Abstract AimTo describe the co-designing process of an online support programme with and for informal carers of people with heart failure.DesignA co-design process built on core concepts and ideas embedded in co-design methodology.Data sources Our co-design process included three phases involving 32 informal caregivers and 25 content creators; (1) Identification of topics and content through literature searches, focus group interviews and user group sessions; (2) Development of the online support programme and; (3) Refinement and finalization which included testing a paper prototype followed by testing the online version and testing and approval of the final version of the support programme.Outcomes The co-design process resulted in a support programme consisting of 15 different modules relevant to informal carers, delivered on a National Health Portal.Conclusion Co-design is an explorative process where researchers need to balance a range of potentially conflicting factors and to ensure that the end users are genuinely included in the process.Relevance to clinical practice Emphasizing equal involvement of end users (e.g. carers or patients) in the design and development of healthcare interventions aligns with contemporary ideas of person-centred care and provides a valuable learning opportunity for those involved. Furthermore, a co-designed online support programme has the capacity to be both accessible and meet end users' information and support needs, thereby optimizing their self-care abilities. Additionally, an online support programme provides the opportunity to address current challenges regarding scarce resources and the lack of healthcare personnel.Reporting methodsConsolidated criteria for reporting qualitative research (COREQ).Patient or public contributionBoth informal carers and content creators were involved in developing the support programme.

Aims and objectives

To extend nurses’ descriptions of how they understood caring, as reflected in the findings of an earlier study (i.e. the hierarchical outcome space) and to gain additional understandings and perspectives of nurses’ views of caring in relation to a coronary care patient case.

Background

Scientific literature from the 1970s–1990s contains descriptions of caring in nursing. In contrast, the contemporary literature on this topic – particularly in the context of coronary care – is very sparse, and the few studies that do contain descriptions rarely do so from the perspective of nurses.

Design

Qualitative descriptive study.

Methods

Twenty-one nurses were interviewed using the stimulated recall interview technique. The data were analysed using deductive and inductive qualitative content analysis.

Results

The results of the iterative and integrated content analysis showed that the data mainly reproduced the content of the hierarchical outcome space describing how nurses could understand caring; however, in the outcome space, the relationship broke up (i.e. flipped). The nurses’ views of caring could now also be understood as: person-centredness ‘lurking’ in the shadows; limited ‘potential’ for safeguarding patients’ best interests; counselling as virtually the ‘only’ nursing intervention; and caring preceded by the ‘almighty’ context. Their views offered alternative and, at times, contrasting perspectives of caring, thereby adding to our understanding of it.

Conclusion

Caring was described as operating somewhere between the nurses caring values and the contextual conditions in which caring occurred. This challenged their ability to sustain caring in accordance with their values and the patients’ preferences.

Relevance to clinical practice

To ensure that the essentials of caring are met at all times, nurses need to plan and deliver caring in a systematic way. The use of systematic structures in caring, as the nursing process, can help nurses to work in a person-centred way, while sustaining their professional values.

Aims and objectives To interpret and understand the interplay between children, their parents, and anaesthetic staff to gain a greater understanding of children being anaesthetised. Background Anaesthesia induction is a stressful procedure for the child and parents in the technologically advanced environment in the operating room (OR). Anaesthesia staff are a key resource for ensuring safety and interplays, but the meeting is often short, intensive, and can affect the child and the parent. Design A qualitative observational design with a hermeneutic approach. Methods Twenty-seven non-participant observations were conducted and videotaped when children were being anaesthetised. The SRQR checklist was used. Results The result is presented as a theatre play with three headings; the scene, the actors, and the plot. The scene was not designed for the child or the parent's comfort and could lead to anxiety and insecurity. Four themes described the interplays: The need to be inviting and to be invited, The need for varying compliance, The need for mutual dependence, and The need to give and to receive emotional support. The plot could lead to uncertainty, and the interplay could change between being caring and uncaring depending on the actors. Conclusions The technologically advanced environment in the OR constituted an emotional obstacle, but the anaesthesia staff themselves can be a powerful resource creating a caring environment. The outcome of the plot may depend on the anaesthesia staff's bearing. Relevance to clinical practice A caring approach in the OR requires a willingness from the anaesthesia staff to invite the child to participate and find a balance between helping the parents to find their place in the OR and support them in supporting their child. The findings can start reflections in the unit on how to create a more caring environment.

Aims and objectivesTo explore the prevalence of decreased appetite and factors associated with appetite among patients with stable heart failure.

BackgroundDecreased appetite is an important factor for the development of undernutrition among patients with heart failure, but there are knowledge gaps about prevalence and the factors related to appetite in this patient group.

DesignObservational, cross-sectional study.

MethodsA total of 186 patients with mild to severe heart failure were consecutively recruited from three heart failure outpatient clinics. Data were obtained from medical records (heart failure diagnosis, comorbidity and medical treatment) and self-rated questionnaires (demographics, appetite, self-perceived health, symptoms of depression and sleep). Blood samples were taken to determine myocardial stress and nutrition status. Heart failure symptoms and cognitive function were assessed by clinical examinations. The Council on Nutrition Appetite Questionnaire was used to assess self-reported appetite. Bivariate correlations and multivariate linear regression analyses were conducted to explore factors associated with appetite.

ResultsSeventy-one patients (38%) experienced a loss of appetite with a significant risk of developing weight loss. The final multiple regression model showed that age, symptoms of depression, insomnia, cognitive function and pharmacological treatment were associated with appetite, explaining 27% of the total variance.

ConclusionIn this cross-sectional study, a large share of patients with heart failure was affected by decreased appetite, associated with demographic, psychosocial and medical factors. Relevance to clinical practiceLoss of appetite is a prevalent problem among patients with heart failure that may lead to undernutrition. Health care professionals should routinely assess appetite and discuss patients' experiences of appetite, nutrition intake and body weight and give appropriate nutritional advice with respect to individual needs.

AimTo describe healthcare workers' experiences of preconditions and patient safety risks in intensive care units during the COVID-19 pandemic. BackgroundHealthcare workers' ability to adapt to changing conditions is crucial to promote patient safety. During the COVID-19 pandemic, healthcare workers' capacity to maintain safe care was challenged and a more in-depth understanding on frontline experiences of patient safety is needed. DesignA qualitative descriptive design. MethodsIndividual interviews were conducted with 29 healthcare workers (nurses, physicians, nurse assistants and physiotherapists) from three Swedish hospitals directly involved in intensive care of COVID-19 patients. Data were analysed with inductive content analysis. Reporting followed the COREQ checklist. ResultsThree categories were identified. Hazardous changes in working conditions describes patient safety challenges associated with the extreme workload with high stress level. Imperative adaptations induced by changed preconditions for patient safety which include descriptions of safety risks following adaptations related to temporary intensive care facilities, handling shortage of medical equipment and deviations from routines. Safety risks triggered by reorganisation of care describe how the diluted skill-mix and team disruptions exposed patients to safety risks, and that safety performance mostly relied on individual healthcare worker's responsibility. ConclusionsThe study suggests that healthcare workers experienced an increase in patient safety risks during the COVID-19 pandemic mainly because the extremely high workload, imperative adaptations, and reorganisation of care regarding skill-mix and teamwork. Patient safety performance relied on the individuals' adaptability and responsibility rather than on system-based safety. Relevance to Clinical PracticeThis study provides insights on how healthcare workers' experiences can be used as a source of information for recognition of patient safety risks. To improve detection of safety risks during future crises, guidelines on how to approach safety from a system perspective must include healthcare workers' perceptions on safety risks. Patient and Public ContributionNone in the conceptualisation or design of the study.

Aims and objectives. This study describes the meaning of the lived experiences of adults with intellectual disabilities in a Swedish institutional care setting. Background. Despite the general intention of the Swedish law to give care and support for adults with intellectual disabilities in small settings in the community, large institutional care settings exist in Sweden. It is also known that adults with intellectual disabilities have more influence over their care and support when living in small settings than in large institutions. There is a dearth research in regard to studies that focus on how adults with intellectual disabilities experiences their everyday life in such settings. Design. A qualitative design was used to gain a deeper understanding of the lived experiences of adults with intellectual disabilities in an institutional care setting in Sweden. Methods. Fieldwork from September 2006 to June 2009 in an institutional care setting including participant observation and in-depth interviews with 12 residents was used. Verbatim-transcribed text was analysed using a phenomenological reflective lifeworld approach. Results. The essential picture of the phenomenon was experienced 'as a meaningful and meaningless existence' and was reflected in residents' descriptions of their everyday life in the setting. It was characterised by the constituents: ambiguous dependency, social interactions and everyday life in a restricted area. Conclusion. The results reveal the importance of paying close attention to what adults with intellectual disabilities have to say about their everyday life when living in an institutional care setting. For caring practices of people with intellectual disabilities, it is scarcely satisfactory that residents experience an ambivalent dependency and of having to live in a restricted area. Relevance to clinical practice. The results of this study contribute to better insight and deeper knowledge of the lived experiences of adults with intellectual disabilities, enabling the staff and management to further enhance the well-being for residents. In addition, the findings provide feedback to staff, managers and researchers working in the intellectual disabilities field.

• Recent policy statements have stressed the need for fundamental changes to the NHS, especially to the hospital care of older people. Person-centred care underpins such changes. If practitioners are to deliver person-centred care, then they need to learn more about the patient as an individual. One way that this might be achieved is through biographical approaches.

• This paper describes the findings of a developmental study undertaken over a 6-month period to investigate the introduction of a biographical approach to care on a unit in a NHS hospital. It concentrates on the views of the practitioners who used the approach.

• The study aimed to explore whether a biographical approach – in the form of storytelling – might be used to encourage person-centred practice.

• Using a practice development approach, the study explored the views of older people, their family carers and practitioners regarding their participation in life story work.

• Initial data were collected by focus groups with staff from a nursing home who regularly used life stories as a basis for care planning. Further data were collected through focus groups, semistructured interviews and observation – undertaken before and after the introduction of life story work – with older people, family carers and practitioners.

• Findings revealed that life stories helped practitioners to see patients as people, to understand individuals more fully and to form closer relationships with their families. Support workers also said how much they enjoyed using the approach to inform their care.

• Further longitudinal research is required to investigate biographical approaches more fully and to work more closely with practitioners to explore how biographical approaches can be undertaken as part of standard practice and be integrated into the culture and management of care.

Aims and objectives. To explore illness beliefs in couples where one spouse has atrial fibrillation.& para;& para;Background. Beliefs are the lenses through which we view the world, guiding our behaviour and constructing our lives. Couples evolve an ecology of beliefs from their interaction whereby their actions and choices arise from their beliefs. Atrial fibrillation is a common cardiac arrhythmia that has implications for both patients and partners. A couple's illness beliefs play an important role in convalescence and illness management, and no previous studies have explored illness beliefs in couples living with atrial fibrillation.& para;& para;Design. A qualitative hermeneutic design.& para;& para;Methods. Data collection constituted in-depth interviews with nine couples (patient and partner together). Hermeneutic philosophy as described by Gadamer was used to interpret and to understand illness beliefs in couples living with atrial fibrillation.& para;& para;Results. The findings revealed both core illness beliefs and secondary illness beliefs. From the core illness belief 'The heart is a representation of life', two secondary illness beliefs were derived: atrial fibrillation is a threat to life and atrial fibrillation can and must be explained. From the core illness belief 'Change is an integral part of life', two secondary illness beliefs were derived: atrial fibrillation is a disruption in our lives and atrial fibrillation will not interfere with our lives. Finally, from the core illness belief 'Adaptation is fundamental in life', two secondary illness beliefs were derived: atrial fibrillation entails adjustment in daily life and atrial fibrillation entails confidence in and adherence to professional care.& para;& para;Conclusion. Couples' interaction has developed mutual illness beliefs regarding atrial fibrillation that guide them in their daily lives and influence their decisions. The adoption of a family-centred perspective in cardiovascular care settings is warranted.

Aims and objectives: To evaluate the effect of group discussions, in which structured reminiscence and a problem-based method were used, on depressive symptoms, quality of life and self-rated health among older people. Background: Depressive symptoms in older people have a considerable impact on self-rated health and quality of life, with a high rate of co-morbidity and mortality. As the ageing population is growing, late-life depression is becoming an important public health problem and there is a need to find preventive interventions to avert unnecessary suffering. Design: The study was quasi-experimental, with a one-group pretest-post-test design and follow-up after one year. Methods: Initially, a questionnaire was sent to the total population of 55-80-year-old retirees in a community in the northeast of Sweden, (n=679). The questionnaire concerned demographics and covered areas such as health, depression and quality of life. The intervention consisted of group discussions where structured reminiscence and a problem-based method were used. The participants (n=18) met 10 times under the guidance of a group-leader, a registered nurse educated in the method. Each session had different themes with a focus on positive memories but also on the present situation and the future. Parametric, nonparametric tests and content analysis were used.Results: Participants evaluated the intervention positively, showed a decrease in depressive symptoms, an increase in self-rated health and experienced an increased autonomy. No long- lasting effect was seen. Conclusion: Group discussions where structured reminiscence and a problem-based method are used might be an option to prevent depressive symptoms in older people. Relevance to clinical practice: This method might provide an opportunity for older people with depressive symptoms to improve their quality of life, however, to maintain the positive outcome the intervention should probably be continuous.

Aims and objectives.  Describe and understand the patient’s first encounter in emergency care at the emergency department, as experienced by the patient, next of kin and first providers from different professions.

Background.  The emergency department is most often described as having high levels of satisfaction with the quality of care delivered. Although the patients appreciate clinical competence, quick assessment and technical skills, a close connection between patient satisfaction and vulnerability has been shown.

Design.  A lifeworld research perspective was used in four different situations at the emergency department.

Methods.  The data consisted of 14 open-ended interviews with patients, next of kin and first providers.

Results.  The analysis showed that narratives of the past, present and future characterises the encounter where mutual narratives form a foundation for those involved in the encounter. Five constituents further described the variations; vague rules and conflicting expectations in the encounter, an encounter with the biological body, ‘courtesy encounters’, isolated in a timeless encounter, striving for meaning in the encounter.

Discussion.  Instead of expecting the patients to know the unwritten rules of the emergency department, the first providers could give clear information about expected waiting times and what to expect in the encounter. The challenge is to make a meaningful comprehensible context for all involved which can be generated in the interpersonal encounter.

Relevance to clinical practice.  The findings highlight the importance of disclosing the rules of the game by means of giving clear information which would give possibilities for the patient to maintain control, for strengthening the nurse’s role as the patients’ advocate and for strengthening the effort for an emergency department to become more of a learning organisation.

Introduction: Satisfactory sleep has many positive benefits for older adults1,2; it may produce daytime wakefulness and reduce the risk of falls3. Sleep complaints and falls are both common with advancing age and negative determinants for health4. However, their relationship with good health or improving health has not been clearly established. The aim of this presentation is to discuss sleep and fall predictors of positive self-rated health among people (n=656, > 78 years), who participated in the longitudinal and multi-centre cohort study, The Swedish National study on Ageing and Care (SNAC), in 2001 and 20045. Positive odds ratio is used in the logistic regression analyses instead of commonly used Odds ratio.

Method: Research synthesis from a longitudinal, multi-centre cohort study, 2001 and 2004.

Results: Findings indicate that younger age, no fear of falling, no problem with balance, or no difficulties sleeping because of mood were associated with positive health, in the model that was adjusted for age, gender and co-morbidity.

Conclusion: It is important to target older adults who are at risk of losing their balance and have low mood to prevent future health problems with advancing age. Also, the use of positive odds ratios appears to be useful when identifying positive health among older people.

AIMS AND OBJECTIVES: The aim of this study was to identify and describe the outcomes of a nurse-led intervention, "Health-promoting conversations with families," regarding family functioning and well-being in families with a member who was critically ill.

BACKGROUND: Families who have a critically ill family member in an intensive care unit face a demanding situation, threatening the normal functioning of the family. Yet, there is a knowledge gap regarding family members' well-being during and after critical illness.

DESIGN: The study utilized a qualitative inductive-descriptive design.

METHODS: Eight families participated in health-promoting conversations aimed to create a context for change related to the families' identified problems and resources. Fifteen qualitative interviews were conducted with 18 adults who participated in health-promoting conversations about a critical illness in the family. Eight participants were patients (6 men, 2 women) and 10 were family members (2 male partners, 5 female partners, 1 mother, 1 daughter, 1 female grandchild). The interviews were analyzed by conventional content analysis.

RESULTS: Family members experienced strengthened togetherness, a caring attitude, and confirmation through health-promoting conversations. The caring and calming conversations were appreciated despite the reappearance of exhausting feelings. Working through the experience and being confirmed promoted family well-being.

CONCLUSION: Health-promoting conversations were considered to be healing, as the family members take part in sharing each other's feelings, thoughts, and experiences with the critical illness.

RELEVANCE TO CLINICAL PRACTICE: Health-promoting conversations could be a simple and effective nursing intervention for former intensive care patients and their families in any cultural context. This article is protected by copyright. All rights reserved.

Aims and objectivesTo identify perceived challenges related to self-management among recently diagnosed adults and those with longer experience of type 2 diabetes as a foundation for the future development of a person-centred information and communication technology service. BackgroundLearning self-management of type 2 diabetes includes mastering the skills required to complete complex emotional and physical tasks. A service developed with the participation of stakeholders may be an alternative way to meet rising needs for self-management. DesignQualitative descriptive design influenced by a participatory approach. MethodsMultistage focus group interviews among one group of recently diagnosed (3years, n=4) adults and one group with longer experience (5years, n=7) of type 2 diabetes. ResultsChallenges in self-management in everyday life with type 2 diabetes were identified: understanding; developing skills and abilities; and mobilising personal strengths. Both groups described challenges in understanding the causes of fluctuating blood glucose and in developing and mobilising skills for choosing healthful food and eating regularly. The recently diagnosed group was more challenged by learning to accept the diagnosis and becoming motivated to change habits while the experienced group was mainly challenged by issues about complications and medications. ConclusionAdults with diabetes have different needs for support during different phases of the disease. From a person-centred perspective, it would be desirable to meet individual needs for self-management on peoples' own terms through a technological service that could reach and connect to a large number of people. Relevance to clinical practiceDiabetes nurses need to address the knowledge needs of patients with diabetes and support them in developing self-management skills. Consistent with person-centred care, practitioners should also encourage patients' abilities to mobilise their own personal strengths to maintain self-management.

Introduction: A key feature of home care is its divided nature. Conditions for coordination are poor. A variety of professionals provides a coherent mix of services. The social care system is in general local, less professionalised and usually moor poorly financed than the health care system. These differences are related to or result in different interests, culture and style and are a ground for communication problems. The existence of this divide will be explored it will be considered what remedies are available and are applied.

Methods and Materials: This presentation is drawn upon the results of the EC-financed EURHOMAP project and a discussion between country experts invited to the conference. The study has collected a wealth of data on various types of home care (including nursing care, personal care, domestic aid and respite care). In 31 countries information was gathered on a large set of indicators in the areas of policy & regulation, financing, organisation & delivery and clients & informal carers.

Results: Home care services may stem from different sectors, systems and organisations. Several countries have identified and addressed problems related to this situation. However, the degree of splitting varies among countries. It can exist at one or more of the following levels: governance and regulation; entry to the home care system; delivery of services. Furthermore the extent to which the division occurs may differ as well. Integration at governance level creates more favourable conditions for integration at access and delivery level. From a clients’ perspective poor integration may manifest itself both at the point of entry (absence of a clear-cut easy access point), and in the delivery of services (which are not tailored to what is needed or lack flexibility).

Conclusion: There are many possible remedies against problems of poor integration; depending on the level and the situation where the problem occurs.

Introduction: Besides the ageing of populations there are many more factors that have an influence on home care demand or supply; such as increased mobility; changing character of family structures; intergeneration solidarity; labour participation of women and the labour market for home care. This presentation will sketch the current trends, problems and how they can be tackled. The year 2025 is still far away but we will try to look ahead without losing the sense of reality.

Methods & Materials: This presentation is drawn upon the EC- financed EURHOMAP project, which included an inventory of contextual factors, problems related to policy, financing and delivery of home care and future challenges in each country. The study has col- lected a wealth of data in each of 31 countries on a large set of indicators.

Results: Trends influencing home care will be presented. We will notice that different trends may apply to groups of countries. The possible affects of more or less general problems will be explored, such as scarcity of financial and human resources. Besides less general, but still burning problems in some countries, will be examined; for instance the lack of integration and coordination between types of home care services; inequalities resulting from decentralisation of authority; limited access to home care services for middle income groups; and absent or poor control of the quality of services. Examples will be presented of how countries respond to the earlier mentioned challenges.

Conclusion: Some problems, such as those related to financial and human resources apply to most countries and are expected to be persistent. Private models of provision may also be considered to be of growing importance. However, cross-country differences in trends and problems will continue to exist, especially between countries with a long tradition of home care and those where it was recently developed.

Despite the assumption that care delivered at home is more cost-effective than care provided in institutions, such as nursing homes, the pressure on expenditures for home care will remain. Financial incentives are widely used to get better value for money. Incentives can be applied to authorities responsible for home care, or to agencies that provide services or to clients who receive care. Details of the financing system of home care services very much determine the possibilities for financial incentives. At present, there is a need for comparative information on financing mechanisms for home care. This presentation is based on the results of the EC-financed EURHOMAP project. Indicators have been developed in this project to map the home care systems in Europe, including details of financing. In 2009 and early 2010, EURHOMAP partners have collected data on these indicators in 31 countries in collaboration with experts in these countries. Results were described in uniformly structured country reports and fed back to national experts for validation. Prevailing models of financing for home care will be presented as well as information of the extent to which home care across Europe is pressured by financial restraints. Especially in Eastern European countries, where home care is not well developed yet, funding is a major problem. Co-payments are applicable in most countries to reduce expenditures and to prevent over-utilisation of services. Usually, financing mechanisms for social community based services differ from the mechanisms in place for home health care services. Consequently, modes of reimbursement for providers of different sorts of home care services and the financial implications for clients differ. Co-payments are more prevalent with social services than with health care. Another financial allocation mechanism is means testing, which is frequently used with publicly financed home care services. There is a large diversity in the type of financing mechanism, both between and within countries in Europe. Budgetary restraints are one of the main problems with regard to home care in almost all countries. Usually, access to home care services is restricted in some way by financial restrictions.

Introduction: The increasing old-age dependency ratio implies future reduction of human resources available to provide services. Little information is available about the level of qualification, contractual aspects, payment and working conditions of home care workers and the existence of staff shortages and recruitment problems in different countries.

Methods & Materials: This presentation is based on the results of the EC-financed EURHOMAP project. Indicators have been devel- oped in this project to map the home care systems in Europe, includ- ing details of human resources. In 2009 and early 2010, EURHOMAP partners have collected data on these indicators in 31 countries in collaboration with experts in these countries. Results were described in uniformly structured country reports and fed back to national experts for validation.

Results: In many countries numbers of those working in private organisations are not available. Furthermore financial incentives and working conditions will be compared, as well as the task division between home care workers and to what extent educational require- ments are explicitly formalised. Mechanisms of quality control of human resources differ strongly (e.g. recertification of nurses; rules for the education of home care nurses). An interesting phenomenon, related to pressures to increase efficiency, is the transfer of tasks or substitution which is taking place between home care workers of dif- ferent qualification levels. In contrast to the provision of technical nursing, the provision of personal care and domestic aid is less strictly related to specific qualifications.

Conclusion: Shortages in human resources are a common problem in many countries, but expectedly most in countries just having developed home care. There is a strong variation in mechanisms of quality control of home care professionals; in the level of education required; and in the strength of the position of home care workers.

In many cases home care is no viable option without the efforts of clients and informal carers. So, an understanding of home care systems would not be complete without taking into account the role of clients and informal carers. As resources and criteria of eligibility are very different across countries, clients differ in their dependency, frailty and availability of informal care. In some countries recipients of home care more behave like critical consumers knowing their rights than those in other countries. Henceforth, systems may differ in the way clients are informed, can choose and, if necessary, can submit complaints. Another difference concerns the acknowledgement and role of informal carers, which is reflected, for instance, in the possibility for informal carers to be supported (e.g. with respite care). Here again, it turns out that very little comparative information is available at this point. On the basis of results of a literature review and from consultations with experts across Europe, the EC-financed EURHOMAP project has developed an extensive set of indicators to map home care systems, including the position and situation of clients and informal carers. EURHOMAP partners collected the data in 2009 and early 2010, in collaboration with experts in 31 European countries. Results were described in uniformly structured country reports and fed back to national experts for validation. An additional source of information was the answers on questions related to four ‘vignettes’ (hypothetical case descriptions of home living people in need of care). These questions were answered by a panel of key informants in each country. In most countries the largest share among recipients of home care consists of people above the age of 65 years. The number of recipients of home care varied enormously. In some countries home is almost limited to the elderly, while in other countries a wider range of services is provided to a wider vaiety of client and patient groups, including those in need of palliative (end-of-life) care and those in need of post-hospital care. Great differences were found in empowering recipients of home care (such as: offering choice of provider, type of provider; personal budget as an option; and availability of benchmark information to enable recipients to compare providers). The 31 countries will be compared on the availability of payment of informal carers; whether the tasks of informal carers have been laid down in a care protocol; whether the availability of informal care is taken into account in the needs assessment. Countries strongly differ in the number of home care recipients, their position in the system and the role of informal carers in the allocation and provision of formal care.

Introduction: Since sleep is found to be a fundamental part in experiencing quality of life and health it is of importance that nurses and other health care personnel strive to improve sleep and prevent sleep disturbances. Insomnia, which is the most common form of sleep disturbances, has also been found to be related with cardiac disorders. Elderly people are especially vulnerable for poor sleep; prevention of sleep disturbances should be of regard when caring for older persons. The Minimal Insomnia Symptom Scale (MISS) is a three item screening instrument previously found to be psychometrically sound and capable of identifying insomnia in the general population (20-64 years). However, its measurement properties have not been studied in an elderly population. Our aim was to test the measurement properties of the MISS among people aged 65+ in Sweden.

Methods and materials: Data from a cross-sectional survey of 548 elderly individuals were analyzed in terms of assumptions of summation of items, reliability and optimal cut-off score by means of ROC-curve analysis and compared with self-reported insomnia criteria. The items of MISS describes the major features of insomnia, i.e. difficulties initiating sleep, waking at night and not feeling refreshed by sleep. A total score ranging between 0 and 12 is calculated, where higher scores indicate more severe insomnia.

Results: Reliability was found to be 0.81. ROC analysis where MISS was compared with self-reported insomnia criteria (i. e. day-time sleepiness, not feeling refreshed by sleep, experiencing sleep difficulties). Optimal cut-off score was identified as more or equal to 7, and sensitivity 93%, specificity 84%.

Conclusions: Data support the measurement properties of MISS as an insomnia screening instrument among elderly persons and its brevity as well as the easy scoring system makes it appealing in clinical practice.

The aim of this study was to explore the development over time of beliefs about  health, illness and health care in migrant women with gestational diabetes mellitus born in the Middle East and living in Sweden. Further to study the influence of beliefs on self-care and care seeking behaviour. There is an extensive global migration and contact with the new society and health care confronts the migrant's culture of origin with the culture of the host country. The question is whether the migrants' patterns of beliefs about health, illness and health-related behaviour change over time? 

A qualitative prospective exploratory study was implemented. Semi-structured interviews were held with 14 women, aged 28-44 years, in gestational weeks 34-38 and three and 14  months after delivery.

The results showed a U-shaped development of beliefs, from focusing on worries about the baby's health during pregnancy and trying to comply with advice from health care staff, particularly a healthy diet, through regression to dietary habits (with intake of more sugar and less fibre) and lifestyle held before being diagnosed with gestational diabetes mellitus three months after delivery but then back to a healthy diet and lifestyle and worries focusing on their own risk, as mothers, of developing type 2 diabetes and being unable to care for the child after one year. Over time, the number of persons perceiving gestational diabetes mellitus as a transient condition decreased. Respondents lacked information about the disease, diet and follow-ups.  

Beliefs changed over time and influenced health-related behaviour. Beliefs about the seriousness of gestational diabetes mellitus among health professionals'  influence development of patients' beliefs. Pregnancy should be used as an opportunity to provide complete information about the disease and future health risks. Continous information should be given after delivery and wishes for regular follow-ups should be met.

Aims.  Exploring beliefs about health and illness in women with gestational diabetes born in Sweden and Africa living in Sweden. Further , to study the influence of beliefs on self-care and care seeking. Design: Exploratory descriptive study. Methods.  Semi-structured interviews. Consecutive sample of women diagnosed with gestational diabetes, 13 born in Sweden and 10 born in Africa, from a diabetes clinic in Sweden. Qualitative content analysis of data was applied. Results.  Beliefs were mainly related to individual and social factors. Health was described as freedom from disease and being healthy. Swedish women perceived heredity and hormonal changes as causing gestational diabetes, avoided work-related stress, had a healthy lifestyle, worried about the baby's health and development of type 2 diabetes, sought information, used more medications and health care and were on sick-leave more often because of pregnancy-related problems than African women, who did not know the cause of gestational diabetes, had a passive self-care attitude and followed prescriptions, often reported being told by staff that gestational diabetes would disappear after delivery and stated more pregnancy-related problems which they treated with rest or watchful waiting. Conclusions.  Health/illness beliefs differed and affected self-care and care seeking. Relevance to clinical practice.  Individual beliefs and risk awareness must be elicited, and adequate information must be given to prevent negative health effects of gestational diabetes.

To our knowledge there are no patients" evaluations of diabetes care in a high-technology area like the hyperbaric oxygen chamber. The burden on persons with diabetic foot complications might be increased if adjuvant therapy with hyperbaric oxygen therapy (HBOT) within a locked airtight vessel is given.

Aim:  To elucidate how diabetic patients with limb-threatening foot lesions perceive and evaluate content and organisation of treatment in a multi-place hyperbaric oxygen chamber.

Design/participants: An explorative study.  Participants were included in the HODFU study, a prospective randomised double-blind study, designed to evaluate whether HBOT heals more chronic foot ulcers than placebo treatment with hyperbaric air. Six females and 13 males, aged 44-83 years (Md 70), with diabetic foot ulcers, participated.

Method: Focus-group interviews were held by an external evaluator.

Results: Management was perceived as well-functioning with competent staff delivering quick treatment in a positive manner and in good co-operation. HBOT sessions, in groups, were described as unproblematic and pleasant, through sharing experiences with others, although time-consuming and tiring. Recognising the responsible physician and communication with other physicians in the health-care chain was perceived as problematic. Placebo treatment, when given, did not reveal any problems; many perceived HBOT as the last resort and respondents had a negative view of future health and expressed fears of new wounds and amputation.

Conclusions and implications: From patients" perspective HBOT in the delivered health-care model was perceived as well-functioning, taking into consideration both technical and relational aspects of care in this high-technology environment. Communication with the patient and between different care givers, with a consistent message given and information about who is responsible and to whom one should turn, wherever treated, is the most crucial aspect of the model. Future fears need to be recognised and group interaction can be encouraged to share the burden of disease.

Aim and objectives: The aim of the study was to describe Emergency Medical Services (EMS) nurses’ experiences of and coping with critical incidents, when providing nursing care as a member of a dyadic team.

Background: Nursing care in EMS is a complex task, taking into account the physical, psychological as well as existential dimensions of the patient's suffering. In this, EMS nurses are dependent on the dyadic team. Teams in EMS are described as essential for providing safe medical care. However, nursing care also comprises relationships with patients as a means of reducing patient suffering.

Design: The study has an inductive descriptive qualitative design, in adherence to the COREQ‐checklist.

Methods: A critical incident technique was used. Thirty‐five EMS nurses were interviewed individually, with a focus on dyadic teams providing nursing care. The interviews were analysed with the aim of defining main areas, categories and sub‐categories.

Results: The experiences of critical incidents emerged to form two main areas: “Functional co‐operation” and “Dysfunctional co‐operation,” comprising seven categories and sixteen sub‐categories. Their coping with critical incidents encompassed two main areas: “Adapting oneself” and “Adapting nursing care and the colleague,” comprising four categories and eight sub‐categories.

Conclusions: Reflection as part of the daily practice emerges as important for the development of nursing care both in relation to individual team members and also the dyadic team as a unit. In addition, the results highlight consensus within dyadic teams regarding the objectives of nursing care, as well as the importance of defined roles.

Relevance to clinical practice: This study underlines the importance of strengthening the dyadic EMS team's ability to co‐operate using common goals and knowledge within clinical nursing care. The individual team members’ different roles have to be explicit. In addition, clinical care has to be organised to generate preconditions for mutual performance monitoring through collegial feedback and reflection.

Aims and objectivesTo report an integrative review of evidence relating to dignity-conserving care in palliative care settings. It will also suggest avenues for future research. BackgroundResearch suggests that dignity is welcomed by those receiving palliative and end of life care. However, as dignity is a subjective term, it is not always explicit how this may be employed by nurses. Given that the preferred place of care for patients with palliative care needs is the home, the issue of dignity may be particularly important for community nurses. Therefore, synthesising evidence of dignity-conserving care for community nurses caring for people with palliative care needs provides clarity in a complex area of palliative care research. DesignIntegrative literature review. MethodThe review involved key bibliographic and review databases CINAHL, MEDLINE, EMBASE, ASSIA and PsycInfo. Medical Subject Headings and free terms were undertaken for articles published from January 2009-September 2014 and retrieved papers were assessed against inclusion criteria. Final included articles were reviewed for reported dignity-conserving care actions, which were classified under nine themes of the Dignity Model. ResultsThirty-one articles were included. Nine Dignity Model themes were used to classify care actions: Level of Independence; Symptom Distress; Dignity-Conserving Perspectives; Dignity-Conserving Practices; Privacy Boundaries; Social Support; Care Tenor; Burden to Others; and Aftermath Concerns. Reported care actions included listening, conveying empathy, communication and involving patients in care. ConclusionCare actions could be classified under most of Dignity Model themes. However, there were less reported care actions related to Level of Independence and Aftermath Concerns, which meant that these had to be formulated independently. Future research should be structured around these areas to determine appropriate care actions for nurses to give dignity-conserving care that addresses these specific themes. Relevance to clinical practiceSynthesising the available evidence of dignity-conserving care identifies evidence-based care actions and provides guidance to nursesin clinical practice caring for patients with palliative care needs. Future opportunities for research are identified to guide promotion of dignity in palliative care.

AIMS AND OBJECTIVES: To describe custodians' experiences of their child's visit to an ill/injured nearest being cared for at an adult intensive care unit (ICU), their thoughts about the visit in relation to the child's health/well being and who initiated the visit.

BACKGROUND: Custodians can feel undecided about whether to allow their children to visit the ICU or not. They wonder how important it is for the child to visit, as well as the consequences, and attempt to protect the child from information/experiences that could provoke anxiety or threaten the child's health.

DESIGN: Quantitative and descriptive.

METHOD: Thirty custodians answered a questionnaire.

RESULTS: It was mainly custodians and their children and not staff who initiated the children's visits. Many children were not informed by staff and the responsibility lay instead with the custodians. The importance of giving children adequate information before, during and after the visit was pointed out. The custodians reported that their child's reactions to the visit differed, i.e. reactions reflecting happiness but also sadness; the visit was good for the child, increased awareness of the nearest's condition and appreciation of the hospital staff and their work; if the visit did not take place the child would be left with thoughts and conjectures; their children were not frightened when they saw the equipment and instead they became curious; older children were more focused on the patient while younger children were interested in both the equipment and the patient. Many children asked questions/made comments during the visit. Many custodians were of the opinion that visiting is not a risk to future health and well being.

CONCLUSIONS: This issue must be addressed and discussed and strategies need to be developed to improve the nurses' obligation to involve visiting children in the care that is/should be provided to a member of the patient's family.

RELEVANCE TO CLINICAL PRACTICE: Nurses need to take more initiative when discussing children's visits with the custodians. Nurses also need to discuss how to meet, inform, support and care for visiting children and their custodians in relation to health and well being. Recommendations/guidelines about children visiting that take both the patient's and child's needs into consideration needs to be developed based on scientific knowledge. Findings from this study may draw attention to children visiting ICUs and encourage nurses to discuss children visiting with custodians and to develop family-centred care at the ICU that includes children.

AIMS AND OBJECTIVES: This study aims to describe surgically treated lung cancer patients' experiences of coming home after discharge from hospital to expand the knowledge about their supportive care needs.

BACKGROUND: Existing research reports that patients suffer from a high symptom burden after lung cancer surgery. Such burden has negative impacts on their physical, emotional and social wellbeing. Few studies have explored the surgically treated patients' supportive care needs after being discharged from hospital.

DESIGN: This study used a qualitative descriptive design, following the EQUATOR guidelines (COREQ).

METHODS: The information about 14 patients' experiences was collected from semi-structured interviews. The interviews were conducted in their homes within three weeks after their discharge from hospital. The data were analysed using qualitative content analysis.

RESULTS: The main theme of the study, "Longing to get back on track with their lives", consisted of four categories: "Burdened with problems related to postoperative symptoms and treatment", "Struggling for the needed support", "A pendulum between being in need of support and being independent", and "Striving to adapt to a new way of life". The participants experienced many problems related to postoperative symptoms and treatment. Information and support from healthcare professionals were deficient. Life was characterised by striving to be independent and adapting to a new lifestyle.

CONCLUSIONS: The findings demonstrate the supportive care needs of surgically treated lung cancer patients. Nurses and other healthcare professionals could offer more individualised support during the first few weeks after the patients' discharge by including them and their caregivers in the discharge planning.

RELEVANCE TO CLINICAL PRACTICE: Knowledge of patients' perspectives and experiences of everyday life at home after lung cancer surgery can provide hospital nurses with a better understanding of what is important for such patients beyond hospitalisation. This knowledge should be included in discharge planning.

Aims and objectivesTo synthesise and interpret previous findings with the aim of developing a theoretical framework for patient autonomy in a high-tech care context. BackgroundPutting the somewhat abstract concept of patient autonomy into practice can prove difficult as when it is highlighted in healthcare literature, the patient perspective is often invisible. Autonomy presumes that a person has experience, education, self-discipline and decision-making capacity. Reference to autonomy in relation to patients in high-tech care environments could therefore be considered paradoxical, as in most cases, these persons are vulnerable, with impaired physical and/or metacognitive capacity, thus making extended knowledge of patient autonomy for these persons even more important. DesignTheory development. MethodsThe basic approaches in theory development by Walker and Avant were used to create a theoretical framework through an amalgamation of the results from three qualitative studies conducted previously by the same research group. ResultsA theoretical frameworkthe control-partnership-transition frameworkwas delineated disclosing different parts cocreating the prerequisites for patient autonomy in high-tech care environments. Assumptions and propositional statements that guide theory development were also outlined, as were guiding principles for use in day-to-day nursing care. Four strategies used by patients were revealed as follows: the strategy of control, the strategy of partnership, the strategy of trust and the strategy of transition. ConclusionsAn extended knowledge base, founded on theoretical reasoning about patient autonomy, could facilitate nursing care that would allow people to remain/become autonomous in the role of patient in high-tech care environments. Relevance to clinical practiceThe control-partnership-transition framework would be of help in supporting and defending patient autonomy when caring for individual patients, as it provides an understanding of the strategies employed by patients to achieve autonomy in high-tech care contexts. The guiding principles for patient autonomy presented could be used in nursing guidelines.

Abstract Aims and Objectives

To describe essential aspects of care continuity from the perspectives of persons with complex care needs and their family carers.

Background

Continuity of care is an important aspect of quality, safety and efficiency. For people with multiple chronic diseases and complex care needs, care must be experienced as connected and coherent, and consistent with medical and individual needs. The more complex the need for care, the greater the need for continuity across different competencies, services and roles.

Design

A constructivist grounded theory approach was applied.

Methods

Sixteen patients with one or more chronic diseases needing both health care and social care, living in their private homes, and twelve family carers, were recruited. Semi-structured interviews were conducted and analysed with constructivist grounded theory. The COREQ checklist was followed.

Results

A conceptual model of care continuity was constructed, consisting of five categories that were interconnected through the core category: time and space. Patients' and family carers' experiences of care continuity were closely related to timely personalised care delivery, where access to tailored information, regardless of who was performing a care task, was essential for mutual understanding. This required clarity in responsibilities and roles, interprofessional collaboration and achieving a trusting relationship between each link in the chain of care, over time and space. To achieve care continuity, all the identified categories were important, as they worked in synergy, not in isolation.

Conclusion

Care continuity for people with complex care needs and family carers is experienced as multidimensional, with several essential aspects that work in synergy, but varies over time and depends on each person's own resources and situational and contextual circumstances.

Relevance to clinical practice

The findings promote understanding of patients' and family carers' experiences of care continuity and may guide the delivery of care to people with complex care needs.

Aims and objectives The aim of this study was to explore caller satisfaction with interaction, and the association to overall satisfaction with calls. Background In the era of expanding healthcare at distance, the telephone remains a common tool for the provision of nursing care. Interaction between telenurse and caller in telenursing is vital for safety, satisfaction and adherence reasons. Few studies have quantitatively explored interaction in calls and how it relates to overall satisfaction with calls. Design Cross-sectional survey study with a deductive approach. Methods A total of 466 callers to the Swedish Medical Advisory Service completed the Telenursing Interaction and Satisfaction Questionnaire. Satisfaction with four theoretically defined components of interaction were compared using repeated measures ANOVA. Associations between satisfaction with interaction and overall satisfaction with calls were evaluated with ordinal logistic regression models with and without adjustment for age, sex, health status, waiting time, time for call, main result of the call and expectations. The study followed the STROBE checklist. Results Callers were most satisfied with affective support, followed by professional-technical competence, health information and decisional control-in that order. A summated score of satisfaction with interaction was positively and significantly associated with overall satisfaction with calls before and after adjustment for waiting time, main result of call and variables related to the individual caller. Conclusions Caller satisfaction with interaction is generally high but can be improved, especially regarding decisional control. Satisfaction with interaction is important for overall satisfaction with calls. Relevance to clinical practice This study provides support for professionals at all levels in telenursing organisations to pay attention to interactional matters. The development of best practice for telenurses needs to consider all four components of interaction to enhance satisfaction with calls.

Aims and objectives. To describe people’s experiences of living with dementia in Iran.

Background. A knowledge gap exists regarding the experiences of living with dementia in nonWestern contexts. This gap may be especially apparent within the Iranian context, where dementia research is relatively new. Deeper understanding about context-related experiences of dementia is a prerequisite for nurses’ ability to provide adequate and meaningful care.

Design. Qualitative, cross-sectional design.

Methods. Qualitative content analysis of semi-structured interviews with people living with dementia in urban Iran (six women and nine men; 60–87 years old).

Results. The participants experienced their condition as a state of forgetfulness that was accompanied by losses and dependency on others. They wanted to feel good about themselves and feel important, but they continually struggled with matters such as a loss of accountability, feelings of futility and the frustration of others. Economic dependency and a lack of economic resources were sources of feelings of futility.

Conclusion. Experiences of living with dementia in Iran included a substantial struggle to stay connected to the social world and to deal with dramatic life changes, aspects of living with dementia that seem to be universal. However, the feelings of financial burden and the experience of being nagged for their shortfalls by family members have seldom been described in other studies and seem to represent a cultural aspect of their experience.

Relevance to clinical practice. The results of the study call for further nursing efforts in supporting people living with dementia in their struggle with their altered lives and in retaining their connections to everyday life. Furthermore, their family members might benefit from specific nursing interventions including information about dementia and advice on how to help the family members with dementia to interact with others while exercising their individual strengths.

Aims and objectives.  Describe next-of-kin’s conceptions of medical technology in palliative homecare.

Background.  Next-of-kin to palliative patients are in an exposed position with increasing responsibility. The more involved they are in the care, the greater caregiver burden they describe. Medical technology has become increasingly common in palliative homecare, and previous research suggests that the devices transform the homes to a hospital ward, thus shifting responsibility from the personnel to the next-of-kin.

Design.  An explorative descriptive design with a phenomenographic approach was chosen to describe qualitatively different conceptions of the phenomenon medical technology.

Method.  Interviews with 15 next-of-kin to patients in palliative homecare were analysed in a seven-step process where 10 conceptions emerged in five description categories.

Results.  Medical technology in palliative homecare required next-of-kin’s responsibility in monitoring or providing practical help. It also implied uncertainty among the next-of-kin because of worries about its safety or because of an improper handling. The technology trespassed on daily life because it restricted and affected the private sphere. Medical technology enabled comfort as it implied security and was a prerequisite for the patient to be cared for at home. It also required an adjustment to comprehend and manage the medical technology.

Conclusions.  Medical technology resulted in an increased caregiver burden and uncertainty among the next-of-kin. Although it meant restrictions and affected their social life, they had great confidence in its possibilities.

Relevance to clinical practice.  It is important to limit the amount of personnel and materials in the home to avoid trespassing on the family’s daily life. Medical personnel also have to be sensitive to what next-of-kin have the strength to do and not use them as informal caregivers.

AimTo explore residents' experiences of the mealtime environment in nursing home.DesignAn exploratory qualitative design was employed to gain in-depth insights.MethodsTwenty semi-structured interviews were conducted with residents at a nursing home. Data were analysed using thematic analysis as outlined by Braun and Clarke. The consolidated criteria for Reporting Qualitative research checklist were used to support the research process.ResultsFour main themes emerged from the analysis: (1) The significance of food, emphasising the centrality of food quality and variety in residents' mealtime experiences. (2) Security through routines, illustrating how established mealtime routines provide comfort and predictability. (3) Variability in staff influence, reflecting residents' perceptions of staff competence and their impact on the dining experience. (4) Limited social interactions, highlighting the varied social dynamics and their effects on residents' sense of community and isolation.ConclusionThe study underscores the critical importance of food quality, staff compliance and consistent routines in enhancing mealtime experiences in nursing homes. Additionally, it reveals that the ability to choose social interactions plays a significant role in residents' satisfaction and social well-being.Implication for Patient CareThis study provides valuable insights for improving mealtime experiences in nursing homes, suggesting that person-centred care and resident involvement in meal planning can enhance satisfaction and nutritional intake.ImpactThe findings offer practical guidance for healthcare management, emphasising the need to prioritise and personalise mealtime environments to better meet residents' needs and preferences.

Aim To explore nurses' experiences of supporting family caregivers in specialised home care while learning to use the Carer Support Needs Assessment Tool Intervention. Background The Carer Support Needs Assessment Tool Intervention can provide guidance for discussions with family caregivers in specialised home care concerning their specific support needs. Little attention has been paid to how nurses experience the use of the intervention in their everyday practice. Design This longitudinal study adopted an inductive qualitative approach using interpretive description. Methods Interviews were conducted at two time points. A total of 22 interviews took place with 12 nurses recruited from six specialised home care services. Data were analysed using interpretive description. Results Nurses' everyday clinical practice changed while learning to use the Carer Support Needs Assessment Tool Intervention, and they experienced professional and personal growth. Their supportive inputs shifted from being reactive towards being more proactive. Their approach changed from taking on great professional responsibility, towards a shared responsibility with family caregivers. The support altered from ad hoc contacts in the hallway, towards scheduled trustful conversations. Nurses were concerned about the amount of time and energy this kind of support might require. They pointed to the importance of holding good nursing skills to conduct this new way of having conversations. Conclusion Nurses' everyday clinical practice can be further developed through the use of the Carer Support Needs Assessment Tool Intervention. Nurses may develop both professionally and personally, increasing their ability to provide person-centred support. Relevance to Clinical Practice With the use of the Carer Support Needs Assessment Tool Intervention, nurses can create trusting conversations with family caregivers of patients with life-threatening illnesses cared for in specialised home care. Reporting Method Reporting of the study follows the Consolidated Criteria For Reporting Qualitative Research (COREQ) checklist (File S1). Patient or Public Contribution Participating nurses were involved in discussing the study design.

Aim and objective.  The aim was to explore empowerment within the patient–staff encounter as experienced by out-patients with chronic kidney disease.

Background.  Empowerment has an important role to play in the patient–staff relationship in the case of patients with a chronic disease. When it comes to patients with chronic kidney disease, there has been little research on empowerment, for which reason interviewing such patients about their experiences of empowerment will provide useful knowledge within the context of out-patient care.

Design.  A qualitative interview study was chosen to gain an understanding of empowerment from the patient perspective.

Method.  The study was carried out at an out-patient clinic in Sweden and involved 20 patients with chronic kidney disease. The interviews were subjected to latent content analysis.

Results.  Five of the seven sub-themes emerging from the analysis represented empowerment: Accessibility according to need, Confirming encounter, Trust in the competence of the healthcare staff, Participation in decision-making, Learning enables better self-management. The other two represented non-empowerment: Meeting with nonchalance, Lack of dialogue and influence. From the seven sub-themes, one comprehensive theme was generated: Creation of trust and learning through encounter.

Conclusion.  The main finding regarding the central role of the creation of trust and learning through the patient–staff encounter underlines the importance of understanding empowerment from the patient’s perspective.

Relevance to clinical practice.  Nursing and other healthcare staff need knowledge and understanding of the meaning of empowerment from the patients’ perspective to meet their needs in out-patient care.

Aims and Objectives: To explore the onset of sepsis based on patients' and family members' experiences.

Background: Knowledge about the onset of sepsis is limited among patients and their families, which makes early recognition of sepsis difficult. Previous studies argue that their stories are important to recognising sepsis and reduced suffering and mortality.

Design: A descriptive design with a qualitative approach was used.Methods: In total, 29 patients and family members participated in 24 interviews with open-ended questions, including five dyadic and 19 individual interviews. The interviews were conducted during 2021, and participants were recruited from a sepsis group on social media. A thematic analysis based on descriptive phenomenology was performed. The study followed the COREQ checklist.

Findings: Two themes emerged from the experiences: (1) When health changes into something unknown, including the two subthemes; Bodily symptoms and signs being vague but still tangible and Feelings of uncertainty, and (2) Turning points when warnings signs are deemed as serious, including the two subthemes Passing borders when feeling out of control and Difficulties understanding the seriousness.

Conclusions: Patients' and family members' stories of the onset of sepsis indicate that symptoms and signs appeared insidiously and then noticeably worsen. The symptoms and signs seemed not be attributed to sepsis; instead, there was uncertainty about what the symptoms and signs meant. It was mainly family members who possibly understood the seriousness of the disease.

Implications for the profession and patient care: Patients' experiences of their symptoms and signs and family members' unique knowledge of the patient, indicate that healthcare professionals should listen and try to understand what the patient and family members are telling and take their concerns seriously. How the condition appears, and family members' concerns are important pieces of the assessment to recognise patients with sepsis.

Patient or public contribution: Patients and family members contributed to the data collected.

Aims and objectives To describe healthcare professionals' perceptions of person-centred care for patients with colorectal cancer, within the standardised care concept of Enhanced Recovery After Surgery. Background International guidelines for colorectal surgery describe standardised perioperative care. Combining standardised care with person-centred care could be accomplished using the person-centred nursing framework for establishing and maintaining relationships with patients. Despite strong evidence for the standardised care concepts' medical benefits, studies concerning the practice of person-centred care from a nursing point of view are sparse. Design A qualitative descriptive design was used. Methods Four focus groups interviews were performed including 22 healthcare professionals with 1-29 years' experience of caring for patients with colorectal cancer. Data were analysed using qualitative conventional content analysis. The COREQ checklist for reporting qualitative research was used. Results Three themes emerged in the analysis; Framework in the healthcare system, Facing differences in participation and Interacting with the person beyond the illness. Conditions for person-centred care were related to the interactions between patients and healthcare professionals, the structure of care were also considered relevant. Conclusion There is a discrepancy between what is considered important to do and what is done in clinical practice to create conditions for patient participation. Interacting with patients and creating an interprofessional environment are important conditions, the structure of care is also a fundamental key to promoting person-centred care. There is a need for further improvement in care of patients with colorectal cancer to achieve person-centredness within standardised care. Relevance to clinical practice The findings provide valuable insights into what healthcare professionals consider to be important for achieving person-centred care. This knowledge can be useful in clinical practice and education programs. Patient or public contribution At the outset of the study, three patients were interviewed aimed at improving the conditions for the healthcare professionals' focus groups.

Aims and objectives To describe the perceptions that municipal primary healthcare nurses and municipal registered nurses had about a web-based learning intervention concerning supportive family health conversations in municipal home health care. Background Even though family health conversations are well grounded in theory with several reported benefits for patients and families, most working nurses have little or no training in practising family systems nursing including family health conversations. Continued learning is necessary for nurses, where web-based learning may be one answer of updating the professional skills and knowledge of nurses regarding supporting families. Design The study used a descriptive design and followed the "Consolidated criteria for reporting qualitative research" (COREQ) checklist. Methods Twenty-one nurses participated in an educational intervention that consisted of web-based learning and two face-to-face seminars about family systems nursing including family health conversations. The nurses were interviewed after completion, and the audio-recorded interviews were transcribed verbatim and analysed using qualitative content analysis. Results The findings consist of nurses' perceptions regarding the disposition of instruction, the prerequisites for learning and a changed approach when working with families. The findings are further reflected on through Illeris' theory concerning learning triangle. Conclusions The findings are encouraging for educating nurses in family health conversations at their workplace, with the purpose of supporting patients and families. However, it is important to be aware of the different dimensions of learning, in addition to the appraisal of social aspects and organisational circumstances when educating nurses as they influence the utilisation of the knowledge. Relevance to clinical practice This web-based learning intervention seems to be suitable for educating nurses in family health conversations and could be an appropriate step towards implementing these conversations in home health care with the purpose of supporting families.

Aims and objectives. To describe nurses' views of forensic care provided for victims of violence and their families in EDs, to identify factors associated with nurses' attitudes towards families in care and to investigate if these attitudes were associated with the involvement of patients' families in care. Background. Interpersonal violence has serious health consequences for individuals and family members. Emergency departments provide care for victims of violence, and nurses play a key role in forensic care. However, there is limited knowledge of their views and their involvement of family members. Design. A cross-sectional design was used with a sample of all registered nurses (n = 867) in 28 emergency departments in Sweden. Methods. A self-report questionnaire, including the instrument Families' Importance in Nursing Care Nurses' Attitudes, was used to collect data. Descriptive statistics, multiple linear regression and ordinal regression were used to analyse data. Results. Four hundred and fifty-seven nurses completed the questionnaire (53%). Most nurses provided forensic care, but few had specific education for this task. Policy documents and routines existed for specific patient groups. Most nurses involved family members in care although education and policy documents rarely included them. Being a woman, policy documents and own experience of a critically ill family member were associated with a positive attitude towards family. A positive attitude towards family members was associated with involving patients' families in care. Conclusion. Many emergency department nurses provided forensic care without having specific education, and policy documents only concerned women and children. Nurses' positive attitude to family members was not reflected in policies or education. Relevance to clinical practice. These results can inspire clinical forensic care interventions in emergency departments. Educational efforts for nurses and policies for all groups of victims of violence are needed. Emergency departments may need to rethink how family members are included in their organisation.

Aims and objectives. This study aimed to describe the significant others’ experiences and needs when a person is critically ill or injured in an acute care setting.

Background. Being a significant other to a hospitalised critically ill or injured patient is a heavily distressing life event. Addressing significant others’ needs adequately has been shown to be essential to mitigate the psychological consequences of such distressing events.

Design. A systematic review of qualitative research.

Methods. Meta‐ethnographic synthesis was used for analysis.

Results. The key findings are described in five major themes: uncertainty and emotional ‘roller coaster’; information – balancing hope and reality; to guard and to protect the loved one; alliance with caregivers – crucial support; and social network – support and disequilibrium.

Conclusions. The study can provide a broader understanding of the significant others’ situation. They are facing an overwhelming and emotionally challenging situation and need to be seen and heard.

Relevance to clinical practice. The results point towards the nurses’ key position in handling the needs of the significant others. This kind of description might be helpful in taking on this delicate task and might also serve as a body of knowledge to influence clinical practice guidelines and nursing interventions in this field.

Aims and objective. The aim of this study was to illuminate nurses’ experiences ofconsolation and how these experiences relate to suffering and care.Background. Consolation is commonly associated with the relief of suffering. Thequestion of consolation in terms of its definition and relevance for care has, however,been a matter of discussion among nurse researchers. The question raisedconcerns about the nature of consolation, its place and its role in relation to care andthe caring sciences.Design. An explorative qualitative interview study with 12 participants, six registeredand six enrolled nurses, was carried out in a home-care context.Methods. A phenomenological-hermeneutic method inspired by the French philosopherPaul Ricoeur was used for the text analysis.Results. Two main aspects of consolation appeared: ‘the present consolation’, whichis flexible, sustaining and opening and ‘the absent consolation’, which conceals thesuffering and is incapable of consoling. The result was interpreted from a philosophical-ethical perspective, based on the works of Levinas and Lo¨ gstrup.Conclusions. Consolation appears as a complex phenomenon, both in terms of itsexistence and its absence consolation, constituting a caring and non-caring consolation.A caring consolation entails meeting the other as different and being presentin a way that gives the other space to be the one he or she really is. It requiresacceptance, accepting the sufferer and his/her way of suffering as unique.

Aims and objectives

To investigate reasons for inadequate documentation of vital signs in an electronic health record.

Background

Monitoring vital signs is crucial to detecting and responding to patient deterioration. The ways in which vital signs are documented in electronic health records have received limited attention in the research literature. A previous study revealed that vital signs in an electronic health record were incomplete and inconsistent.

Design

Qualitative study.

Methods

Qualitative study. Data were collected by observing (68 hr) and interviewing nurses (n = 11) and doctors (n = 3), and analysed by thematic analysis to examine processes for measuring, documenting and retrieving vital signs in four clinical settings in a 353-bed hospital.

Results

We identified two central reasons for inadequate vital sign documentation. First, there was an absence of firm guidelines for observing patients’ vital signs, resulting in inconsistencies in the ways vital signs were recorded. Second, there was a lack of adequate facilities in the electronic health record for recording vital signs. This led to poor presentation of vital signs in the electronic health record and to staff creating paper “workarounds.”

Conclusions

This study demonstrated inadequate routines and poor facilities for vital sign documentation in an electronic health record, and makes an important contribution to knowledge by identifying problems and barriers that may occur. Further, it has demonstrated the need for improved facilities for electronic documentation of vital signs.

Relevance to clinical practice

Patient safety may have been compromised because of poor presentation of vital signs. Thus, our results emphasised the need for standardised routines for monitoring patients. In addition, designers should consult the clinical end-users to optimise facilities for electronic documentation of vital signs. This could have a positive impact on clinical practice and thus improve patient safety.

Aims and objectives To illuminate the meaning of living with alcohol dependency as a woman. Background The number of women suffering from alcohol dependency is increasing. Today there are shortcomings in knowledge about the lived experiences of being a woman with alcohol dependency; knowledge which might be of importance for meeting these women's specific needs of care. Design The study has a qualitative design. Fourteen women with alcohol dependency participated in open in-depth interviews. Method Data were analysed according to a phenomenological-hermeneutic method, and interpreted by help from gender and caring perspectives as well as results from previous research of alcohol dependency. Results In relation to the women's senses of well-being, four main gender formations were found; An unstable self involving continual and rapid swings between emotional and bodily reactions. Ambivalence meaning ambiguous feelings towards themselves as human beings and how they lead their lives. Introspectiveness involving reflections, pondering and being introverted. Attempts to perform normality covering dealing with life through various strategies and facades to live up to the expectations of how to behave as a woman. Conclusion Living with alcohol dependency as a woman constitutes of a rapid shifting everyday life resulting in senses of alienation as well as private introspection leading to self-degradation, and to a lesser extent meaningfulness and hope. It also constitutes of managing to perform normality. Relevance to clinical practice When supporting women with alcohol dependency towards wellbeing, professionals need to work towards approaching the woman's inner thoughts, share them and reflect over them together. To support these women to find balance in life, caregivers need to cooperate with the women to find out how best to live a life adjusted to the woman's abilities and wishes.

Aim: To explore experiences of cardiac arrest in-hospital and the impact on life for the patient who suffered the arrest and the family member who witnessed the resuscitation.

Background: Guidelines advocate that the family should be offered the option to be present during resuscitation, but little is known about family-witnessed cardiopulmonary resuscitation in hospital and the impact on the patient and their family.

Design: A qualitative design consisting of joint in-depth interviews with patients and family members.

Methods: Family interviews were conducted with seven patients and their eight cor- responding family members (aged 19–85 years) 4–10 months after a family-witnessed in-hospital cardiac arrest. Data were analysed using interpretative phenomenological analysis. The study followed the guidelines outlined in the consolidated criteria for reporting qualitative research (COREQ) checklist.

Results: The participants felt insignificant and abandoned following the in-hospital cardiac arrest. Surviving patients and their close family members felt excluded, alone and abandoned throughout the care process; relationships, emotions and daily life were affected and gave rise to existential distress. Three themes and eight subordinate themes were identified: (1) the intrusion of death—powerless in the face of the fragility of life, highlights what it is like to suffer a cardiac arrest and to cope with an immediate threat to life; (2) being totally exposed—feeling vulnerable in the care relationship, describes how a lack of care from healthcare staff damaged trust; (3) learning to live again—making sense of an existential threat, pertaining to the family's reactions to a difficult event that impacts relationships but also leads to a greater appreciation of life and a positive view of the future.

Conclusion: Surviving and witnessing a cardiac arrest in-hospital is a critical event for everyone involved. Patients and family members are vulnerable in this situation and need to be seen and heard, both in the hospital and after hospital discharge. Consequently, healthcare staff need to show compassion and attend to the needs of the family, which involves continually assessing how family members are coping during the process, and providing support and information during and after resuscitation.

Relevance to clinical practice: It is important to provide support to family members who witness the resuscitation of a loved one in-hospital. Structured follow-up care is crucial for cardiac arrest survivors and their families. To promote person-centred care, nurses need interprofessional training on how to support family members during resuscitation, and follow-up care focusing on providing resources for multiple challenges faced by survivors (emotional, cognitive, physical) and families (emotional) is needed.

Patient or public contribution: In-hospital cardiac arrest patients and family members were involved when designing the study.

Aims and objectivities.  The aims were to test internal consistency and interrater reliability of Mini Nutritional Assessment during implementation of Mini Nutritional Assessment in community residential homes and to test sensitivity, specificity and diagnostic predictivity of Mini Nutritional Assessment-short form vs. Mini Nutritional Assessment.

Background.  There is a need in clinical practice to assess nutritional status in older people and to identify those who could benefit from early intervention.

Methods.  The two-step Mini Nutritional Assessment procedure (Mini Nutritional Assessment-short form and Mini Nutritional Assessment) was used in 127 older people admitted to eight residential homes. In three of those homes (A, B and C), registered nurses simultaneously performed the assessment procedure, after receiving education and training. The intention was to offer the registered nurses a tool for independent practice use.

Results.  Internal consistency was 0·68 (Cronbach's alpha) (n = 127). In residential home A, B and C, the registered nurses carried out Mini Nutritional Assessment in 45 residents out of 68. The agreement level between the author's and the registered nurses’ assessments was 62% (kappa 0·41). In residential home A, B and C, the agreement level was 89%, 89% and 44%, respectively. Sensitivity, specificity and diagnostic predictivity of Mini Nutritional Assessment-short form vs. Mini Nutritional Assessment were 89%, 82% and 92%, respectively.

Conclusions.  The two-step Mini Nutritional Assessment procedure seems to be a useful tool to identify residents in need of nutritional interventions, despite the registered nurses not carrying out Mini Nutritional Assessment in all residents and the low agreement in residential home C. It indicates that to implement and use Mini Nutritional Assessment in nursing care demands the creating necessary staff resources, such as adequate staffing, sufficient education and continual supervision.

Relevance to clinical practice.  Because of the high sensitivity of Mini Nutritional Assessment-short form and Mini Nutritional Assessment, Mini Nutritional Assessment-short form alone might be sufficient for practice use, as its simplicity might increase its usefulness.

Aim and objectives(i) To determine whether a central tendency, median, based on patients' self-rated pain is a clinically applicable daily measure to show patients' postoperative pain on the first day after major surgery (ii) and to determine the number of self-ratings required for the calculation of this measure. BackgroundPerioperative pain traits in medical records are difficult to overview. The clinical applicability of a daily documented summarising measure of patients' self-rated pain scores is little explored. DesignA repeated measure design was carried out at three Swedish country hospitals. MethodsAssociations between the measures were analysed with nonparametric statistical methods; systematic and individual group changes were analysed separately. Measure I: pain scores at rest and activity postoperative day 1; measure II: retrospective average pain from postoperative day 1. ResultsThe sample consisted of 190 general surgery patients and 289 orthopaedic surgery patients with a mean age of 65; 56% were men. Forty-four percent had a pre-operative daily intake of analgesia, and 77% used postoperative opioids. A range of 49 pain scores seem to be eligible for the calculation of the daily measures of pain. Rank correlations for individual median scores, based on four ratings, vs. retrospective self-rated average pain, were moderate and strengthened with increased numbers of ratings. A systematic group change towards a higher level of reported retrospective pain was significant. ConclusionsThe median values were clinically applicable daily measures. The risk of obtaining a higher value than was recalled by patients seemed to be low. Applicability increased with increased frequency of self-rated pain scores and with high-quality pain assessments. Relevance to clinical practiceThe documenting of daily median pain scores at rest and during activity could constitute the basis for obtaining patients' experiences by showing their pain severity trajectories. The measures could also be an important key to predicting postoperative health-related consequences.

Aims and objectives. To explore the experience of being an adolescent with chronic fatigue syndrome. Background. Despite ample research, chronic fatigue syndrome is still poorly understood, and there are still controversies related to the illness. Adolescents with chronic fatigue syndrome are often unable to attend school and lose social relations with friends. The challenges they face will affect their quality of life. Design. A qualitative, phenomenological hermeneutical design. Method. Six boys and twelve girls, aged 12-18, were interviewed, emphasising their own experiences living with chronic fatigue syndrome. Analyses were performed using a phenomenological hermeneutical method. Results. The core theme, 'Sometimes it feels as if the world goes on without me', encompasses the feelings an adolescent living with chronic fatigue syndrome might have about life. The core theme was supported by four subthemes: 'On the side of life - locked in and shut out'; 'the body, the illness and me'; 'if the illness is not visible to others, does it exist?'; and 'handling life while hoping for a better future'. The subthemes reflect the experience of social isolation, their own and others' understanding of the illness and hope for the future. Conclusions. Not being able to be with friends, or attend school, made the adolescents feel different and forgotten. They felt alienated in their own bodies and were struggling to be visible to themselves and to their surroundings. Spending less time with friends and more time with their parents constituted a threat to independence and development. Yet they managed to envision a better future despite all the difficulties. Relevance for clinical practice. To provide effective support and constructive relations to adolescents with chronic fatigue syndrome, all health professions involved need insight from the persons who are themselves ill. Health centres could function as resource centres for patients and healthcare professionals.

Aims and objectives: To evaluate a walk-in centre at a healthcare centre in an immigrant-dense area where a high proportion of the patients have limited language ability in Swedish, from the perspective of healthcare personnel. Background: Increased global migration results in higher vulnerability in migrants, with the risk of increased morbidity and mortality. Migrants’ health often deteriorates, which can be attributed to an increased level of stress and adaptation to a new lifestyle. Therefore, immigrants are at higher risk of being affected by, for example, cardiovascular diseases and diabetes. This requires access to good health care. Design: A qualitative exploratory study was conducted, using semi-structured interviews. Content analysis was used in the analysis process. Methods: Semi-structured interviews were held with 15 purposively sampled doctors and nurses, working at a healthcare centre in Sweden. Data were collected during autumn 2017. The study was performed in accordance with COREQ. Results: Working at the walk-in centre involved caring for everything from basic to advanced health problems and meant a high pace that required stress-resistant personnel. The walk-in centre was described as both promoting and threatening patient safety. The personnel had several ideas on how to develop the walk-in centre. Conclusions: A walk-in centre can be seen as a necessity related to issues of ensuring patient safety and delivering care for everyone in an immigrant-dense area. However, it cannot be the only form of care offered, as it seems not be adapted to certain groups, such as people with disabilities and the elderly. Relevance to clinical practice: The findings emphasise that a walk-in centre is a way to increase accessibility for the entire population and offer equal care for all, even if it involves challenges that need to be addressed.

AIMS AND OBJECTIVES: To describe next of kin empowerment in an intensive care situation. Background. Next of kin is important in reducing intensive care patients' fear and anxiety. However, admission to an intensive care unit is often recognised as an extremely stressful event, causing next of kin to experience shock, fear, anxiety and vulnerability. More knowledge is needed about how next of kin in intensive care can be empowered.

DESIGN: The study was conducted using a phenomenological method.

METHODS: Ten interviews were conducted with intensive care patients' next of kin.

FINDINGS: Perceptions of both a genuine will and a capacity to help and relieve were found to be essential for next of kin's experiences of empowerment in an intensive care situation. All informants were empowered by a caring atmosphere where they received continuous, straightforward and honest information that left room for hope and in which closeness to the patient was facilitated and medical care was perceived as the best possible. Some of the informants were also strengthened by support from other family members and/or by being involved in caring for the patient.

CONCLUSIONS: Next of kin empowerment was found to be associated with being met with human warmth and sensitivity. This emphasises the importance of discussing attitudes and behaviours as well as surveillance and treatment when trying to improve the care of next of kin in intensive care unit and when working with staff development.

RELEVANCE TO CLINICAL PRACTICE: Knowledge of how to empower next of kin in an intensive care situation allows caring staff to support these persons in a more sensitive and appropriate way. Findings underline the importance of creating caring relations with patients' next of kin.