This article aims to describe the phenomenon of learning at a university-based nursing student–run health clinic, as experienced by student nurses and lecturers. The study is based on a reflective lifeworld research approach founded on continental philosophy. Eight group interviews were conducted with 38 student nurses and 5 lecturers. The data were explored and analysed for meaning. The results show that learning is supported by a permissive learning environment that builds on both individual and common learning as well as equal relationships within the student group, in relation to the visitors at the health clinic and, to a certain extent, in relation to the lecturers. The most significant finding is that reflective, development-oriented learning takes place when the students, supported by each other and their lecturers, reflect on how to relate to problems and situations. A situation-based learning approach is thus shown to create the prerequisites for lecturers being nearby, reflective dialogue partners but also supervisors in situations where the students ask for support and guidance.

Detta är en guide till kliniska examinationer som syftar till att du,som student, ska vara väl förberedd och genomföra examinationen på bästa sätt. Innehållet i boken är tänkt att ge en överskådlig och intresseväckande bild av de olika kliniska examinationsformerna.

Boken är lätt att bära med sig i kliniska undervisningssituationer,den ger konkreta tips kring olika moment i examinationerna.  Författarna till boken är sjuksköterskor, specialistsjuksköterskor  och universitetslärare med mångårig erfarenhet av kliniska examinationer och kliniska slutexaminationer på olika nivåer och i olika utbildningsprogram.

Målgruppen är studenter i sjuksköterske- och specialistsjuksköterskeprogrammen där kliniska examinationer är en del av utbildningen. Den kan också läsas av lärare vid universitet eller högskolor som inspiration och stöd i arbetet med kliniska examinationer. Liknande böcker finns på den brittiska och amerikanska marknaden men detta är den första i Sverige.

Purpose: A patient is vulnerable and exposed due to illness, relies on and surrender to other people. In caring this means a special dependency. The aim of this study was to describe the origin of the concept ‘exposed’, to elucidate how the definition of this term has changed over time, and to outline its relevance in caring science. Method: A semantic concept analysis in two phases was conducted. Results: The findings show that over time, the degree of binding of the following synonyms has become stronger; unprotected/defenseless, naked/bare, pressed/jostled and unsafe/unprotected and can easily be transferred to a clinical nursing context. Conclusions: This study provides a deeper understanding of the concept 'exposed' semantically. Being exposed is a profound experience for patients who need to be seen as the person they really are. A life-world led care has an existential power that can support professionals, strengthen patients’ health processes, and alleviate the patient’s suffering.

Purpose

This study presents several accounts of user experiences with assistive technology (AT). Although previous studies on dyslexic students reported promising results from using audiobooks, text-to-speech (TTS), and speech-to-text (STT), qualitative research is relatively sparse and short-term, and little is known about adolescents’ long-term experiences of using AT in schools. Therefore, this five-year follow-up study aimed to describe dyslexic students’ experiences of AT.

Materials and methods

Nine students with dyslexia were interviewed using a semi-structured framework and a descriptive pattern-based thematic analysis. The students had previously participated in an AT intervention in Sweden.

Results

Three main themes are reported: Contextual factors: facilitators or barriers; Emotional responses in the learning environment; Developing meaningful strategies. The results align with previous research findings that audiobooks are beneficial throughout the school years, while STT is of mixed utility. TTS was mainly used in learning to decode texts. Continued AT use is discussed thematically, concretising experiences connected to schools’ multilevel support.

Conclusions

This study can contribute to the development of AT academic practices enriched by users’ views. The findings reveal factors enabling or hindering students’ continued AT usage. Contextual factors in schools concern organisational elements rather than AT accessibility. Students’ emotional responses (using AT in the classroom) are influenced by dyslexia self-acceptance and AT attitudes. Students’ understanding of how and why to use AT may limit the development of meaningful strategies. Implications and suggested further research are provided to improve dyslexic students’ AT experiences and success in school.

Forest fires, i.e., wildfires, often cause an inevitable strain on society and human living conditions. Incident Commanders (IC) at the Fire and Rescue Services (FRS) are challenged to handle forest fires and at the same time address the forest owners’ needs; this stipulates a need for collaboration, information, and communication. Hence, the aim of this study was to explore and describe the ICs’ experiences and actions in their interactions with forest owners during forest fires on private property. Interviews were conducted and analyzed using Flanagan’s Critical Incident Technique (CIT) to describe the experiences and actions of 22 ICs. The results showed that a firefighting operation needs clarity in information exchange with the forest owner as a stakeholder, not a victim. The trust between forest owner and IC accelerated the operational phase. The ICs demonstrate more care than the law stipulates, and they worry about the forest owners. Therefore, the FRS needs to form a strategic partnership with forest owners and their network on a local level. Also, future forest fire drills should not only include emergency stakeholders (i.e., police, ambulance, etc.) but also forest owners and local volunteer organizations. For a resilient community, FRS and forest owner collaboration is vital.

Background: Severe stress is one of the most common causes of sick leave in Sweden. Previous research hasshown that compassion interventions for healthcare professionals can decrease work-related stress through theintroduction of self-care, self-awareness, and emotion regulation abilities when experiencing difficult situations.Internet-based stress management interventions have hitherto shown promising results in reducing stress.However, further research is needed to examine the effectiveness of internet-based compassion interventions forhealthcare professionals.Objective: In the present study protocol, a randomised controlled trial is described, aiming to examine the effectsof an internet-based compassion course for healthcare professionals on work-related stress and stress ofconscience.Method: Healthcare professionals will be offered an internet-based stress management course of five modulesacross a period of five weeks. The design is a randomised controlled study consisting of three groups enrolled inone of the following: a compassion course (n = 120), a cognitive behavioural stress management course (n =120), or placed on a waitlist followed by either the compassion course or the cognitive behavioural stressmanagement course (n = 36). We hypothesise that the internet-based compassion course would reduce theparticipants’ stress of conscience to a greater degree compared to the other two groups. The secondary hypothesisis that the compassion course would increase the participants’ professional quality of life (i.e., higher jobsatisfaction and lower empathy fatigue) and self-compassion. In addition, the internet-based compassion courseis expected to reduce the participants’ work-related stress and sick leave rates to the same degree (non-inferiority)as the cognitive behavioural stress management course and to a higher degree when compared to thewaitlist condition. The primary outcome measure is the Stress of Conscience Questionnaire (SCQ) and the secondaryoutcome measures are the Professional Quality of Life Scale (PROQOL), the Work-related StressCopenhagen Psychosocial Questionnaire (COPSOQ), and the Self-compassion Scale (SCS). Assessments will beperformed at baseline, four weekly assessments during treatment, post-treatment (5 weeks), and follow-ups at 10weeks, 15 weeks, and 6 months. The repeated measures data will be analysed using a generalised estimatingequation for repeated measurements to examine whether changes over time differ between the groups andwhether the improvements persist over time.Discussion: The clinical trial is expected to provide novel data on the effects of compassion interventions and addto the existing knowledge of internet-based interventions for stress management in healthcare professionals.

Aim:  To describe and develop understanding of  the patient’s first encounter with the involved persons at the scene of an accident and at the emergency department; with a special focus on describing the meaning of emergency care of patients in these caring contexts. 

Method: The thesis uses a reflective lifeworld research (RLR) approach founded on phenomenological philosophy. The purpose with this approach is to describe the essential meaning and the variations of a phenomenon. Interviews with a lifeworld perspective were used for data collection and analyzed according to the RLR approach for searching for the essence of the phenomenon.  The four essences in the studies (I-IV) establish a general structure for the phenomenon.

Findings:  Emergency care is characterized by an organisation, whose goal and resources are focused on life-saving, and that encounters a human being with needs of emergency care as well as existential support. The responsibility in emergency care means an intertwining of doing and being.  The one who is in charge takes responsibility for performing or “doing” medical actions, and by “being” close and present in the situation the patient can at the same time feel an existential support. The responsibility for the injured or ill body is handed over to a chain of persons with more and more specialized competence and resources. This hand-over entails a relief for all involved but fails in one link in the chain, namely to explicitly hand back  the responsibility to the patient.  When the patient’s condition allows the distance to be larger the responsibility pales and the existential support decreases. A gap between doing and being arises where the patient is left to regain control and independence. The intertwining of doing and being, which appears as soon as the one in charge is close and present to the patient, facilitates the hand-over to the patient who in a natural way is able to receive the responsibility with possibilities to be able to conclude the encounter.

Conclusions: A new understanding of emergency care appears which entails more than just life support measures.  Emergency care includes different ways of communication in order to hand over the responsibility and complete the care chain back to the patient in a safe way. The results highlight the importance of empowering patients with a confirming, communicative contact throughout the whole caring process in order for them to retain their identity. There are also implications for educating students and personnel in inter-professional communication and work. In order to assist the intertwining between doing and being there are needs for the development of supportive structures for inter-professional reflection, which in turn would improve the interaction between patients and professionals in their encounter. 

Aim: To describe and develop an understanding of the patient’s first encounter with different professionals at the scene of an accident and at the emergency department (ED), with a special focus on describing the meaning of emergency care of patients in these care contexts.

Design and Methods: The study, having a descriptive design, was carried out with a reflective lifeworld (RLR) approach founded on phenomenological philosophy

Results: The general structure revealed that emergency care is characterized by a hand-over of responsibility, which is characterized by life-saving medical actions and constitutes a doing. Those life-saving actions need a conscious presence, which at the same time means an existential support for the patient that is constituted by a being. The responsibility then intertwines the doing and the being and all persons involved are brought together into a mutual space. When the patient’s condition allows for increased physical distance from the professionals, a gap or an interspace in the intertwining between doing and being arises as well as an interspace in the patient's understanding of the encounter. For the patient and next-of-kin, this interspace means an empty space with paradoxical feelings of being interesting and at the same time uninteresting - a paradox of care. For the professionals, this interspace provides a needed  breathing space, but also feelings of being split between the high demands of efficiency and the patient's need for existential support and a meaningful encounter - an ethical dilemma.

Discussion: Knowledge of the temporal meaning ofthe encounter, to be here andnow,can give professionals an opportunityto fillthe interspacedespite increasingphysical distance as patient health improves. Furthermore, it will also give professionals an opportunity toreflect on howthe available timeis used.

RACTThe article focuses on the hand-over process as clinical hand-over of patient. It mentions that hand-over may begin if the fire or the police service are the first responders at the scene of an accident and they hand-over the responsibility for the injured patients to the ambulance. It says that hand-over also starts when the injured is handling over the responsibility for their own body to the first responders.

Prehospital emergency care includes the care and treatment of patients prior to them reaching hospital. This is generally a field for the ambulance services, but in many cases firemen or police can be the ones to provide the first responses. The aim of this study was to describe and understand experiences of being the first responder on the scene of an accident, as described by policemen, firemen and ambulance staff. A lifeworld perspective was used in four different traumatic situations from southern Sweden. The data consisted of 13 unstructured interviews with first responders. The phenomenological analysis showed that experiences of being the first responder on the scene of an accident is expectations of doing a systematic course of action, dressed in the role of a hero, and at the same time being genuine in an interpersonal encounter. This entails a continuous movement between ‘being’ and ‘doing’. It is not a question of either – or, instead everything is to be understood in relation to each other at the same time. Five constituents further described the variations of the phenomenon; a feeling of security in the uncertainty, a distanced closeness to the injured person, one moment in an eternity, cross-border cooperation within distinct borders and a need to make the implicit explicit. This finding highlights the importance of using policemen and firemen in doing life support measures while waiting for the ambulance staff, and would in turn increase the importance of the relationship between the different professionals on the scene of an accident.

IntroductionThe care in the emergency department (ED) is often characterised by high standards of efficiency and rapid treatment and the encounter between patient and staff can be described as both short and fragmented. Research within this field has mostly been performed with quantitative measurements and patients are both satisfied and vulnerable in their care at an ED. There is a lack of qualitative studies about patient's strategies to deal with their situation. AimThe aim was to describe patient's strategies for dealing with their situation at an ED. MethodsSecondary analysis has been made of 13 qualitative interviews grounded in a lifeworld perspective. The interviews were analysed by qualitative content analysis. ResultsThe results showed that patients' strategies to deal with the situation at the ED are passive or active. The passive strategy is being patient and the active strategies varied in terms of having hidden tactics, using visible tactics and using families as support. ConclusionThese findings increase the importance of gaining knowledge about these strategies so that the staff at the ED can support the patients so they do not have to use them.

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.

A common focus in research studies within the Emergency Department (ED) is physician patient relations, experiences of the triage model and nurses´ experiences of caring. Little has, however, been written about different first providers´ experiences of working on the “front line” at the ED. The aim of this study was to describe and understand experiences of being the first provider on the “front line” at the ED, as expressed by nurse assistants, registered nurses and physicians. A reflective lifeworld research approach was used in four different caring situations. The data consisted of eight open-ended interviews with first providers. The analysis showed that being the first provider on the “front line” at the ED entails a continuous movement between providing and responding through performing “life-saving” actions and at the same time create a good relationship with the patient and the next of kin. Five constituents further described the variations of the phenomenon. The readiness to save lives creates a perceived stress of time pressure and the first providers adopt different strategies to cope with the work. Instead of leaving the first providers to find their own way to cope with the complex situation, there are needs for a redesigning of the internal work process within ED organizations.

Background: It is well recognized that long waiting times at Emergency Departments (ED) influence patient satisfaction rates. Evidence suggests that changes in the design of healthcare environments can improve patient care when these changes include the provision of nature and music elements in different ways.

Aim: To explore how patients, relatives and staff perceive a slideshow with nature pictures and music in the emergency department waiting room.

Method: A descriptive survey design including a slideshow with nature pictures and music shown in the waiting room. Questionnaires were distributed to patients and relatives (n=94) as well as to the staff (n=76), analysed with descriptive statistics and content analysis.

Results: A majority (67%) of the participants thought that the slideshow contributed to a positive environment in the waiting room. Content analysis of 254 comments demonstrated it to be experienced as relaxing and calming. There is, however, room for improvement regarding quality, length and variation of the slideshow.

Conclusion: An organized wait time with different alternative activities including nature elements and music in the waiting environment may have positive impacts. The challenge lies in creating a supportive design, which supports the three separate groups and their needs for control in terms of freedom of choice and variation.

Den mobila vården behöver definieras nationellt och bli en egen organisationsform och vårdnivå, skriver företrädare från Centrum för interprofessionell samverkan inom akut vård.

Objectives Patients >= 65 years old represent 30%-50% of all ambulance assignments (AAs), and the knowledge of which care level they are disposed to is limited and diverging. The aim of this study was therefore to describe and compare characteristics of patients' aged >= 65 years dispositions during AA, including determining changes over time and factors associated with non-conveyance to hospitals. Design A longitudinal and comparative database study. Setting Ambulance service in a Swedish region. Participants 32 085 AAs with patients >= 65 years old during the years 2014, 2016 and 2018. Exclusion criteria: AAs with interhospital patient transfers and lack of patients' dispositions data. Outcome measures Dependent factors: conveyance and non-conveyance to hospitals. Independent factors: age, sex, symptom, triage level, scene, time, day and season. Results The majority (n=29 060; 90.6%) of patients' dispositions during AA were conveyance to hospitals. In total, the most common symptoms were circulatory (n=4953; 15.5%) and respiratory (n=4529; 14.1%). A significant increase, p<0.01, of non-conveyance to hospitals was shown during 2014 and 2018, from 801 (7.8%) to 1295 (11.4%). Increasing age was associated with decreasing odds of non-conveyance, 85-89 years (OR=0.85, 95 % CI=0.72 to 0.99) and 90 years or older (OR=0.80, 95 % CI=0.68 to 0.93). Several factors were associated with non-conveyance, for example, symptoms of diabetes (OR=8.57, 95 % CI=5.99 to 12.26) and mental disorders (OR=5.71, 95 % CI=3.85 to 8.48) in comparison with infections. Conclusions The study demonstrates several patient characteristics, and factors associated with non-conveyance to hospitals, such as age, symptom, triage level, scene, time, day and season. The increasing non-conveyance trend highlights the importance of further studies on optimal care levels for patients >= 65 years old.

Aim

The aim of this study was to disclose the meaning of patients and relatives lived experience of dissatisfaction when visiting an emergency department.

Introduction

Even though most patients are pleased with the emergency department care, there are areas that dissatisfy them, for example lack of communication and unoccupied wait time. However, there are few studies that describe both patients and relatives experience of dissatisfaction.

Methods

This explorative study uses a phenomenological hermeneutic approach where patients and relatives were interviewed.

Results

Patients and relatives meaning of dissatisfaction mainly contain powerlessness, struggling for control over the situation, lacking knowledge and information, receiving and providing support.

Conclusions

The results showed that the experiences of dissatisfaction were similar among patients and relatives. They suffer in the same way when being treated like objects during their visits. Nursing rounds are one way to decrease dissatisfaction by making patients and relatives participating in the care continually updated with information.

Background: Complex level-of-care decisions involve uncertainty in which decisions are beneficial for older patients. Knowledge of physicians' decision-making during acute situations in older patients' homes is limited. Therefore, this study aimed to describe physicians' experiences and actions in making complex level-of-care decisions during the assessment of older patients in acute situations within their own homes.

Methods: Individual interviews and analyses were performed according to the critical incident technique (CIT). In total, 14 physicians from Sweden were included.

Results: In making complex level-of-care decisions, physicians experienced collaborating with and including older patients, significant others and health care professionals to be essential for making individualized decisions regarding the patients' and their significant others' needs. During decision-making, physicians experienced difficulties when doubt or collaborative obstructions occurred. Physicians' actions involved searching for an understanding of older patients' and their significant others' wishes and needs, considering their unique conditions, guiding them, and adjusting care according to their wishes. Actions further involved promoting collaboration and reaching a consensus with all persons involved.

Conclusion: Physicians strive to individualize complex level-of-care decisions based on older patients' and their significant others' wishes and needs. Furthermore, individualized decisions depend on successful collaboration and consensus among older patients, their significant others and other health care professionals. Therefore, to facilitate individualized level-of-care decisions, the health care organizations need to support physicians when they are making individualized decisions, provide sufficient resources and promote 24 - 7 collaboration between organizations and health care professionals.

Background: Care decisions for older patients in acute situations are challenging to make, and there is limited knowledge of support in home healthcare settings, where older patients receive ongoing health care from, for example, community health nurses. Therefore, this study aimed to describe the support for all involved in acute situations when a community health nurse was called, as experienced by older patients, their significant others and healthcare professionals involved.

Methods: The study was conducted using a phenomenological reflective lifeworld research approach, in which meanings of the study phenomenon were analyzed. The included participants were those who had been involved in acute situations. Twelve participants from four acute situations were interviewed. The participant included three older patients, one significant other, four community health nurses, one registered nurse student, one specialist in general practice, and two ambulance personnel, with one being a registered nurse and the other a specialist ambulance nurse.

Results: Support in decision-making was received from the knowledge of temporality, which provided a comprehensive understanding based on past and present knowledge of the older patient. The knowledge of temporality allowed for the early detection of new symptoms and facilitated care decisions tailored to the older patient. There was a dependency on pre-existing mutual interpersonal support, and confidence developed through relational, caring, and medical competence.

Conclusions: The advantages of temporality, confidence and mutual interpersonal support in acute situations highlight the importance of enhancing relational continuity in home healthcare settings and establishing a structural collaboration among community health nurses, specialists in general practice, and ambulance personnel. This collaboration aims to provide support for making decisions regarding tailored care.

Purpose This study aimed to describe extended collaboration in situations when an ambulance was called, as experienced by older patients, a significant other, and ambulance- and primary healthcare (PHC) centre personnel. Methods The study used a phenomenological reflective lifeworld research (RLR) approach. Participants included in three specific situations with extended collaboration were interviewed: three older patients, one significant other, three ambulance personnel and four personnel at the PHC centre. The transcribed interviews were analysed for meanings of the phenomenon. Results The extended collaboration means that decisions were supported through dialogue by bridging knowledge spaces between person, within-team and across-team levels. Through dialogue experience and knowledge were shared and certainty in decisions was increased. The extended collaboration was built on trust, responsibility taken, shared and entrusted, and the common goal of adapted care for the unique patient. A need for further improvement and transparency was elucidated. Conclusions The difficulty of making care decisions stresses the importance of available extended collaboration based on the dialogue between patients, significant others, and ambulance- and PHC centre personnel to increase certainty in decisions. Collaboration further requires respectful encounters, trust, responsibility and a common goal of adapting the care for the unique patient.

Introduction

Overcrowding is a common international problem at Emergency Departments often due to those patients get recommendations or referrals from other health professionals to seek care at the emergency department. Crowding brings with it an amount of adverse consequences for both patients and staff, and knowledge about staff’s strategies of dealing with this caring situation is limited.

Aim

The aim of the present study was thus to describe staffs’ strategies to deal with the caring situations at an emergency department.

Method

Secondary analysis has been made of 18 qualitative interviews grounded in a lifeworld perspective. The interviews were analysed by qualitative content analysis.

Findings

The results showed that the staff at the ED worked in twofold directions using both proactive and reactive strategies in order to deal with the care situation when caring for patients at ED. The proactive strategy is optimising conditions, controlling patient flow and being boundary. The reactive strategy is about customising the conversation and holding an open approach.

Conclusion

In conclusion, the proactive strategy is to make what you decided for unseen circumstances. The reactive strategy is then about less anticipation of the encounter, waiting for the patient to act and react to it.

Implication

The result can have implications with respect to developing and improving care at crowded Emergency departments. Knowledge about strategies creates a fundament for developing visible sustainable structure for patient flow in making work patient safety for patients, staff and organisation.

Objectives: Chronic, clinical pain states are often accompanied by distress such as anxiety and depression. The aim of this study was to determine if certain clinical pain variables could predict the level of anxiety and depression in subjects with musculoskeletal pain.Methods: Two multiple linear regression analyses were conducted on a sample consisting of 189 subjects with clinical pain with the independent pain variables of pain intensity, the influence of pain on daily activities, pain persistence, pain duration, and the number of pain locations. The dependent variables measured anxiety and depression, respectively.Result: Two statistically significant models were found, where the predicted variables accounted for 37.0% of the variability in the anxiety levels and 43.7% of the variability in the depression levels. The independent variable, the influence of pain on daily activities, significantly predicted the level of anxiety. The variables, the influence of pain on daily activities and the number of pain locations, significantly predicted the levels of anxiety and depression.Conclusions: This study showed that two different independent variables, the influence of pain on daily activities and the number of pain locations, significantly predicted the levels of depression. The predictor, the influence of pain on daily activities, significantly predicted the levels of anxiety. The knowledge gained about which specific pain variables are more likely to coexist with anxiety and depression in clinical pain states could be important in implementing holistic treatment plans for chronic pain.

BackgroundTo minimize the risk of perioperative hypothermia, it is recommended that healthcare professionals be familiar with heat conservation measures and use passive and active warming methods, in line with international guidelines. However, there is a low level of adherence perioperatively to the use of heat conservation measures. To understand why, there is a need to capture the nurse anesthetists' perspective. The aim is to describe nurse anesthetists' perceptions of heat conservation measures in connection with surgery.MethodsAn inductive descriptive design with a phenomenographic approach was chosen. A total of 19 nurse anesthetists participated and were interviewed. Data were analyzed according to Larsson and Holmstrom's phenomenographic seven-step model.ResultsSix ways of understanding the phenomenon heat conservation measures in connection with surgery were found: the preventive, the useable, the untenable, the caring, the adaptive, and the routine care approach. These approaches were related to each other in a flexible way, allowing for several to co-exist at the same time, depending on the situation.ConclusionsNurse anesthetists want to prevent the patients' heat loss and maintain normothermia, regardless of the type of surgery. This willingness, motivation, and intention enable the use of heat conservation measures. However, there are perceptions that have an impact, such as doubts and uncertainty, access, time and financial constraints, preconditions, routines or habits, and lack of availability of education/training. These barriers will require support from an organizational level to promote lifelong education and guidelines. As well as offer education at the nurse anesthetists' program.

Purpose

The aim of this study was to determine if nurse anesthetists (NAs) have access, knowledge, and adhere to recommended guidelines to maintain normal body temperature during the perioperative period.

Design

A descriptive survey design.

Methods

Questionnaires were sent to heads of the department (n = 56) and NAs in the operating departments in Sweden.

Finding

The level of access to the recommendations is high, but only one third of the operating departments have included the recommendations in their own local guidelines. The NAs' adherence was low, between 5% and 67%, and their knowledge levels were 57% to 60%.

Conclusions

A high level of knowledge, access, and adherence are important for the organization of operating departments to prevent barriers against implementation of new recommendations or guidelines. There are needs for education about patients' heat loss due to redistribution and clear recommendations.

Purpose: The aim was to describe patients' lived experience of warmth and coldness in connection with surgery.

Methods: A reflective lifeworld research (RLR) approach founded on phenomenology and the methodological principles of openness, flexibility, and bridling were used. The data consisted of 16 in-depth interviews with patients from four hospitals in Sweden.

Results: Warmth and coldness in connection with surgery means an expectation to maintain one ' s daily life temperature comfort. When patients' needs of temperature comfort is fulfilled it give a sense of well-being and calmness. Despite the body is covered there are feelings of vulnerability. When patients have the ability to change their own temperature comfort, they feel independent.

Conclusion: The individual feeling of temperature comfort could be affected or changed to discomfort during the perioperative context, and an intervention is required to avoid suffering due to the care. An ability to independently influence one ' s own temperature comfort can strengthen the patient, whereas the opposite entails suffering in silence. The phenomenon is also related to feelings of confidence about receiving the best care as well as being exposed and vulnerable. When the patient ' s need of comfortable temperature is met then feelings of security and sense of well-being emerged.

IntroductionMaking decisions about the appropriate level of care is a significant challenge for healthcare professionals, especially when older patients present with diffuse symptoms. Collaboration between ambulance services and primary care may promote a comprehensive understanding of patient needs. However, such collaboration remains limited, potentially leading to lower care quality and higher costs. There is a need to understand how collaboration can be effectively implemented. This scoping review aims to explore existing models of collaboration between ambulance services and primary care, identifying their characteristics, outcomes and current research gaps.

Methods and analysisThis scoping review will follow the methodological framework proposed by Arksey and O’Malley, supplemented with recommendations from the Joanna Briggs Institute Handbook for Scoping Reviews. A comprehensive literature search will be conducted in PubMed, CINAHL, Web of Science and Scopus. In addition, Google Scholar, Overton, SwePub and the Swedish national library database Libris will be searched for relevant grey literature. The review will include studies published from January 2014 to the present. Data will be analysed descriptively, with findings categorised by collaboration models and patterns identified through inductive analysis to address the research questions. The review will apply the Preferred Reporting Items for Systematic Review and Meta-Analysis extension for Scoping Reviews to present the results.

Ethics and dissemination This review is the first stage of an overarching research study to develop a model for extended collaboration between ambulance services and primary care (the ECAP project). Results will be disseminated through peer-reviewed publications, conference presentations and sharing with ambulance services and primary care stakeholders to inform practice and policy. This scoping review protocol has been registered on the Open Science Framework (https://osf.io/nrkm5/). No participants will be involved at this stage, and the selected literature is publicly available, so no ethical approval will be required for this scoping review.