Background: Discrimination and inequities in healthcare have gained increased attention worldwide. Although many healthcare systems strive to provide equal care, evidence indicates that treatment can be influenced by patient characteristics such as gender, age, race/ethnicity, and socioeconomic status. In particular, research exploring healthcare professionals’ perceptions on equality in acute, life-threatening conditions remains limited. This study aimed to describe Swedish healthcare professionals’ perceptions of unequal and equal care when treating patients with cardiac arrest.

Methods: The study adopted a qualitative inductive design, using semi-structured interviews with 12 physicians and nurses who work in acute care clinics in Sweden. Data were analysed using thematic analysis.

Results: The overarching theme, “Equal care under pressure—guided by principles, shaped by context”, captured how professionals perceive the provision of cardiopulonary resuscitation (CPR) during sudden cardiac arrest as fundamentally equal. CPR was described as an automatic, protocol-driven intervention offered to all patients, reinforcing the principle of equality and without any clear discrimination based on ethnicity, gender, or socioeconomic background. However, equality in practice was nuanced. Decision-making about CPR introduce ethical complexity, particularly for older patients from whom prognostic uncertainty and emotional factors could influence care. Team competence was critical for maintaining equity under pressure, while contextual factors such as location, cultural norms, and safety concerns could delay or complicate treatment. Finally, professionals emphasize the need for structured reflection, recognizing its role in learning and ethical decision-making. Together, these findings illustrate that while CPR was guided by principles of equal care, its delivery was shaped by clinical judgment, team dynamics, and situational realities.

Conclusions: Healthcare professionals perceive cardiac arrest care as predominantly equal. However, subtle vulnerabilities challenge this perception. Older age emerged as the most influential factor in CPR decisions, raising concerns about potential ageism and the need for clearer Do Not Attempt Resuscitation (DNAR) criteria and patient involvement. Promoting equality requires team competence, structured reflection, and proactive communication about resuscitation preferences. Further research should examine age, multimorbidity, psychiatric illness, DNAR practices, and gender differences to strengthen equity in cardiac arrest care.

Rationale

Patient participation should encapsulate the individual's resources and needs, though such standards remain rationed for people living with a long-term health concern like kidney failure.

Aims

To illustrate what patient participation signified to patients and staff in kidney care, and whether an agreed or disagreed conceptualisation occurred over time, evaluating the influence of two study-specific interventions to facilitate more person-centred participation.

Method

By convergent mixed methods design across 9 units in Sweden, we repeated the following data collection at 3 time points over 18 months: semistructured interviews with patients and staff (n = 72), and structured reviews for accounts of participation in patient records (n = 240). Data were subjected to content analysis and descriptive statistics, respectively. The outcomes were appraised for changes over time besides the interventions to enhance attention to patients' participation: a clinical tool and guidance distributed to management, and additional local support, respectively.

Results

Both patients and staff described patient participation as a comprehension of the disease and its management in everyday life. Yet, patients accentuated participation as one's experiences being recognised, and mutual knowledge exchange. Instead, staff emphasised the patients managing their treatment. The health records primarily represented what staff do to support their notion of patient participation. No influence of the interventions was noted, but what signified patient participation was maintained over time.

Conclusion

Both patients and staff stress the importance of patient participation, although they focus on different elements. Further person-centred conduct warrants a shared conceptualisation and strategies addressing and scaffolding patients' preferences and means.

Background The transfer of innovations into healthcare is laden with challenges. Although healthcare professionals are expected to adopt and fulfil new policies, a more person-centered healthcare with conditions for preference-based patient participation is anticipated.

Methods The aim of the study was to evaluate two implementation strategies for person-centered patient participation in kidney care, including dissemination of a clinical toolkit, and additional training and support of internal facilitators. Nine Swedish kidney care units joined the study (August 2019-September 2021), strategically organized into: a control group (three sites, no support); a standard dissemination group (three sites, with a tool for patient participation and guidance disseminated to the site managers); and a facilitated implementation group (three sites, with the tool and guidance disseminated as above, plus a six-month support program for designated internal facilitators). This process evaluation was comprised of repeat interviews with managers (n = 10), internal facilitators (n = 5), recordings, and notes from the interventions, and Alberta Context Tool survey data (n = 78). Hybrid analyses comprised mixed methods: descriptive and comparative statistics, and qualitative descriptive analysis.

Results None of the control group sites addressed patient participation. While the standard dissemination sites' managers received and appreciated the toolkit, they made no attempts to make further use of it. In the facilitated implementation group, five internal facilitators from three sites engaged in the support program. They welcomed the opportunity to learn about preference-based patient participation, and about implementation, including potentially enhanced opportunities for preference-based patient participation via the tool. Each site's facilitators developed a separate strategy for the dissemination of the tool: the tool was used with a few patients in each site, and only some staff were involved. Although noting a general interest in improving patient participation, the internal facilitators described limited local support. Rather, they suggested a longer support program and more local backing and engagement.

Conclusions Facilitating person-centered patient participation is complex, given the need to address attitudes, beliefs, and behaviors. This study indicates slow uptake and change, and more efficient strategies are needed to ensure the fundamentals of care remain accessible to all.

Aim

To describe educators' conceptions of the pedagogical challenges involved in teaching practical topics to nursing students at clinical skills centres (CSCs).

Design

A qualitative descriptive design.

Methods

The study used a phenomenographic approach. Data were collected through individual qualitative interviews with 17 educators teaching at CSCs, between November 2020 and March 2021. The checklist called Consolidated Criteria for Reporting Qualitative Research for qualitative research was used.

Results

Three categories of description emerged regarding the educators' conceptions of the pedagogical challenges: teaching with credibility, teaching with confidence and creating a conducive learning environment. These conceptions were interrelated based on the way that the teaching was performed. Further, the results indicate that educators had to manage two different professional areas, that is, nursing and pedagogy, which both needed to be integrated in order to create the right learning environment.

Conclusion

To increase competence and confidence, it is recommended to develop educational course for the educators at the clinical skills centre where pedagogy and nursing are intertwined.

Implications for the Profession

This study indicated the need for educators to be prepared with credibility and confidence when teaching at CSCs to create a conducive learning environment. In order to develop this, it is key to provide support through formal and informal mentoring and entail the need for educators to combine the two roles of nursing and pedagogy.

Reporting Method

Consolidated criteria for reporting qualitative research (COREQ).

Public Contribution

No patient or public contribution.

Background Among those elements establishing decent quality of care from a patient perspective, opportunities to participate in accord with one's individual needs and preferences are central. To date, little is known the extent of preference-based patient participation in kidney care, and what facilitates optimal conditions. This study investigated i) preference-based patient participation in kidney care over time, and ii) the effects of interventions designed to enhance person-centred patient participation.Methods A quasi-experimental study was conducted across nine kidney care sites in southeast Sweden. A cohort of 358 patients with stage IV chronic kidney disease (eGRF 15-19 ml/min) or V (eGRF < 15 mL/min) entered the study. Of these, 245 patients (with kidney replacement therapy or intermittent outpatient visits only) completed a survey on patient participation at four time points: every six months from August 2019 to May 2021, patients reported their preferences for and experiences of participation using the validated Patient Preferences for Patient Participation tool, the 4Ps. Between the first and second data collection points, interventions were provided for designated staff to facilitate person-centred participation, using two strategies for two subgroups at three sites each: the managers receiving a bundle of information via e-mail on patient participation in a standard dissemination procedure (three sites), or an additional half-year support program for implementation offered to 1-2 staff per site (three sites), with no intervention for a control group (three sites). The differences in 4Ps data between groups were analysed using multilevel ordinal regression.Results Over time and across all sites, most patients' experiences of participation fully or almost fully matched their engagement preferences (57%-90%). Still, up to 12% of patient reports indicated that their preferences and experiences were insufficiently matched: in these cases, the patients had preferred to be more involved than they had experienced, for example, in making healthcare plans and setting health-related goals. The interventions did not affect the levels of preference-based participation, but patients in the control group sites had slightly more consistent matches.Conclusions Living with kidney failure necessitates patient engagement, but opportunities to participate in accordance with one's preferences are not fully provided for all patients. Additional efforts to support a common understanding and to ensure person-centred patient participation is still needed.

Divorce, nowadays an increasingly more prevalent life event in Iran, can create poor general health among Iranian women, possibly due to bigger challenges for health-related behaviors. The aim was to explore challenges to achieve health-related behaviors as experienced by divorced Iranian women acting as household-heads. An inductive exploratory design based on qualitative content analysis was utilized. Twenty strategically selected divorced women acting as household-heads in Tehran were interviewed between September 2019 and January 2020. The divorced women experienced individual-centered and social and environmental-centered challenges concerning their health-related behaviors. Lack of competence, lack of personal control, and lack of emotional support were described as individual -centered barriers. Lack of community-based support, lack of financial support, and lack of labor market support were described as social and environmental challenges to health-related behaviors. A wide range of individual, social, and environmental-centered factors hindered divorced women acting as household -heads to engage in health-related behaviors. Therefore, person-centered interventions are necessary alongside efforts to develop appropriate policies and amend protection laws to increase the welfare and health of divorced women acting as household-heads.

Teaching practical topics is a central part of nursing education. The aim of this study was to describe the teaching of practical topics to nursing students at clinical skills centres (CSCs) in Sweden regarding organisation, structure and content. Data collection consisted of structured and open-ended questions through telephone interviews with responsible educators at all Swedish Universities (n = 25). The analyses consisted of descriptive statistics and compilation. The results showed that teaching of practical topics varied, depending on each university’s pre-requisites, and a lot of resources were needed. Teaching at CSCs enabled integration of practical and theoretical knowledge. Having large student groups and confusion over terms hamper the teaching, and there was lack of a specific education for the educators at CSCs. Teaching practical topics at CSCs is a complex task, and educators need competences in nursing, theoretical knowledge and pedagogy.

Background

Safe health care of good quality depends on structured and unceasing efforts to progress, promoting strategies tailored to the context, including elements such as patients' preferences. Although patient participation is a common concept in health care, there is yet limited understanding of the factors that facilitate and hinder it in a healthcare context.

Aims

This paper identifies what patients and health professionals depict in terms of enablers and barriers for patient participation in dialysis care.

Methods

An explorative qualitative design was applied with seven focus group discussions with patients, staff, and managers across different types of hospitals, with the texts analyzed with content analysis.

Results

The dialysis context represents three key elements-people, resources, and interactions-that can both enable and hinder patient participation. Both barriers and facilitators for patient participation were found to reside at individual, team, and organizational levels, with a greater number of enabling factors implied by both patients and staff.

Linking Evidence to Action

While the dialysis context comprises opportunities for progress in favor of patient participation, a shared understanding of the concept is needed, along with how contextual factors can facilitate conditions for participation by patient preferences. In addition, the most favorable strategy for implementing person-centered care is not yet known, but to facilitate patient participation from a patient perspective, creating opportunities to enable staff and patients to share a common understanding is needed, along with tools to facilitate a dialogue on patient participation.

Qualitative studies are often found to be accompanied by quotations from interviews or similar data sources. As with any methodological tradition, it is essential to critically explore the general principle of including quotations in scientific papers: what is the purpose and justification for including quotations? Are there standards and, in that case, what are they and what are their scientific positioning? This paper presents an overview of the somewhat diverse guidance found in the literature in reference to the representation of quotations. Yet, both students and scholars use a variety of approaches to quote from their data, ranging from presenting numerous, extensive, and/or comprehensive quotations throughout the results section to the reporting of a few particular quotations to illustrate certain aspects of the findings only. While their function may be described, scientific reasoning for using quotations is scarce. Along with an overview of the scientific background and options for including quotations in qualitative studies, we discuss the consequences of the different epistemological and methodological aspects found in the literature. In conclusion, we argue that there are incentives for promoting a more deliberate employment of references from data; deriving from the human sciences tradition, a corresponding epistemological stance would suggest that quotations preferably apply for illustrating the analysis process and/or findings, while the idea that quotations can be employed to validate findings has limited support. Further critical examination of the application of and justification for including quotations in the reporting of qualitative studies is needed among researchers, journal editors and reviewers.

Abstract Background and objective End-stage renal disease (ESRD) affects a multitude of aspects in the patient's daily life, often entailing their own involvement in various aspects of the treatment. Although patient participation is a core health-care value, what the concept signifies is not yet fully known. The purpose of this paper is to conceptualize patient participation in dialysis care, depicting patients? and health-care professionals? perspectives. Design This explorative study employed qualitative interviews and content analysis. Setting and participants Seven focus group discussions engaging 42 key informants were performed, including patients, staff and managers with experience of dialysis care. Results In dialysis care, patient participation connotes a sharing of information and knowledge, the learning of and planning of care, including partaking in shared decisions with regards to treatment and management, and being involved in the management of one's own health-care treatment and/or self-care activities. Although these attributes were illustrated by all stakeholders, their significance varied: patients suggested that their preferences regarding primary aspects of participation vary, while staff considered patients? performance of dialysis to be the ultimate form of participation. Further, while patients considered multiple ways to execute participation, staff suggested that aspects such as sharing information were a route to, rather than actual, involvement. Conclusions Without a common understanding to denote the idea of patient participation, staff and patients are exposed to a potential deficit in terms of facilitating patient participation in everyday encounters of dialysis treatment. Further studies and means to serve a mutual understanding are needed.