperation with other healthcare professionals, it is problematic that knowledge of interactions and side-effects of different types of medication were reported as having the highest need of training. Longitudinal follow up of newly graduated nurses regarding their continuous development of competence as well as further training is needed.

Aim: The aim of this study was to describe how patients with chronic back pain experience encounters with health care. Persons with chronic back pain are a stigmatized group often treated based on stereotypes, which may lead to misunderstandings and create frustrated patients and healthcare personnel. Few studies have examined the generic aspects of quality of care in this context.

Design: A descriptive design with a qualitative approach was used.

Methods: Nine individual interviews were conducted with chronic back pain patients after admission to an orthopaedic hospital ward. Data were analysed using content analysis.

Results: The patients’ experiences of healthcare encounters can be described by the theme “Struggling to be seen and understood as a person,” comprising the categories “Lack of access and trust to care",“A desire to be taken care of and listened to” and “Own strength to handle healthcare situations.”

The objective of this study was to explore children's and caregivers' experiences and management of postoperative recovery at home after tonsil surgery. The study had an explorative qualitative design with an inductive approach. Twenty children (5-12 years of age) undergoing tonsillectomy or tonsillotomy with or without adenoidectomy participated along with their caregivers in semi-structured interviews at a mean time of 28 days after surgery. The interviews were analyzed with content analysis. One main category emerged from the interviews: children and caregivers struggle to establish resilience in a challenging recovery. The families' resilience relied on their situational awareness and capacity to act, which in turn formed a basis for the ability to return to normal daily life. Children and caregivers described the recovery as an evident interruption of daily life which had an impact on the children's physical and psychological well-being. Both children and caregivers described the pain as a central concern. The families used different pharmacological and complementary strategies to manage the pain, which in some cases were complex. Some families said that the analgesics were insufficient in preventing breakthrough pain, and spoke about a lack of support as well as inadequate and contradictory information from healthcare staff. Caregivers also expressed uncertainty, ambivalence, or anxiety about the responsibility associated with their child's recovery. To optimize and support the recovery after tonsil surgery, it is crucial to obtain knowledge of children's and caregivers' perspectives of postoperative recovery at home. The results indicate that the postoperative period included several troublesome experiences for which neither the children nor the caregivers were informed or prepared. The experience of pain was significant, and often complex to manage. To increase families' resilience, the information provided by healthcare professionals needs to be broadened. Multidisciplinary teamwork is necessary to achieve this goal.

BACKGROUND AND PURPOSE: Many newly graduated nurses lack proficiency in practical skill performance. Presently, nursing students' practical skill is assessed by summative instruments with overarching items. The purpose of this study was to develop a more detailed instrument to use in summative assessment of nursing students' practical skill performance and to assess its psychometric properties.

METHODS: A 50-item instrument was developed. Video-recorded performances were rated by experienced clinical supervisors. A multifacet measurement design was developed. Relevant parameters were estimated by generalizability analysis.

RESULTS: Findings indicated that error of measurement were mainly caused by raters far more than by items.

CONCLUSIONS: The present study suggested that summative assessment in realistic settings may not apply one rater only. Two to three/four raters appear necessary to dependably measure most skills.

Population-based cervical cancer screening programs (PCCSPs) were introduced in Stockholm in the 1960s; today all women residents aged 23-60 are invited to a cost-free Pap smear at regular intervals. A shift in scientific knowledge has occurred, with clarification of the link between human papilloma virus (HPV) and cervical cancer (CC), and the introduction of HPV-vaccines for primary prevention of CC. While there is a large body of research on CC screening, fewer studies address screening experiences of women in different phases of life with different screening histories. The aim of this thesis was to explore how women reason about CC, its causes, prevention and participation in CC screening. Method: These studies were guided by the inductive approach interpretive description . Sub-study I is based on qualitative analysis of 12 telephone interviews and 86 fax messages sent to the screening organisation by women who actively chose not to participate in PCCSP. Sub-study II is based on longitudinal interview data from 30 women, who underwent medical follow-up of an abnormal Pap smear. Sub-studies III and IV are based on data from 30-year old women with varied screening background and experiences, derived from 9 face-to-face focus group discussions (FGD) (sub-studies III, IV) and 30 internet-based FGDs (sub-study IV). Results: Women s ways of conceptualizing health, illness, and risk for disease in general impacted on their decision-making about attending PCCSP. Matters related to sickness, including CC and its prevention, were generally described as distant and unprioritized by many women. The manner 30-year old women self-defined themselves in the transition between youth and adulthood appears to strongly influence their reasoning not only about PCCSP, but also about other forms of health maintenance and disease prevention. How women defined and conceptualized distinctions between, and roles and responsibilities of, the private and the public was also found to be central in explanations of decision-making, especially among women who actively chose not to take a Pap smear. Women described a wide range of factors which could motivate them to participate in PCCSP, related to all aspects of the program, from invitation through follow-up, and a need for different types and forms of information. Many suggestions were related to individualization of the PCCSP; a need to understand the relationship between HPV and CC also was addressed. We also found that medical follow-up of an abnormal Pap smear involved an experience of both having and being a body, which changed over time. The conceptualization of bodily boundaries appeared to change, e.g. through vaginal discharges and bleeding, as well as linkages to the bodies of women in their extended families through the generations. Conclusion: All facets of the PCCSP and social marketing were found to influence women s experiences of and decisions about screening attendance. Women s views of the PCCSP as a comprehensive system suggest a need for increased collaboration among the many professionals with direct and indirect involvement in the PCCSP. These studies suggest that coordination with and information about PCCSP is an important implication for when initiating HPV vaccination programs, as a means of aiding women in integration of different types of knowledge and information.

Background: Clinical group supervision has existed for over 20 years in nursing. However, there is a lack of studies about the role of supervision in nursing students' education and especially the focus on ethical reasoning.

Aim: The aim of this study was to explore and describe nursing students' ethical reasoning and their supervisors' experiences related to participation in clinical group supervision.

Research design: The study is a qualitative interview study with interpretative description as an analysis approach.

Participants and research context: A total of 17 interviews were conducted with nursing students (n = 12) who had participated in clinical group supervision in their first year of nursing education, and with their supervisors (n = 5).

Ethical conciderations: The study was based on the ethical principles outlined in the Declaration of Helsinki, and permission was obtained from the Regional Ethical Review Board in Sweden.

Findings: The analysis revealed that both the form and content of clinical group supervision stimulated reflection and discussion of handling of situations with ethical aspects. Unethical situations were identified, and the process uncovered underlying caring actions.

Disscusion and conclusion: Clinical group supervision is a model that can be used in nursing education to train ethical reflection and to develop an ethical competence among nursing students. Outcomes from the model could also improve nursing education itself, as well as healthcare organizations, in terms of reducing moral blindness and unethical nursing practice.

AIMS AND OBJECTIVES: To describe nursing students' experience of stress during clinical practice and evaluate the risk of stress in relation to the clinical setting characteristics and the organisation of the clinical education.

BACKGROUND: Stress during clinical practice is well documented, but there is a lack of knowledge concerning whether the clinical setting characteristics and the organisation of the education make a difference.

DESIGN: A cross-sectional study with evaluative design.

METHODS: Data were collected by means of a numerical rating scale for the assessment of stress and questions about the clinical setting characteristics and the organisation of the education. One hundred and eighty-four students who had completed their final year on the nursing programme at three universities in Sweden were included.

RESULTS: Nearly half of the students (43%) experienced high level of stress during clinical practice. Measured by decision in the tree analysis, the absolute risk of stress was 57% in students with placements in hospital departments, as compared to 13% in students with placements in other clinical settings. The risk of stress increased to 71% if the students with placement in a hospital took the national clinical final examination. Performance of practice in a hospital department overcrowded with patients was also associated with increased risk of stress. The organisation of supervision and number of students at the clinical placement had an effect on the experience of stress, but did not prove to be risk factors in the analysis.

CONCLUSIONS: The risk of stress in nursing students during their clinical practice differs depending on clinical setting characteristics. The taking of the national clinical final examination could be a source of stress, but this requires further investigation.

RELEVANCE TO CLINICAL PRACTICE: It is important that supervisors are aware that students in hospital departments overcrowded with patients are at risk of stress and may have increased need of support.

OBJECTIVE: The objective of this study was to explore and describe the experience of a childhood diagnosis of epilepsy and its consequences for the experiences of daily life over a span of 50 years.

METHODS: A descriptive mixed method design was chosen. Data were collected through a survey returned by 86 persons (59% response rate) who had received diagnoses of epilepsy as children. The survey contained questions about education, vocation, family status, and included the 14-item Hospital Anxiety and Depression Scale (HAD). Additionally, interviews (n = 11) were conducted and analyzed by interpretative description.

RESULTS: Few persons reported that the childhood diagnosis of epilepsy had affected their choice of education, work, or leisure activities. However, 20% reported that the diagnosis had caused problems in school or at work and had restricted their activities of daily living. Sixty-six percent of the participants were married, and 68% had children; of those, 12 (20%) reported that one or more of the children had also had seizures. Almost all reported no anxiety (82%) and no depression (90%). The results of the interviews revealed a balancing act between 'Controlling and managing the situation' and 'Not being restricted by the condition'.

SIGNIFICANCE: This long-term follow-up over a 50-year life-span of persons who received childhood diagnoses of epilepsy suggests that the consequences for education, work, and leisure activities were few. Most of the participants had developed strategies to manage their situation.

BACKGROUND: The extensive vaccination programme against swine flu resulted in an increased incidence of narcolepsy among children and adolescents. There is a need to explore if these young persons' experiences have affected their trust in healthcare, their willingness to participate in future prevention programmes, and their contacts with the healthcare system. The overall aim is to identify factors important for the life-situation of children and adolescents with narcolepsy and their families, and factors that correlate with trust in healthcare.

METHODS/DESIGN: Data will be collected via questionnaires from all available children with narcolepsy following the vaccination and their families, as well as a control group of children with diabetes and their families. Longitudinal descriptive interviews will also be conducted with a selection of 20-25 children and their families. Techniques from media research will be used for Internet-based data collection and analysis of information relating to narcolepsy from social media.

DISCUSSION: This project will use the situation of young persons with narcolepsy after the swine flu vaccination as a case to build a model that can be used in situations where trust in healthcare is essential. This model will be based on findings from the included studies on how trust is influenced by support, quality of life, burden of disease, impact on family, and use of social media. The model developed in this project will be beneficial in future situations where trust in healthcare is essential, such as new pandemic outbreaks but also for "everyday" adherence to health advice.

Objective: The aim of the study is to investigate the manner in which women who choose not to participate in a population-based cervical cancer screening program (PCCSP) reason about their decision.

Method: All women between 23 and 60 years of age, residing in Stockholm county council receive an invitation from the regional Oncological Center (OC) to attend PCCSP at regular intervals. Women who actively contacted OC to report that they do not wish to participate in PCCSP were the subjects for the study. Data was collected through unstructured telephone interviews with 11 women and fax messages from 86 women. Data analysis is inspired by interpretive description.

Results: Preliminary analysis indicates that two salient themes are related to the division of responsibility for health maintenance between the individual and society, as well as the manner in which women described being able to 'know' one's own body. Descriptions include not wanting to know if one has cancer, previous negative experiences in relation to screening that led to feeling self-exposed and insulted, beliefs that a healthy lifestyle could protect one from cancer and a standpoint that the screening program represents undesired societal control of private issues. A relationship with one's own gynaecologist was described as important and as one reason for not attending PCCSE Reasoning was also influenced by conceptualizations of sexuality.

Conclusion: Cervical cancer screening can be viewed as a relatively simple routine check-up, but for the individual woman it may also involve a sensitive situation, with both the risk of a life-threatening sickness and an intimate physical examination. In order to improve PCCSP, it is important to highlight different perspectives on screening, and perspectives from women who have chosen not to attend are essential.

Background: In 2010, newly diagnosed narcolepsy cases among children and adolescents were seen in several European countries as a consequence of comprehensive national vaccination campaigns with Pandemrix against H1N1 influenza. Since then, a large number of people have had to live with narcolepsy and its consequences in daily life, such as effects on school life, social relationships, and activities. Initially, the adverse effects were not well understood and there was uncertainty about whether there would be any financial compensation. The situation remained unresolved until 2016, and during these years affected people sought various ways to join forces to handle the many issues involved, including setting up a social media forum.

Objective: Our aim was to examine how information was shared, and how opinions and beliefs about narcolepsy as a consequence of Pandemrix vaccination were formed through discussions on social media.

Methods: We used quantitative and qualitative methods to investigate a series of messages posted in a social media forum for people affected by narcolepsy after vaccination.

Results: Group activity was high throughout the years 2010 to 2016, with peaks corresponding to major narcolepsy-related events, such as the appearance of the first cases in 2010, the first payment of compensation in 2011, and passage of a law on compensation in July 2016. Unusually, most (462/774, 59.7%) of the group took part in discussions and only 312 of 774 (40.3%) were lurkers (compared with the usual 90% rule of thumb for participation in an online community). The conversation in the group was largely factual and had a civil tone, even though there was a long struggle for the link between the vaccine and narcolepsy to be acknowledged and regarding the compensation issue. Radical, nonscientific views, such as those expounded by the antivaccination movement, did not shape the discussions in the group but were being actively expressed elsewhere on the internet. At the outset of the pandemic, there were 18 active Swedish discussion groups on the topic, but most dissolved quickly and only one Facebook group remained active throughout the period.

Conclusions: The group studied is a good example of social media use for self-help through a difficult situation among people affected by illness and disease. This shows that social media do not by themselves induce trench warfare but, given a good group composition, can provide a necessary forum for managing an emergency situation where health care and government have failed or are mistrusted, and patients have to organize themselves so as to cope.

While there is a large body of research on cervical cancer screening, fewer studies address the experiences of women receiving abnormal Pap smear results after routine screening. Those studies highlighting such experiences tend to concentrate on resulting psychosocial distress, with an absence in the literature about women's experiences of their bodies during medical follow-up for dysplasia, and no studies were found that explore such experiences over time. In this article, we focus on bodily experiences over time during medical follow-up of an abnormal Pap smear among a group of women in Sweden. This qualitative analysis is based on interview data from a total of 30 women, and with in-depth analysis of the content of 34 transcribed interviews with nine women who were followed longitudinally. We found that medical follow-up involved an experience of both "having" and "being" a body, which changed over time. Women described a process that ranged from having a cervix that was neither felt, 'heard', nor seen, to having a body that became known to them first indirectly through professional mediation and later through direct experience after professional manipulation. The conceptualization of bodily boundaries appeared to change, e.g. through visualization of the previously unfamiliar cervix, pain, vaginal discharge, and bleeding, as well as linkages to the bodies of women in their extended families through the generations. Thus, bodily experiences appear to be an intrinsic part of medical follow-up of an abnormal Pap smear through which health, disease, and risks in the past, present, and future were reconceptualised. (C) 2008 Elsevier Ltd. All rights reserved.

Background: Compassion has been identified as an essential element of nursing and is increasingly under public scrutiny in the context of demands for high quality health care. While primary research on effectiveness of interventions to support compassionate nursing care has been reported, no rigorous critical overview exists.

Objectives: To systematically identify, describe and analyse research studies that evaluate interventions for compassionate nursing care; assess the descriptions of the interventions for compassionate care, including design and delivery of the intervention and theoretical framework; and to evaluate evidence for the effectiveness of interventions.

Review methods: Published international literature written in English up to June 2015 was identified from CINAHL, Medline and Cochrane Library databases. Primary research studies comparing outcomes of interventions to promote compassionate nursing care with a control condition were included. Studies were graded according to relative strength of methods and quality of description of intervention. Narrative description and analysis was undertaken supported by tabulation of key study data including study design, outcomes, intervention type and results.

Results: 25 interventions reported in 24 studies were included in the review. Intervention types included staff training (n=10), care model (n=9) and staff support (n=6). Intervention description was generally weak, especially in relation to describing participants and facilitators, and the proposed mechanisms for change were often unclear. Most interventions were associated with improvements in patient-based, nurse-based and/or quality of care outcomes. However, overall methodological quality was low with most studies (n=16) conducted as uncontrolled before and after studies. The few higher quality studies were less likely to report positive results. No interventions were tested more than once.

Conclusions: None of the studies reviewed reported intervention description in sufficient detail or presented sufficiently strong evidence of effectiveness to merit routine implementation of any of these interventions into practice. The positive outcomes reported suggest that further investigation of some interventions may be merited, but high caution must be exercised. Preference should be shown for further investigating interventions reported as effective in studies with a stronger design such as randomised controlled trials.

OBJECTIVES: To explore health problems and the recovery process after being deployed in a major incident.

DESIGN: Qualitative, explorative design.

SETTING: Ambulance services in Sweden.

PARTICIPANTS AND METHODS: Semistructured, individual two-session interviews with 15 ambulance nurses with the experience of being deployed to major incidents were conducted. Data were analysed with thematic analysis.

RESULTS: Being deployed in major incidents was perceived to be straining and led to both physical health problems and distress. To recover, the ambulance nurses strived to use strategies to distance themselves from the situation and created supportive conditions for their recovery, and if successful, the experiences led to both professional and personal growth and self-awareness. However, being deployed in major incidents without significant preparedness or experience could harm individuals and, in the worst case, end their career.

CONCLUSIONS: A successful recovery from the physical and mental exhaustion experienced after being deployed in a major incident required both individual abilities and self-care strategies as well as a supportive working environment. Supporting individual recovery strategies and following up on physical and mental well-being over time should be part of all ambulance services procedures after major incidents.

BACKGROUND: Human papillomavirus (HPV) self-sampling has shown to be acceptable and feasible across cultures and effective in reaching women who do not participate in regular cervical cancer screening. However, most of these studies have included younger women. There is a lack of knowledge of how older women reason about HPV self-sampling.

OBJECTIVE: The aim of this study was to describe how women (>60 years old) experience the offering of self-sampling of HPV, compared to having a sample collected by a healthcare professional.

DESIGN AND PARTICIPANTS: The study had a qualitative explorative design. Four focus group discussions were conducted with women 60-69 years old (n = 22). Data were analysed using principles of interpretive description.

RESULTS: Five themes were identified: self-sampling-convenient and without pain, lack of knowledge, worries related to HPV self-sampling, need for information and taking a societal perspective.

CONCLUSION: Women aged >60 years found that HPV self-sampling was convenient and easy to perform. Further, they stressed the importance of being able to remain in the screening programme in advanced age and that self-sampling could be a possible solution. This study also revealed a lack of knowledge among women in this age group regarding HPV infection, how the disease is transmitted and its relation to cervical cancer.

PUBLIC CONTRIBUTION: Women who had performed HPV self-sampling participated in the focus group discussion.

Aim: The aim was to investigate occupational stress among newly graduated nurses in relation to the workplace and clinical group supervision.

Background: Being a newly graduated nurse is particularly stressful. What remains unclear is whether the workplace and clinical group supervision affect the stress.

Method: A cross-sectional comparative study was performed in 2012. Data were collected by means of a numerical scale measuring occupational stress, questions about workplace and clinical group supervision. One hundred and thirteen nurses who had recently graduated from three Swedish universities were included in the study.

Results: The stress was high among the newly graduated nurses but it differed significantly between workplaces, surgical departments generating the most stress. Nurses who had received clinical group supervision reported significantly less stress. The stress between workplaces remained significant also when participation in clinical group supervision was taken into account.

Conclusions: Newly graduated nurses experience great stress and need support, especially those in surgical departments. Nurses participating in clinical group supervision reported significantly less stress.

Implications for nursing management: It is important to develop strategies that help to adapt the work situation so as to give nurses the necessary support. Clinical group supervision should be considered as an option for reducing stress.

BACKGROUND: Although registered nurses (RNs) play a central role in the care of older persons, their work in elderly care has historically been described as "low status" in nursing. This is especially problematic due to the global issue of RN turnover, but there is still little evidence of how to change this trend. Better understanding is needed of the reasons why RNs work in elderly care, as well as knowledge of whether these reasons have changed over time.

AIM: The aim was to explore the meaning of working in elderly care, over time, from the perspective of RNs.

METHOD: We interviewed thirteen RNs working in nursing homes, six of them in 2000 and the remaining seven in 2012, and analysed the resulting data using Interpretive Description.

RESULTS: The results show similarities and differences over time in the RNs' reasoning about the meaning of their work with older persons, from a focus on obstacles to a view of opportunities.

CONCLUSION: An RN's intention to continue working in elderly care might be based on their beliefs; their view of older people, and their experiences of being able to influence the care. Managing this knowledge could be an essential factor in reversing the historical trend of RN work in elderly care being seen as low status, and the increasing turnover in such nurses. Our results could stimulate reflection on daily care and beliefs about caring for older persons.

BACKGROUND: The Patient Dignity Inventory (PDI) is based on an empirically-driven dignity model that has been developed and used for clinically assessing the various sources of dignity-related distress. In a recent review, it received the highest score as a useful instrument in both practice and research in palliative care. The PDI has been adapted to and validated for use in various countries, but not yet Sweden.

AIMS: To translate the PDI into Swedish, including cultural adaptation for clinical use.

METHODS: A multi-step process of translation, negotiated consensus, expert group discussion (n=7: four invited experts and three researchers) and cognitive interviewing (n=7: persons with palliative care needs).

FINDINGS: Discussion, by the expert reviewers, of both linguistic and cultural issues regarding the content and readability of the translated Swedish version resulted in revisions of items and response alternatives, focusing mainly on semantic, conceptual, and experiential equivalence. A pilot version for cognitive interviews was produced. The analysis of data showed that most of the items were judged to be relevant by the persons with palliative care needs.

CONCLUSION: The process of translation and adaptation added clarity and consistency. The Swedish version of the PDI can be used in assessing dignity-related distress. The next step will be to test this Swedish version for psychometric properties in a larger group of patients with palliative care needs before use in research.

BACKGROUND: Disaster responders are exposed to several physical and mental health risks. This study aimed to describe self-care strategies used by disaster responders after the earthquake in Syria and eastern Turkey in February 2023.

METHODS: A study specific web-based questionnaire survey was used to collect quantitative and qualitative data according to a convergent mixed methods approach. Data from 252 disaster responders responding to the earthquakes in Turkey and Syria were analyzed using both descriptive and analytical statistics and summative content analysis of free-text answers. Data were collected in March to July, 2023.

RESULTS: The most used self-care strategies included resting, social support from colleagues in the field, extra intake of food or drink, and intake of medicines. The recovery strategies varied due to previous disaster response experience, indicating that supportive self-care strategies can be developed or learned.

CONCLUSION: Given the extreme conditions and limited possibilities of external support, sufficient self-care is an essential competence among disaster responders. Self-care strategies can be both external processed such as intake of medicines, social support from others, and internal processes such as personal reflection. Providing oneself with self-care activities seems to be a skill developed with increasing experience supported by pre-deployment training. Therefore, to enhance resilience, self-care strategies should be encompassed in pre-disaster response training.

Background: Leaders play an essential role in the health care of older adults. The leadership role has changed over the years because of new demands in providing care for older adults with multiple chronic conditions, as well as a lack of resources.

Aim: The aim of this study was to describe formal leaders’ views over time on their leadership and the competence among staff in care of older adults.Method: Individual interviews and focus group discussions with leaders in care of older adults were conducted with a total of 46 formal leaders in 2000 (n=20) and 2011 (n=26). The analysis took a qualitative approach, using interpretative description.

Results: The leaders’ descriptions of leadership encompassed two different views on leadership over time, from “I as a leader” to “We together”. The leaders interviewed in 2011 saw practical wisdom (phronesis) as a central aspect of staff competence. Throughout the interviews, a greater focus on personal characteristics was seen over time.

Conclusions: Differences over time in views of the leaders’ role and staff competence, especially the increased focus on personal characteristics, may have an impact on the health care provided to older adults. This is particularly true if formal education is not prioritized. Strategies within organizations and continuing development and education must take these changes into consideration

Aims and objectives. The aim of this study was to describe how care team members caring for patients with advanced cancer describe how they handle difficult situations in daily care. In this paper 'difficult situations' refers to those situations team members themselves describe as difficult. Background. Serious illness and impending death involve great changes in a person's life. The care of patients with advanced cancer is complex and many different factors influence each care situation. This places demands on the way care team members handle problems and difficulties in daily care. Design. Qualitative descriptive study. Methods. The study is based on 16 focus group discussions with care team members who were caring for patients with advanced cancer at three different care units in two Swedish cities. The focus group discussions included 77 participants. The procedure for data analysis was inspired by the phenomenological method. Findings. The results show that care team members handled difficult situations by balancing between being close and distancing themselves. In most situations their choice of strategy seemed spontaneous rather than being a conscious decision, although it was sometimes described as a more conscious approach. Variations of closeness and distance that were identified were Identity, Meaning, Limit-setting and touching, Prioritization, the Team and the Organization. These could also be seen as tools that could facilitate or impede the use of closeness and distance. Conclusions. The results show that care team members have a need to reflect over daily care and to become aware of what governs different care actions. Relevance to clinical practice. If the experienced difficult situation is not handled in a way that is beneficial to the care team member, patient and relatives, it is assumed that this can result in stress, burnout and, above all, non-optimal care.

In Stockholm, Sweden, women are invited to a cost-free population-based cervical cancer screening programme (PCCSP) at regular intervals. Despite this, many women choose not to attend screening at all or to take opportunistic tests instead. This study explores bow women who actively declined participation in the PCCSP reasoned about their choice. Qualitative telephone interviews and fax, messages from women who actively declined participation in the PCCSP were analysed inductively. The manner in which women defined and conceptualized distinctions between, and the roles and responsibilities of, both private and public spheres were found to be central in explanations of decision making. Factors related to women's decisions not to participate in screening at all include a lack of confidence in the benefits of screening, previous negative health care and preventive experiences, a belief in one's own ability to discern health changes or a belief that one was not at risk for cervical cancer, as well as a number of unconventional standpoints on social and political issues. Women who chose not to participate in the organized PCCSP, but who did use private opportunistic screening, generally motivated this with direct or indirect criticism of the screening programme itself. Not only was the examination itself sensitive but also all facets of the PCCSP, from invitation letter on, were found to influence women's decisions. Using Jepson et A's ethical framework to peruse the evidence-base underlying women's 'informed decision-making' about CCS is suggested to be more constructive than discussing potential participants' knowledge versus lack of knowledge.

Background. Cervical cancer screening (CCS) using Pap-smears has been carried out for decades and is still an essential tool for secondary cancer prevention. Focus has traditionally been on what hinders women's attendance, instead of researching this issue from a positive standpoint, i.e. what factors encourage women to take a Pap-smear? In this article, we therefore explore issues that 30-year-old women have addressed as encouraging CCS attendance, with particular focus on aspects susceptible to intervention. Material and methods. Through the population-based cervical cancer screening (PCCSP) registry in Stockholm, Sweden, a stratified random sampling technique was used to recruit women from the same birth cohort with varied CCS histories and results. Nine face-to-face focus groups discussions (FGDs) and 30 internet-based FGDs were conducted with a total of 138 women aged 30. Qualitative analysis was inspired by interpretative description, to generate clinically relevant and useful data. Results. In general, these women expressed positive views about the PCCSP as an existing service, regardless of screening history. They described a wide range of factors encompassing the entire screening trajectory from invitation through follow-up which could motivate young women to CCS participation, including social marketing. Many of the suggestions related to individualization of the PCCSP, as well as a need to understand the relationship between human papilloma virus (HPV) and cervical cancer. Discusssion. These results are discussed in terms of the inherent tension between population-based public health initiatives and individually-oriented health care provision. Many suggestions given are already incorporated into the existing Stockholm-Gotland screening program, although this information may not reach women who need it. New research should test whether systematic information on HPV may provide a missing link in motivating young women to attend CCS, and which of their suggestions can serve to increase CCS participation.

BACKGROUND: Health care professionals' knowledge and attitudes may have an impact on older persons' nutritional status. Therefore, it is important to explore different health care professionals' perspectives on older persons' meals.

AIM: The aim of this study was to describe health care professionals' understanding of and views on the mealtime experience of older persons in municipal care.

METHODS: Seven focus group discussions with various health care professionals (nurse assistants, registered nurses and occupational therapists) (n=52) working in nursing homes and/or home care for older persons were conducted and analysed using interpretive description. The COREQ checklist was used for reporting the findings.

RESULTS: The results revealed a striving to create conditions for an appealing meal, regardless of profession. This overall theme, "An appealing meal - creating conditions for older persons' mealtimes", consisted of four sub-themes: "Food is crucial", "The mealtime as a social interaction", "Identifying the individual older person's needs" and "Integrating different perspectives of meal-related situations among the team".

CONCLUSION: The findings show that the different professionals strive to prioritise meals in the everyday care of older persons, but at same time there is a lack of a common view on how to prioritise meal-related issues. This indicates that the care may be fragmented, being based on each professional's duties and interpretation of responsibility for older persons' meals, rather than constituting comprehensive integrated person-centred care provided by a multidisciplinary team.

RELEVANCE TO CLINICAL PRACTICE: To enhance older persons' mealtimes we need to map how mealtimes are valued and implemented in clinical practice and approached in health care professionals' education. Education on older person's nutritional needs should be team-based, and not focus on the perspective of a single profession.

Purpose: Under-diagnosed and uncontrolled symptoms in patients with prostate cancer during radiotherapy can have a negative impact on the individual's quality of life. An opportunity for patients to report their symptoms systematically, communicate these symptoms to cancer nurses and to receive self-care advice via an application in an Information and Communication Technology-platform could overcome this risk. The content in the application must precisely capture symptoms that are significant to both patients and health care professionals. Therefore, the aim of the study was to map and describe symptoms and self-care strategies identified by patients with prostate cancer undergoing radiotherapy, by health care professionals caring for these patients, and in the literature.

Methods: The study combines data from interviews with patients (n ¼ 8) and health care professionals (n ¼ 10) and a scoping review of the literature (n ¼ 26) focusing on the period during and up to 6 months after radiotherapy.

Results: There was a concordance between the patients, health care professionals, and the literature on symptoms during and after radiotherapy. Urinary symptoms, bowel problems, pain, sexual problems, fatigue, anxiety, depression, cognitive impairment and irregular symptoms were commonly described during the initial treatment period. Self-care strategies were rarely described in all three of the sources.

Conclusions: The results show which symptoms to regularly assess using an Information and Communication Technology-platform for patients with newly-diagnosed prostate cancer during radiotherapy. The next step is to evaluate the efficacy of using the platform and the accuracy of the selected symptoms and self-care advice included in a smartphone application.

Background: Although there is a significant amount of research on cervical cancer screening (CCS), few studies address screening experiences of women related to reasoning about health maintenance and disease prevention in general. Research tends to neglect experiences in different phases of life and experiences of women with different screening histories. Recent literature primarily focuses on adolescents targeted for human papilloma virus vaccinations, whereas perspectives of women who need continued CCS are lacking.

Objective: The aim of the study was to explore how 30-year-old women reason about health, ill health, health maintenance, and disease prevention, in relation to cervical cancer, its prevention, and screening.

Methods: Through a population-based CCS registry, we randomly sampled women to attend focus group discussions stratified by previous patterns in screening history and test results. Data from 38 attendees were inductively analyzed.

Results: Women’s discussions encompassed temporal aspects of the past and the future, with youth in the rearview mirror and the demands of adulthood ahead. Matters related to sickness, including cancer and its prevention, were described as distant and not prioritized in this phase of life. This situation was compounded by lack of relevant information about cervical cancer and screening.

Conclusions: The manner 30-year-old women self-defined themselves in the transition between youth and adulthood appears to strongly influence their reasoning about CCS and other forms of health maintenance and disease prevention.

Implications for Practice: Cervical cancer screening programs are challenged to adapt both information and organizations to new cohorts of women with different needs and life situations.

Physical touch is a basic need of all people, regardless of age or life situation. It can provide security, well-being and belonging. But negative perceived physical touch can generate emotions such as fear, vulnerability and perceived as violations. As a consequent of the #metoo movement in the fall of 2017, it’s a risk that physical contact and especially physical touch are avoided by professions where it’s central. For example, in the context of education, studies show that sports teachers in many countries have become more cautious and avoid having physical contact with students due not to being misinterpreted as negative touch (Fletcher, 2013; Öhman, 2016; Piper, Garratt & Taylor, 2013). 

In healthcare, caregivers who use physical touch in their work with disabled and elderly people have also become insecure and worried that they may be misunderstood (Bergstrand, 2018). A review shows that healthcare professionals see physical touch as part of the work but want to be the initiator of the contact, not that it should be initiated by the patients (Kelly et al. 2018).

The use of physical touch in healthcare is also affected by the need to avoid contamination and widespread of infections agents, a question with extra relevance in the light of the Covid-19 pandemic.

There is currently a lack of knowledge about how physical touch is experienced and used. As a first step is to increase the knowledge and understanding of how physical touch is experienced and used in healthcare by mapping studies explored physical touch both in daily care but also from the perspective of nursing students. With increased knowledge, a basis for developing interventions/teaching modules can be generated.

Objectives: The purpose of this study was to explore the experiences of patients living with body dysmorphic disorder (BDD), including their experiences with the health care system.

Methods: Fifteen individuals with BDD were interviewed, and interpretive description was used to analyse the interviews.

Results: The following six themes were identified: being absorbed in time-consuming procedures, facing tension between one's own ideal and the perceived reality, becoming the disorder, being restricted in life, attempting to reduce one's problems and striving to receive care. The overarching concept derived from the themes was feeling imprisoned - struggling to become free and to no longer feel abnormal.

Conclusions: Ideas of imprisonment and abnormality compose the entire experience of living with this disorder. Although the participants suffered greatly from their BDD, these patients encountered difficulties in accessing health care and had disappointing experiences during their encounters with the health care system. Therefore, it is important to increase awareness and knowledge of BDD among health care professionals to ensure that patients with BDD receive the appropriate care.