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 To describe nurse anesthetists' attitudes towards the importance of parental presence during their child's anaesthesia induction and to explore associating factors. Design A cross-sectional design. Methods Nurse anesthetists from 55 Swedish hospitals were asked to participate (n = 1,285). A total of 809 completed the questionnaire, Families' Importance in Nursing Care-Nurses' Attitudes (FINC-NA) during 2018. Data were analysed by descriptive statistics and multiple linear regression analysis. Results Nurse anesthetists generally had a positive attitude towards the importance of parental presence. They reported a more positive attitude in family as a resource in nursing care (median = 40) followed by family as a conversational partner (median = 25), family not as a burden (median = 17) and family as its own resource (median = 13). Multiple linear regression analyses showed that working in a district hospital, working only with children, having routines/memorandum about parental presence, being a woman, allowing both parents to be present in their child's anaesthesia and greater experience of children's anesthesia, were associated with a more positive attitude. Conclusion This nationwide survey contributes important knowledge for understanding nurse anesthetists' attitudes and the result shows that nurse anesthetists generally have a positive attitude towards the importance of parents. Areas of improvement were, however, identified; the nurses tend to not value family as its own resource and family as a conversational partner highly. Impact Nurse anesthetists have a crucial role in children's anesthesia care since the quality of parental presence experience depends on a positive attitude from the nurses. Parental involvement is important to establish a child-centered anaesthesia care, which should be highlighted in the education of nurse anesthetists. Parental involvement should also be addressed in healthcare policies and routines should be established.

Introduction Children experience anesthetization as stressful, and many preoperative measures have been tested for reducing their anxiety. There is, however, little research about children's own experiences and thoughts about being anesthetized. Aims The aim of the present study was thus to explain and understand the meaning of being anesthetized as experienced by children. Methods A qualitative lifeworld hermeneutic approach was used. Data were collected through nonparticipant video observations, field notes, and interviews. The participants were children (n = 28) aged 4-13 years who required general elective minor surgery performed in four Swedish hospitals. Results The four interpreted themes describe the children's experiences of being anesthetized: Being powerless, Striving for control, Experiencing an ambiguous comprehensibility, and Seeking security. The children struggled with anxiety as a result of their inability to protect themselves from perceived external threats while being anesthetized. In order to meet their needs, it would be beneficial for them to receive appropriate information in a calm, supportive, and protective environment. Conclusion The reasons for children experiencing anxiety when being anesthetized are multifaceted, and this study highlights the importance of listening to each child's own voice and striving to create an individually adapted caring and safe environment with as much protection as possible.

I Sverige finns idag ett stort antal palliativa rådgivningsteam. En av deras huvudsakliga uppgifter är att genom råd, stöd och utbildning höja kompetensen hos de primära vårdgivarna avseende förhållningssätt och behandling inom palliativ vård. Med denna målsättning startade år 1998 det palliativa rådgivningsteamet i Västervik, Vimmerby och Oskarshamn (PRIVO), i form av ett projekt, som sedan permanentades.

Syftet med denna rapport är att utvärdera PRIVO:s verksamhet, som en uppföljning av tidigare utvärdering år 2000. Datainsamlingen omfattar statistiska data, enkäter till primära vårdgivare inom landstingets öppen- och slutenvård, privat öppenvård samt kommuner. Intervjuer har genomförts med patienter och familjemedlemmar, samt PRIVO:s medlemmar.

Enkäten, som skickades ut till 89 arbetslag, efterfrågar kommunikationsvägar, teamets tillgänglighet och service, genomförande och effekter av teamets insatser, samt synpunkter om förbättringar av teamets fortsatta verksamhet. Enkäten besvarades tillsammans i arbetslagen med så många yrkeskategorier som möjligt närvarande. Svar inkom från 71 arbetslag (80 %), vilket omfattar totalt 291 personer. Beräkningar har gjorts med dataprogrammet SPSS. Familjeintervjuerna var semistrukturerade och omfattade patienternas (n=8) och familjemedlemmarnas (n=12) upplevelser av den erhållna vården, samt PRIVO:s insatser. Intervjuerna med teamets medlemmar omfattade arbetssätt, kvalitetssäkring och målsättning, intern funktion, kompetensutveckling, marknadsföring, extern samverkan, utbildning samt dokumentation och informationsöverföring. Samtliga intervjuer bandades, skrevs ut ordagrant och analyserades genom att sortera och gruppera dess innehåll.

Från och med september år 2003 arbetar samtliga teammedlemmar heltid; en läkare och tre sjuksköterskor. Utbildning till de primära vårdgivarna har omfattat 470 timmar och totalt inkluderat 3585 vårdpersonal under tiden 2001 - 2003. Antal personer och utbildningstillfällen har successivt minskat under perioden. Totalt gjordes 718 nyinskrivningar vid PRIVO under åren 2001 - 2003 och under samma period avled totalt 598 patienter. Av de med känd önskan att dö hemma var det 72% som faktiskt dog i hemmet. Antalet besök gjorda av teamets läkare och sjuksköterska tillsammans har ökat markant från 110 besök år 2001, till 275 besök år 2003. Ökningen består av flera besök på vårdavdelningar (från 45 till 117) och i eget boende (från 49 till 152), medan besöken i de särskilda boendena minskat från 16 till sex.

Resultatet av enkäten påvisade en klar förbättring, avseende hur de primära vårdgivarna uppfattar PRIVO:s verksamhet, jämfört med utvärderingen år 2000. Den största förbättringen avser hur snabbt personalen får det stöd de efterfrågar och att PRIVO är lättillgängliga. De primära vårdgivarna anser att patienterna fått bättre vård och behandling sedan PRIVO kopplats in, främst när det gäller symtomlindring. En stor majoritet ansåg att teamet även i fortsättningen ska arbeta konsultativt, även om undantag kan göras i speciella situationer. Så gott som samtliga arbetslag ansåg att PRIVO ska fortsätta sin verksamhet och de efterfrågade fortsatt kontinuerlig utbildning. Enligt de primära vårdgivarna är det bästa sättet att utveckla den palliativa vården att höja kompetensnivån hos all personal med generella utbildningsinsatser och genom att utbilda palliativa ombud.

Familjerna upplevde att vården i stort fungerade bra vad det gäller det fysiska omhändertagandet, men ansåg att det psykosociala och existentiella stödet var bristfälligt. PRIVO utgjorde en stor trygghet för familjerna då de var lättillgängliga och vården ansågs förbättrad efter att teamet kopplats in, framför allt vad det gäller smärtlindring. De patienter som hade en så kallad morfinpump, ansåg systemet som sårbart och upplevde otrygghet, då de primära vårdgivarna inte har kunskap om hur de ska skötas. Familjerna hade svårt att fullt ut förstå PRIVO:s roll och samverkan med andra vårdgivare. Familjemedlemmarna beskrev att de inte blev 'sedda', varken av vården i stort eller av PRIVO:s medlemmar, avseende deras välbefinnande och behov av stöd. Familjerna var i allmänhet osäkra på om de kunnat påverka den egna vården och de ansåg att de saknade information om sjukdomen och om tillgängliga resurser.

PRIVO:s medlemmar gav uttryck för en stor arbetsbelastning och svårigheter att dra gränser för hur mycket de ska 'ta på sig'. Det konsultativa arbetssättet är visserligen mer inarbetat nu än vid utvärderingen år 2000, men inte ovillkorligt självklart för alla medlemmar i teamet. De olika geografiska förutsättningarna var, enligt teammedlemmarna, en orsak till att de inte arbetar helt lika. Samtliga trivdes med sitt arbete, som upplevdes intressant och utvecklande, men krävande. Samtliga ansåg att kompetensen hos de primära vårdgivarna ökat samtidigt som utbildningsbehovet aldrig sinar. Patienternas valfrihet av vårdnivå ansågs begränsad med anledning av för liten eller undanhållen information och otillräckliga resurser.

Utvärderingen visar att de flesta rekommendationer från föregående utvärderingstillfälle är mer eller mindre uppfyllda. PRIVO utför ett mycket gott arbete och är uppskattade av patienter, familjemedlemmar och primära vårdgivare, oavsett vårdverksamhet. För framtida verksamhet är det dock viktigt att PRIVO skapar enighet i teamet om deras roll och arbetssätt och gör detta tydligt, så att adekvat information kan ges framför allt till familjerna. Idag kan flera av teamets medlemmar nås utanför dagtid/vardagar, vilket å ena sidan är till gagn för primära vårdgivare och familjer,men som å andra sidan måste ifrågasätts. En orsak till den ökade tillgängligheten är att primära vårdgivare och familjer inte klarar av de så kallade morfinpumparna, om något 'krånglar'. Det är stor risk att teamet hamnar i en negativ spiral; ju mer tillgängliga teamet är, desto mer krav på ytterligare tillgänglighet kommer att krävas av primära vårdgivare, patienter och deras familjemedlemmar. Det kan till och med ifrågasättas om avancerad teknisk utrustning ska användas så länge de primära vårdgivarna inte har den kunskap som behövs för att kunna sköta den. Ett sätt att förhindra den negativa spiralen är att teamet intensifierar utbildningen för primära vårdgivare i medicinsk teknik, så att sårbarheten i vården minskas när PRIVO:s medlemmar ej är tillgängliga. Det är uppenbart att teamet behöver prioritera kunskaper avseende psykosociala och existentiella frågor samt uppmärksamma familjemedlemmars behov för att kunna genomföra steg två i utbildningspaketet till de primära vårdgivarna. Teamets kvalitetssäkring måste systematiskt utvecklas och PRIVO:s dokumentation bli mer fokuserad, tillgänglig och användarvänlig.

Med dessa åtgärder kan PRIVO:s fortsatta verksamhet vara till stor gagn för både primära vårdgivare, patienter och familjemedlemmar.

Objective: The aim of thé study was to investigate Swedish nurses1 attitudes to thé significance of families in nursing care. Method: An instrument (FAMBO), based on a research literature review, was developed by thé researchers. The instrument consists of 60 items about nurses' attitudes to thé significance of families in nursing care, i.e. for thé patients, thé family members and for thé nurses. The items include nurses' thoughts, feelings and actions in relation to, for example, engagement, communication, information and family resources. During May 2004, thé questionnaire was posted to 1000 nurses randomly sampled from The Swedish Association of Health Professionals' list of members, excluding administrators, teachers and retired nurses. After two reminders, we received 709 instruments, of which 50 were unanswered. The response rate was 66% (n = 659). The analysis, descriptive and analytic statistics, has just begun (Nov, 2004). The study is a co-operation between Kalmar University and The Swedish Association of Health Professionals. Results: At thé conférence, nurses' attitudes to thé significance of families in nursing care will be presented, for example, in relation to âge, organizational form and in relation to nurses' areas of work. Conclusion: The resuit of this study will be a part of thé foundation for further development of family nursing in Sweden.

In 2010, a rather unique legislation was introduced in Sweden that healthcare professionals must pay special attention to children-as-next-of-kin and their needs for information, advice, and support. Based on that, between 2011 and 2020, the National Board of Health and Welfare (NBHW) has had a governmental commission to promote developmental work focused on children-as-next-of-kin. The work has been carried out in close collaboration with other national and regional authorities as well as competence centers. Through increased knowledge and the construction of sustainable structures, both social and health care services have received support in order to better apply a child- and family perspective in their work with families facing different difficulties.

Through the assignment, the NBHW has had a strategic collaboration with the Swedish Family Care Competence Center (SFCCC), a national competence center for the support of informal carers, together with the Linnaeus University. Since 2012, the SFCCC has received special funding from the NBHW in order to develop its work focusing on children-of-next-of-kin. The assignment including producing and disseminating knowledge, working with exchange of experiences, systematic follow-up and learning networks. The goal is to increase knowledge about children-of-next-of-kin among politicians, decision-makers and professionals in regions, municipalities, scholars, and NGO’s, and giving empowerment to identify, listen to and support children-as-next-of-kin. This presentation is about what we have done so far.

Method: The aim of this study was to explore the systematic follow up of supportive activities in non-profit organizations targeted at childrenas next of kin. Managers and group leaders were interviewed, and findings were content analysed.

Result: The findings indicated that a child focus, education, safety and trust were important. These factors were observed as the primarytasks and the key reason for being involved in supportive activities. Managers expressed concern about not retaining funding, if the organization was unable to demonstrate the effects of their activities. Namely, to enhance the health and wellbeing of children. In order to continuously develop their work most organisations explained that they used some form of system for follow up. However,there was a wide variation in how non-profit organizations worked with follow ups.

Conclusion: Overall, it was evident that there was a major need for education and support in this area.

Children as next of kin are now regarded as a risk group in social services. A common effort for these children is support groups for children with similar problems, for example families with abuse, mental or physical illness. Most support groups are run municipally but also by county/regional bodies, non-profit organizations and churches, and sometimes the municipality works jointly with other organizations. Knowledge of support groups’ methods and results is limited and National Board of Health and Welfare recommends social services to implement systematic monitoring as part of evidence-based practice, EBP. Before this monitoring it is important to have knowledge and understanding of the goals of the support groups and how the work proceeds. The aim of this presentation is to elucidate the social services’ support groups for children as next of kin, to ascertain the goals and what is central in the work of support groups. With a participatory action research approach, a qualitative study was performed in 2015/2016. Seven Swedish municipalities took part and 23 people were interviewed, 18 group leaders and five managers.

Objectives/Outcomes: The respondents stated that the support group’s purpose was educational but they could have therapeutic effects. The goals of support groups addressed the children but in some cases also the family. The goals of the seven groups can be divided into three levels: 1) Acquiring knowledge; 2) Learning to cope with different situations; 3) Emotional processing. Support groups used manual-based methods, mixed methods and methods that they themselves had devised. The methods were the starting point, but other aspects were perceived as central to the performance: a) flexibility; b) preparation; c) cooperation with parents; d) professional approach. Flexibility meant not using the method rigorously but adapting it to the target group and modifying it according to what the group leader considered important. Preparatory work meant that the group leaders met parents and children several times before the support effort started. These talks emphasized the priority of the group sessions, getting participants to realize that it can be laborious, and starting collaboration with parents. Collaboration with the parents was deemed crucial; if the support group did not work it was mainly due to parents’ resistance. Children’s group leaders worked to create trust in parents. A professional approach meant being observant and confronting what happened in the group. The seven support groups aimed to help key aspects of these children’s lives and development generally for all children as next of kin. The group leaders’ work was based on methods, but they decided how to use these in practice. A manual-based approach could be implemented in different ways depending on the group leaders, the situation and the children’s needs.

Nationellt kompetenscentrum anhöriga (Nka), som är en del av Linnéuniversitetet, är en av aktörerna i det nationella utvecklingsuppdraget kring barn som anhöriga, som Socialstyrelsen är huvudman för (www.anhoriga.se). Nka arbetar som ett expertstöd för praktiker, beslutsfattare och andra aktörer inom området barn som anhöriga. Nka har ingått som ett av partnerländerna inom det Erasmus+ (KA2 Youth) finansierade projektet Care2Work tillsammans med the IARS International Institute (Storbritannien, projektkoordinator), the Family and ChildrenCare Centre (KMOP, Grekland) och Anziani e Non Solo (Italien). Projektet Care2Work handlar om unga omsorgsgivare med minoritets- och utländsk bakgrund inom Europa, och de hinder och möjligheter de kan uppleva inför framtida utbildning, träning och arbete (www.care2work.org). Under projekttiden har vi undersökt hur ett utbildningsstöd för unga omsorgsgivare (15-29 år) med minoritets- och utländsk bakgrund skulle kunna utformas. Utöver det har en kartläggning av befintliga verksamheter och utbildnings- eller stödfunktioner som direkt eller indirekt riktar sig till målgruppen genomförts.

Den här rapporten är en sammanställning av de lärdomar och reflektioner som vuxit fram under projekttiden. Vi har inte funnit någon forskning i Sverige som direkt belyser den här gruppen utan har istället använt oss av forskning där målgruppen indirekt är berörd tillsammans med de studier vi själva genomfört. Det här gör det än viktigare att lärdomar från projektet används som material i utformandet av stöd till unga omsorgsgivare samt vägledning i de kunskapsluckor som finns inom området. Under projekttiden har de deltagande länderna bidragit i skapandet av en interaktiv webbplattform som innehåller utbildningsverktyg, hjälpmedel, bloggar, projektuppdateringar, events och nyheter. Webbplatsen (www.care2work.org) är speciellt designad för en bred målgrupp som inkluderar unga omsorgsgivare, ungdomsledare, forskare, akademiker, beslutsfattare och arbetsgivare. Den nya webbplattformen syftar till att öka medvetenheten om behoven hos unga omsorgsgivare och skapar en mötesplats för kreativa debatter bland olika berörda parter. Webbsidan erbjuder även en rad innovativa utbildningsverktyg, som riktar sig till både unga omsorgsgivare och professionella, och kan användas för att höja och framhäva unga omsorgsgivares kompetens och kunskap som de förvärvat genom anhörigomsorg och därmed ökat deras utbildningsmöjlighet och anställningsbarhet.

Background: In nursing care, the steady increase of health related information implies aneed for useful Information and Communication Technology (ICT) tools that easilyprovide mobile access to accurate information. Updated information is usually available onthe Internet but personal computers are rarely available at the patients’ bedside. In Sweden,although handheld devices provide mobile access to information, they are rarely used innursing practice. Aim: This thesis aimed to explore the views of nurses and nursingstudents of using handheld devices in nursing practice. Method: Four intervention studieswere carried out during the years 2006 to 2008; a total of 30 nurses and 63 nursing studentsused handheld devices for 5-15 weeks in nursing practice, and answered questionnairesand/or participated in interviews. In 2012, a cross sectional study was undertaken with 111nurses and 287 nursing students answering a questionnaire about their views of usinghandheld devices. Quantitative data were analyzed using descriptive statistics andqualitative data were analyzed by content analysis. Results: The handheld device wasregarded to facilitate nursing practice and to be a useful tool with benefits for the patients,the nurses and for the nursing students. Independent of time and place, nurses and nursingstudents were able to access necessary information and also to make notes, plan their workand save time. The handheld device was regarded to improve patient safety and quality ofcare. The participants would not have to leave their patients to look up information,subsequently giving a more complete encounter. Additionally, the handheld device waspresumed to imply increased confidence, and support learning for nurses and nursingstudents. Conclusion: In order to continuously improve the safety and quality of healthcare,it is important to implement handheld devices in nursing practice. This issue is importantat all levels in the healthcare systems, from nurses to nursing management, policy makersand moreover for educators. Handheld devices adjusted for nursing, technical, statutory,cultural, and language country specific conditions, should be further developed,implemented, and evaluated in future research.

Många barn växer upp som anhöriga till en förälder eller annan vuxen som har psykisk eller fysisk ohälsa/sjukdom, missbruk eller som avlidit. Många av dessa barn uppvisar ofta psykisk ohälsa och svaga skolresultat till följd av den situation de lever i. För att hjälpa dessa barn är det av stor vikt att ge ett ändamålsenligt stöd för deras specifika behov. Dock är kunskaperna om resultatet av olika stödinsatser som ges till barn som anhöriga begränsade och systematisk uppföljning av dessa insatser genomförs i mycket begränsad omfattning. Vid systematisk uppföljning dokumenteras stödinsatsernas syfte, mål, innehåll och resultat för att kunna följa upp om barnen får ett behovsanpassat stöd, behöver utökat stöd eller om det finns behov av annat stöd. Det handlar om att kunna följa upp resultaten av aktuella stödinsatser på individnivå, men även på gruppnivå, vilket ger möjlighet till kontinuerlig kvalitets- och verksamhetsutveckling.

Syftet med detta utvecklings- och forskningsprojekt är att i samverkan med verksamheter inom hälso- och sjukvård, kommunal vård och omsorg samt idéburna organisationer införa/utveckla systematisk uppföljning av stödinsatser för barn som anhöriga. Verksamheterna som ingår i projektet får stöd i att utveckla metoder och arbetssätt för att genomföra systematisk uppföljning, finna lämpliga instrument för att mäta insatsernas resultat samt följa, analysera och utvärdera uppföljningen.

Verksamheter som inkluderas ska ge insats i form av råd/stöd till barn som anhöriga. Insatsen kan också ges till barnens föräldrar, där insatsen i sin tur leder till att barnen får hjälp i sin situation. Verksamheterna behöver inte göra någon uppföljning av insatserna när de går med i projektet, men det ska finnas intresse av och möjlighet till att införa systematisk uppföljning med resultat på individnivå. Forskarna arbetar som ett stöd/bollplank för uppföljningsarbete och/eller inspiratörer till förbättringsarbete. Upplägget omfattar workshops och hjälp till verksamheterna med uppföljningsmått, implementering och förslag till förbättringsarbete genom följeforskning.  

Med ett bekvämlighetsurval identifieras verksamheterna, de får information via mail och/eller kontaktas per telefon. Därefter svarar verksamheterna upp om de är intresserade av att delta och tid bokas för ett första informationsmöte. Verksamhetsledningen intervjuas för sig och ledare/utförare av stödinsatserna intervjuas för sig. Intervjuer genomförs före och efter införandet/utvecklingen av systematisk uppföljning. Intervjuerna är semistrukturerade och görs individuellt eller i fokusgrupper. Data analyseras med hjälp av innehållsanalys för vartdera verksamhetsområde, en jämförande analys genomförs avslutningsvis. Datainsamling med observationer och studier av verksamhetdokumentation kan också ingå.

Projektet kan bidra med kunskap om vad som hämmar respektive främjar implementering av systematisk uppföljning. Designen möjliggör replikering och framtida förutsägbarhet av liknande försöks effekter. Införande och/eller utveckling av systematisk uppföljning inom de enskilda verksamheterna medger resultat på individ och gruppnivå som kan påvisa att insatserna verksamheterna ger till barn som anhöriga är ändamålsenliga och av god kvalitet. Resultatet som framkommer medger dessutom en möjlighet till kontinuerlig kvalitets- och verksamhetsutveckling. Datainsamling pågår och preliminärt resultat redovisas på konferensen.

Människor som har en avancerad cancer drabbas ofta av multipla både fysiska, psykiska, sociala och existentiella symtom. När de sjuka inte längre orkar eller kan förmedla sina symtom är de beroende av andra personers förmåga att tolka dem istället. Samstämmigheten mellan hur patienter upplevelser sina symtom och hur familjemedlemmar och vårdpersonal uppfattar att patienterna mår är avgörande för att patienterna ska kunna hantera sin sjukdom på bästa sätt. Flera studier visar att det finns skillnader mellan hur patienter uppfattar sina symtom med hur andra uppfattar att patienten upplever dem. Tidigare studier visar en tendens till att familjemedlemmar överskattar patientens symtom medan vårdpersonal underskattar, men det finna även studier med motsägande resultat.

Syftet med denna studie är att beskriva skattningar av cancerrelaterade symtom och hantering av sin situation hos patienter med avancerad cancer. Studien syftar vidare till att belysa patienters, familjemedlemmars och primäransvarig personals (läkare och/eller sjuksköterska) skattningar av patienters symtom.

Det var sju patienter, sju familjemedlemmar och tolv personal (sjuksköterskor/ läkare) som deltog i studien. Totalt genomfördes 45 intervjuer varav 15 intervjuer med respektive patienter, familjemedlemmar och personal, och totalt genomfördes 75 skattningar med the Edmonton Symptoms Assessment Scale (ESAS), 25 med respektive patienter, familjemedlemmar och personal.

Första analysen av intervjuerna mynnade ut i en kärnberättelse om hur det kan se ut över tid för en patient, familjemedlem och primäransvarig personal, dvs. en triad. Därefter delades texterna in i kategorier utifrån skattnings-skalans symtom. Tre huvudkategorier, fysisk domän och psykisk, existentiell domän, hantering av sin sjukdom och 13 subkategorier bildades. En korrelationsanalys med Pearsons korrelations koefficient och en signifikansnivå på p<0.05 användes för att hantera data från ESAS.

Resultatet visade att det råder en bättre samstämmighet inom den fysiska domänen än inom den psykisk existentiella domänen. Mellan patienterna och familjemedlemmarna ses svaga korrelationer i skattningar av andfåddhet, oro/ångest och välbefinnande, och mellan patienterna och personalen råder lägst samstämmighet för smärta och oro/ångest. Både familjemedlemmarna och personalen tenderar att överskatta patientens symtom. För att hantera situationen var familjemedlemmarna det största stödet, men även vårdpersonal och tron på Gud angavs som stöd i sjukdomssituationen.

Jämförs skattningar mellan patienter och familjemedlemmar och mellan patienter och personal, kan det konstateras att samstämmigheten trots allt var ganska god. Detta ger stöd för att främst familjemedlemmar, men även vårdpersonal kan vara ett gott alternativ för att agera som patientens proxy.

Sjuksköterskor kommer ofta i kontakt med familjemedlemmar i sitt arbete och familjer intar en allt större roll i omvårdnaden. Det är viktigt i sjuksköterskans omvårdnadsarbete att se den sjuke som en del av sin familj, eftersom alla i familjen påverkas när någon av dess medlemmar blir sjuk. Till dags datum är kunskapen om svenska sjuksköterskors inställning i denna fråga begränsad. Denna studie är därför baserad på ett generellt urval av landets sjuksköterskor.

Syftet med denna studie var att beskriva sjuksköterskors inställningar till familjers betydelse i omvårdnaden och att relatera dessa till personliga och organisatoriska bakgrundsdata.

Enkäten, Familjers betydelse i omvårdnaden (FAMBO), som utvecklats för studien, består av 26 påståenden och avser att mäta sjuksköterskors inställning till familjers betydelse i omvårdnaden utifrån deras professionella perspektiv. Enkätens fyra delskalor handlar om Familjen som en resurs i omvårdnaden (Fam-RO), Familjen som en samtalspartner (Fam-SP), Familjen som en börda (Fam-B) och Familjen som sin egen resurs (Fam-ER). Enkäten skickades ut till ett slumpmässigt urval av 1000 sjuksköterskor från Vårdförbundets medlemsregister. Sjuksköterskorna skulle vara klinisk verksamma inom den direkta patientvården. Urval och utskick administrerades helt av Vårdförbundets personal, deltagarna blev därigenom anonyma för forskarna. Responsen var 65 % (n=634) och de som svarade kan anses som representativa för landets sjuksköterskor eftersom flera bakgrundsvariabler var jämförbara med medlemsregistrets data.

Data har behandlats som ordinaldata och analyserats med Mann-Whitney U-test, Kruskal Wallis test samt med Post hoc test (Mann-Whitney U-test med reducerat p-värde enligt Bonferroni). För att se vilka variabler som predicerade för lägst skattning genomfördes en multipel logistisk regressionsanalys.

Resultatet visade att sjuksköterskorna var mycket positivt inställda till familjers betydelse i omvårdnaden, men det fanns skillnader i den totala skattningen gällande all bakgrundsdata, förutom kön. De som var yngre (≤30 år) skattade lägre än de som var äldre och likvärdiga resultat visade sig för hur länge sedan det var som sjuksköterskorna tagit sin examen. De som varit legitimerade kortast tid (≤5 år) skattade lägre än sina mer erfarna kollegor. Manliga sjuksköterskor skattade lägre på vissa skalor i förhållande till sina kvinnliga kollegor, samtidigt som de som inte hade någon erarenhet av att vara familjemdlem till någon som varit svårt sjuk skattade lägre i jämförelse med dem som hade denna erfarenhet. Bland de organisatoriska bakgrundsdata som efterfrågades visade det sig bland annat att sjuksköterskorna som arbetade med barn skattade högst på samtliga skalor medan de som arbetade inom akutsjukvården skatta lägst (förutom på Fam-RO). De som hade ett gemensamt synsätt angående familjer på sin arbetsplats skattade högre än de som inte hade detta synsätt. De variabler som predicerade för en lägre inställning till familjers betydelse i omvårdnaden var att: vara man eller att ha en legitimationstid ≤5 år eller om det inte fanns ett gemensamt synsätt angående omvårdnad av familjer på arbetsplatsen.

Skillnaderna som påvisades i förhållande till flera variabler, till exempel kön och ålder, finns mycket sparsamt beskrivet i tidigare forskning och är intressanta att studera vidare. Samtidigt som studiens resultat påvisar att sjuksköterskornas inställning till familjers betydelse i omvårdnaden är mycket positiv så vet vi inget om hur de verkligen agerar i möten med familjer.

Children as next of kin are at a significantly increased risk to be affected negatively when they are involved in incomprehensible situations in life, such as anxiety and unpredictable incidents. The family economy, social relationships, communication and division of roles are additional examples of risk factors. This can in turn lead to socio-economic problems, poor school performance and mental illness for the children affected. The Swedish legislative changes in health care, in 2010, gained increased attention on children as next of kin and their need for and right to advice, support and information. A major development action to improve health and social care for affected children started. Alongside Swedish health and social care services, non-profit organizations provide support for children as next of kin. Non-profit organizations are categorized as civil society, but their works are usually regulated by health care or social service laws. Although there are a number of organizations that provide support to these children, there is little knowledge of the results of the support given. Therefore, this study focuses on systematic follow up of supportive activities targeted at children as next of kin, in the work of non-profit organizations. Systematic follow up in this context is about continuously exploring the needs of children as next of kin. Furthermore check-up whether the child had adequate support, need more support, or whether there is a need for other support. In 2015, a descriptive study with a sample of managers and group leaders in ten non-profit organizations, who provide supportive group activities to children as next of kin (up to 18 years), was conducted. Data were collected through individual and group interviews, and analysed with content analysis. The interviews included information about the organizations, such as background, goals, results of the support group activities, and the managers’ and the group leaders’ encouragement to provide systematic follow up.

Objectives/results: The aim of this study was to explore how non-profit organizations work with supportive group activities for children as next of kin and how they follow up to obtain results. The findings indicated that a child focus, education, safety and trust were important. These factors were observed as the absolute main tasks and the reason for being involved in supportive activities. Additionally, great differences in how non-profit organizations work with follow ups were shown. A large and clear need for education on the subject of systematic follow up was revealed.

Many Swedish children are growing up with difficulties in the family, and it is common that this children as next of kin have a higher incidence of mental illness and poor school performance. There is a risk that in these families occur secrecy, rapid unpredictable changes and reverse liability and role distributions. The children can have difficulty understanding what is happening and may feel anxiety, fear, guilt and shame. Much of the child's energy can be focused on family problems, preventing their own development and impacting negatively on well-being. Even though the situation for children as next of kin may differ in many ways, their needs may be similar in several respects. Swedish social care services provide various forms of support and interventions for these children; however, there is little knowledge of the results of the support given. The basic idea of support group activities is that children from similar domestic situation will meet and support one another, can take advantage of the knowledge of group leaders and that the children have the opportunity to talk about their situation. A support group for children is both a preventive and promotive effort; intervention aims to prevent ill health but also improves the mental health and social situation of the children. Systematic follow up is a part of evidence-based practice, which is in turn based on systematic knowledge from the user's experience, scientific knowledge and professional experience. Systematic follow up in the context of children as next of kin is about continuously exploring their needs and obtaining whether the child had adequate support, need more support, or whether there is a need for other support. A single case study was conducted in 2015/2016 of one organization, within municipal care, that provides support in the form of group activities for children as next of kin. The target group was healthy children aged 6-12 years whose parents or siblings had a serious medical condition or disability. The study approach was participatory action research, where the group leaders collaborate with the researchers, in order to implement systematic follow up. Data were collected from the group leaders through interviews, meetings, documents and notes.

Objectives/Outcomes: Data collection is ongoing but preliminary findings can describe the implementation process of systematic follow up in four phases: enthusiasm, confusion, fumbling and decision.

A considerable proportion of young people across Europe carry out a critical role in caring for their ill and/or disabled family members^[1]. Being a Young Carer (YC) is recognised as a risk factor for social exclusion, higher absenteeism and drop-out rates from education, low employability, social stigma and bullying^[2]. Teachers and school staff are usually not aware of the frequency of YCs and are not always able to identify YCs in their class. Therefore, the main goal of this EU Erasmus+ programme co-funded project was to empower teachers and other school staff in upper secondary education (ISCED-3 level) to recognise adolescent YCs (16-19 years old) in classes and maximise their learning opportunities. The Eurocarers consortium consisted of researcher and carer organization members in the partner countries of Sweden (coordinator), Slovenia, Italy and Portugal together with Eurocarers secretariat.

The specific objectives were to develop:

• an assessment tool to identify YCs;
• educational strategies, didactical approaches and organisational adjustments to support YCs in their scholastic career;
• a handbook on how to work at best with YCs;
• a massive open online course (MOOC) about YCs, their needs and preferences.

The achieved project outcomes, consisting of the above tools and strategies, can help to raise awareness of YCs’ needs, empower school staff to recognise and keep YCs involved in school and lead to a new attitude of YCs, which in turn can influence other stakeholders and organisations. Further, the concrete project outputs can help lead to new opportunities for peer recognition and awareness of YCs among school pupils themselves, to help make YCs more comfortable at school, satisfied with education, avoid drop outs, increase their educational and social environment and attempt to combat YCs’ social exclusion, loneliness, social stigma and any unmet educational and support needs. All materials are available in English, Swedish, Italian, and Portuguese^[3].

^[1] Leu, A., Frech, M., Wepf, H., Sempik, J., Joseph, S., Helbling, L., & Jung, C. (2019). Counting young carers in Switzerland–a study of prevalence. Children & Society, 33(1), 53-67.^[2] Becker, S., & Leu, A. (2014). Young Carers. In. Oxford Bibliographies in Childhood Studies. Heather Montgomery (Hrsg): Oxford University Press.^[3] All materials and results are available at the EDY-CARE project web page: https://eurocarers.org/current-projects/edycare/  

Att vara ung omsorgsgivare medför att ta ett stort ansvar i att ge stöd/omsorg till en anhörig som är handikappad, har kronisk sjukdom, psykiska problem eller andra svårigheter. Stödet som den unga omsorgsgivaren ger kan bestå av hushållsarbete, fysisk omvårdnad, ta hand om syskon eller bidra till familjens försörjning. I Sverige kan gruppen unga omsorgsgivare dock beskrivas som en dold population, då ämnet aldrig varit föremål för offentlig diskussion. Detta avspeglas i vår lagstiftning som ger vuxna anhörigvårdare rätt till stöd och avlastning men inte till barn under 18 år. Det förutsätts att de inte utövar omsorg trots att cirka 7% av barn och unga (15-18 år) i Sverige är unga omsorgsgivare och flera av dessa har minoritets- och utländsk bakgrund. Dessa unga omsorgsgivare får ofta svårt med att skaffa sig en utbildning och blir begränsade i att kunna få ett arbete på grund av sitt omsorgsansvar. Trots allt, genom att ha detta omsorgsansvar, utvecklar unga omsorgsgivare ofta flera styrkor och färdigheter som kan hjälpa dom att bli mer motståndskraftiga, problemlösande och mer oberoende.

Ett europeiskt samarbetsprojekt (Care2Work www.care2work.se), med Sverige, Italien, Grekland och England, har utforskat hur ett utbildningsstöd för unga omsorgsgivare med minoritets- och utländsk bakgrund (15-29 år) kan designas så de kan få hjälp med att bli mer medvetna om sina styrkor och färdigheter, och hur de kan användas i framtida utbildning och arbete. Under projektet har en kartläggning av forskning och befintliga resurser genomförts, utbildnings- och stödfunktioner som direkt eller indirekt ger stöd till målgruppen skapats i form av fysiska workshops och onlinekurser.

Det särskilda fokusområdet för detta projekt har varit att särskilt titta på de styrkor och färdigheter som målgruppen kan erhålla, samt att undersöka hur dessa kan användas i utbildning och arbete. Eftersom vi fortfarande är i ett tidigt skede avseende medvetenheten om och arbetet med unga omsorgsgivare med minoritets- och utländsk bakgrund anser vi att de pedagogiska verktygen bäst levereras i riktiga möten mellan människor i stället för via nätet. Det är i mötet mellan människor som deltagarna lättast kan utbyta erfarenheter, lära av varandra och bli stärkta. Kanske kan onlinekurser vara ett bra hjälpmedel i framtiden när medvetenheten kring frågorna är högre. Att arbeta i workshops är en bra form, och vi kan tydligt se från utvärderingsdata att deltagarna uppskattar den direkta kontakten och stödet från varandra. De unga omsorgsgivarna upplevde det som viktigt att träffa andra i liknande situation, som kunde förstå hur dom har det. De professionella ansåg att det var betydelsefullt att diskutera med andra inom samma men också från andra verksamheter. Det här projektet har varit ett första steg i vårt arbete med unga omsorgsgivare med minoritets- och utländsk bakgrund och så vitt vi vet är det här det första projektet inom området. De viktigaste resultaten av projektet har varit att öka medvetenheten om unga omsorgsgivare med minoritets- och utländsk bakgrund.

Children as next of kin are at a significantly increased risk to affect negatively when they are involved in incomprehensible situations in life, such as anxiety and unpredictable incidents. Family economy, social relationships, and division of roles can changes negatively. This can in turn lead to socio-economic problems, poor school performance and mental illness. Swedish health and social care services, and non-profit organizations provide support for this group. Although, there is little knowledge of the results of the support given. Therefore, a national project was conducted aiming to implement or develop systematic follow-up of supportive activities for children as next of kin,

Managers and professionals from 24 organizations, within Swedish health and social care services and non-profit organizations, participated. Initially, participants were interviewed to explore how these organizations work with support activities for children as next of kin and how they follow up to obtain results. After, the work began to develop or implement systematic follow-up in the participating organizations. The results show differences regarding organizations' conditions and how they worked with systematic follow-up. But also many similarities on how they experienced the children who participated in their support activities, but also their incentives to implement systematic follow-up.

Inappropriate use of medicines increases the risk of hospital admissions for the elderly. Not only does this lead to unnecessary suffering for the patients but also incurs a great financial cost to the society. A medicine decision support system in a Personal Digital Assistant (PDA), with a barcode reader, can provide an overview of the patients' complete medicine use, and detect unsuitable drugs and drug combinations. Focusing on the elderly, our aim was to evaluate if a mobile medicine decision support system with a barcode reader is useful and user-friendly for nurses in home care. The participants received a comprehensive overview from the patients' medicine use and noted drug-drug interactions, therapeutic duplications and warnings for drugs unsuitable for elderly people. The nurses regarded that the decision support system increased prevention and safety, was useful and user-friendly. Our findings suggest that most of the content and functions were regarded as important. Therefore, this decision support system might be a useful tool for district nurses.

Aim The aim of this study was to describe one nurse’s experience of using a personal digital assistant (PDA) in nursing practice.

Background Nurses handle large amounts of information and a PDA may contain valuable information that nurses need in their daily work.

Methods In this qualitative single case study, data were collected through an open-ended interview with one registered nurse and were analysed by content analysis.

Results The findings show that the PDA provides immediate access to information anywhere and at anytime, with advantages for both the nurse and for her patients. The PDA increased her confidence and efficiency in practice; it was easier to keep up-to-date and spend more time with the patient. Furthermore, the PDA was perceived as improving patient safety and patient participation.

Conclusions The PDA requires improved content and more functions. Ease of use should also be improved. This study indicates that PDAs could be valuable and may inspire further research.

Implications for nursing management The incorporation of a multifunctional PDA is an important issue for nursing management, as it could both change and provide new possibilities for nursing practice. The use of PDAs could also aid decision-making, improve patient safety and benefit patient outcomes.

Background

A personal digital assistant (PDA) is a multifunctional information and communication tool allowing nursing students to keep up to date with expanding health related knowledge.

Objectives

This study was aimed at exploring nursing students' experience of using a PDA in clinical practice.

Method

In this intervention study, nursing students (n=67) used PDAs during a period of 15weeks, replied to questionnaires, and participated in focus group interviews.

Results

The PDA was found to support nursing students in clinical practice and to have the potential to be a useful tool with benefits for both the patients and for the students. The PDA was regarded as useful, and was presumed to imply increased confidence and time savings, and contribute to improved patient safety and quality of care.

Conclusions

With available mobile technology, nursing students would be able to access necessary information, independent of time and place. Therefore, it is important that stakeholders and educators facilitate the use of PDAs to support nursing students during their clinical practice, in order to prepare them for their future work, and to continuously improve the safety and quality of healthcare.

Introduction: Inappropriate medication among elderly people increases the risk of adverse drug–drug interactions, drug-related falls and hospital admissions. In order to prevent these effects it is necessary to obtain a profile of the patients’ medication. A personal digital assistant (PDA) can be used as a medical decision support system (MDSS) to obtain a profile of the patients’ medication and to check for inappropriate drugs and drug combinations, and to reduce medication errors.Aim: The aim of the present study was to evaluate nurses’ experiences of using a MDSS in a PDA with a barcode reader, in order to obtain profiles of the patients’ medication, regarding drug–drug interactions, therapeutic duplications, and warnings for drugs unsuitable for elderly in home care.Methods: The LIFe-reader^® is a MDSS in a PDA with a barcode reader. By scanning the drug packages in the patients’ home, the LIFe-reader^® obtained profiles of the patients’ medication and checked for drug–drug interactions, therapeutic duplications and warnings for drugs unsuitable for elderly people. The LIFe-reader^® also contained, e.g. drug information and medical reference works. Nurses (n = 15) used the LIFe-reader^® for five weeks during their nursing home care practice assignment. The nurses answered questionnaires about the content and functions of the LIFe-reader^® before, during and after the nursing home care practice assignment, and were interviewed in focus groups. Descriptive statistics were used and content analysis was applied for qualitative data.Results: By using the LIFe-reader^®, the majority of the nurses found it easy to obtain profiles of the patients’ medication and check for drug–drug interactions, therapeutic duplications and warnings for drugs unsuitable for elderly people. Most nurses regarded the LIFe-reader^® to reduce drug-related risks of falling, and some thought it could reduce the drug-related admissions to hospitals. The scanning function was described as easy and time saving, although not always possible to use. The LIFe-reader^® was regarded as a useful and user-friendly MDSS, but more content and functions were requested.Conclusions: We found that the LIFe-reader^® has the potential to be a useful and user-friendly MDSS for nurses in home care when obtaining profiles of the patients’ medication regarding drug–drug interactions, therapeutic duplications and warnings for drugs unsuitable for elderly. A regular scanning of the patients’ drugs in their home might support nurses and general practitioners (GPs) in reducing the inappropriate use of drugs. If the LIFe-reader^® should be used in a larger scale among nurses, more content and functions are necessary.

Background: In nursing care, the steady increase of healthrelated information implies that there is need for useful tools thateasily provide mobile access to accurate information.Aim: This study is aimed at exploring nurses’ and nursingstudents’ experience of using a mobile device in nursing practice,with the emphasis on usefulness, information retrieval, savingtime, patient safety, the quality of care, and confidence in thework performed.Methods: In this descriptive intervention study, registered nurses(RN) (n=14) and nursing students (NS) (n=7) used mobiledevices in nursing practice during a period of 15 weeks, andreplied to questionnaires prior to and after the intervention.Results and conclusion: We found that the mobile device wasperceived as useful and was presumed to imply increased confidenceand time savings, and to contribute to improved patientsafety and quality of care by enhancing access to necessaryinformation. To facilitate nursing practice, mobile devicesadjusted for technical, statutory, cultural, and language countryspecificconditions, should be further developed and implementedfor RNs and NSs. Furthermore, future research shouldinclude the end-users’ views.

Advanced mobile devices allow registered nurses and nursing students to keep up-to-date with expanding health-related knowledge but are rarely used in nursing in Sweden. This study aims at describing registered nurses’ and nursing students’ views regarding the use of advanced mobile devices in nursing practice. A cross-sectional study was completed in 2012; a total of 398 participants replied to a questionnaire, and descriptive statistics were applied. Results showed that the majority of the participants regarded an advanced mobile device to be useful, giving access to necessary information and also being useful in making notes, planning their work and saving time. Furthermore, the advanced mobile device was regarded to improve patient safety and the quality of care and to increase confidence. In order to continuously improve the safety and quality of health care, advanced mobile devices adjusted for nursing practice should be further developed, implemented and evaluated in research.

Children-as-next-of-kin have received little attention during the Covid-19 pandemic, and it is unclear how these children have been affected by the pandemic. There is thus an urgent need to better understand their situation and to develop creative solutions to ensure good quality support. Present study is funded by the National Board of Health and Welfare, and the aim is to describe how professionals working with children-as-next-of-kin experiences that the situation and support systems for children-as-next-of-kin are affected by the pandemic, and how the support can be further improved. 

In the autumn of 2020, focus group interviews were conducted digitally with participants (n=45) from four Swedish national networks; within county councils, municipalities, researchers, and NGOs, working with children-as-next-of-kin. The interviews lasted for 1,5 hours, were recorded, transcribed, and analysed using content analysis.

The result shows that children-as-next-of-kin have become increasingly invisible during the pandemic, partly due to public restrictions, preventing children from accompanying or visiting their sick parents. Cancelled support groups, decreased social networks, increased anxiety as well as care responsibilities are the main themes brough up by the professional, often affecting children-as-next-of-kin studies. Furthermore, fear of contagion prevents carers or the next-of-kin to use the support still available. New support for children-as-next-of-kin has been developed, mostly digital or outdoor activities. 

Urgent suggestions concern increased knowledge among professionals about children-as-next-of-kin as well as increased digital competence. In the long run, support to children-as-next-of-kin during crises need to be secured by crisis management plans, local routines and follow up policies.

Background: Health care personnel need access to updated information anywhere and at any time, and a Personal Digital Assistant (PDA) has the potential to meet these requirements. A PDA is a mobile tool which has been employed widely for various purposes in health care practice, and the level of its use is expected to increase. Loaded with suitable functions and software applications, a PDA might qualify as the tool that personnel and students in health care need. In Sweden today, despite its leadership role in mobile technologies, PDAs are not commonly used, and there is a lack of suitable functions and software applications.Objective: The aim of the present review was to obtain an overview of existing research on the use of PDAs among personnel and students in health care.Methods: The literature search included original peer-reviewed research articles written in English and published from 1996 to 2008. All study designs were considered for inclusion. We excluded reviews and studies focusing on the use of PDAs in classroom situations. From March 2006 to the last update in May 2008, we searched PubMed, CINAHL, Cochrane, IngentaConnect, and a local search engine (ELIN@Kalmar). We conducted a content analysis, using Nielsen’s Model of System Acceptability as a theoretical framework in structuring and presenting the results.Results: From the 900 references initially screened, 172 articles were selected and critically assessed until 48 articles remained. The majority originated in North-America (USA: n=24, Canada: n=11). The categories which emerged from our content analysis coincided to a certain extent to Nielsen’s Model of System Acceptability (social and practical acceptability), including usefulness (utility and usability) subcategories such as learnability, efficiency, errors, and satisfaction. The studies showed that health care personnel and students used PDAs in patient care with varied frequency. Most of the users were physicians. There is some evidence that the use of a PDA in health care settings might improve decision-making, reduce the numbers of medical errors, and enhance learning for both students and professionals, but the evidence is not strong, with most studies being descriptive, and only 6 randomized controlled trials. Several special software programs have been created and tested for PDAs, and a wide range of situations for their use have been reported for different patient groups. Drug and medical information were commonly accessed by PDA users, and the PDA was often viewed as the preferred tool when compared to paper-based documents. Some users regarded the PDA easy to operate, while others found it difficult in the beginning.Conclusions: This overview of the use of PDAs revealed a positive attitude towards the PDA, which was regarded as a feasible and convenient tool. The possibility of immediate access to medical information has the potential to improve patient care. The PDA seems to be a valuable tool for personnel and students in health care, but there is a need for further intervention studies, randomized controlled trials, action research, and studies with various health care groups in order to identify its appropriate functions and software applications.

Electronic patient record (EPR) systems have a huge impact onnursing documentation. Although the largest group of end-usersof EPRs, nurses have had minimal input in their design. Thisstudy aimed to review current research on how nurses experienceusing the EPR for documentation. A literature search was conductedin Medline and Cinahl of original, peer-reviewed articles from2000 to 2009, focusing on nurses in acute/ inpatient ward settings.After critical assessment, two quantitative and three qualitativearticles were included in the study. Results showed that nursesexperience widespread dissatisfaction with systems. Currentsystems are not designed to meet the needs of clinical practiceas they are not user-friendly, resulting in a potentially negativeimpact on individualized care and patient safety. There is anurgent need for nurses to be directly involved in software designto ensure that the essence and complexity of nursing is notlost in the system.

Introduction

Informal carers in paid employment–working carers (WKCs)—have complex support needs. However, little is known about WKCs’ pattern of informal care provision, the support they receive, the impact providing care has on their employment, and how these vary between male and female WKCs. This study describes the pattern of informal care provision and received support among Swedish WKCs.

Research method/Design

The study was a cross-sectional questionnaire-based survey of a stratified random sample of the Swedish population aged 18 or over. The questionnaire addressed the type and extent of informal care provided, support received and the impact of care provision on employment. Of the 30,009 people who received the questionnaire, 11,168 (37.3%) responded, providing an analytic sample of 818 (7.32% of respondents) employed or self-employed informal carers.

Findings

A typical Swedish WKC was a middle-aged female, providing weekly or daily care to a non-cohabitant parent, who experiences care as sometimes demanding and receives no formal support as a carer. Female WKCs were more likely than males to care alone and with higher intensity, to report a need for help in meeting their care-recipient’s needs, and to experience care as demanding. Approximately 17% of WKCs reported their employment had been affected due to caring, 40% their ability to work, and 31% their career development opportunities. Female WKCs’ ability to work was affected more than males’, and they were more commonly prevented from applying for work.

Conclusion

Swedish female WKCs compared to males provide more hours of informal care, across more care domains, more often alone. This places them in a challenging situation when combining paid work and care. Greater recognition of the challenges faced by WKCs is required in Sweden and other countries, as are policies to reduce gender inequalities in informal care provision in this group.

BackgroundEfficient information dispersal and effective communication are key issues in increasing quality of care for patients undergoing radiation therapy. Radiation therapy consists of daily treatment sessions every weekday for 4-6 weeks. Although this means that patients are in daily contact with nursing staff, there is little time at these quick in-and-out sessions to address any substantive issues beyond the mechanics of the actual treatment procedure. Our aim is to explore the potential usefulness of computer tablets as an enabling device for making patient-staff information interchange more accessible and efficient. We are especially interested in investigating the empowerment effects that we believe will follow when making it easier for patients to influence the course of their treatment.

MethodsFrom april to june 2012 all breast cancer patients scheduled for adjuvant radiation therapy treatment at the county hospital in Kalmar (Sweden) will be offered the opportunity to borrow a tablet computer during the course of their treatment. The tablet offers secure access to a web site containing illness-, treatment- and clinic-specific information, including a number of videos demonstrating the treatment procedure; a secure discussion forum in which patients can ask questions to staff; and a set of automatically processed surveys that provide staff with instant feedback from patients. Post-treatment interviews will be conducted with participating patients as well as with the staff on their respective experience of using the tablets. Patients will also fill out a survey and user logs from the web site will be analyzed to determine usage patterns.

ResultsAt the time of writing we have started off the first couple of patients. Initial reactions are positive from both patients and staff. At the the time of the conference we will have evaluated the first set of patients and be able to present the results of this. We expect to see patients that are more confident and less anxious by being better prepared for their treatment both factually and emotionally. For the medical staff, we expect to see that the instant feedback provided by patients, via the questions they ask and the survey answers they submit, will allow staff to react more swiftly and more accurately to meet the patients’ needs and wants, and in so doing provide both better medical care and better emotional support.

ConclusionsComputer tablets offer an efficient and accessible way for patients to inform themselves and to communicate with staff. The instant feedback from patients provides staff with the input they need to provide the best possible care, both medically and in providing emotional support. The sense of control, and actual control, over the course of their treatment that this will bring to patients, we believe will lead to a sense of empowerment that will help them better deal with the emotionally taxing experience it is to undergo treatment for a life-threatening condition.