Aim: To explore frontline decision-making, adaptation, and learning in ambulance care during the evolving COVID-19 pandemic.

Design: Descriptive and interpretative qualitative study.MethodsTwenty-eight registered nurses from the Swedish ambulance services described 56 critical incidents during the COVID-19 pandemic through free-text questionnaires. The material was analysed using the Critical Incident Technique and Interpretive Description through the lens of potential for resilient performance.

Results: The findings were synthesized into four themes: ‘Navigating uncharted waters under never-ending pressure’, ‘Balancing on the brink of an abyss’, ‘Sacrificing the few to save the many’ and ‘Bracing for the next wave’. Frontline decision-making during a pandemic contribute to ethical dilemmas while necessitating difficult prioritizations to adapt and respond to limited resources. Learning was manifested through effective information sharing and the identification of successful adaptations as compared to maladaptations.

Conclusions: During pandemics or under other extreme conditions, decisions must be made promptly, even amidst emerging chaos, potentially necessitating the use of untested methods and ad-hoc solutions due to initial lack of knowledge and guidelines. Within ambulance care, dynamic leadership becomes imperative, combining autonomous frontline decision-making with support from management. Strengthening ethical competence and fostering ethical discourse may enhance confidence in decision-making, particularly under ethically challenging circumstances.

Impact: Performance under extreme conditions can elevate the risk of suboptimal decision-making and adverse outcomes, with older adults being especially vulnerable. Thus, requiring targeted decision support and interventions. Enhancing patient safety in ambulance care during such conditions demands active participation and governance from management, along with decision support and guidelines. Vertical communication and collaboration between management and frontline professionals are essential to ensure that critical information, guidelines, and resources are effectively disseminated and implemented. Further research is needed into management and leadership in ambulance care, alongside the ethical challenges in frontline decision-making under extreme conditions.

Introduction: Top-level managers in municipal social care administration play a central role in ensuring high-quality care through coordination within and between organisations. However, there is limited understanding of the specific tasks and responsibilities they undertake in this regard. Therefore, this study aimed to explore municipal top-level managers’ perspectives on fostering safe and integrated care for older adults with complex care needs living at home.

Methods: Thirteen top-level managers in municipal social care administration were interviewed. Interview data were analysed thematically.

Results: One theme ‘Leading through trust and empowerment, and encouraging collaborations within and between organisations to foster safe and integrated care’ and five subthemes were identified: ‘Creating conditions for seamless care by minimising cross-organisational barriers’, ‘Using the mandated role when navigating the bigger picture’, ‘Empowering middle managers and nursing staff’, ‘Fostering trust in working towards a common goal’ and ‘Leveraging successful partnerships across organisations’.

Conclusion: Top-level managers see themselves as parts of a larger system that requires them to collaborate with others. Empowering middle managers and nursing staff to thrive in their roles, through leadership based on trust, promotes a unified effort toward the common goal of safe and integrated care for older adults with complex care needs.

Background: This study, conducted across three distinct geographical regions in Sweden, highlights the diverse conditions and challenges in healthcare provision. The study focuses on the sparsely populated northern regions of Sweden, the capital city of Stockholm, and the southeast rural area of Sweden. Each location presents unique obstacles to continuity of care, influenced by factors such as population density and geographical disparities. By examining the experiences of patients with complex care needs, their family carers, and healthcare personnel, this study aims to describe the conditions for and identify potential solutions associated with the delivery of continuity in care in different geographical regions of Sweden, with differing population densities.

Method: Secondary analysis was conducted using qualitative content analysis on interview data from two studies, consisting of 53 transcripts from individual, pair, and focus group interviews held between August 2018 and November 2019. The potential solutions identified from participants’ experiences were categorized into region-specific and common themes. Three personas—Vera, Bo, and Inga—were developed, each representing a scenario based on the region-specific analyses.

ResultsDespite regional differences, universal solutions to common challenges were identified focusing on relational, management, and informational aspects. Common key obstacles to continuity of care included resource shortages, insufficient information transfer, and privacy regulations. Possible solutions for overcoming these challenges include prioritizing relational continuity, streamlining processes, and advocating for a unified communication system. By collaborating, building trust, understanding patient preferences, and ensuring clear communication, healthcare personnel can effectively promote continuity of care.

Conclusions: Building a stable workforce while prioritizing relational continuity, along with patients’ preferences and needs, is essential for ensuring continuity of care from multiple providers. Digital solutions can enhance collaboration across distances, while coordinating responsibilities within smaller geographical areas can strengthen partnerships among healthcare organizations. Direct dialogue, along with ensuring that everyone has access to relevant information through a unified communication system, is vital for management continuity. By integrating these universal and transferable solutions to the obstacles associated with continuity of care, we can create a cohesive care experience for patients, regardless of geographical and demographic conditions.

Background

Access to timely mental healthcare relies on patients' descriptions of their mental health problems. We therefore sought to better understand, from the patients' perspective, how they communicate their need for specialised mental healthcare to their GPs or mental health specialists and what factors affect communication when patients are referred from their GPs to specialised mental healthcare.

Methods

This was an exploratory interview study. Ten adults who started treatment in specialised mental healthcare facilities were interviewed individually. The interviews were audiotaped and transcribed verbatim. A method based on thematic analysis was used to develop patterns and themes within the dataset using an iterative inductive approach, with checks for internal consistency throughout.

Results

Three typical personal approaches - or styles - of communicating needs could be generated. These approaches varied in how active the patients were in their help-seeking, how unrestrictedly they communicated their health concerns and their receptiveness to input from healthcare professionals. Relevant factors affecting the communication were the characteristics of the healthcare services; the responses of others; fear of rejection and misunderstanding; health literacy and experience with mental healthcare; taking responsibility for one's own treatment; and the mental health problem itself.

Conclusions

The different patient approaches to getting help for mental health problems and how those approaches are affected by individual, contextual and system factors highlight the need for individualised and welcoming communication by care providers. The current study contributes with useful insights from the patient's perspective into how e.g. the patient's previous experiences and understanding of the healthcare system influences the process of seeking help from a GP and being referred to specialist mental health services.

Purpose: A long-term evaluation of The Caregiver Pathway, a model to follow up family caregivers on Post-intensive Care Symptoms among Family (PICS-F).

Methods: A single-center non-blinded randomized controlled trial including 196 family caregivers to critically ill patients randomized to intervention (n = 101) or control group (n = 95). The Caregiver Pathway intervention consists of: (1) a digital assessment followed by a conversation with a nurse in the first days at the ICU, (2) a supportive card when leaving the ICU, (3) an offer to receive a phone call following patient transfer to a step-down unit, and (4) a follow-up conversation within 3 months after discharge. Outcome measures were collected at 6 and 12 months, including symptoms of post-traumatic stress disorder (PTSD), anxiety, depression, Health-related Quality of Life (HRQoL), hope, and self-efficacy.

Results: The Caregiver Pathway was associated with a significant effect for symptoms of PTSD after 6 months compared with controls, mean IES-R score: 25.8 [95% CI 21.9-29.7] versus 30.9 [95% CI 26.7-35.0], p = 0.009, and a trend toward an effect after 12 months: IES-R score: 25.0 [95% CI 21.3-28.7] versus 28.4 [95% CI 24.1-32.7], p = 0.057. Subgroup analyses at 12 months showed a significant intervention effect among family caregivers of patients who survived compared to controls for PTSD, IES-R score: 19.8 [95% CI 15.3-24.2] versus 29.1 [95% CI 23.5-34.6], p = 0.001, and anxiety, HADS-A score: 4.3 [95% CI 3.1-5.4] versus 6.8 [95% CI 5.2-8.4], p = 0.003.

Conclusions: The Caregiver Pathway has the potential to reduce the symptoms of PICS-F, especially among family caregivers whose patient has survived.

Aim: The aim of this study was to visualize vulnerabilities and explore the dynamics of inter-professional collaboration and organizational adaptability in the context of care transitions for patients with complex care needs.

Design: An ethnographic design using multiple convergent data collection techniques.

Methods: Data collection involved document review, participant observations and interviews with healthcare and social care professionals (HSCPs). Narrative analysis was employed to construct two illustrative patient scenarios, which were then examined using the Functional Resonance Analysis Method (FRAM). Thematic analysis was subsequently applied to synthesize the findings.

Results: Inconsistencies in timing and precision during care transitions pose risks for patients with complex care needs as they force healthcare systems to prioritize structural constraints over individualized care, especially during unforeseen events outside regular hours. Such systemic inflexibility can compromise patient safety, increase the workload for HSCPs and strain resources. Organizational adaptability is crucial to managing the inherent variability of patient needs. Our proposed ‘safe care transition pathway’ addresses these issues, providing proactive strategies such as sharing knowledge and increasing patient participation, and strengthening the capacity of professionals to meet dynamic care needs, promoting safer care transitions.

Conclusion: To promote patient safety in care transitions, strategies must go beyond inter-professional collaboration, incorporating adaptability and flexible resource planning. The implementation of standardized safe care transition pathways, coupled with the active participation of patients and families, is crucial. These measures aim to create a resilient, person-centred approach that may effectively manage the complexities in care transitions.

Implications: The recommendations of this study span the spectrum from policy-level changes aimed at strategic resource allocation and fostering inter-professional collaboration to practical measures like effective communication, information technology  integration, patient participation and family involvement. Together, the recommendations offer a holistic approach to enhance care transitions and, ultimately, patient outcomes.

Background: Maintaining and motivating physical functioning among older adults has substantial health-related benefits, such as reducing the risk of falls and increasing the opportunities for independent living. Supporting preventive actions among older adults also has socioeconomic relevance. Previous studies have shown that digital tools involving video feedback can facilitate reflection and learning by encouraging active engagement.

Objective: This study aimed to explore health care professionals’ experiences of using a video-based tool as part of the rehabilitation to facilitate physical functioning among older adults (aged ≥65 years) living at home.

Methods: An experience-based co-design approach was used, involving 20 health care professionals. Nine iterative workshops were conducted, followed by 9 group interviews held between 2022 and 2023. The data were analyzed using reflexive thematic analysis.

Results: The results from this study captured the experiences of health care professionals using a video-based tool to facilitate physical functioning in older adults living at home. The participants described focusing on supporting patient commitment, creating a shared language to enhance collaboration in the rehabilitation process, and navigating barriers to adopting the video-based tool in practice.

Conclusions: From the perspective of health care professionals, video feedback has the potential to improve movement performance in daily activities and may play a crucial role in providing motivation and promoting sustainable physical functioning among older adults. Clinical recommendations include training health care professionals to introduce video feedback in a patient-centered manner and using it to foster shared communication that promotes professional development and patient engagement. Further research is needed to assess the impact of video feedback on older adults’ health outcomes and to identify strategies for implementation in complex rehabilitation needs.

Healthy ageing is a global priority due to a growing older population, which increases the need for preventive measures and tailored technology. In health technology development, co-design is emphasised as a valuable strategy to support a person-centred approach. Co-design, a value-driven and collaborative approach, involves end users in development processes to overcome barriers connected to capability, opportunity, and motivation. While a growing number of older adults are involved in design processes, there is a deficit of suitable methodologies for achieving active involvement. Additionally, the COVID-19 pandemic necessitated a shift to developing methodological skills and tools to facilitate co-design remotely in a digital setting. Here, we draw on experiences of conducting iterative co-design workshops with a Canadian and a Swedish cohort of older adults about technology development to support mobility, balance, and confidence in daily movement. We describe and discuss methodological and ethical challenges and opportunities to provide recommendations for conducting co-design research in a digital setting with older adults (+65 years). Our recommendations include the use of live mind mapping to facilitate participation involvement, and we address the issue of 'homework' in co-design and the importance of setting expectations.

Introduction

Integrated care has the potential to mitigate patient safety risks by enhancing collaboration andmaintaining a patient-centred approach. However, best practices for successful implementation are lacking. This study aims to identify and describe key components of best practices for integrating health and social care to increaseunderstanding of successful implementation.

Methods

A Collaborative Reflexive Deliberative Approach was used. The data comprised twenty-one publishedarticles and five unpublished manuscripts from 2015 to 2023, along with the experiences of ten clinicians andresearchers in integrated care, and the research team itself.

Results

Components identified as best practices for integrated care, each describing different aspects shaped by andfor the patient, were: holistic co-creation in an ethical stance, trust through physical and relational proximity, flexiblecaring, learning and adaptable organizations and flexible information and communication.

Discussion/conclusion

The study emphasizes the importance of building trust through proximity and adaptableorganizational learning, and the need for a holistic perspective, acknowledging both the limitations and potentialsof health and social care integration. Embracing innovative thinking and recognizing that not everyone needs allservices at all times can foster flexible, person-centred integrated care. Addressing these complexities is essential forsuccessful integration efforts.

Objectives The aim is to evaluate the effects of a motivational interviewing-based intervention, Supporting Patient Activation in Transition to Home, on rehospitalisation and patient activation among patients with heart failure or chronic obstructive pulmonary disease.Design A randomised, controlled, analysis-blinded trial was conducted.Setting Participants were recruited from two hospitals in mid-Sweden and the intervention and interviews were conducted post-discharge.Participants 207 participants with heart failure or chronic obstructive pulmonary disease were recruited. Participants were randomised to receive five motivational interviewing sessions post-discharge (n=103) or a control group (n=104).Outcome measures Rehospitalisation within 180 days post-discharge was retrieved, and patient activation was assessed using the Patient Activation Measure at baseline, 30, 90 and 180 days post-discharge. We used a generalised estimating equation to assess the difference in the secondary outcome, patient activation, between the intervention group and the control group during the 180-day follow-up.Results No statistically significant differences between the groups were found for rehospitalisation (p=0.33 to 0.41) or patient activation over time (B=-1.67, -0.71 and -0.83 (95% CI -5.45 to 2.10, -4.06 to 2.64 and -4.28 to 2.62), respectively).Conclusion Post-discharge motivational interviewing to decrease rehospitalisation or support patient activation does not seem beneficial for patients with heart failure or chronic obstructive pulmonary disease. The high disease burden may have limited patient participation in the intervention.Trial registration number NCT02823795.