Background: The implementation of evidence-based methods in hospital settings is challenging and multifaceted. There are several different factors that may affect implementation processes, of which the organisational culture may be one. It is well known that conservative organisational culture can hinder implementations; accordingly, a mix of different organisational cultures is preferable. Aim: The aim of this thesis was to follow the implementation process of an ICF-based assessment tool regarding cultural differences associated with the implementation in a psychiatric clinic. As part of the project, an assessment tool based on the International classifi cation of functioning disability and health (ICF) was developed and implemented. Method: In Study I, three Swedish expert groups participated and analysis of inter-rater reliability was conducted through simulated patient cases. In Study II, data were collected through focus group interviews pre- and post-implementation of the ICF-based assessment tool; thereafter, data were analysed using directed content analysis guided by Normalization Process Theory (NPT). Data from 109 nursing staff who completed the organisational values questionnaire (OVQ) and resistance to change (RTC) were investigated, and the association between the OVQ and RTC was examined with regression analysis (Study III). Patients n=50 representing the intervention hospital and n=64 representing the control hospital answered the Empowerment scale (ES) and Quality in psychiatric care (QPC-IP) (n=45 from intervention hospital and n=64 from control hospital). Staff n=37 at the control hospital answered the OVQ which was presented as descriptive data (Study IV). Results: Inter-rater reliability of the ICF-based assessment tool (DLDA) displayed acceptable kappa values (Study I). The DLDA tool showed the potential for empowering patients. Furthermore, it was considered useful for dialogues, refl ection and for identifying patients’ strengths. Nonetheless, it was diffi cult to implement it in practice due to contributing factors such as time pressure, heavy workload, stress and lack of routine in using the tool (Study II). The intervention hospital was characterised by an organisational culture of trust, belongingness and fl exibility, i.e. a human relation culture. One ward (I.W.3), however, was not dominated by a human relation culture. This ward had an almost equal mix of different cultures (human relation, open system, internal processes and rational goal) (Study III). The results of Study IV were non-signifi cant; however, it indicated that intervention ward 3 proved to be the most prominent ward regarding patient participation and empowerment among the intervention group. The results suggest hospital wards with equal mix of different cultures is more successful than cultural polarisation. Conclusion: Only one of fi ve wards succeeded in implementing the DLDA successfully (ward 5). Ward number three was the most successful of the inpatient intervention wards. The intent of the DLDA method was considered to be good and its use in a psychiatric nursing context can provide structured support in order to improve the dialogue with the patient, but it was not used in practice in all the studied wards. The organisational culture of the intervention hospital was dominated by human relation properties, however with one exception, ward number three. The results tentatively show that organisational culture may affect outcomes of implementation processes. Consequently, it appears that an equal mix of different cultures are more auspicious than cultural polarisations. The results seems to confi rm previous research, where one ward with a balanced mix of different cultures succeeded best to implement DLDA, of the wards representing psychiatric inpatient care. Ward number three did also show the best results in terms of empowerment and patient participation of the intervention wards. Further research aims to continue developing and conducting psychometric testing of the DLDA tool. The DLDAs impact on patient assessed empowerment and patient participation requires studies on larger populations than the current study

An equal mix of organizational cultures is important for a successful implementation process. The aim of this study was to examine the implementation of a new working method in psychiatric hospital wards, representing different cultural characteristics. Descriptive quantitative data were collected at two hospitals (intervention and control). The results revealed one ward characterized by a mix of organizational cultures. This ward, compared with other intervention wards, showed the best results regarding patient assessed empowerment and participation. The result shows tentatively that organizational culture may have an impact on the implementation processes.

Background: The Swedish population is getting older. Ageing can be defined from several perspectives. How elderly people experience ageing depends on a number of different factors. If the elderly can participate in social activities, it brings meaningfulness and strengthens their wellbeing and health through sense of coherence. Music and singing has previously been beneficial in regards to the care of elderly. The elderly that are living in nursing homes tend to be old and dependent on the help of others. To give person centred care is to be aware of, and see, the whole being. The advanced nurse in elderly care has a responsibility to person centred care and to help and support co-workers and nursing staff in this. Aim: To describe the staff experience of the effect singing with children has on the elderly. Method: A qualitative interview study. Results: Three major themes emerged: To sing with children gives the elderly validation, it awakens feelings in them but it also brings stressors. The elderly is validated through the relationship that forms between the elderly and the children. This also brings understanding between them. The feelings that are awakened are joy and anticipation. The stressors are related to tiredness and failing health which means the elderly cannot always participate in the activities. Conclusion: Singing with children brought the elderly joy and validation. To make meaningful activities part of nursing home care can contribute to better health in the elderly.

In this article, we studied collaboration exercises (3LC) between the rescue services, ambulance services, and police force, which were developed to enhance learning and usefulness. The exercises’ structure was based on identified deficiencies in previous collaboration exercises. The purpose was to test the exercise model in terms of learning and usefulness. Ten 3LC exercises were observed. A total of 65 semi-structured interviews were conducted (2011–2014) in connection with the exercises. The exercises contained across-boundary elements, seminars, and interactive documentation. The participants were given the opportunity to discuss, analyze, and critically reflect on their efforts. During the seminars, the individual actions were analyzed, which led to alternative strategies that were subsequently tested in a repeated exercise. Our results demonstrate that repetitive features and seminars during collaboration exercises promote learning toward an organic behavior and usefulness in the actual incident work.

Background: Leg ulcers are a clear problem in Primary Care and causes suffering for patients and cost society large sums every year. Part of our role as district nurses is to prevent ulcers and in the treatment do so that the wounds do not become chronic, and reduce costs for Primary Care.

Aim: The purpose of this study was to describe factors affecting healing in leg ulcers based on data from the National Registry.

Method: A quantitative retrospective registry study of 1142 patients with leg ulcer during the period 1 may 2009 until 1 december 2014 in Sweden.

Results: There was a difference in healing time between groups based on BMI and gender. The study also shows that there were different causes that affect wound healing time, such as smoking and exercise, and that men generally have a longer wound healing time than women that are statistically significant.

Background: During the recovery after myocardial infarction patients has to deal with several bothersome symptoms and consequences. One such negative consequence is fatigue.

Aim: To describe strategies that persons, who have survived a myocardial infarction, are using to cope with symptoms of fatigue.

Method: The study has a qualitative design and was conducted with nine persons in individual interviews with focus on how they had managed to cope with their symptoms associated with fatigue after myocardial infarction. Data was analysed using content-analysis.

Findings: Participants displayed a strong ambition to recover, to struggle against fa-tigue, a will to return to the life as prior to the myocardial infarction and to struggle forward.

Conclusion: District nurses need to help patients who lacking strategies to cope with fatigue. Support during rehabilitation needs to be further developed

Homosexual's health has shown to be worst then the rest of the Swedish population. Discrimination is a part of that result. There has also been studies that show some nurses in Sweden would choose to refrain from nursing homosexual patients. The aim of this study is to describe homosexual's experiences of treatment in Swedish health care. The method used a quantitative questionnaire that has been distributed mostly through social media. An open question has been analysed with manifest content analysis and validates and exemplified the quantitative result according to mixed method and triangulation.

The result shows that 50 % of the informants felt that they at some point during the latest ten years, been treated in a negative way in the Swedish health system, because they were homosexuals. We have found that women experience negative treatment more often than men. Twenty-seven percent of the informants would refrain from telling the healthcare personal that they were homosexual, because they were afraid to get another treatment or were afraid of the healthcare personals reaction. Forty-two percent would say they experienced discrimination in contact with the Swedish healthcare. The discussion shows that the homosexual informants in this study are at the same risk of discrimination as they are in rest of the society. One implication of this study is to educate nursing personal in question regarding homosexuality, to improve the quality of care and public health for the homosexual patients.

Background/Objectives:The prevalence of obesity, defined as body mass index (BMI) greater than or equal to30 kg/m2, differs between populations; however, there is a need for data on description on body composition in reference populations of different ages and from different countries. The objective of this study was to pool dual-energy X-ray absorptiometry (DXA) body composition reference data from population-based Swedish cohorts.Subjects/Methods:Four population-based cross-sectional cohort studies including 1424 adult Swedes were divided into five age groups (20–29, 30–39, 40–49, 50–61 and 75 years of age); BMI 24.6±3.9 kg/m2 were pooled. Body composition was measured with DXA.

Results:The difference in BMI from the youngest to the oldest age group was 3.2 and 4.3 kg/m2 in men and women, respectively (P<0.001, both sexes), and fat mass (FM) was 9.9 and 9.1% higher in the oldest compared with the youngest men and women (P<0.001, both sexes). Fat-free mass (FFM) remained stable up to 60 years of age in men (P=0.83) and was lower at 75 years of age compared with the younger ages. In women, FFM was lower from age 60. From youngest to oldest age groups, height-adjusted FM differed from 4.6 to 7.8 kg/m2 in men and from 6.8 to 10.8 kg/m2 in women (P<0.001, both sexes).

Conclusions:Our results provide reference data on body composition in Swedish populations. BMI and FM were higher among older age groups compared with the younger ones. FFM remained stable up to 60 years of age and was lower first among the 75 years of age.

Duration of breast feeding was studied in 249 randomly chosen, healthy, term infants of Danish origin of which 80.7% participated. Breast feeding was initiated by 99.5% of the mothers. At 3, 6 and 9 months, 71%, 52% and 33%, respectively, were still breast feeding. Only 1 infant (0.5%) was exclusively breast fed beyond 7 months of age. In a Cox multiple regression analysis of factors influencing duration of breast feeding, we found a positive association with maternal education (p < 0.001) and age (p = 0.02) and a negative association with the amount of formula given at the maternity ward (p < 0.001). Six months after delivery, 79% of the mothers with higher school education (> or = 12 years) were still breast feeding, compared to 29% with a low school education (< or = 9 years). There is still a need for an increased effort to support mothers in breast feeding, focusing particularly on younger mothers with short school education. Formula supplements during the first days of life, given to 73% of the infants, were associated with a shorter duration of breast feeding and should be discouraged.

Objective The aim of this prospective and population-based longitudinal study was to explore patients’ expectations before surgery and their experiences both short and long term after epilepsy surgery. Methods A national sample of adult patients answered open-ended questions preoperatively, 2 years after surgery and at a cross-sectional long-term follow-up (mean 13 years, standard deviation [SD] 1.85). The answers were analyzed by qualitative content analysis. Results Eighty patients participated in the study. Before surgery, patients experienced a belief in a “normal” life; they hoped for reduction of seizures and medication, a richer social life, and more self-confidence. However, they also experienced anxiety of the unknown. They were afraid of the operation, of continued seizures, and of complications. At both postoperative follow-ups patients experienced increased independence. They had symptom reduction, felt relief from worries and fears, and felt that they had a new life. However, some patients experienced that the operation had changed their life to the worse due to both psychological and neurologic adverse effects, regardless of whether they had obtained seizure freedom or improvement. Significance Positive experiences of epilepsy surgery dominated, both in the short and long term. However, attention must be paid to negative expectations before and negative experiences after surgery in order to provide individual support and information. This should increase the possibility for patients to have realistic hopes before surgery and to find coping strategies in the new life situation after surgery.

Background: In end of life care, ethical problems often come to the fore. Little research is performed on ways or strategies for handling those problems and even less on obstacles to and possibilities of using such strategies. A previous study illuminated stroke team members’ experiences of ethical problems and how the teams managed the situation when caring for patients faced with sudden and unexpected death from stroke. These findings have been further explored in this study. Objective: The aim of the study was to illuminate obstacles and possibilities perceived by stroke team members in using strategies for handling ethical problems when caring for patients afflicted by sudden and unexpected death caused by stroke. Research design: A qualitative method with combined deductive and inductive content analysis was utilized. Participants and research context: Data were collected through individual interviews with 15 stroke team members working in stroke units of two associated county hospitals in western Sweden. Ethical considerations: The study was approved by the Regional Ethics Review Board, Gothenburg, Sweden. Permission was also obtained from the director of each stroke unit. Findings: All the studied strategies for handling of ethical problems were found to have both obstacles and possibilities. Uncertainty is shown as a major obstacle and unanimity as a possibility in the use of the strategies. The findings also illuminate the value of the concept “the patient’s best interests” as a starting point for the carers’ ethical reasoning. Conclusion: The concept “the patient’s best interests” used as a starting point for ethical reasoning among the carers is not explicitly defined yet, which might make this value difficult to use both as a universal concept and as an argument for decisions. Carers therefore need to strengthen their argumentation and reflect on and use ethically grounded arguments and defined ethical values like dignity in their clinical work and decisions. © 2014, © The Author(s) 2014.

BACKGROUND: Parents of children with cancer experience a demanding situation and often suffer from psychological problems such as stress. Trying to coping with the complex body of information about their child's disease is one factor that contributes to this stress. The aim of this study is to evaluate an intervention for person-centred information to parents of children with cancer that consists of four sessions with children's nurses trained in the intervention method.

METHODS/DESIGN: This is a multi-centre RCT with two parallel arms and a 1:1 allocation ratio. The primary outcome is illness-related parental stress. Secondary outcomes are post-traumatic stress symptoms, anxiety, depression, satisfaction with information, expected and received knowledge, and experiences with health care providers. A process evaluation is performed to describe experiences and contextual factors. Data are collected using web questionnaires or paper forms according to the parents' preference, audio recording of the intervention sessions, and qualitative interviews with parents and the intervention nurses.

DISCUSSION: Few studies have evaluated information interventions for parents of children with cancer using large multi-centre RCTs. This intervention is designed to be performed by regular staff children's nurses, which will facilitate implementation if the intervention proves to be effective.

TRIAL REGISTRATION: Clinical trials NCT02332226 (December 11, 2014).

Background: Between six to twelve people per 100,000 have Huntington's disease (HD). There are an estimated 1 000 people with the disease in Sweden. Relatives are those who are closest to the person with HD. As the disease progresses, the relatives often become carers for the person with HD. As a result, their own life becomes affected and life situation changes. The relatives have important information about the person with HD, which can be useful for the nurse. It is therefore important as a nurse to know what the relatives go through when they take care of a person with HD. Aim: The aim of this literature-based study is to highlight the relative's experiences of taking care of a person with HD.Method: A literature-based study was based on ten articles with a qualitative approach.Results: The analysis resulted in two themes; "loss of life as it once was" and "relatives experiences of lack of control". The nurse's should be aware that it is of importance to be able to give support, both mentally and physically to patients and their relatives. It is of importance that the nurse shows the relatives that they have an important part in the care of the person with HD, even when they are hospitalized.Conclusion: Our results indicate that the relatives often have extensive knowledge in the care of the person with HD. It also shows that there is a psychological strain to take care of a person with HD and for the most part it affects them negatively. Nurse should meet and talk to the relatives so that they feel involved in the care of the person with HD.

At the onset of dementia, the disease has an impact on the whole family. The next-of- kin assume a new role that affects them physically, mentally and emotionally. How they are treated by health care is not perceived as satisfying. To understand the kindred caregiver's experiences and reactions is important for health caregivers. A person-centered approach is not only about the ill person but also the relatives.

The aim of the study was to elucidate next-of-kins’ experiences of caring for a family member of working age and suffering from dementia.

A qualitative study with an inductive approach was chosen. The selection of participants in the study was done with the help of a counselor at a memory clinic, a total of eight informants participated. Data collection was conducted through face-to-face interviews using open-ended questions. To analyze the outcome qualitative content analysis was chosen.

The analysis revealed an overall theme ‘Being alone in their loneliness’ and five main themes: Living with a constant concern, Life got another turn, Steps to seek help, The understanding from their environment and “ “Although dad is at home, I miss him”. The results of this study give healthcare professionals a deeper under-standing of kindred´s experiences of caring for a younger person with dementia in the home. The support to the relatives is inadequate and in need of improvement.