Background: Educational environments are considered important in strengthening students’ health status and knowledge, which are associated with good educational outcomes. It has been suggested to establish healthy universities based on a salutogenic approach – namely, health promotion. The aim of this study was to describe health-promoting resources and factors among first-semester students in higher education in healthcare and social work. Methods: This cross-sectional study is based on a survey distributed among all students in seven healthcare and social work programmes at six universities in southern Sweden. The survey was carried out in 2018 using a self-reported, web-based questionnaire focussing on general health and well-being, lifestyle factors together with three validated instruments measuring health-promoting factors and processes: the Sense of Coherence (SOC) scale, Salutogenic Health Indicator Scale (SHIS) and Occupational Balance Questionnaire (OBQ). Results: Of 2283 students, 851 (37.3%) completed the survey, of whom 742 (87.1%) were women; 722 (84.8%) were enrolled on healthcare programmes, and 129 (15.2%) were enrolled on social work programmes. Most reported good general health and well-being (88.1% and 83.7%, respectively). The total mean scores for the SOC scale, SHIS and OBQ were, respectively, 59.09 (SD = 11.78), 44.04 (SD = 9.38) and 26.40 (SD = 7.07). Well-being and several healthy lifestyles were related to better general health and higher SOC, SHIS and OBQ scores. Multiple linear and logistic regressions showed that perceived well-being and no sleeping problems significantly predicted higher general health and higher SOC, SHIS and OBQ scores. Being less sedentary and non-smoking habits were significant predictors of higher SOC. Conclusions: Swedish students in higher education within the healthcare and social work sector report good general health and well-being in the first semester, as well as health-promoting resources (i.e. SOC, SHIS and OBQ), and in some aspects, a healthy lifestyle. High-intensity exercise, no sleeping problems and non-smoking seem to be of importance to both general health and health-promotive resources. This study contributes to knowledge about the health promotive characteristics of students in the healthcare and social work fields, which is of importance for planning universities with a salutogenic approach. © 2022, The Author(s).

It can be challenging for nursing students to navigate between theory and practice and to implement theoretical knowledge in real work situations and vice-versa.Work-integrated learning can support the students by enabling them to combine theoretical studies with practical work experience during their clinical placement.The aim of this integrative literature review was to identify models for the integration of theory and practice during clinical placements in nursing education by usingwork-integrated learning. Sixteen articles were found and analyzed using an integrative review method. Three themes were identified: 1) Supervisor support toenable students to develop a professional identity 2) Variety of modalities for teaching and 3) Collaboration between academic lecturers and clinical supervisorsaimed at integrating theoretical and practical knowledge. Work-integrated learning enables students to integrate theory and practice, develop skills for knowledge-inpractice and prepares them for working life. It also supports the sharing of experiences between various healthcare professionals. This review identified a need forfurther research on work-integrated learning as a method for enhancing nursing students’ workplace learning.

The project "Health care interaction" among different care providers was introduced as a trial activity in the municipalities of Strömstad and Tanum in the spring of 2010. The aim of health care interaction is to provide citizens health care adapted to their specific need within shortest possible time frame; Is emergency care not needed, the aim is to avoid that the care seeker ends up in an emergency room at the hospital. In this study experiences from health care interaction is described with quantitative as well as qualitative data. Empirical data is based on available medical statistics, focus group interviews with nurses with long experience from pre-hospital emergency care and home health care, questionnaires data gathered from other health professionals involved in the activity, individual interviews with nurses and physicians at call centers for medical information, primary health care centers, home health care, pre-hospital health care and elderly care. The analysis of the data reveal opportunities and expectations among the personnel as well as their willingness to develop and improve the health care. It's also evident that the general impression among health care personnel is that increased interaction among health care providers improves the quality of the health care given. Health care interaction also contributes to improved opportunities for person-centered care with an increased degree of continuity and participation for the patient. The study also reveals that collaboration between colleagues promotes development of individual and collective knowledge. Conclusions drawn from the study is that the documentation and information system used in health care interaction needs to strengthen the participation of the care seekers as well as to improve in accessibility for the personnel involved. In order for health care interaction to evolve and develop through close follow-up and evaluation, a more transparent and uniform system for documentation is recommended. It's also concluded from the study that the call center for medical information (1177) as one of the major actors in the health care interaction program has the best potential to instigate an expansion and development of the health care interaction among care providers.

Praxis is a concept that is both vague and overused in nursing science. Hence, a more stringent use of the concept praxis could help clarify the connections between theory and practice. The purpose of this theoretical article was to highlight the advantages of developing praxis in nursing education. By using praxis as a dialectic concept, nurse educators can make significant contributions to clinical practice by clarifying that theory and practice are perceived as 2 sides of same coin, leading to a move from "being in praxis" to "being of praxis," a way to develop the professionÊs autonomy. © 2014 Lippincott Williams and Wilkins.

The Swedish welfare debate increasingly focuses on market liberal notions and its healthcare perspective aims for more patient-centered care. This article examines the new Swedish Patient Act describing and analyzing how the patient is constructed in government documents. This study takes a Foucauldian discourse analysis approach following Willig’s analysis guide. The act contains an entitlement discourse for patients and a requirement discourse for healthcare personnel. These two discourses are governed by a values-based healthcare discourse. Neo-liberal ideology, in the form of New Public Management discourse, focusing on the value of efficiency and competition, is given a hegemonic position as laws and regulations are used to strengthen it. The new Swedish Patient Act seems to further strengthen this development. The Act underlines the increased entitlement for patients, but it is not legally binding as it offers patients only indirect entitlement to influence and control their care. To safeguard the patient’s entitlement under the Patient Act, healthcare personnel should be made aware of the contents of the Act, so that they can contribute to the creation of systems and working methods that facilitate respect of the Act’s provisions in daily healthcare work.

The Swedish welfare debate increasingly focuses on market liberal notions and its healthcare perspective aims for more patient-centered care. This article examines the new Swedish Patient Act describing and analyzing how the patient is constructed in government documents. This study takes a Foucauldian discourse analysis approach following Willig's analysis guide. The act contains an entitlement discourse for patients and a requirement discourse for healthcare personnel. These two discourses are governed by a values-based healthcare discourse. Neo-liberal ideology, in the form of New Public Management discourse, focusing on the value of efficiency and competition, is given a hegemonic position as laws and regulations are used to strengthen it. The new Swedish Patient Act seems to further strengthen this development. The Act underlines the increased entitlement for patients, but it is not legally binding as it offers patients only indirect entitlement to influence and control their care. To safeguard the patient's entitlement under the Patient Act, healthcare personnel should be made aware of the contents of the Act, so that they can contribute to the creation of systems and working methods that facilitate respect of the Act's provisions in daily healthcare work.

The aim of this study was to describe nurses’ experiences of person-centered care within an integrated care chain.

Method: The study included four data sets: Two focus group interviews with a total of 22 nurses; an open questionnaire answered by 17 nurses; and individual follow-up interviews with 4 volunteers from among the 17 nurses. In total, 39 informants were included in this study. Qualitative content analysis was carried out to identify the latent content of the focus group and interview data, and the manifest content of the questionnaire data.

Results: The results showed that learning about, from and with each other were prerequisites for achieving person-centered care. The ability to provide person-centered care was influenced by factors that could be related to both the organization and to the individual nurse. Important factors were organizational transparency and structure, leadership and collaboration between healthcare centers, partnership, sole caregiver attitudes and skills.

Conclusion: In order to develop person-centered care, it is crucial that an integrated care chain feature a joint documentation system; efficient use of the resources allocated to the needs of the various healthcare centers; and a change of focus from the professional to the person seeking care.

Aim: The aim of this study was to describe how nurses in child health centres deal with parents who are hesitant to child vaccinations. Method: A study with a qualitative approach that was based on 12 semi-structured interviews. The informants were nurses working in child health centres in the Västra Götaland region. The interviews were analysed using qualitative content analysis. Results: The results identified six strategies for dealing with vaccine-hesitant parents: 1) using the family’s resources and knowledge to create a trusting relationship; 2) meetings with the same nurse; 3) open dialogue and active listening; 4) regular meetings between nurse and paediatrician; 5) nurse training on new vaccines and vaccination programme; and 6) nurse training on parents’ use of publicly available information. Conclusion: Nurses should get to know the vaccine-hesitant parents, by listening to them and understanding their point of view. Thereby, nurses establish a good relationship, inspire trust and actively involve the parents in the decision-making concerning the vaccination of their child. Nurses should not make vaccine-hesitant parents feel guilty about not wanting to vaccinate their child.

Background: The purpose of this survey was to relate completion rate and results on national clinical final examinations to student’s admission background and examination results for nursing and medical courses.

Methods: The research data were based on a quantitative case study, with 286 nursing students, using statistical analysis.

Results: The programme's overall completion rate was 76%, i.e. almost one out of four students did not complete the programme. The higher students' upper secondary/high school grades, the fewer attempts they needed to pass the nursing and medical courses exams (p<0.001). The average examination attempts needed to pass courses in medical science was significantly greater than the number needed to pass courses in nursing science (p<0.001). In a multivariate analysis both upper secondary/high school grades and average examination attempts needed to pass were significant predictors for national clinical final examination score.

Conclusion: In sum, upper secondary/high school grades and examination attempts needed, especially for courses in medical science, may be regarded as important indicators of achieved knowledge and skills which are tested in the national final examination.

Extensive research shows nurses’ work environment to be particularly stressful. This study develops, explores, and psychometrically tests a new profession-specific questionnaire identifying generalised and specific resistance resources, that make it possible to measure resources to manage work-related stress. An exploratory study design was employed. The questionnaire development was inspired by the MEASURE approach and the salutogenic theory of health. Building on the results from a literature review of nursing research and salutogenesis, supplemented by twelve interviews with hospital nurses, an item pool was generated. The first version was pilot-tested in a group of nurses who were studying to become specialist nurses. The second version of the questionnaire was psychometrically tested on a sample of registered nurses in close patient care (n = 475), analysed using confirmatory factor analysis to test seven predefined domains of the questionnaire. The analysis revealed a first order seven-domain model of 21 items: job satisfaction, professional role, work motivation, commitment, belonging in the workplace, factors and conditions for remaining in the profession, and workload. The structure of the questionnaire indicates its usefulness in clinical practice for measuring resistance resources.

Aim To explore the level of sense of coherence among Swedish nursing staff.

Design: An explorative quantitative study design was adopted using a short form for measuring sense of coherence.

Methods Data were collected in January 2018 from nurses working in full‐time positions at two hospitals in Western Sweden. A total of 93 nurses completed the 13 item questionnaire measuring sense of coherence. Descriptive statistics were applied to obtain means and standard deviations. Spearman's rank correlation was used to describe strength of association between sense of coherence and socio‐demographic categories. Between‐group differences were defined using the nonparametric tests of Mann Whitney U test and Kruskal‐Wallis test.

Results The internal consistency of the SOC‐13 was low. An inter‐item‐correlation test indicated that two items decreased the internal consistency of the scale. The level of the three dimensions of sense of coherence varied; manageability was weakest and decreased the total sense of coherence. The meaningfulness dimension was as strongest.

Conclusion On a national level, nurses reported weaker SOC than the general population, but stronger in an international comparison of nurses. They found their work difficult to manage, but meaningful.

Impact On a national level, the nurses report weaker SOC than the general population, but stronger in an international comparison of nurses. Findings from this study will have an impact on how nurses can manage work related stress in terms of sense of coherence. There will also be an impact on nurses' well‐being, which in a long run benefits patients.

Abstract Aim The study aimed to describe coordinated care planning via a video meeting from the perspective of older persons and their relatives. Design A qualitative inductive research design was used to describe older persons and relatives’ experience of care planning via video meeting. Methods Eight unstructured interviews were conducted. Purposive sampling resulted in a sample of four older persons and four relatives. The material was analysed by qualitative content analysis. Results The theme being excluded illustrates how the older persons and their relatives experienced care planning via a video meeting as lack of a personal relationship, meaninglessness and lack of participation. The older persons and their relatives had a feeling of being excluded and in an unfamiliar situation. Lack of information about the meeting’s structure and content impaired their ability to prepare for it beforehand, which led to uncertainty.

The move from student to nurse has been described as difficult and tough for new nurses. New nurses' feeling of lacking competence can reduce the opportunity to develop professional competence.They also reported fears of being "exposed" as clinically incompetent, and failing to provide safe care.Entering the nursing profession requires a high degree of adaptation where graduates are shown what skills are needed.There is a qualitative difference between the professional competence conveyed during education and the competence demanded in working life.The aim of this paper is to discuss and propose hown urses ́praxis can be developed by means of Work Integrated Learning as a pedagogical approach.The study departs from a model which shows processes newly registered nurses must manage to achieve a sense of competence. These processes will behighlighted by discussing the model's processes related to praxis in the Aristotelian tradition, situated learning, social construction and WIL.One idea behind this paper is to,by using the concept of praxis, hold up the potential of WIL It is concluded that WIL may provide an analytical perspective using reflection where the student is given the opportunity to develop metacognitive skills to reflectt heir experiences in orde rto create understanding and manifest praxis by learning in and by clinical practice, the move from being a student to becoming a nurse. The intent of praxis and WIL is to integrate scientific knowledge with practical knowledge as a pedagogical approach that provide an analytical perspective where the student is given the opportunity to develop metacognitive skills and to test their experiences in order to create understanding and manifest their praxis by learning in and by clinical practice, the move from being a student to becoming a nurse.One way to do it is by using praxis as a component in WIL and to identify knowledge that is generated in practical knowledge, professional nursing activities and endeavors by nurses on the one hand and scientific knowledge that is generated in the academy on the other hand, in order to elaborate ways to mixt hem and create a certain kind of knowledge that is neither theoretical nor purely practical.The result of this study will be proposed as a complement to nursing program curriculum in clinical practice, to identify special challenges facing students when managing and developing their professional competence

Background: Social interactions between registered nurses, older patients and their relatives are essential and play a central role in developing a successful care relationship in healthcare encounters. How nurses interact with patients affects the patient’s well-being. Limited time and demands for efficiency influence the encounter and complaints from patients and relatives often concern social interactions. Therefore, the aim of this study was to explore the social interaction in encounters between registered nurses, older patients and their relatives at a department of medicine for older people.

Methods: The study has an ethnographic approach including participatory observations (n = 21) and informal field conversations (n = 63), followed by a thematic analysis with an abductive approach reflecting Goffman’s interactional perspective.

Result: The result revealed a pattern where the participants manoeuvred between interplay and context. By manoeuvring, they defined roles but also created a common social situation. Nurses led the conversation; patients followed and described their health problems, while relatives captured the moment to receive and provide information. Finally, nurses summarised the encounter using ritual language, patients expressed gratitude through verbal and non-verbal expressions, while relatives verbally confirmed the agreements.

Conclusion: The social interaction between registered nurses, older patients and relatives was shaped by a pattern where the participants manoeuvred between interplay and context. When all participants assume responsibility for the social interaction, they become active and listen to each other. The approach adopted by nurses is crucial, thus training in communication and social interaction skills are important. When the asymmetry due to imbalance, is reduced, less misunderstanding and a satisfactory care relationship can be achieved.

AIM: To describe how nurses communicate with older patients and their relatives in a department of medicine for older people in western Sweden.

BACKGROUND: Communication is an essential tool for nurses when working with older patients and their relatives but often patients and relatives experience shortcomings in the communication exchanges. They may not receive information or are not treated in a professional way. Good communication can facilitate the development of a positive meeting and improve the patient's health outcome.

DESIGN: An ethnographic design informed by the sociocultural perspective was applied.

METHOD: Forty participatory observations were conducted and analyzed during the period October 2015 to September 2016. The observations covered 135 hours of nurse-patient-relative interaction. Field notes were taken and 40 informal field conversations with nurses and 40 with patients and relatives were carried out. Semi-structured follow-up interviews were conducted with five nurses.

RESULTS: In the result, it was found that nurses communicate with four different voices: a medical voice described as being incomplete, task-oriented and with a disease perspective; a nursing voice described as being confirmatory, process-oriented and with a holistic perspective; a pedagogical voice described as being contextualized, comprehension-oriented and with a learning perspective; and a power voice described as being distancing and excluding. The voices can be seen as context-dependent communication approaches. When nurses switch between the voices this indicates a shift in the orientation or situation.

CONCLUSION: The results indicate that if nurses successfully combine the voices, while limiting the use of the power voice, the communication exchanges can become a more positive experience for all parties involved and a good nurse-patient-relative communication exchange can be achieved.

RELEVANCE TO CLINICAL PRACTICE: Working for improved communication between nurses, patients and relatives is crucial for establishing a positive nurse-patient-relative relationship, which is a basis for improving patient care and healthcare outcomes. This article is protected by copyright. All rights reserved.

The nursing profession is close to clinical practice and vital to the student’s professional development. Innovative learning activities and models are sought to improve clinical placements. A student-centered supervision model based on patient-oriented care was introduced in a medical ward. The aim of this study was to describe nursing students’ experiences of learning with a student-centered supervision model based on patient-oriented care during their clinical placement. A qualitative descriptive study involving interviews with 12 nursing students analyzed through inductive qualitative content analysis was conducted in accordance with COREQ. The findings revealed that the nursing students viewed learning as personal, knowledge, and professional development. Their learning experiences can be seen as a process in which the scaffolding is gradually reduced in line with each student’s ability to act independently and establish a professional identity. The model can enhance structure and support in the practice setting to maximize learning.

Clinical placement constitutes a significant part of developing a professional identity and an essential bridge to future professional work as a registered nurse (Vabo et al., 2021). In traditional supervision in Sweden, the student follows the workplace supervisor, where the focus is on teacher-driven learning (Hellström-Hyson et al., 2012), or student-driven such as peer learning (Jassim et al., 2022). Due to high staff turnover, there is a need to develop pedagogical supervision models that are sustainable over time. Therefore, a student-centered model was developed in collaboration between healthcare staff, hospital educators, university teachers and nursing students, to ensure the quality of clinical placement for students.

The Student-Centered Supervision Model

The supervision model is based on Cajvert’s (2021) description of integrated learning and focuses on how the workplace supervisor can help students reflect on their work. The content of the model is based on the learning objectives specified in the curriculum of the nursing student’s course. Gibbs’ (1988) reflective cycle model is included to stimulate each student’s ability to create care relationships and be prepared for the future profession by training responsibility, reflection, critical thinking, and cooperation. The supervision model implies that instead of merely following the workplace supervisor’s work, students follow the selected patient's care trajectory during their clinical placement. The number of patients for which they are responsible increases over time. While the student is not connected to one workplace supervisor, one nurse is assigned as the main supervisor. Each student's learning is followed via documents stored in a personal folder outlining their expected development. During the week, each student's learning is documented together with a workplace supervisor.

Theoretical Framing

According to the sociocultural perspective (Vygotsky, 1978), the learning process requires communication, interaction, reflection and meaning-making to be successful. The clinical environment connects and encourages learning for a future professional function. According to Zegwaard et al. (2023) work-integrated learning can be defined as an educational approach in which the student, educational institution and an external stakeholder are included and where experiences are developed in the organization as part of the program syllabus. The student's learning takes place through active engagement together with purposeful work tasks. This allows the integration of theory with meaningful practice relevant to the student's professional development.

Aim

This study aimed to describe nursing students’ experiences of learning with the student-centered supervision model based on patient-oriented care during their clinical placement.

BACKGROUND: When patients, relatives and nurses meet, they form a triad that can ensure a good care relationship. However, hospital environments are often stressful and limited time can negatively affect the care relationship, thus decreasing patient satisfaction.

OBJECTIVE: To explain the care relationship in triad encounters between patients, relatives and nurses at a department of medicine for older people.

DESIGN: A qualitative explorative study with an ethnographic approach guided by a sociocultural perspective.

METHOD: Participatory observations and informal field conversations with patients, relatives and nurses were carried out from October 2015-September 2016 and analysed together with field notes using ethnographic analysis.

RESULT: The result identifies a process where patients, relatives and nurses use different strategies for navigating before, during and after a triad encounter. The process is based on the following categories: orienting in time and space, contributing to a care relationship and forming a new point of view.

CONCLUSION: The result indicates that nurses, who are aware of the process and understand how to navigate between the different perspectives in triad encounters, can acknowledge both the patient's and relatives' stories, thus facilitating their ability to understand the information provided, ensure a quality care relationship and strengthen the patient's position in the health-care setting, therefore making the mission to establish a care relationship possible.

AIMS AND OBJECTIVES: To explore and describe the content of the communication exchanges between nurses, patients and their relatives in a department of medicine for older people in western Sweden.

BACKGROUND: Information, messages and knowledge are constantly being communicated between nurses, older patients and relatives in the healthcare sector. The quality of communication between them has a major influence on patient outcomes. A prerequisite for good care to be given and received is that there is mutual understanding between the parties involved.

DESIGN: An ethnographic study was informed by a sociocultural perspective.

METHOD: Data were collected through 40 participatory observations of meetings between nurses and older patients and/or relatives which covered 135 hours of nurse-patient-relative interaction, field notes, 40 field conversations with 24 nurses and 40 field conversations with patients (n=40) and relatives (n=26). Five semi-structured interviews were conducted with nurses. An ethnographic analysis was performed.

RESULTS: The analysis identified three categories of content of the communication exchanges: medical content focusing on the patient's medical condition, personal content focusing on the patient's life story, and explanatory content focusing on the patient's health and nursing needs. The content is influenced by the situation and context.

CONCLUSIONS: Nurses would benefit from more awareness and understanding of the importance of the communication content and of the value of asking the didactic questions (how, when, what and why) in order to improve the patients' and relatives' understanding of the information exchanges and to increase patient safety.

RELEVANCE TO CLINICAL PRACTICE: Nurses can use the communication content to create conditions enabling them to obtain a holistic view of the patient's life history and to develop an appropriate person-centered care plan. This article is protected by copyright. All rights reserved.

The difference between the professional competence conveyed during education and the competence demanded in working life is substantial and needs to be taken seriously. In this chapter where the case is nursing education, Work Integrated Learning (WIL) and Learning Integrated Work (LIW), are suggested as pedagogical approaches in Higher Education aiming to integrate scientific knowledge and with practical knowledge, and to provide an analytical perspective where students have the opportunity to develop metacognitive skills and praxis by learning through experiences during internship. One way to achieve this in vocational education to learn from the knowledge and skills used when performing inpractice. By integrating scientific and practical vocational knowledge, one promotes professionalization that is exhibited as Learning Integrated Work (LIW), i.e. the capability to perform the expected tasks and learn at work by using a critical and development-oriented attitude in daily work and actively participate in renewals of work assignments.

The move from student to nurse has been described as difficult for newly registered nurses. Newly registered nurses’ feelings of lacking competence can reduce the opportunity to develop professional competence. Entering the nursing profession requires a high degree of adaptation. The difference between the professional competence conveyed during education and the competence demanded in working life is substantial and needs to be taken seriously. The aim of this paper is to propose a model for developing professional competence. The theoretical discussion starts with a model showing processes newly registered nurses must manage to achieve a sense of competence. These processes are highlighted by discussing how they relate to praxis in the Aristotelian tradition, situated learning and Work Integrated Learning (WIL). Learning Integrated Work (LIW) is a pedagogical approach aiming to integrate scientific knowledge with practical knowledge, and to provide an analytical perspective where students have the opportunity to develop metacognitive skills and praxis  by learning in and by clinical practice experiences. One way to achieve this is to learn from the knowledge and skills used when performing practical work. The aims of WIL and LIW are to identify both practical knowledge generated by nurses in the course of their professional activities and theoretical knowledge generated in the academy, and to elaborate an understanding constituting the essence of both theoretical and practical knowledge. By integrating theoretical and practical vocational knowledge, one promotes professionalization, including the ability to perform the expected tasks and to have a critical and development-oriented attitude in daily work.

Nursing education and the nursing profession have an artisanal character, which has dominated the profession for a long time. Work-integrated learning in nursing education means that theoretical studies are integrated with a clinical placement. The aim of the study was to describe how nursing students experience work-integrated learning in nursing education. The study has a qualitative descriptive design. Qualitaitive content analysis was used and the analysis focused on both the manifest and latent content of the material. The analysis resulted in the theme Sustainable learning during education and for the future profession as a nurse, revealing students' experiences of work-integrated learning during their education. The categories Different methods, Collaboration and Bringing the parts together as a whole constitute the integrated learning process during the education and depend on each other for increased understanding. When the students practice their theoretical knowledge in the clinical placement, work-integrated learning can facilitate them to bring the parts together as a whole, thus giving them an opportunity to enhance their learning process and develop professional skills.

In nursing practice, awareness of ethical inner values and a common understanding of nursing and caring are needed. It is therefore important to highlight ideas of caring in nursing practice. The aim of this paper was to illuminate nursing, caring and ethical inner values in caring and caring in nursing practice. By being attentive, open, respectful and treating the patient as a person, nurses can enhance both their own and the patient's sense of personal meaning in the caring relationship. Nurses can use self-reflection to create an awareness of nursing, caring and ethical inner values in caring.

AIM: This study aimed to explore nursing personnel's health while working in end-of-life care.

INTRODUCTION: End-of-life care is challenging both for nursing personnel and for the healthcare organisation, as retaining nursing staff is difficult. Although end-of-life care involves the risk of burnout, it also encompasses protective factors that can lead to personal and professional development and satisfaction, and that can enable personnel to encounter their own inner selves. In order to focus on the health of nursing personnel we chose the theory of caritative caring as our theoretical perspective.

METHOD: A qualitative inductive research design with a hermeneutical approach was chosen to explore nursing personnel's health while working in end-of-life care. Two assistant nurses and six registered nurses with experience in end-of-life care at a palliative care unit participated. The study was approved by a Regional Ethical Review Board.

RESULTS: The results are presented on three levels: rational, structural and existential. In the rational level, fellowship and togetherness with colleagues, as well as being able to distinguish between private life and work were important for nursing personnel's strategies for maintaining their health. At the structural level, social togetherness, sharing emotions and being involved in each other's emotions were important for nursing personnel's health. The existential level showed that the nursing personnel's own existential situation was affected when their inner self was emotionally affected by the patients' suffering. The awareness of suffering, life and death made the nursing personnel feel inner security, both as nursing professionals and as human beings.

CONCLUSION: A common perspective based on a theory of caritative care may be helpful for retaining nursing personnel. While the study highlights nursing personnel's health while working in an end-of-life care context, the results may also be applicable to nursing professionals' health in other contexts.

Objective

The aim was to explore whether occupational balance is associated with health, health-promoting resources, healthy lifestyle and social study factors among students during higher education within healthcare and social work.

Design

The study has a multicentre repeated cross-sectional design. Data were collected via a self-reported, web-based questionnaire based on the validated instruments: the 11-item Occupational Balance Questionnaire (OBQ11), the Sense of Coherence (SOC) Scale, the Salutogenic Health Indicator Scale (SHIS) and five questions from the General Nordic Questionnaire (QPS Nordic) together with questions about general health and lifestyle factors.

Setting

Students at six universities in western Sweden at one of the following healthcare or social work programmes: biomedical scientists, dental hygienists, nurses, occupational therapists, physiotherapists, radiology nurses and social workers. Participants Of 2283 students, 851 (37.3%) participated.

Results

The students experienced that occupational balance increased during education. The total OBQ11 score was higher among students in semesters 4 and 6/7, compared with semester 1 students. Students with higher OBQ11 also reported higher SOC throughout their education, while health seemed to decrease. Students who reported higher levels of OBQ11 reported lower levels of health and well-being in semesters 4 and 6/7, compared with semester 1. There was an opposite pattern for students reporting lower levels of OBQ11.

Conclusions

The association between higher levels of OBQ11 and lower levels of health and well-being is remarkable. There is a need for more research on this contradiction and what it means for students’ health and well-being in the long run.

The World Health Organization has highlighted the importance of health promotion for health service providers in order to ensure sustainable working life for individuals involved in providing health services. Such sustainability begins when students are preparing to manage their own future health and welfare in working life. It has been suggested that universities, employees and trainee health professionals should adopt or follow a salutogenic approach that not only complements the providing of information on known health risks but also favors health promotion strategies. This paper describes the study design and data collection methods in a planned study aiming to explore health-promoting factors for a sustainable working life among students in higher education within healthcare and social work.

Background

Extensive research describes how nurses experience their work environment. The conditions are described as stressful and dissatisfying with nurses intending to leave their workplace. Knowledge about the personal perception regarding why nurses consider leaving the hospital workplace is limited. The purpose of this study was to understand why hospital nurses remain in their workplace, which facilitates their continuation in the profession.

Objective

The objective was to explore and describe factors explaining why hospital nurses remain in the workplace.

Methods

This was a descriptive qualitative study with a purposive sample of hospital nurses in Sweden. The salutogenic theory was the basis for the interview guide and the semi-structured questions. Individual interviews were conducted in a hospital in western Sweden. Content analysis was performed to organize the coded data according to the sense of coherence.

Results

Data saturation was achieved with 12 interviews. Within the three themes of coherence (comprehensibility, manageability, and meaningfulness), ten subthemes were categorized from the data as follows: job satisfaction and fun at work, acknowledgement and productivity, togetherness and team security, manageable workload, variable work and challenging situations, workplace and personal space balance, collaboration and supportive leadership, valued role and good work, commitment and involvement, and pride in the professional role.

Conclusions

The main findings of this study have shown the critical importance of being in a meaningful, comprehensible and manageable work context that supports nurses in maintaining their professional identity.

Portfolio is a systematic, purposeful, consolidated and structured collection of study works that the teacher and students use to follow up the development of knowledge, skills and attitudes in some area. Work integrated learning (WIL) can be seen as a process and an educational strategy for an active exchange of knowledge, reflected action and lifelong learning. The purpose of this report is to describe and discuss portfolio as a pedagogical method and WIL as a pedagogical strategy in the clinical education in the nursing program at University West. One of the main ideas behind the WIL-portfolio method isthat students have the opportunity to take control of their learning and thereby become more active in the learning and better understand the generated learning. The WIL-portfolio can create opportunities for nursing students to develop professional skills, systematized by using the portfolio structure and content. WIL-portfolio methodical process consists of the six phases; prereflection, reflection-in-action, reflection-on-action, self-evaluation, metareflection and knowledge-in-action. WIL-portfolio can serve as a basis for reflection and become a mirror image of learning, both in the present and in the future. The WIL-portfolio method can thus contribute to a deeper understanding of one's own knowledge of the process of lifelong learning.

Background: Patients' understanding of their illness is of great importance for recovery. Lacking understanding of the illness is linked with the patients' level of reflection about and interest in understanding their illness. Objective: To describe patients’ variations of reflection about and understanding of their illness and how this understanding affects their trust in themselves or others. Method: The study is based on the “Illness perception” model. Latent content analysis was used for the data analysis. Individual, semi-structured, open-ended and face-to-face interviews were conducted with patients (n=11) suffering from a long-term illness diagnosed at least six months prior to the interview. Data collection took place in the three primary healthcare centres treating the participants. Results: The results show variations in the degree of reflection about illness. Patients search for deeper understanding of the illness for causal explanations, compare different perspectives for preventing complication of their illness, trust healthcare providers, and develop own strategies to manage life. Conclusion: Whereas some patients search for deeper understanding of their illness, other patients are less reflective and feel they can manage the illness without further understanding. Patients' understanding of their illness is related to their degree of trust in themselves or others. Patients whose illness poses an existential threat are more likely to reflect more about their illness and what treatment methods are available.

AIMS AND OBJECTIVES: To describe how healthcare professionals facilitate patient illness understanding.

BACKGROUND: Healthcare professionals and patients differ in their illness understanding. If the information provided by healthcare professionals is not adapted to the patient's daily life it may be unusable for the patient. Previous research has found that healthcare professionals should individualise the information to enable the patient to apply the knowledge to the personal situation and to develop illness understanding. However, little is known of how healthcare professionals can facilitate patient illness understanding.

METHOD: A qualitative descriptive study based on individual, semi-structured, open-ended and face-to-face interviews was conducted with healthcare professionals (n=11) concerning how they facilitate patients illness understanding. Three health centres were involved during the period of March to November 2014. The interviews were analysed with qualitative content analysis.

RESULTS: The result identified a continuous and collaborative process with three strategies used by healthcare professionals to facilitate the patient's illness understanding: 1) assess the patient's illness understanding, 2) interact with the patient to develop illness understanding, and 3) support the patient's personal development for illness understanding. The steps in the process depend on each other.

CONCLUSIONS: The results of our analysis indicate that healthcare professionals can use the continuous and collaborative process to enhance the patient's self-care ability and turn his or her knowledge into action for improving illness understanding.

RELEVANCE TO CLINICAL PRACTICE: The three continuous and collaborative process strategies involving pedagogical approaches can create conditions for healthcare professionals to obtain a holistic view of the patient's life and to be a key resource for person-centred care. This article is protected by copyright. All rights reserved.

In previous research, no uniform picture emerged of the role of relatives in the meeting between an elderly patient and a physician. Knowledge about relatives' experiences of the meeting between an elderly patient and a physician will help healthcare practitioners better understand the role of relatives during the meeting and how practitioners can assist relatives in assuming their supporting role more efficiently. The purpose of this study is to explore experiences of relatives of meeting with the physician in a hospital setting when an elderly patient is discharged from hospital care to home care, in order to identify aspects that may facilitate relatives in taking up their role in a more efficient manner. This descriptive and exploratory study is based on 20 interviews with relatives. The result shows that the physician's communication style influences the meeting between the relative, the elderly patient, and the physician, and that this style is the result of power and interaction. A trustful relationship during the meeting between the relative and the physician can increase the relative's feeling of confidence with the healthcare organization and treatment of the elderly patient. The relative has an important supporting role in the care for the elderly family member, both in the hospital and the home setting. It is likely that the relative's value as a resource, for both the patient and the physician, increases as the relative experiences feelings of confidence in the meeting with the physician. It is therefore of value to increase our knowledge about the conditions and circumstances facilitating and/or hampering the meeting between the relative and the physician. The result stresses the importance of encouraging relatives to participate in the meeting. Physicians need more guidance and training in communication skills, respectful demeanor, and collaboration while meeting the relatives. © 2013 S. Pennbrant.

The aim of this study was to clarify the meanings and dimensions of the concepts “profession” and “role.” The results from the concept determination were discussed in relation to the profession “nurse educator.” This study is based on Koort's semantic analysis methods, using select parts of Eriksson's approach for concept determination, using dictionaries published between the years 1948 and 2015. The findings underline the complexity of the professional role of nurse educators. The nurse educator profession is based on society's trust and requires integration of ability, attitudes, norms, reflection, and theoretical knowledge, along with individual, organizational, and social conditions. Nurse educators must achieve a sufficient degree of pedagogical competence, subject competence, social competence and organizational competence in order to develop their professional role. When nurse educators define their function, a professional role takes form.

In Swedish healthcare, great emphasis is laid on the patient’s rights. Patients should receive information on their conditions and treatment options so that they can make informed choices and become involved. My study described elderly patients’ experience of meeting with the physician in a hospital setting specialized in geriatrics and medicine. To understand how the patient experienced the meeting, I used the following research questions: What is of importance for the experience of the meeting? How is the meeting experienced by the elderly patient? To explain the patients’ experiences of meeting with physicians, a sociocultural perspective was used. The main conclusion of the study is that physicians’ position of powe rmakes it difficult for elderly patients to participate in meetings. It would be helpful if physicians had a patient-centered attitude and translated medical terminology into everyday language.Physicians need to be aware of their body language and learn to acknowledge the patients’ questions and consider their medical conditions and personalities when building relations. The healthcare sector needs to become a learning organization in which physicians are trained to prevent misunderstandings when meeting elderly patients. Future research could focus on efforts to integrate geriatrics into the full curricula of medical schools. This case study provides an account of one practical aspect, namely, semi-structured interviews, with focus on some specific methodological problems that arose during the research.

In Swedish healthcare, great emphasis is laid on the patient’s rights. Patients should receive information on their conditions and treatment options so that they can make informed choices and become involved. My study described elderly patients’ experience of meeting with the physician in a hospital setting specialized in geriatrics and medicine. To understand how the patient experienced the meeting, I used the following research questions: What is of importance for the experience of the meeting? How is the meeting experienced by the elderly patient? To explain the patients’ experiences of meeting with physicians, a sociocultural perspective was used. The main conclusion of the study is that physicians’ position of power makes it difficult for elderly patients to participate in meetings. It would be helpful if physicians had a patient-centered attitude and translated medical terminology into everyday language. Physicians need to be aware of their body language and learn to acknowledge the patients’ questions and consider their medical conditions and personalities when building relations. The healthcare sector needs to become a learning organization in which physicians are trained to prevent misunderstandings when meeting elderly patients. Future research could focus on efforts to integrate geriatrics into the full curricula of medical schools. This case study provides an account of one practical aspect, namely, semi-structured interviews, with focus on some specific methodological problems that arose during the research.

Diabetes is a growing health problem and risk increases with age. Self-care is an important part of treatment. The aim of this qualitative systematic literature review was to investigate how older patients with diabetes experience self-care. A systematic literature review relating to older patients, diabetes and self-care was conducted. Systematic searches were carried out in the CINAHL, PubMed/MEDLINE and PsycINFO databases. The results show that older patients with diabetes are mainly concerned with the issues of blood glucose testing, dietary requirements, information about diabetes, motivation and support. To support safe self-care for older patients with diabetes, nurses need opportunities to increase their knowledge and reflection about diabetes and safe self-care support. Further research is needed to identify how nurses can promote older patients’ self-care and quality of life in the context of a person-centred approach.

Background: The job demands on nurses have increased. Conflict between work life and family life may lead to stress and lower work engagement. Consequently, nurses may choose a different career path or leave the profession.

Objective: Examine the extent to which perceived job demands (interpersonal conflicts at work and workload), work engagement, work-family conflict and family-work conflict are associated with turnover intentions, and examine a possible moderating effect of work-family conflict on the relationship between the intention to leave the nursing profession, job demands and work engagement.

Methods: Cross-sectional study using Hobfoll's Conservation of Resources theory. Data were collected from a sample of 807 registered nurses (RNs) from western Sweden. Tests of moderation were conducted using the PROCESS software macro developed by Andrew F. Hayes.

Results: Work-family conflict was a significant moderator in the relationship between the intentions to leave the nursing profession and work engagement as well as interpersonal conflicts at work. Low work engagement, high work-family conflict and high job demands intensify turnover intentions in well-educated and well-experienced nurses.

Conclusions: The results imply that work-family conflict has a greater impact when RNs experience lower work engagement. In other words, higher motivation implies a lower moderation effect of work-family conflict. Managers should promote a positive working climate by listening to and providing nurses with opportunities to develop their skills. By so doing, managers can gain better understanding of nurses' resources, knowledge and work situation, thus strengthening nurses' confidence and ability to practice their profession.

Sexual activity is an important aspect of quality of life and contributes to healing and recovery. Adequate information may minimize post-operative risks and improve wellbeing. The aim of this literature review was to identify and review articles regarding the information on sexual activity after hip replacement provided to or obtained by patients and partners prior to their hip replacement surgery. The literature search was performed in the following databases: CINAHL, PubMed/Medline, MEDLINE (via Ebscoost) and Scopus. The results underline the importance of providing hip replacement patients and partners with relevant information, to reduce their concerns and improve their satisfaction and quality of life. Such information could promote person-centered care for patient and partner, and increase long-term cost-effectiveness for the healthcare organization. Information to patients and partners on post-hip-replacement sexual limitations has not been closely studied. Further research is needed to help healthcare providers promote patients’ and partners’ sexual health and quality of life and improve wellbeing.

Objective: Primary healthcare is facing increasing numbers of people with mental illness. Although district nurses are expected to promote health and prevent illness, most health centers in Western Sweden have no psychiatric nurses. The aim of this study was to explore how district nurses experience meeting with and providing care to patients with mental illness in health centers. Methods: Eight individual, semi-structured interviews with district nurses working in health centers were analyzed using qualitative content analysis. Results: The district nurses felt that it is challenging to meet with patients with mental illness and that they need to learn to master such situations better. In particular, interaction challenge when assessing the patient’s mental care needs, the dialogue challenge when attempting to achieve the patient’s trust, and the competence challenge when trying to determine correct and safe care for the patient. Conclusions: District nurses would benefit from having specific guidelines on how to provide person-centered care to patients with mental illness. Such guidelines would help district nurses in their planning and facilitating meetings with patients with mental illness and in their efforts to find solutions adapted to the specific patient, thus increasing both the district nurses’ feelings of adequacy and the patient’s feelings of safety and trust.

AIMS AND OBJECTIVES: To describe nurses' experiences of palliative care for older people with advanced dementia living in residential aged care units.

BACKGROUND: Dementia is a global health problem and the number of older people with dementia who need palliative care is increasing. Previous research has revealed that care for older people with dementia in the final stage of life is usually complex. However, little is known about how nurses experience palliative care for older people with advanced dementia living in residential aged care units.

METHOD: Nine individual, semi-structured face-to-face interviews with nurses working in residential aged care units for older people with advanced dementia in palliative care in western Sweden were analysed using qualitative inductive content analysis. The COREQ checklist was followed.

RESULTS: The nurses considered that palliative care for older people with advanced dementia is a complex and challenging form of care. In particular, they identified three challenges that must be met: developing specialised knowledge and skills, developing teamwork as a working method, and creating a caring relationship.

CONCLUSIONS: The results of our analysis indicate that if nurses are aware of and understand that the challenges are essential for 'joining all the pieces together', the palliative care for older people with advanced dementia may become a positive experience for nurses and may increase their sense of satisfaction and security in their professional role.

RELEVANCE TO CLINICAL PRACTICE: For the palliative care to be successful the nurses need to 'join all the pieces together', i.e. succeed in developing specialised knowledge and skills, developing teamwork as a working method, and creating a caring relationship to establish a person-centred care with the older person with advanced dementia and with his or her relatives.

Aim: To describe unlicensed personnel’s experience of digital signing lists via a smartphone application for the distribution of medication in municipal healthcare in Western Sweden. Design: A qualitative and quantitative design was used.

Methods: The study included 48 unlicensed personnel, 28 of whom answered an open-ended questionnaire, while an additional 20 volunteered for individual interviews. The material was analysed by qualitative content analysis.

Results: The results indicate that digital signing lists via a smartphone application are feasible, and efficient and facilitate the work. However, some aspects negatively affected the sense of security, meetings with patients and quality of care, such as an insufficient internet signal in some rural areas, difficulty remembering the password, as well as the change of focus from patient to smartphone. To improve quality of care and the meeting with the patient, it is crucial that the technology works and that unlicensed personnel develop technical skills.

The aim of caring is to promote health. The global trend is that people are living longer, but in many cases, there is no support system for the care of older people, leading to major challenges in ensuring their health and well-being. The proportion of older people is expected to increase globally, and skilled healthcare professionals will be required to care for them. There is a risk that older people as suffering and vulnerable human beings will be forgotten due to the increasingly effective and technical care worldwide. A caring culture and relationship should be prioritised and developed to promote participation, well-being and dignity for older people in order to fulfil their care needs and ensure quality healthcare. It is important that research focusing on universal health coverage identifies the benefits of increased investment in service quality. To contribute to the improvement of this output, we propose the application of Eriksson's caritative theory. The aim of this theoretical chapter is to provide examples of how the dignity and well-being of older people can be promoted, at no additional cost to the person, by means of Eriksson's caritative theory, which can strengthen healthcare for universal health coverage.

The trend is that people are living longer, leading to major challenges in ensuring their health and well-being. The proportion of older people is expected to increase, globally, and nurses will be required to care for them. There is a risk that older people as suffering and vulnerable human beings will be invisible due to the increasingly effective and technical care. A caring culture and relationship should be prioritized and developed to promote participation, well-being and dignity for older people, and it is important with research in the field for increased quality in healthcare. In order to contribute to the well-being and dignity for older people in healthcare, we propose the application of Eriksson's caritative theory. The aim of this report is to create, with the support of Katie Eriksson's caritative theory, a model that promotes the dignity and well-being for older people for good caring.