Background Nurse migration impacts global healthcare, which has a shortage of nurses, as many nurses move from lower-income to higher-income countries for better opportunities, working conditions, and salaries. Internationally educated nurses (IENs) have often been seen as a crucial solution to this issue. However, policies and regulations have been set in place to protect the public, including the recertification process and training to ensure educational comparability and competence. IENs' contributions to the nursing workforce are significant, underscoring the importance of these policies and regulations. Aim The aim was to describe the demographic and social characteristics of IENs who had completed recertification for nurses' licenses in Sweden and to compare these characteristics among those who completed recertification through the National Board of Health and Welfare (NBHW) or bridging programs. Methods A cross-sectional design using a survey and 818 questionnaires was sent to IENs with an identified postal address who had undergone the recertification process in Sweden. Of them, 296 (38%) were completed. Data were analyzed with descriptive statistics, chi-square tests, Fischer's exact tests, and independent sample t-tests. Results Most IENs who had participated in a bridging program were women, commonly aged between 31 and 40 years of age who had immigrated mainly from Asian or Middle Eastern countries for family-related reasons. The average time to obtain a nursing license was 5.9 years, starting from the year they immigrated until recertification. IENs who received recertification by the NBHW were significantly younger (p < .001), had been in Sweden for a shorter time (p < .001), and the time to license was shorter (p < .001). Significant differences were also shown for origin (p < .001) and reason for immigration (p < .001). Conclusions The findings can be used by decision-makers and authorities when developing higher education strategies for legalization and immigration policy to contribute to IENs' career advancement opportunities.

Background: When moving to a nursing home, the new resident also meets a new kind of culture, including communal, shared meals. Gaining greater insight into the resident experience of mealtimes in nursing homes is essential to identify the meaning that mealtime situations have and highlight the potential barriers and facilitators to the implementation of mealtime situations that create wellbeing for residents. The aim of this integrative review was therefore to shed light on mealtime situations in nursing homes from the residents’ perspective. Methods: The literature search was performed using a combination of MeSH keywords and free text terms in ASSIA, CINAHL, PsycInfo, PubMed, and Web of Science. After scrutinizing the articles and quality checks, 13 articles were chosen. The analysis was performed following Whittemore and Knafl’s instructions for integrative reviews. Results: The experiences of the mealtime situations were partly connected to residents’ personhood and partly to the nursing home’s organization of the mealtimes. Three main categories emerged: mealtimes as a source of well-being in nursing home life, mealtimes (re)creating continuity in life and preserving identity, and mealtimes as a balancing act between autonomy and need of support. Residents in nursing homes want the possibility to choose both what to eat, with whom they will eat and where they eat. The mealtimes in nursing homes and how they are constructed have an important role in residents’ feelings of having control over their life situation and can also strengthen residents’ identity and autonomy. Conclusion: Staff needs to be aware of the meaning of mealtimes to promote person-centered care in regard to meals. Further research is needed to explore how different mealtime situations have an impact on nursing home residents’ lives as well as on the care the staff gives. 

In the context of long-term care facilities, mealtime situations have been linked to residents’ health and well-being. The optimisation of mealtime situations is dependent on multiple aspects and is complex. To better understand this complexity, this qualitative study aimed to identify staffs’ beliefs about the values of mealtime situations for residents’ health and well-being and to explore the facilitators of, barriers to, and challenges and actions in accomplishing and upholding these values. The results demonstrated that staffs’ belief consisted of achieving social and relational values, vitality values, self-strengthening values and atmospheric values. During mealtimes, participating staff had to constantly balance these values in relation to mealtime situational preconditions and residents’ individual and communal needs. Experienced facilitators, challenges, barriers and actions could be traced to and explained by identified beliefs, implying that knowledge regarding beliefs about values could be helpful for understanding and managing the complexity inherent in the mealtime situation.

Mealtimes are important events in care homes for physical and social well-being. However, residents usually have little input concerning meal timings, what food is offered, and how it is served. This integrative review explored mealtime interventions and their outcomes in care homes related to the Five Aspects Meal Model (FAMM). Research articles published 2010–2021 were searched for in ASSIA, CINAHL, PsycINFO, PubMed, and SveMed+ and resulted in 13 articles focusing on interventions. The analysis was based on the aspects of FAMM: room, meeting, product, management control system, and atmosphere. The result shows that even though interventions specifically focused on one aspect, they often evaluated outcomes related to several aspects. Different aspects can work together to foster effective mealtimes. FAMM eased to visualise the usefulness of mealtime interventions from a broad perspective and can be a useful tool for assessing and improving mealtime situations in clinical practice.

Background: Countries all over the world are experiencing a shortage of registered nurses (RNs). Therefore, some countries, including Sweden, have tried to solve this by recruiting internationally educated nurses (IENs). Countries offer bridging programs as educational support to qualify IENs for nursing work in the destination country. However, there is little research on IENs’ experiences of bridging programs in European countries and how these programs facilitate their integration into the world of work and their new society. The aim of this study is to explore the experiences of nurses, originally educated outside the EU (European Union)/EES, of the Swedish bridging program and of the program’s role in facilitating their integration into the nursing profession in Sweden.

Methods: A qualitative descriptive design was used to explore the topic based on 11 informants’ perspectives and experiences. Purposive sampling was used to recruit participants at one university in Sweden. Data were collected by individual interviews using a semi- structured interview guide during the year 2019 and were analysed using an interpretative thematic approach.

Results: Two main themes emerged from the analysis: 1) Return to nursing, and 2) The bridging program as a tool for transition to nursing in Sweden. The first theme includes conditions and experiences such as personal motivation and determination, and support from others that the participants described as important in order to achieve the goal of re-establishing themselves as registered nurses in Sweden. Furthermore, the second theme describes the participants’ experiences of the bridging program as mostly positive because it led to new learning and achievements that were valuable for the transition to nursing in Sweden; however, the participants also emphasised the challenges of their transition into the nursing profession, which were related to instances of misrecognition of their professional competence and the uncertain outcome of the program.

Conclusions: This study found that the bridging program facilitated integration into the nursing profession for nurses educated outside the EU/EES, especially knowledge gained in clinical-based training. Thus, it is important to recognise and value the IENs’ experience and previous knowledge and training when developing the bridging program’s curriculum.

Introduction

Leaders in postgraduate medical education are responsible for implementing educational change. Although difficulties in implementing change are described both in the general leadership literature as well as in the field of medical education, knowledge of what characterises successful change leadership in postgraduate medical education is limited. The aim of this study is to explore the process used by educational leaders in successful change implementation in postgraduate medical education.

Methods

Semi-structured interviews were conducted with 16 programme directors to explore how they had implemented successful change projects. The sample consisted of programme directors who had reported in a previous survey having high educational impact at their workplace. Interviews were analysed using Ödman’s qualitative interpretative method.

Results

The interviews identified similarities in how participating programme directors had implemented changes. Five interconnected themes crystallised from the data: (1) belonging to a group, (2) having a vision and meaning, (3) having a mandate for change, (4) involving colleagues and superiors, and (5) having a long-term perspective.

Conclusions

Our findings illuminate important aspects of successful change management in postgraduate medical education. Change is ideally based on a clear vision and is implemented in coalition with others. A long-term strategy should be planned, including involvement and anchoring of key persons in several discrete steps as change is implemented. While some of these findings are congruent with the general literature on change management, this study emphasises the importance of a mandate, with successful change leadership dependent on coalition and the facilitation provided by the next level of leadership.

BackgroundMedical education leaders are important for educational quality in postgraduate medical education. Their work tasks are complex and contain different components. However, factors that are influencing leaders effectiveness in completing these tasks are unexplored. Understanding and developing these factors is most likely essential to strengthen postgraduate medical education and to consequently improve the quality in health care delivery. This study explores the experiences of factors that influence effectiveness of clinical consultants responsible for postgraduate medical education at clinical departments. Effectiveness was defined as fulfillment of work tasks.MethodsA qualitative study was performed with data gathered through semi-structured face-to-face interviews with 17 consultants responsible for postgraduate medical education. Data was analyzed by qualitative content analysis.ResultsFindings clustered into four themes of factors influencing effectiveness: individual (being an expert, social competence), relational (support and cooperation, communication), attitudinal (shared vision, organizational values, colleagues' attitudes) and structural (organizational characteristics, regulations and guidelines, conditions for the role). The factors were experienced to influence effectiveness in a positive or a negative direction.Conclusions This study shed light on the complex and interrelated factors experienced to have impact on the role of consultant responsible for postgraduate medical education. Viewing the result through the concept of power, the role mainly relies on personal power sources like expert and referent power whereas power connected to the position often are lacking. To increase effectiveness of the role, a differentiated strategy which involves activities at both individual, group and organizational levels is needed.

The aim of the study was to describe patients' experiences with preoperative skin disinfection carried out in their home before elective hip replacement surgery with the aim of lowering the microbial burden and avoiding surgical site infections. The literature was reviewed for relevant studies. Optimal preparations before surgery depend on patients being able to assimilate preoperative information and instructions. The study was based on 14 interviews with patients who had undergone elective hip replacement surgery. Data were analysed with qualitative manifest content analysis according to Graneheim and Lundman (2004). The main categories of findings were: patients' experience of obstacles and limitations, the importance of supportive surroundings, and personal resources as strength when performing preoperative skin disinfection. The findings of this study agree with earlier studies showing a lack of compliance to preoperative skin disinfection. The findings also suggest reasons for non-compliance. Preoperative skin disinfection involves many important steps that need to be accomplished to ensure the maximum effect on microbial burden on skin surface. These steps can be difficult for some patient groups. Perioperative dialogue is one way to identify patients' individual needs and to help patients participate in the process. The study concludes that patients who carried out skin disinfection at home before surgery have a great responsibility to prepare themselves. The challenge for perioperative nurses who work with preoperative information is to identify and individually guide those patients who need extended support so that all patients with elective hip replacement surgery receive the same quality of care. Further research should focus on how caregivers discover individuals with extended needs and on identifying the kind of support that is effective to achieve optimal conditions for hip replacement surgery.

Knowledge about family caregivers in rural areas remains sparse. No studies to date have addressed the sociocultural aspects in caregiving, thus neglecting potentially significant data. This study aimed to explore and better understand family caregivers’ experiences in rural and urban areas and the sociocultural spheres that these two areas represent. How do family caregivers approach their caregiving situation? A hermeneutical approach was chosen to uncover the underlying meanings of experiences. Open-ended in-depth interviews were conducted. The ontological and epistemological roots are based on hermeneutic philosophy, where a human being’s existence is viewed as socially constructed. The study followed a purposeful sampling. Semi-structured in-depth interviews were conducted with 12 rural and 11 urban family caregivers to persons with dementia. These were then analyzed in accordance with the hermeneutical process. The findings provide insight into the variations of family caregiver approaches to caregiving in rural and urban areas of Sweden. There seemed to be a prevalence of a more accepting and maintaining approach in the rural areas as compared to the urban areas, where caregiving was more often viewed as an obligation and something that limited one’s space. Differences in the construction of family identity seemed to influence the participants approach to family caregiving. Therefore, community-based caregiving for the elderly needs to become aware of how living within a family differs and how this affects their views on being a caregiver. Thus, support systems must be individually adjusted to each family’s lifestyles so that this is more in tune with their everyday lives.

Aims. To explore the factors that facilitate or hamper identification of stroke in emergency calls concerning patients with stroke who have fallen or been in a lying position.

Background. Early identification of stroke in emergency calls is vital but can be complicated as the patients may be unable to express themselves and the callers generally are bystanders. In a previous study, we found presentation of fall or the patient being in a lying position to be the major problem in 66% of emergency calls concerning, but not dispatched as acute stroke.

Design. A qualitative study using interpretive phenomenology.

Methods. Analysis of transcribed emergency calls concerning 29 patients with stroke diagnoses at hospital discharge, in 2011 and presented with fall/lying position.

Findings. Patients' ability to express themselves, callers' knowledge of the patient and of stroke, first call-takers' and nurses' authority, nurses' coaching and nurses' expertise skills facilitated or hindered the identification of stroke. Certain aspects are adjustable, but some are determined by the situation or on callers' and patients' abilities and thus difficult to change. Nurses' expertise skills were the only theme found to have a decisive effect of the identification of stroke on its own.

Conclusion. To increase identification of stroke in emergency calls concerning stroke, the first call-takers' and nurses' action, competence and awareness of obstacles are crucial and if strengthened would likely increase the identification of stroke in emergency calls. In complicated cases, nurses' expertise skills seem essential for identification of stroke.