AIMS AND OBJECTIVES: The present study aimed to explore patients' experiences of participating in their rehabilitation process in the context of specialised rehabilitation in Norway.

BACKGROUND: The rights of patients to participate in their care and treatment is an ideology that underlines newer international and Norwegian public documents. However, there is a gap between policy statements and clinical practice, and a discrepancy between patients' and professionals' statements about patient participation in rehabilitation.

DESIGN: A qualitative approach with a narrative design.

METHODS: Eleven patients were individually interviewed to tell their stories about the rehabilitation processes. We utilised narrative analysis with a three-dimensional space narrative structure including temporality, sociality and spatiality. This study followed the COREQ checklist.

RESULTS: The analysis identified two throughout plots: 'person-centred culture' and 'time', and three plots which constructed how the patients participate in change through the rehabilitation process: (a) dependent-'open doors'; (b) motivation from within; and (c) independence-'locked doors'.

CONCLUSIONS: Patient participation in rehabilitation was dependent on person-centred cultures in the unit and on different aspects of time. The dialogue and the power balance between the patients and the health personnel changed as the rehabilitation progressed. Motivation for rehabilitation had to come from within patients. The paternalistic ideology did not seem to dominate the specialised rehabilitation unit in the present study.

RELEVANCE TO CLINICAL PRACTICE: This study gives new insight into how patients participate in change in the rehabilitation process. This can be valuable for healthcare professionals and governments. Insight into how the lack of person-centred focus can harm the rehabilitation process, and a deeper understanding of the meaning of time in the rehabilitation process is essential. These results may provide a stimulus for discussions on how patients might participate in their rehabilitation process.

We compared online distributed information provided to patients with cancer in Scandinavian countries through the lens of governmentality. A secondary comparative qualitative analysis was conducted. Discourses in online patient information showed differences in governmentality techniques across the countries: Norway used a paternalist approach, Denmark an educative approach, and Sweden an individualistic approach and expected the patients to make the “right” decisions. Online information for patients with cancer in Denmark and Norway showed high professional and health care system involvement, whereas in Sweden, there was high patient involvement. There was almost no use of the person-centered approach among the online discourses

Background: Prediabetes is a condition where the blood sugar levels are higher than normal but below the level that allows the use of diabetes as diagnosis. If not addressed, there is an increased risk of developing type 2 diabetes, which increases the risk of cardiovascular disease and premature death. The incidence of type 2 diabetes is increasing rapidly worldwide and is expected to affect 592 million people by 2035. Preventing diabetes is therefore of great importance in reducing diabetes-related costs for both the individual and the society.

Aim: Specialist nurse´s experiences in caring for patients with prediabetes within primary care

Method: Qualitative interview study with inductive approach where seven semi-structured interviews were conducted. The interviews were transcribed and analyzed with qualitative content analysis.

Results: From the analysis seven subcategories and three categories emerged, to identify patients with prediabetes, the specialist nurse role and responsibility and we can do more. The specialist nurses described their caring for patients with prediabetes as an important mission considering the health of the patient but also considering the society and health center perspective. The experiences of the specialist nurses showed that efforts for patients with prediabetes had low priority within primary care. By creating clearer guidelines the specialist nurse's perception was that the care towards patient with prediabetes would be better and more equal. They felt that the knowledge and the instruments already exist, but the resources were missing.

Conclusion: By creating clearer guidelines on the care of patients with prediabetes the experience of health could be strengthened, and the prevalence of type 2 diabetes could be reduced. More directed control of the primary care towards these patients would give more equal care and set a higher priority for prediabetes within the health center.

Purpose: To explore and compare cancer patients’ perceptions on the quality of nursing care in four European countries. Methods: Data were collected in Cyprus, Finland, Greece and Sweden. The sample comprised 596 hospitalized cancer patients. The quality of nursing care was measured using the “Oncology Patients’ Perceptions of the Quality of Nursing Care Scale” (OPPQNCS). Patient characteristics were also collected. Analysis of variance was used to examine the effects of country on the perceptions of the quality of nursing care. Results: Patients’ age ranged from 18 to 86 years, and 58% were male. The comparison of cancer patients’ perceptions regarding the quality of nursing care between the four countries showed a statistically significant difference in the total OPPQNCS scores (p <0.001) as well as in the subscales responsiveness (p <0.001), individualization (p<0.001), co ordination (p<0.001) and proficiency (p<0.001). The Cronbach’s alpha coefficient for the OPPQNCS ranged between 0.89 and 0.95. A multivariate analysis of variance for the OPPQNCS controlled by respondents’ demographic characteristics revealed that only the patient’s country was significantly related with the patients’ perceptions of quality care. Conclusion: Quality of nursing care as perceived by cancer patients was high, but differed between the four countries. The impact of the clinical status of cancer patients on the quality of nursing care and managerial factors such as staffing/nursing care delivery models that influence the ability of nurses to offer high quality care should also be explored by more focused studies.

Background According to the Swedish law "skollagen" the school shall encourage all children’s development and strive to mitigate differences in pupils individual conditions to utilize their education. The role of the school nurse is to proactively prevent illness amongst the pupils. With some girls, absence is high in physical exercises and their presence in other activities that aim for increased health is limited. This absence affects these pupils’ ratings and limits their chances of having physical activities, but it also reduces their possibilities to interact in social activities within and outside school.

Aim The aim of this study was to describe school nurses’ approach to strengthen girls who are in a situation where their guardians restrict their participation in health promotive activities.

Method This is a qualitative, descriptive study based on individual semi-structured interviews with nine school nurses. The transcribed interviews were subjected to qualitative content analysis.

Results The school nurses had an active approach to create a mutual understanding between the girls, their guardians and the school. This was conducted by strengthening of democratic appraisals, finding new ways to reach girls and their guardians and finally building and widening the school nurses’ own competence in the situation.

Conclusions: The studie shows that school nurses make use of the steering documents that exists within the school system in order to strengthen girls’ equality rights. A prerequisite for the school nurse to influence guardians and girls was to create a good relation for all of them. The school nurses were interested in understanding the family’s situation and their life experiences as well as inform about the core values of the school in order to create mutual understanding and build a foundation for further work based on each family’s situation. In the role of a school nurse it was not found viable to reach results only by informing the guardians and girls. Instead the school nurses tried to reach an open discussion with respect for both parties.

Only through such a dialogue the school nurses argued that they could reach out and create the right conditions for a positive change to support the girls’ equality rights.

Background; The nurse often works in teams with other professional groups. Communication is a key factor for the collaboration in a well functioning team. The system theory is a useful to apply within teamwork at the health center, to better gain understanding of the roles and responsibilities of the team members. Studies show that there is a need to set aside time for team meetings and that the current lack of time in the health center has a negative impact on teamwork and patient safety. Therefore it is important to explore the nurse's experience of teamwork.

Aim; Nurse's experience of teamwork in primary care.

Method; A qualitative content analysis was used to analyse the data collection, where semi structured interviews were applied to elucidate the purpose of the study. The number of informants interviewed was 11 from four different health centers in four different municipalities.

Result; Three categories emerged from the experience of teamwork at the health center. These were described as competence that provides security and that the work structure facilitates the team's workload and that there were impediments in the work. The result showed that the nurse felt that, with the right skills, the nurse could provide security to colleagues, patient and their relatives. An impediment was lack of time to conduct team meetings. This made it a challenge to plan for the patient's continued care. Despite this, the nurse did her best to prevent the patient from being adversely affected. It turned out that when the nurse structured up the day's work, the workload is facilitated and errands that arose got solved more quickly.

Conclusions; The barriers in the development of the teamwork mentioned are lack of time and resources. In order to develop teamwork, additional communication tools are needed to facilitate communication within the team.

Background: The work done by the nurse at the primary health care center includes meeting with people of different ages and with different health problems and diseases. It is important that the work is carried out in a good environment. Former studies show that the workload for the district nurse has increased and become more stressful with threats and violence from patients who expect more treatment.

Aim: To describe the district nurse's experiences of their work situation.

Method: A qualitative interview study with eight district nurses working in primary health care in Sweden were interviewed. The data was analysed using a qualitative content analysis with an inductive approach.

Results: Three main categories and nine subcategories were generated by the authors. The categories included: The content of a good day is when all the colleagues are present, and the timetable is good planned with enough work containing good meetings. When planning fails is the change of planning because of more patients and obstacles in communication skills. Experience of their environment is the impact of the physical environment such as good working environment and threatening environment.

Conclusion: There was negative employment in the district nurses' work situation, but despite that, the experience was positive to work independently, make decisions and use their resources. They felt collegial support and it was important to know where to turn when things went wrong.

Background: At the end of 2019, a new type of coronavirus was detected, called SARS-coronavirus-2 (SARS-CoV-2). The virus can cause severe respiratory symptoms that may require intensive care. More than 5,600 people with Covid-19 have been treated in intensive care in Sweden during the pandemic. Previous research has shown that intensive care nurses find it very stressful to care for patients with Covid-19.

Aim: The aim is to highlight how intensive care nurses experience caring for patients with Covid-19 in an intensive care unit during a pandemic.

Method: Qualitative method. Data were collected through individual semi-structured interviews. A total of ten intensive care nurses participated in the study, eight women and two men. The interviews have been transcribed and analyzed according to qualitative content analysis.

Results: The analysis gave two categories and six subcategories. The first category Feeling of inadequacy highlights how intensive care nurses experience a heavy overall responsibility, that patients' care suffers and it also points out that contact with loved ones is perceived as difficult. The second category Feeling of chaos highlights that intensive care nurses find it tough not to have knowledge of the disease and that work environment became more stressful and that there were shortcomings in management support.

Conclusion: A stressful and unfavourable care environment affects intensive care nursesnegatively. When nursing and contact with loved ones are deficient, ethical stress can lead to burnout. With more knowledge and new guidelines for care, intensive care nurses can feel more satisfied, but management faces major challenges and needs to compensate their staff to stop them from leaving their work during the pandemic. 

Background: The use of physical restraint in Swedish psychiatric healthcare against children under the age of 18 years has been critized against the United Nations. The psychiatric compulsory care act is used when a patient is suffering from a serious mental illness, and it may mean that the patient receives physical coercive measures against his/her will. When a patient obtains a physical coercive measure, a registered nurse is involved in the procedure. For a nurse, being involved with the use of physical coercive measures against the patients will could be perceived as a violation against the patients autonomy and also going against the essence of caring. Research shows that registered nurses experiences of being involved in the usage of physical coercive measures can cause an ethical dilemma.

Aim: To illustrate registered nurses' experiences of participating in the usage of physical coercive measures against children and teenagers that is hospitalized under the psychiatric compulsory care act.

Method: An interview study was conducted with seven registered nurses from all over Sweden. The interview material was analyzed through a qualitative content analysis.

Results: Three themes appeared during the analysis. The first main theme is Go against one's ethical beliefs with the subthemes experiencing ethical dilemmas, meeting the fragile child and to abandon one's professional assignment. The second theme is Questioning, with the subthemes questioning the benefit of coercive measures, to be questioned by other health care professionals and questioning one's own approach. The third theme that appeared was Change, with the subthemes to find alternative ways of dealing with the situation, a desire to contribute to a positive development of healthcare and to have contributed to a positive change for the patient.

Conclusion: The registered nurses' experiences of participating in the usage of physical coercive measures against children under the age of 18 years is described as a feeling of going against one's ethical values. The nurses also describe a questioning against the actual benefit of physical coercive measures. However, there's a hope for a change in the form of finding other ways than using physical coercive measures.

Aims and objectives: To investigate changes in self-reported fatigue and depression from four months to two years following a myocardial infarction, as well as to explore gender differences, identify the incidence of fatigue without coexisting depression and finally predict health-related quality of life at a two-year follow-up. Background: Depression and fatigue are associated with decreased health-related quality of life after myocardial infarction. Although there is a close relationship between fatigue and depression, it has been shown that symptoms of fatigue can occur without coexisting depression. Design: Quantitative and longitudinal design. Methods: Participants (n = 155) were asked to complete the following questionnaires: the Hospital Anxiety and Depression Scale, the Multidimensional Fatigue Inventory-20 (MFI-20) and the Short Form Survey (SF-36) following myocardial infarction (after four months and two years). Descriptive statistics, paired t-tests and multiple regressions were carried out. Results: In the entire group, self-reported fatigue had decreased from four months to two years after myocardial infarction. After two years, 18% of respondents reported depression together with fatigue and 30% reported fatigued without depression. Women scored higher than men on the fatigue dimensions reduced activity, reduced motivation and mental fatigue. Moreover, the physical dimension of health-related quality of life two years after myocardial infarction was predicted by experienced general fatigue at four months. Conclusion: Fatigue with or without coexisting possible/probable depression remains as a significant symptom two years after myocardial infarction in nearly half of the entire group. Relevance to clinical practice: Fatigue is a problem following myocardial infarction. Therefore, systematic screening and early identification of patients experiencing symptoms of depression and fatigue after myocardial infarction are important for suitable care planning. In contemporary coronary care, strategies aimed at relieving fatigue should be developed. ￜ 2013 Blackwell Publishing Ltd.

Recovery from a myocardial infarction (MI) can be a very difficult process and some patients are also stricken by fatigue. The aim of the study was to describe the difficulties experienced by men with fatigue during the first year following their MI. The study was conducted using qualitative content analysis of semi-structured interviews with nine men in working age (mean age: 55 years) with verified fatigue (≥12 of 20 on the Multidimensional Fatigue Scale with a mean of 17) one year after their MI. During the first year after the MI the men suffering from fatigue experienced various difficulties in terms of both themselves and the care received. The analysis generated three themes with difficulties described by the interviewed men. 1) Going through involuntary change: not recognizing their body and the inability to recognize themselves. 2) Lacking individualized care: To be denied satisfactory health care treatment and to be denied respectful treatment. 3) Not being seen in the light of the social context: The MI affects the whole family and caregivers do not pay attention to the family. In order to make both the patient and relatives feel secure and cared for, it is essential that caregivers be aware of the importance of providing individualized care over time with particular attention for the patient’s social context.

Background

Mental illness is increasing in the society. People with borderline personality syndrome have difficulties with affect regulation, relationship to one self and others, and have a higher risk of suicide. Health care professionals find the work in psychiatric care rewarding, but also challenging and difficult. Nurses feel less empathy for patients with borderline personality disorder and perceive them as more dangerous than other patients. Patients with borderline personality disorder feel rejected by the health care.

Aim

To explore the experiences in the mutual meeting between people with borderline personality disorder and healthcare professionals.

Method

The study is conducted with the qualitative method of meta ethnography. Searches were made through seven databases which resulted in 24 included studies. The studies were synthesized which resulted in two main metaphors and two respectively three sub metaphors.

Results

The result consists of two main metaphors; What is hidden under the surface where staff and patients feel they have too little knowledge about the diagnosis, which gives negative feelings. The changing waves of the sea where it emerges that the meeting between patient and staff is complex. Lack of knowledge is seen as an obstacle, and trust and respect have been identified as decisive factors for a good meeting.

Conclusion

Both patients and health professionals experience suffering in the care meeting. Patients want to be helped at the same time as healthcare professionals experience obstacles along the way. In order for healthcare staff to be able to meet patients, knowledge is needed to be able to create trust.

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.

The implementation of evidence-based methods in hospital settings is difficult and complex. The aim of the present study was to highlight the implementation process concerning a new working method, i.e. a new assessment tool, based on the International Classification of Functioning Disability and Health (ICF), among psychiatric nursing staff on five participating wards at a Swedish county hospital. Descriptive, qualitative data were collected through focus group interviews pre- and post-implementation. Data were analysed using directed content analysis, guided by Normalization Process Theory (NPT). The results revealed that just one of the five participating wards met the criteria for a successful implementation process. The results confirm previous studies showing the difficulty of implementation. Although participants agreed with the intention of the model, they were reluctant to apply it in practice. The implementation process seemed to be influenced by factors such as: time pressure; heavy workload; stress; lack of routines in using the tool; lack of nursing staff; as well as cultural characteristics and resistance to change.

Background: Research shows that persons from the Middle East are at higher risk to develop type 2 diabetes which increases the risk of diabetic complications and early death. Both illness perception and self care are significant factors for the disease process. The diabetes nurse needs to search for knowledge of illness perception thus they have a central role in strengthening the individuals' ability to handle treatment, symptoms, emotional, cognitive and physical consequences as well as lifestyle changes.

Aim: The aim of this study was to investigate illness perception of type 2 diabetes among persons from The Middle East living in Sweden.

Method: A descriptive analysis of a pilot study was conducted in the region of VästraGötaland during spring 2019. 27 individuals answered the Brief Illness Perception Questionnaire about their illness perception of type 2 diabetes.

Results: The participants perceived type 2 diabetes to be a chronic disease and reported a very high degree of coherence of the disease. They also perceived that type 2 diabetes can be controlled by both treatment and themselves to a very high degree and to a relatively high degree. Trust in treatment was greater than in their own control. The study shows a significant difference in coherence of type 2 diabetes between women and men in the study, where women experienced a higher degree of coherence than men. Identity and consequences were the dimensions of illness perception with the lowest median.

Conclusion: Illness perception affects the degree of self care and disease progress. The results can be used to give an increased understanding of illness perception of type 2 diabetes among persons from the Middle East living in Sweden.

INTRODUCTION: Research indicates that newly graduated registered nurses struggle to develop practical skills and clinical understanding and to adapt to their professional role. To ensure quality of care and support new nurses, it is vital that this learning is elucidated and evaluated. Aim The aim was to develop and evaluate the psychometric properties of an instrument assessing work-integrated learning for newly graduated registered nurses, the Experienced Work-Integrated Learning (E-WIL) instrument.

METHOD: The study utilized the methodology of a survey and a cross-sectional research design. The sample consisted of newly graduated registered nurses (n = 221) working at hospitals in western Sweden. The E-WIL instrument was validated using confirmatory factor analysis (CFA).

RESULTS: The majority of the study participants were female, the average age was 28 years, and participants had an average of five months' experience in the profession. The results confirmed the construct validity of the global latent variable E-WIL, "Transforming previous notions and new contextual knowledge into practical meaning," including six dimensions representing work-integrated learning. The factor loadings between the final 29 indicators and the six factors ranged from 0.30 to 0.89, and between the latent factor and the six factors from 0.64 to 0.79. The indices of fit indicated satisfactory goodness-of-fit and good reliability in five dimensions with values ranging from α = 0.70 to 0.81, except for one dimension showing a slightly lower reliability, α = 0.63, due to the low item number. Confirmatory factor analysis also confirmed two second-order latent variables, "Personal mastering of professional roles" with 18 indicators, and "Adapting to organisational requirements" with 11 indicators. Both showed satisfactory goodness-of-fit, and factor loading between indicators and the latent variables ranged from 0.44 to 0.90 and from 0.37 to 0.81, respectively.

CONCLUSION: The validity of the E-WIL instrument was confirmed. All three latent variables could be measured in their entirety, and all dimensions could be used separately for the assessment of work-integrated learning. The E-WIL instrument could be useful for healthcare organisations when the goal is to assess aspects of newly graduated registered nurses' learning and professional development.

Aim: The aim of this study was to describe newly graduated nurses´(NGNs´) experience of work-integrated learning (WIL), from an educational and occupational perspective.

Background: NGNs often find themselves unprepared to meet occupational demands on their competence on entering working life, and express difficulties integrating educational theory into a practical context. Qualitative and effective WIL becomes particularly important for NGNs to develop the competence required to handle the transition from education to working life.

Design: This is a qualitative, descriptive study with an inductive approach.

Methods: Seven focus-group discussions were performed and subjected to qualitative content analysis.

Results: The results revealed that WIL for NGNs includes personal mastering of several professional roles: a self-directed and collaborative learning role, a relational nursing role, and a transition from a student role to a collegial role. Furthermore, WIL entails adapting to organisational requirements, including development of contextual workplace knowledge and understanding; striving for confidence in medical-technical performance; and developing an experience-based understanding of clinical situations.

Conclusion: The results reveal that WIL is complex, encompassing adaptation to roles and personal capabilities that increase new graduates´competence and preparation for work. In addition, WIL requires personal commitment to one’s own learning as well as organisational and social support. 

The aim of this study was to describe health care- and social service professionals' experiences of a quality-improvement program implemented in the south of Sweden. The focus of the program was to develop inter-professional collaboration to improve care and service to people with psychiatric disabilities in ordinary housing. Focus group interviews and a thematic analysis were used. The result was captured as themes along steps in process. (I) Entering the quality-improvement program: Lack of information about the program, The challenge of getting started, and Approaching the resources reluctantly. (II) Doing the practice-based improvement work: Facing unprepared workplaces, and Doing twice the work. (III) Looking back-evaluation over 1 year: Balancing theoretical knowledge with practical training, and Considering profound knowledge as an integral part of work. The improvement process in clinical practice was found to be both time and energy consuming, yet worth the effort. The findings also indicate that collaboration across organizational boundaries was broadened, and the care and service delivery were improved.

Society is constantly evolving and changes are taking place, which creates the opportunity to collaborate around several different areas. Working for a work-integrated learning (WIL) could mean that you work structured together with healthcare and college with common goals and collaborative issues. The content of the study deals with healthcare representatives´ perceptions of the importance of collaboration, the possibility of nursing education's vocational education. Method used in the study is qualitative method with focus group interviews. In the study, three focus groups and one interview were interviewed. Interviewees consisted of managers, supervisors and supervisors. The care activities that the informants represented were somatic care in emergency medical care, psychiatric care and home care. A qualitative content analysis was made by the interviews that were themed by interpretation of the interviews. Healthcare representatives wanted a collaborative perspective in various areas, such as development and collaboration of teaching models, assessment and evaluation. Working together with work-integrated learning as a model can be a way of interacting. There is a hope that the healthcare and higher education institutions will find development pathways in the future to ensure the knowledge of nursing students and their future occupational role, as to ensure the quality of care.

Background

Previous studies have shown that rapid treatment for stroke, especially ischemic stroke, reduces mortality and disability. The focus has mainly been on reducing time from arrival at hospital to start of treatment. However, the main reason for delay is often time from symptom onset to arrival at hospital. This study therefore aimed to explore decision‐making processes after the onset of stroke symptoms in patients experiencing a first‐time stroke.

Methods

We included 36 patients aged 18 and older, all of whom were hospitalized with a first‐time stroke between October 2018 and April 2020. All patients were interviewed once within 4 weeks of symptom onset and before hospital discharge. Eligible patients were identified retrospectively through a targeted review of medical records. The data were collected and analyzed according to the grounded theory methodology.

Results

In total, 43 potential patients were identified and asked to participate. Overall, 36 patients were included in the study: 17 women (median age 77.0 years, interquartile range 17.5) and 19 men (median age 65.7 years, interquartile range 17.2). All interviewees felt fear, and this affected their decision to seek emergency care. The decision‐making processes were described by the core category of “Acting on fear.” The reason for feeling frightened determined the actions taken. The reasons were sorted into 3 main categories: (1) “seeking care”–recognized stroke symptoms and acted immediately; (2) “pending and reluctance”–suspected stroke but awaited to seek care; and (3) “seeking an explanation”–confused by symptoms.

Conclusion

We found that decision‐making when experiencing stroke symptoms was complex. All patients felt fear, which determined their actions. Some patients knew about stroke symptoms and acted immediately. Others suspected stroke but still chose to wait, whereas others were confused and tried to find answers. These results could contribute to form future awareness campaigns.

Background and aims: Stroke symptoms vary and could be hard to recognize. In addition, stroke severity has decreased according to the National Institutes of Health Stroke Scale (NISSH), with less pronounced symptoms expression. Knowledge on the patient’s description of stroke symptoms is therefore needed. The aim was to describe patient’s symptoms at stroke onset.

Methods: A qualitative content analysis was used. Data were collected through individual interviews with 27 patients (16 men and 11 women, median age 70.4 years). All patients were hospitalized with a first-time stroke. The interviews were conducted within 4 weeks of symptoms onset and before hospital discharge.

Results: All patients had symptoms that affected their daily life. Some patients described having multiple symptoms at the same time, others had symptoms that began insidiously and worsened over time. Symptoms such as overwhelming fatigue or nausea were described as Premonition of becoming ill, feeling unwell or that something was wrong. Motoric bodily changes were multifaceted as slurred speech or dizziness, balance difficulties and losing control of the body or motor dysfunction. But also, that the surroundings were distorted, and solid objects moved around. Symptoms of Dazed and affected senses included confusion and visual impairment or headache.

Conclusions: Stroke is a complex disease with several different symptoms’ expressions and could be difficult to recognize, especially when symptoms are less typical or perceived as not serious. Increased awareness of stroke symptoms among caregivers and among members of the community is important and needed.

Background: Stroke is a common and severe disease that requires prompt care. Symptom expressions as one-sidedweakness and speech difficulties are common and included in public stroke campaigns. For some patients stroke canpresent with subtle and less common symptoms, difficult to interpret. The symptom severity assessed by the NationalInstitutes of Health Stroke Scale has decreased, and symptoms at onset may have changed. Therefore, we aimed toinvestigate how patients describe their symptoms at the onset of a first-time stroke.

Methods:The study used a qualitative descriptive design and conventional content analysis. Data were collectedthrough recorded interviews with 27 patients aged 18 years and older hospitalised with a first-time stroke betweenOctober 2018 and April 2020. Data were analysed on a manifest level.

Results: Symptoms at stroke onset were presented in two themes: Altered Reality and Discomfort and Changed BodyFunctions and described in five categories. Various types of symptoms were found. All symptoms were perceivedas sudden, persistent, and never experienced before and this appear as a “red thread” in the result. Regardless ofsymptom expressions, no specific symptom was described as more severe than another.

Conclusions: Stroke symptoms were described with a variety of expressions. Many described complex symptomsnot typical of stroke, which can make it difficult to recognise the symptoms as a stroke and delay medical care. Publicstroke campaigns should emphasize the importance of seeking medical care at the slightest suspicion of stroke andcould be designed to help achieve this.

Physical activity on prescription, so-called FaR is an important task for the district nurse in order to promote the individual´s health. Physical activity can relieve pain and symptoms as well as lead to reduced medication. The purpose of this study was to examine adult patients’ experiences of having been prescribed FaR. An interview study using an inductive qualitative approach was set up and ten patients were interviewed. The interviews were analyzed using content analysis according to Graneheim and Lundman’s description of the method. The results show that those who received tailored FaR had, in different ways, been offered, given to reason and discuss, agree and given the choice of activity and degree of activity the following individual condition and disease. To be asked to increase activity was almost as common as getting tailored FaR. Monitoring and support varied from close contacts if necessary to no follow-up at all. Those who had close contact described they had been met with a motivational interview. Some patients had no need of frequent follow-ups and were pleased to have received encouragement to the increased activity. The medical staff need ongoing training in motivational interviewing and in being flexible when there is a prescribed FaR to be consistent in patients undergoing treatment. To get repeated encouragement at follow-ups was one of the main categories that made the patients motivated progressively, increased activity and reduced resistance.

Background: Type 2 diabetes is the most common form of diabetes, 90% of all people living with diabetes have type 2 diabetes. The reason for obtaining type 2 diabetes is rising age, obesity, physical inactivity and genetic factors. Symptoms from the disease are fatigue, thirst and increased amounts of urine. Lifestyle changes can be explained as an act performed to change lifestyle, such as diet and physical activity. Treatment of type 2 diabetes is dietary changes and increased physical activity in combination with medications.

The aim of this literature study was to identify factors that prevent patients with type 2 diabetes from performing lifestyle changes.

The method was a systematic literature study where seven qualitative articles were analyzed and the result was based on. Six articles were found through searches in databases Cinahl and PubMed, one article via manual search.

Results: Two categories and six subcategories emerged from content analysis of the included articles, the categories were; Internal factors and external factors. Subcategories were; lack of inner motivation, lack of support, lack of knowledge/information, attitude/expectations to lifestyle changes, physical barriers and surrounding obstacles.

Conclusions: Interpretation of the result could be that patients need different types of support to be able to implement the lifestyle changes required by them. It can be assumed that each patient needs an individualized counseling/information about type 2 diabetes and how obstacles to carrying out lifestyle changes could be eliminated. More research and increased knowledge are required for specialist nursing in diabetes regarding obstacles to the implementation of lifestyle changes.

Background: Diabetes is a growing threat to public health, and secondary diseases like foot complications are common. Foot ulcers affect the individual’s quality of life and are a great cost to society. Regular foot examinations prevent foot ulcers and are a recommended approach both in Sweden and worldwide. Despite existing guidelines, there are differences in the execution of the foot examination, which results in care inequality. A structured foot examination form based on current guidelines was developed in this study as the first step toward digitalized support in the daily routine, and was validated by diabetes health care professionals. Objective: The study aimed to validate a structured foot examination form by assessing health care professionals’ experiences of working with it “foot side” when examining patients with diabetes. Methods: Semistructured interviews were held in a focus group and individually with 8 informants from different diabetes professions, who were interviewed regarding their experiences of working with the form in clinical practice. The users’ data were analyzed inductively using qualitative content analysis. The study is part of a larger project entitled “Optimised care of persons with diabetes and foot complications,” with Västra Götaland Region as the responsible health care authority, where the results will be further developed. Results: Experiences of working with the form were that it simplified the foot examination by giving it an overview and a clear structure. Using the form made differences in work routines between individuals apparent. It was believed that implementing the form routinely would contribute to a more uniform execution. When patients had foot ulcers, the risk categories (established in guidelines) were perceived as contradictory. For example, there was uncertainty about the definition of chronic ulcers and callosities. The expectations were that the future digital format would simplify documentation and elucidate the foot examination, as well as contribute to the accessibility of updated and relevant data for all individuals concerned. Conclusions: The foot examination form works well as a support tool during preventive foot examination, creates a basis for decision-making, and could contribute to a uniform and safer foot examination with more care equality in agreement with current guidelines.

The present study describes and analyses how social interactions between individual actors form institutional work in the highly institutionalized setting of healthcare organizations. Based on a qualitative case study, we affirm that social interactions mainly form maintaining institutional work, thus primarily upholding the rigidity of healthcare organizations. Social interactions either preserve distance between different actors or prevent their mutual influence, which decreases the effects of institutional complexity. However, when institutional work goes beyond maintaining, social interaction is characterized by processes of claiming influence and granting influence between individual actors who adhere to different institutional logics, which allows effects of institutional complexity. Such institutional work is contingent upon physicians' strong power position, and granting influence is likely to precede claiming influence.

The program in Social Psychiatric Care is a three-year program at the university level leading to a vocational qualification in social psychiatric care and a bachelor's degree in the field of Health Sciences. Until the spring of 2018, six litters have graduated. Students in the social psychiatric care program often have personal interest, previous professional experience from the business areas or inspiration from related friends working in the field of activity. Personal experiences of problems in the fields of activity are also prominent among the students. Students believe that personal experience, willingness and ability is important in order to work within the profession. Characteristics of the students are also an interest and a clear empathetic willingness to work with people and they consider that the profession primarily requires characteristics such as altruism, empathy, social skills and deeper knowledge and understanding in the field. Upon completion of education, students want a career role where they can help other people, feel motivated, or they aim for specific positions or areas of activity. Both managers and alumni from the Social Psychiatric Care program value the broad professional competence that the program leads to. Psychiatric competence is emphasized as particularly valuable by both alumni and managers. This competence means that they also complement the other professions in the activities. Students consider themselves possessed a professional identity that involves introducing psychiatric and custody skills to organizations that previously lacked these perspectives. Something that also brings new approaches to patients, users and clients. Being able to use knowledge from several disciplines are considered to be a strength and competence that are well-needed in environments where people with mental ill health are cared for. The alumni perceive their knowledge as both interdisciplinary and interprofessional.

The interaction between people with intellectual disabilities and professional carers is often influenced by communicative difficulties contributing challenging behaviours. The aims of this study were to evaluate to a web-based training program aimed at improving carers' abilities to interact with people with learning disabilities who exhibit challenging behaviours and to explore carers' experiences of participating in such a program. A single-subject experimental design and mixed methods were used to integrate qualitative and quantitative data. Triangulation of questionnaires, interviews with carers, and assessments of one woman's behaviour was performed. The participants were professional carers aged 20 to 55 years. The web-based training program increased carers' abilities to handle challenging behaviours and decreased challenging behaviours in daily care. The program improved the opportunities to offer training to carers who work in community-based accommodations with limited time to receive training.

BACKGROUND: Nurse managers need to create cultures that are worthy, not only of the commitment of everyone who comes to work but also of the trust of everyone who comes to be served. The aim of our study was to describe the challenges faced by Swedish nurse managers in a perioperative setting.

METHODS: A qualitative study was conducted. The participants were chosen by convenience sampling, and individual in-depth interviews were conducted. Data were analysed by Systematic Text Condensation. The COREQ checklist was consulted throughout the study to optimise the quality.

RESULTS: Nineteen nurse managers (all women) participated. Six themes were identified: "striving to treat employees with consideration and solicitude"; "the obligation to take care of each employee's individual needs"; "convincing others was an uphill battle", "finding solutions when things seem impossible"; "staff recruitment, allocation, and management"; "working with constantly changing planning".

CONCLUSIONS: The nurse managers faced challenges because of the overwhelming amount of work tasks, with almost no time for reflection. Having carefully chosen tasks and a realistic time schedule for each work task, plus time to find one's own path to inner peace, are essential for nurse managers. Organisations that provide these prerequisites show that they care about their nurse managers. The results of this study indicate the need for time to reflect, as well as support from superior managers and from the human resources department.

AIM: To describe reasons why nurse managers in perioperative settings decide to leave their employment.

BACKGROUND: Current literature has shown that perioperative nurse managers' reasons to leave their positions are formed through an interaction of factors.

METHODS: Individual in-depth interviews were performed with seven nurse managers, all women, in perioperative settings in Sweden. Data were analysed using Systematic Text Condensation.

RESULTS: Five key themes were identified: a- To end where I started, as a front-line nurse; b- I wanted to develop further to the next level in my career; c- I ran out of ideas; d- I lost trust in my head manager and did not believe in the new organization, and e- I had had enough of being offended by my superior manager and my employees.

CONCLUSION: Nurse managers experienced feeling forced into a decision to leave because of being offended by their superiors or their employees. Furthermore, the findings indicate that nurse managers should be offered support from superior managers and the organization together with time for discussions.

IMPLICATIONS IN NURSING MANAGEMENTS: The most essential element should be the influence of caritative leadership and the obvious expectation of being treated with dignity, respect, and appreciation.

Purpose To investigate why nurse anesthetists and operating room nurses choose to stay in the same workplace.

Design Qualitative design.

Methods Individual interviews were conducted with 15 nurse specialists from four hospitals in Sweden. Two men and 13 women aged between 43 and 63 participated. Data were analyzed with systematic text condensation according to Malterud.

Findings Three themes were identified. (1) Organizational stability contributed to low staff turnover, with good spirits between colleagues, representing everyone’s equal value and resulting in a feeling of homelikeness. (2) Sustained development in one’s own profession. (3) A humane head nurse who was at hand, who was a facilitator, who knew staff members, and eliminated obstacles for them.

Conclusions In a nonhierarchical and stable organization with a head nurse with caritative leadership skills, a welcoming working environment with opportunities for professional development is created. Thus, nurse specialists choose to stay, contributing to organizational development.

AIMS AND OBJECTIVES: To determine the meaning of person-centred care from the patient's perspective and in the context of perioperative nursing. BACKGROUND: Person-centred care (PCC) is used but not defined in the perioperative context. The concept indicates an interest in the patient's own experience of health, illness, needs and preferences. As with many terms that are frequently used, there is a tendency for person-centred care to mean different things to different people in different contexts. METHODS: A two-part search strategy was employed; firstly, a computerized database search of PubMed and CINAHL, using Medical Subject Headings and free terms to search articles dating from 2004 to 2014, and secondly, a hand-search of those articles' reference lists was performed. Twenty-three articles were selected and an integrative review was conducted. RESULTS: Four themes were discovered: 'Being recognized as a unique entity and being allowed to be the person you are', 'Being considered important by having one's personal wishes taken into account', 'The presence of a perioperative nurse is calming; prevents feelings of loneliness and promotes wellbeing, which may speed up recovery', and 'Being close to and being touched by the perioperative nurse during surgery'. CONCLUSIONS: PCC means respecting the patient as a unique individual, considering the patient's particularities and wishes, and involving the patient in their own care. PCC also implies having access to one's own nurse who is present both physically and emotionally through the entire perioperative process and who guides the patient and follows up postoperatively, guaranteeing that the patient is not alone. RELEVANCE TO CLINICAL PRACTICE: By having a common understanding of the concept of PCC, the nurse anaesthetists' and theatre nurses' caring actions or concerns will be directed towards the patient', resulting in personalization of care rather than simply defining the concept. This article is protected by copyright. All rights reserved.

AIM: The study describes what helps nurse managers maintain the strength to keep going as leaders.

BACKGROUND: Good leadership is important for the quality of patient care, patient satisfaction in care and efficiency. Many nurse managers stay on despite challenges at work.

METHODS: Twelve nurse managers were interviewed. Data were analysed by systematic text condensation according to Malterud.

RESULTS: The results were as follows: A-Walking side by side with my employees; B-Knowing that I mean something to my employees; C-Talking to myself-asking myself tough questions; D-Having someone to talk to, to decrease the feeling of being alone; E-Leading and managing in my own way-the fear of not succeeding is my motivation.

CONCLUSION: The nurse managers built their own strategies to get through and get on when difficult situations arose. In order to succeed in leading their employees, the nurse managers gathered their inner strength through moving caritatively back and forth between the 'secret room' and the 'staff room' in the house of leadership.

IMPLICATIONS IN NURSING MANAGEMENT: The manuscript gives insights into where nurse managers found sources of strengths in their everyday work. To realize their employees' strengths and motivation made a difference for nurse managers as a driving force. By having someone to talk to and by asking themselves tough questions, they were prepared for the challenges that came.

Background: A low arousal approach is defined as a working method that focus on the interaction between the patient and the caregiver. The approach is one of the most important tools in psychiatric inpatient care, which focus on getting the patient to maintain control over their emotions. The work method has been well-evaluated in other contexts outside psychiatry but sparingly evaluated in psychiatric inpatient care. The aim of the study has been to increase knowledge about low arousal approach and its effect in psychiatric inpatient care.

Aim: The aim of the study was to describe registered nurses' experiences of low arousal approach in psychiatric inpatient care.

Method: The study is a descriptive qualitative study in which interviews were conducted with ten registered nurses in child- and adult psychiatric inpatient care. The data was analyzed by a qualitative content analysis. An inductive approach was used where similarities and differences in the collected material were described.

Result: The analysis resulted in three categories. Low arousal approach: Gives an inner and outer strength, Gives a feeling of uncertainty and Put the patient in the center. The result of the study shows both a strength in the low arousal approach experiences, but at the same time it can give the registered nurse a feeling of uncertainty when there are a knowledge gap both in herself or in the staff group. The registered nurses in the study find that the low arousal approachmeans that the patient is seen as a person regardless of diagnosis.

Conclusion: When the registered nurse feels safe in his or her knowledge and the working group works on a staff-common way with low arousal approach, can this create a calmer careenvironment and a good working climate. The registered nurses also feel that the working method gives the patient an increased opportunity to control his or her feelings and this increases the patient's sense of empowerment.

This study explores and analyzes how adult women in Sweden exposed to childhood maltreatment describe wellbeing, by using a thematic analysis of 22 semi-structured interviews with women maltreated as children. The results show that wellbeing was described as relative to both social norms and the childhood experiences and constituted four dimensions: Material and/or economic; Social and relational;Emotional; and Physical and/or mental. This study concludes that it is important to consider the relative and multiple ways wellbeing can be experienced and understood and to problematize norms of wellbeing, acknowledging the various ways people appraise their lives.

Background: Relatives were a large part of palliative care and how they really felt was sparsely studied. Home care was often involved as part of the care chain, and the district nurse in charge could, with her in-depth knowledge, support and help relatives to cope with the difficult times in life.

Purpose: To shed light on relatives' experiences of palliative care at home, before and after the death.

Method: An inductive qualitative study. Interviews with eight participants, both men and women. Qualitative content analysis was used as an analytical method.

Results: The result showed two categories, before death and after death with six subcategories, feelings of losing hope, having control and being strong, the importance of information and communication, feeling neglected, security, feelings of emptiness and the need for support. Many relatives who cared for their sick family member were at risk of developing ill health due to the mental and physical strain the situation entailed. Relatives felt that home care gave them security, but still demanded more support from home care for communication and information. Home care's treatment and support played a large and important role in how the relatives experienced and handled the already difficult situation.

Conclusion: Close relatives felt that they received a certain amount of security from home care but requested more support and conversations. The district nurse had in-depth knowledge in communication and in health which promotes the work with palliative care. Therefore it is important that there is a district nurse connected to all activities where palliative care is performed.

Background/Objectives

Previous research shows that the stronger the sense of coherence (SOC) the healthier behaviour. A strong SOC seems to be related to lower consumption of drugs and smoking, more frequent physical exercises and healthier food choices. Further it is established by previous research that there is a difference in health behaviour between socioeconomic groups. Individuals with lower socioeconomic status (SES) smoke to greater extent, have more sedentary lifestyle and make unhealthier food choices than individual with higher SES. The evidence regarding the interactive relations of SOC and SES to health behaviour or the potential mediating role of SOC in the relationship between SES and health behaviour is more unclear. In order to explore this, there is a need of systematic reviews of the evidence concerning SOC and health behaviour and interactions with SES.

Thus, the objective of this study is to explore and synthesize empirical findings on the relationship between SOC and health behaviour among adults. Further the aim is to explore to what extent interactions with SES is considered in the studies of SOC and health behaviour.

 Methods

The study is descriptive and analytical with a systematic integration of the contemporary knowledge base on the salutogenic research focusing on the relationship between sense of coherence and health behaviour among adults and interrelations with socioeconomic status. The review covers scientific publications as well as doctoral theses published 2008–2018. The review is systematic in the sense that all the included papers will be critically examined and analyzed according to (1) the study objective, (2) the study designs and methods for analysis and, (3) the applicability and practical use of the results.

 Results

Expected outcomes of this study will be established state of the art regarding the relationship between sense of coherence and health behavior and interrelations with socioeconomic status. Further the results will identify knowledge gaps important to address in future research.

Discussion

The potential contribution of the synthesized knowledge to achieve a sustainable and equal development of health will be discussed as well as to what extent health inequalities can be explained or understood by SOC.

To suffer from bipolar disorder can cause significant distress. Bipolar disorder causes severe shifts in mood. The person can, apart from having a normal mood, experience depressive episodes or a highly elevated mood – hypomania or mania. Psychoeducation as a complement to medicine treatment can help persons manage their disorder and reduce severe changes in mood. Little is known about psychoeducation programs in the country as a whole. Knowledge about these programs can be useful for evaluation and can contribute to valuable insights. The aim of this study was to survey the setup and content of psychoeducation programs for people with bipolar disorder in outpatient care in the country. To accomplish this a cross-sectional study was made through a web-based questionnaire sent to staff involved in outpatient psychoeducation. The Swedish National Quality Register for Bipolar Disorder – BipoläR contributed with contact information to the outpatient clinics. All 234 clinics involved were linked to BipoläR, 56 answers were returned resulting in the following information: Most of the psychoeducation programs were group-based. The major part used programs designed by themselves. Nurses were the most frequently staff involved. The mean amount of time for education delivery was 12 hours. The psychoeducation content was rich in important aspects related to the disorder. The programs were delivered through lectures and discussion. The conclusion of this study was the emphasis on group-based programs developed at the clinics, the quality content of programs and the possible need for more evidence-based programs.

Background: Inpatient aggression is common as a phenomenon in psychiatric inpatient care. Inpatient aggression arises for several reasons. It disturbs the nurses in their work assignments and causes negative emotions, which can be reflected in the interaction with the patients.

Aim: To describe nurse's experiences of caring for aggressive patients in psychiatric inpatient care

Method: An interview study was conducted with eight nurses at two psychiatric clinics at a hospital in a big town in Western Sweden. The material was analysed through qualitative content analysis.

Results: The analysis resulted in four main categories. The first category is uneasiness, with subcategories: to feel anxiety, to feel stress, to feel sad and to feel offended. The second category is fear, with subcategories: to feel fear for the aggressive patient and to feel fear for others sake. The third category is powerlessness, with subcategories: to lose control, to feel frustration and to work with a ticking time bomb. The fourth category is work to create security policies with subcategories: understanding the patients' situation and courage to remain in an aggressive encounter.

Conclusion: Inpatient aggression is often associated to symtoms and/or drug abuse, which also was confirmed in our study. In most scenarios the nurses had a deeper understanding for the patients behavior and thereby a higher tolerance towards inpatient aggresion. The nurses claimed that beeing available to the patients was very important, since that created an atmosphere of security for both parties and it was assumed a presumtion for a good caring relationship.

To describe surgical nurses’ strategies for enhancing their pain management proficiency.A qualitative design was used to conduct the study. The participants were forty surgical nurseswho had at least six years of nursing experience in caring for patients with pain. They responded toopen-ended questions based on a review of the policy documents concerning the main elements ofthe pain management programme to be implemented by surgical nurses. Three key themes emergedfrom the surgical nurses’ suggested strategies: partnering, disrupting, and becoming familiar withpain management competency concerns. Surgical nurses’ strategies in acute and chronic painmanagement nursing units included solving patients’ problems and promoting and enhancing painstrategies to address health challenges in organisations. The themes presented in the results includeenhancing pain management in nursing competencies. State-of-the-art healthcare technologies arebeing applied to pain management. Surgical nurses’ strategies should improve the quality of nursingcare, especially post-surgery recovery time. It is recommended to engage patients, their families, andmultidisciplinary care teams in other healthcare fields.

Aim: To illuminate relatives need of support when caring for or supporting a person suffering from mental illness

Background: Relatives of a person suffering from mental illness have different needs. It has for the past few years merely been little improvements in the relative's situation.

Methods: Focus group interviews with fourteen relatives. Data were analyzed through manifest content analysis.

Findings: Three categories were found: Functioning contact channels to the psychiatric health care organization, Need of an active support from the psychiatric health care organization and Need of support from community resources.

Conclusion: The relatives need more attention and understanding for their situation. The support of relatives must be designed and monitored individually. A collaboration or a well-functioning relation with the psychiatric nurses, other professionals working in the health care organisation and social services gives a mutual respect and trust which in turn leads to that the relative is confirmed as an important resource in the care of the mentally ill person. The relatives need an increased support and understanding from the community.

Loneliness can be experienced in different ways. By visualizing the dimensions of loneliness, healthcare professionals have a deeper understanding of what the concept of loneliness is. The purpose of this study was to analyze the meaning of the word loneliness through a concept analysis. The method used in this study was a concept analysis according to Peep Koort´s semantic method. Loneliness was defined according to etymological dictionaries as in the relationship to be lonely, for example,”A frozen trail that disappears in the loneliness of the forest”. In the definition of loneliness the analysis of the dictionaries resulted in several synonyms, three of which were chosen for further analysis. The most prominent synonyms was ”ödslighet” (desolation),” enslighet” (solitude) and ”isolering” (isolation). The theoretical definition of the outcome was discussed in a philosophical and health science perspective. The result showed both positive and negative aspects of loneliness. Loneliness can be a time of silence and reflection, but can also mean human suffering. From a scientific perspective, it is important to pay attention to the experiences of loneliness in patients and relatives in order to be able to provide appropiate support as a heathcare professional. In summary, loneliness can be illustrated by the metaphor ” The loneliness that exists in the deepest forest”.

Poor adherence to asthma medication treatment is a dilemma as it decreases the chance of achieving and maintaining a proper asthma control. Another dilemma is that there seems to be a small range of functional interventions that enhance adherence to long-term medication treatments. The aim was to review the last five years of published educational interventions for improving adherence to asthma medication. Through systematic database searches 20 articles were identified, which matched the inclusion criteria and described educational interventions to improve asthma self-management including adherence. The current review showed that addressing unintentional non-adherence in terms of incorrect inhaler technique by recurrent education improved the technique among many patients, but not among all. Phoning patients, as a means to remove medication beliefs as adherence barriers, seemed to be an effective educational strategy, shown as increased adherence. Involving patients in treatment decisions and individualising or tailoring educational support also seemed to have favourable effect on adherence. To conclude, addressing specific adherence barriers such as poor inhaler technique or medication beliefs could favour adherence. To change adherence behavior, the current review proposes that educational adherence support should be a collaborative effort between the patient and the health-care professional based on each individual patient's needs and patient factors, including elements such as personality traits.

Background: Every year 3.3 million people die in the world due to harmful use of alcohol. Alcohol is a public health problem in Sweden as well, where one in ten people considered having risky drinking habits. Research shows that excessive alcohol consumption leads to the development of alcohol-related illnesses. Nurses' dialog with patients is important to support them to change unhealthy habits. What experiences have nurses about discussion concerning the patients' drinking habits?

Aim: The purpose of this study was to investigate nurses' attitudes to, and experiences of, dialog with patients about their alcohol use habits.

Method: A descriptive cross-sectional study was conducted with the help of a questionnaire.

Results: Most nurses felt that they have a good knowledge and were secure in their work with patients who have unhealthy alcohol consumption. They asked the patients about their drinking habits and used the AUDIT screening form for mapping unhealthy consumption.

Conclusion: Nurses in specialist psychiatric services have a good knowledge of the causes of alcohol problems and can provide consultative support. Their experience of success helping patients with alcohol problems varies.

Background. Patients cared in intensive care units found the care stressful both physically and mentally. They suffered from altered memory images, hallucinations and even an altered body. During the physical and mental recovery, which can be affected by gender or age, existential questions were raised. Aim. The aim of this study was to investigate whether age and gender influenced patients' existential ruminations and their views of revaluation of life after being treated for critical illness in intensive care. Method. Quantitative method with comparative analysis between-subjects with longitudinal design, based on the RAIN-instrument. Two factors, “Existential ruminations” and “Revaluation of life”, were compared based on the age groups <65 years and >65 years and between women and men. Analyzed data was collected at six and 12 months after discharge from intensive care. Results. Existential thoughts: The group <65 years had recovered less regarding “Existential ruminations” both after six months (p. <0.05) and 12 months (p. <0.05) compared with the group > 65 years. No differences were seen regarding gender. No differences in the result were seen regarding women and men. Revaluation of life: The group <65 years to a large extent experienced “Revaluation of life” both after six months (p. <0.05) and after 12 months (p. <0.05) compared with the group> 65 years. After six months, no difference was seen between women and men, but after 12 months, women had largely revalued life (p <0.05). Conclusion. The recovery after intensive care was affected by age and to some extent by gender. Existential ruminations and how patients experienced revaluation of life after intensive care is an area that needs to be highlighted more during the patient's recovery to increase patients' ability to achieve health. Further research in this area is needed. 

Background: The goal of palliative care is to increase the quality of life for the person and their relatives and for the care to be designed in consultation with the patient. The number of people living in special housing and in need of palliative care is constantly increasing. Nurses who work with palliative care must be able to provide care that presupposes respect for human rights, values, habits, beliefs, respect for self-determination, integrity and dignity. 

Aim: The purpose of the study is to investigate how nurses who work in nursing homes experience self-determination in older people at the end of life. 

Method: An interview study with a qualitative approach was conducted with seven nurses in a municipality in the City of Gothenburg. Data were collected via individual interviews, which were analyzed with qualitative content analysis.

Results: The analysis resulted in three categories that describe nurses' experiences of self-determination in elderly people at the end of life who live in special housing. The categories included: 1) Application of palliative care, 2) Ethical dilemma when the patient's self-determination is prevented and 3) Organization that increases dependence. Nurses within nursing homes feel that the person's self-determination is promoted if the palliative approach is applied continuously. In the work with people at the end of life, ethical dilemmas have always arisen. In addition, it was the organization with its routines, poor planning and varying values that negatively affected the self-determination of people at the end of life.

Conclusion: Palliative approach is implemented in practice in nursing homes and logical consequence is the promotion of self-determination of the people in the end of life. There are factors that negatively affect self-determination, however, continuous conversations with the elderly and education in palliative care are seen as the most important tools for promoting the person's self-determination

Background: Making people feel safe and secure in health care is one of the most importanttasks of nursing. A good response is not only important to patients but also to their relatives. Previously, for most of last century, relatives were not welcome to the psychiatric health care. But research show they are in need of information and support from the health care. It istherefore important that nursing staff learn what kind of response the relatives require.

Aim: To investigate how relatives experience the response from nursing staff within thepsychiatric care.

Method: Qualitative interviews with eight respondents, where the answers were transcribedand analysed to learn how they had experienced the response from nursing staff. In theanalysis the text was condensed and abstracted into subcategories and categories.

Result: The analysis resulted in twelve subcategories and three categories; Feeling valued andmaking a difference, Feeling left out and not wanted, Response improvement suggestions.

Conclusion: This study shows that relatives still to a large extent are left out fromparticipation in psychiatric care, although society has placed the main responsibility on themto support their next of kin. The result shows that relatives require more information andparticipation to be able to support their next of kin. Getting a good response from nursing caremeans for them to be seen, listened to and getting information and support. They don´t wantto be left out any more.

Background According to the Swedish Association of Local Authorities and Regions should all healthcare professionals within the regions, municipalities and county councils work for an introduction of person-centered care, which will aim to promote good and equitable health care and to enhance patients and users as co-creators in their own care process.

Aim The aim of this study was to describe the district nurses' perception of person-centered care and the conditions required to implement person-centered care in home care.

Method A qualitative study was conducted using eleven face-to face interviews.

Results The analysis showed that the district nurses perceive person-centered care was to have the person at the center when it comes to planning and implementation of health care. To achieve this goal the nurses declared the need for certain conditions. These are reported to be team work, support from the organization and patient involvement in their care.

Conclusion All nurses in the study were positive to a person-centered care approach and basically they were aware of the meaning of the term. The district nurses who had recently undergone specialized training focusing on district nursing had a more scientifically based definition of what person-centered mean In relation to those with older training. The former appeared more likely to work on a basies of a person-centred approach and were more positive to develop such approach in health care.

Background:  Diabetes is one of the most common chronic diseases in the world and according to studies, the disease has a rapid development, especially type 2 diabetes that may be similar to an epidemic. Foot complications are among the most risky and costly late complications of diabetes mellitus. Neuropathy is the commonest complication and affects about half of all with diabetes. An important part of the preventive work of diabetes-related foot ulcers to provide both patient and family with knowledge, information and self-care education. Aim:  The aim of this study was to describe district nurse's and diabetic nurse's experience of meeting patients with diabetes who are at risk of foot ulcers Method:  The study had a qualitative approach. The study was based on individual interviews, with nine participants. Data analysis was then done using qualitative content analysis. Results:   The study resulted in four categories: conditions for a good start of a long-term relationship, different care depending on where the patient lives, the nurse as a mediator of knowledge and difficulties in preventive work. Conclusion:  This study shows that a large part of the preventive work is about self-care. It also appears that it is a challenge for nurses when patients do not want to take care of the advice and information they receive.

Background: As more women with congenital heart disease (CHD) are reaching childbearing age, it becomes more common for their symptoms to be evaluated during pregnancy. However, pregnancy-related symptoms are similar to those caused by heart disease. This study investigated the prevalence of factors associated with symptoms during pregnancy in women with CHD.

Methods: The national birth register was searched for primiparous women with CHD who were registered in the national quality register for patients with CHD.

Results: Symptoms during the third trimester were reported in 104 of 465 evaluated women. The most common symptom was palpitations followed by dyspnea. Factors associated with symptoms were tested in a univariable model; higher NYHA classification (>1) (OR 11.3, 95%CI 5.5-23.2), low physical activity (≤3 h/week) (OR 2.1 95%CI 1.3-3.6) and educational level ≤ 12 years (OR 1.9 95%CI 1.2-3.0) were associated with having symptoms. In multivariable analysis, low physical activity level (OR 2.4 95%CI 1.2-5.0) and higher NYHA class (OR 11.3 95%CI 5.0-25.6) remained associated with symptoms during pregnancy. There were no cases with new onset of impaired systemic ventricular function during pregnancy.

Conclusion: Symptoms during pregnancy are common in women with CHD but are often already present before pregnancy. Because ordinary symptoms during pregnancy often overlap with symptoms of heart disease, it is important to know if symptoms were present before pregnancy and if they became worse during pregnancy. These results should be included in pre-pregnancy counselling and considered in the monitoring during pregnancy.