BACKGROUND: Hospice care is a perceived need in the Iranian health system. AIM: This qualitative study is explaining the stakeholders' perception of what is required to develop a hospice care system for patients living with cancer in Iran.

METHODS: A total of 21 participants (specialists, policymakers, healthcare providers, cancer patients and family caregivers) were selected through purposeful sampling and interviewed in-depth in 2020. Interviews were analysed through directed content analysis.

FINDINGS: A total of 1054 codes, 7 categories and 21 subcategories were extracted. The requirements include the need to provide: multiple settings and diverse services; participatory decision making; integration into the health system; specialised human resources; an organised system of accountability; the preparation of the existing health system; and wider capacity-building in existing Iranian society.

CONCLUSION: It is essential that Iranian services create a participatory comprehensive care plan, utilise expert manpower, integrate hospice care into the existing health system and organise a system of accountability. Policymakers should focus on the preparation of the health system and capacity building in society.

Background

Designing and implementation of screening programs depend on greatly epidemiologic basic data in every country. Also Variation in the incidence of various cancers in our country has been a favorite topic.

Objectives

This systematic review was conducted to provide an overall perspective about incidence, geographical and age distribution of cancers in Iran.

Methods

A comprehensive search were done according to MOOSE guideline criteria in national and international databases for selecting eligible articles from 2005 to 2015. After screening titles and abstracts, duplicated and irrelevant studies were excluded. Selected papers are written in Persian or English. The standard error of the cancer incidence was calculated based on the binomial distribution. Because of the significant heterogeneity observed among the results, we used a random-effects model combine the results of the primary studies. Moreover, a sensitivity analysis was undertaken to explore the effects of the risk of bias and other sources of heterogeneity.

Results

Overall 16 articles met eligibility criteria for inclusion. The total incidence of cancer was 19.4 and 17.2 per hundred thousand of people in males and females respectively. The five most common cancers in male were: Lymphoma, leukemia, esophagus, stomach, colorectal and in the female are: breast, colorectal, stomach, thyroid and esophagus. The highest incidence rate was seen in Golestan Province and in the age group over 65 years.

Conclusion

According to increasing incidence rate of cancers in Iran, Development, holding and accomplish of universal public cancer control program should be the first precedence for health policy.

Aim: The aim of the study was to describe continuity from the perspective of working as an agency nurse (AN).

Design: Qualitative design was applied using individual semi-structured interviews. 

Method: Individual interviews with fifteen registered nurses working at agency companies were conducted in 2020. The interviews were analyzed with thematic analysis. The study followed the guidelines addressed in the COREQ (Consolidated Criteria for Reporting Qualitative Research) framework.

Results: Thematic analysis yielded one theme – standing strong and taking command – and four categories: being competent and experienced, being prepared and at ease, ensuring an unbroken chain of care, and belonging on my own terms. The categories illustrated the engagement, professionalism, and natural leadership showed by the ANs to uphold quality and continuity.

The Perceived Stress Scale (PSS) measures general stress and the Swedish version, although used in several studies, has not been extensively evaluated for psychometric properties. Aims: This study aimed to investigate psychometric properties and the factor solution of the Swedish 14-item version when used with two samples, namely a mixed Internet sample of women and men (n = 171) and another of women with stress-related disorders (n = 84). Classical test theory, including confirmatory factor analysis, was employed. Results: The factor structure supported a two-factor model for the PSS and confirmed other language versions of the PSS, although one items showed a low item-total correlation. The PSS showed to be feasible with the investigated samples and the results indicated no ceiling or floor effects and good internal consistency of the PSS. Several aspects of construct validity were shown. An association of − 0.66 between the PSS and a measure of coping indicated good concurrent validity. Criterion validity was demonstrated through a statistically significant difference (P < 0.001) between the women with stress-related disorders and the Internet sample. Predictive validity of the PSS could be demonstrated in a short-term perspective. Based on the sample with stress-related disorders, sensitivity to change was shown through a statistically significant stress reduction (P < 0.001) from entering work rehabilitation to discharge. Conclusions: The Swedish version of the PSS showed satisfactory psychometric properties and may be recommended for use with people with and without known stress-related disorders.

Background: The Swedish healthcare system employs information and communication technologies (ICT) in nursing practice to meet quality-, security- and efficiency-related demands. Although ICT is integrated with nursing practices, nurses do not always feel that they are convenient to use it. We need to improve our knowledge of the role of ICT in healthcare environments and so we decided to complement existing experience of how ICT influences nursing practice. Aim: This study aimed to review and synthesise the available literature on the role of ICT in nursing practice in Swedish healthcare settings. Method: To consolidate previous studies based on diverse methodologies, an integrative literature review was carried out. Three databases were used to search for literature, 20 articles met the inclusion criteria. Results: The literature review indicates that ICT integration into nursing practice is a complex process that impacts nurses’ communication and relationships in patient care, working conditions, and professional identities and development. Nurses are found to express ambiguous views on ICT as a usable service in their everyday practice since it impacts both positively and negatively. Discussion and conclusion: Although ICT cannot replace physical presence, it can be considered a complementary service that gives rise to improved patient care. However, nonverbal communication cues may be missed when ICT is used as mediating tool and ICT can be limiting because it is not always designed to meet nurse and patient needs. The meaning of an encounter appears to change when ICT is used in nursing practice, not only for patient relationships but also for interpersonal communication.

BackgroundSuicide in old age is a significant contributor to mortality. However, the extent to which life weariness and suicidal thoughts impact on mortality in a long-term perspective is unknown. The aim of this study was to investigate the effect of life weariness and suicidal thoughts on long-term survival (16 years) in an older Swedish population, controlling for demographic and social network factors and depression. A further aim was to investigate differences in sex and age interactions in relation to mortality among individuals with and without life weariness and suicidal thoughts.

MethodsA longitudinal cohort study on a national, representative sample of individuals aged 60+ years was conducted within the Swedish National Study of Aging and Care study. The sample included 7213 individuals, who provided information about life weariness and suicidal thoughts through an item derived from the Montgomery-Åsberg Depression Rating Scale. Data were analysed with multivariate Cox proportional hazards models, adjusted for potential confounders.

ResultsAt baseline, 12.5% of the participants (14.6% of females and 9.5% of males) reported life weariness and suicidal thoughts. During the 16-year follow-up, a mean survival time was 11.5 years (standard deviation (SD) 5.6), and 3804 individuals died (59.5% females and 40.5% males). Individuals with life weariness and suicidal thoughts had half the survival rate compared with those without such thoughts (24.5% vs. 50.6%), with a mean survival time of 8.4 years (SD 5.7) versus 12.0 years (SD 5.4). The multi-adjusted hazard ratio of mortality for those reporting life weariness and suicidal thoughts was 1.44 (95% confidence interval, 1.30–1.59), with the population attributable risk at 11.1%. In the models, being male or female 80+ years showed the highest multi-adjusted hazard ratio of long-term mortality (ref. female 60–69 years).

ConclusionsThe findings suggested that life weariness and suicidal thoughts were risk factors for long-term mortality, when controlled for sex and age interactions that were found to strongly predict long-term mortality. These findings have practical implications in prevention of mortality, emphasising the importance of screening, identifying, and intercepting older men and women with signs of life weariness and suicidal thoughts.

Background

eHealth solutions have often been considered favourable for improved effectiveness and quality in healthcare services for wound management. Staff engagement related to organisational changes is a key factor for successful development and implementation of a new eHealth solution, like a digital decision support systems (DDSS). It is essential to understand the engagement process in terms of sustainability, wellbeing in staff and efficiency in a long-term perspective. The aim of this study was to describe healthcare staff’s engagement during a 6-month test of an eHealth solution (DDSS) for wound management.

Methods

A qualitative design, including interviews conducted with healthcare staff working with wound management within primary, community and specialist care (n = 11) on two occasions: at the introduction of the solution and after 6 months, when the test period was over. Data were interpreted with qualitative content analysis.

Results

Healthcare staff’s descriptions from a 6-month test of an eHealth solution for wound management can be summarised as Engaging through meaning, but draining. The analysis revealed a result with three subcategories: Having a shared interest is stimulating, Good but not perfect and Exciting, but sometimes exhausting. The staff described their engagement as sustained through feelings of meaningfulness when using the eHealth solution, but limited by feelings of exhaustion due to heavy workload and lack of support and understanding from others.

Conclusions

The results indicate that the healthcare staff who tested the eHealth solution described themselves as individuals who easily become engaged when an idea and efforts felt meaningful. The staff needed resources to nourish engagement in their new role when implementing eHealth in the clinical everyday work of wound management. Allocating time and support are important to consider when planning for sustainable implementation of eHealth solutions in healthcare organisations.

From the perspective of psychiatric and mental health nurses in Sweden, this discussion paper aims to position psychiatric and mental health nursing as a transformative force contributing to enforcing person-centered values and practices in health care. We argue the potential impact of psychiatric and mental health nursing on service user health and recovery, nursing student education and values, and the organization and management of health care. Psychiatric and mental health nursing is discussed as a caring, reflective, and therapeutic practice that promotes recovery and health. Implications for nursing education, research, management, and practice are outlined.

ObjectiveThis study described the experiences and perceptions of how primary health care professionals (PHCPs) support patients with venous leg ulcers (VLUs) in self-care monitoring.DesignA qualitative approach with reflexive thematic analysis was used, with 24 individual qualitative open interviews.SettingPrimary health care clinics and community health care in four southern regions in Sweden.SubjectsRegistered nurses, district nurses and nurse assistants who had experience of caring for patients with VLUs. In total, 24 interviews were conducted with PHCPs in Sweden.ResultsPHCPs have a vital role in promoting patient independence and responsibility, identifying needs and adapting care strategies, while also recognising unmet needs in patients with VLUs.ConclusionPHCPs actively monitor patients' self-care and establish caring relationships. They see a need for a structured primary health care work routine for ulcer management. PHCPs described encouraging patients by identifying needs, adapting care and promoting self-care monitoring using various skills and strategies.PHCPs described unmet needs and insufficient care practices for patients with VLUs.PHCPs pointed out the importance of establishing caring relationships in order to involve patients in their VLU treatment.

Aim

To delineate and clarify the meaning of the concept of self-care monitoring from a patient perspective.

Methods

A systematic search was performed in the databases ASSIA, CINAHL, PsycInfo, and PubMed (January 2016–September 2021). A selection of 46 peer-reviewed articles was included in the study and analysed using Rodgers’ Evolutionary Method for Concept Analysis.

Results

The following four attributes were identified: Tracking symptoms, signs, and actions, Paying attention, Being confident, and Needing routines, creating a descriptive definition: “Self-care monitoring is an activity that means a person has to pay attention and be confident and needs routines for tracking symptoms, signs, and action.” The antecedents of the concept were shown to be Increased knowledge, Wish for independence, and Commitment. The concepts’ consequences were identified as Increased interaction, Perceived burden, and Enhanced well-being.

Conclusions

This concept analysis provides extensive understanding of self-care monitoring from a patient perspective. It was shown that the concept occurs when a person practices self-care monitoring at home either with or without devices. A descriptive definition was constructed and presented with exemplars to encourage practice of the concept in various healthcare settings and could be of relevance to people with chronic illnesses or other long-term conditions.

Anorexia nervosa (AN) is a serious disease which is difficult to treat. Little is known about the recovery from AN, and therefore, this review's aim was to review and synthesise patients' experiences and perceptions of what is meaningful for recovery from anorexia nervosa while having contact with psychiatric care. Cinahl, PubMed, and PsycINFO were systematically searched, and 24 studies met the inclusion criteria and were included in the review. Three themes were identified: Being in a trustful and secure care relationship, Finding oneself again, and Being in an engaging and personal treatment. Efforts supporting staff learning and person-centred care should be emphasised and researched further.

Background:The EQ-5D index often fails to detect the effect of ophthalmic diseases and sight loss. Investigating predictors of individual EQ-5D health dimensions might reveal the underlying reasons. The aim of this study was to investigate predictors of health dimension ratings obtained with the EQ-5D-3L from participants with impaired vision representing a spectrum of eye diseases.

Methods: Observational cross-sectional study with participants recruited at four public hospitals in Portugal. Outpatients with visual acuity of 0.30 logMAR(6/12) or worse in the better-seeing eye were invited to participate. Participants completed two instruments: the EQ-5D-3L (measures participants’ perceived health-related quality-of-life) and the Massof Activity Inventory (measures visual ability–ability to perform vision-related activities). This study used logistic regression models to identify factors associated with responses to the EQ-5D-3L.

Results: The study included 492 participants, mean age 63.4 years (range = 18–93), 50% females. The most common diagnosis was diabetic retinopathy (37%). The mean visual acuity in the better seeing eye was 0.65 logMAR (SD = 0.48) and the mean visual ability was 0.62 logits (SD = 2.04), the correlation between the two was r = − 0.511 (p < 0.001). Mobility and self-care were the health dimensions with the fewest problems (1% reported extreme problems), anxiety and depression the dimension with the most problems (24% reported extreme problems). ROC curve analysis showed that the EQ-5D index was a poor predictor of cases of vision impairment whilst visual ability given was a good predictor of cases of vision impairment. Visual ability was an independent predictor of the response for all dimensions, higher ability was always associated with a reduced odds of reporting problems. The odds of reporting problems were increased for females in 3 out of 5 dimensions. Comorbidities, visual acuity and age-category were predictors of the odds of reporting problems for one dimension each.

Conclusions: The odds of reporting problems for the five health dimensions of the EQ-5D-3L were strongly influenced by the ability to perform vision-related activities (visual ability). The EQ-5D index showed poor performance at detecting vision impairment. These findings are informative and relevant for the clinic and for research evaluating the impact of eye diseases and disease treatments in ophthalmology.

It  is  seldom  that  it  is  only  the  patient  who  is  affected  when  someone  is  admitted  to  compulsory  psychiatric  inpatient  care,  the  next  of  kin  is  usually  also  impacted.  The  aim  was  to  describe  the  lived  experiences  of  being  a  next  of  kin  to  a  woman  in  need  of  compulsory  psychiatric  inpatient  care.  Ten  next  of  kin  were  interviewed  and  the  material  was  analyzed  with  a  Reflective  Lifeworld  Research  approach.  The  results  show  loneliness  and  feelings  that  their  existence  has  collapsed.  An  emotional  duality  is  described  in  the  realization  that  the  care  is  needed  but  they  are  devastated  that  the  woman  is  there.  A  trust  exists,  but  it  changes  when  the  next  of  kin  are  no  longer  a  part  of  the  care  process.

Background: The efficacy of various massage doses in palliative cancer care settings is still debated, and no specific protocol is available. Aim: Evaluating response to various massage doses for symptom cluster of pain-fatigue-sleep. Design: A 7-arm randomized-controlled trial with weekly massage for 4 weeks depending on the prescribed dose (15-, 30-, or 60-min; 2x or 3x/week) and a 4-week follow-up. The intensities of pain, fatigue, and sleep disturbance were measured using a 0-10 scale at nine-timepoint; baseline, weekly during the intervention, and the follow-up period. Then, the mean scores of the three symptoms were calculated as the symptom cluster intensity at each timepoint. IRCT.ir IRCT20150302021307N5. Setting/participants: Adults with cancer (n = 273) who reported all three symptoms at three oncology centers in Iran. Results: The odds of clinical improvement (at least 30% reduction in symptom cluster intensity from baseline) increased with dose-escalation significantly [(OR = 17.37; 95% CI = 3.87-77.90 for 60-min doses); (OR = 11.71; 95% CI = 2.60-52.69, for 30-min doses); (OR = 4.36; 95% CI = 0.94-20.32, for 15-min doses)]. The effect durability was significantly shorter at 15-min doses compared to 30- and 60-min doses. The odds of improvement for doses 3x/week was not significant compared to doses 2x/week (OR = 12.27 vs OR = 8.34); however, the effect durability for doses 3x/week was significantly higher. Conclusions: The findings indicated that dose-escalation increases the efficacy of massage for the pain-fatigue-sleep symptom cluster. Although the 60-min doses were found to be more effective, the 30-min doses can be considered more practical because they are less costly and time-consuming. Our findings can be helpful to develop massage guidelines in palliative care settings.

This systematic review aims to synthesise the research on children's perceptions and experiences of their involvement in a parent's mental health care. After an extensive search and quality appraisal, 22 articles remained and were included in the review. The results show that children-although resourceful and with good intentions-frequently felt excluded. They hungered for information and felt their questions were abandoned. They also felt caught in a tumultuous life situation and struggled for support. Finally, they expressed the need to be seen and ultimately did not feel involved in their parent's mental health care.

PURPOSE

Venous leg ulcer is a recognized condition, affecting people globally. Ulcers mainly affect the elderly and recurrences are not uncommon. There is knowledge about life with venous leg ulcers, but the situation after healing is unexplored. This paper explores and describes meanings of experiences of daily life after healing of a hard-to-heal venous leg ulcer.

METHODS

Lived experiences of 15 individuals with healed hard-to-heal venous leg ulcers generated data for this study. Interviews were recorded for analysis using a reflective lifeworld research approach. An essence emerged, further described by its constituents.

RESULTS

Memories of a difficult time with leg ulcer were ever present, in a way becoming part of the self. A striving for control in daily life entailed a struggle to do what was best for the own body. After healing, a new normal emerged in daily life, a reality that encompassed the risk for a new ulcer. The body had changed physically, with marks alongside those from ageing, in a life that still went on.

CONCLUSIONS

For those who had healed from a venous leg ulcer, life had changed. Even if they referred to life as normal, it was not the same normal as before.

Venous leg ulcers have multiple consequences for the patient. Ulcer management can be lengthy and recurrence is common. As the patient is the expert on their experiences and life, the aim of the present study was to describe patients' lived experiences of undergoing management for a venous leg ulcer. The study encompassed 16 phenomenological interviews. The analysis led to a description of the phenomenon's essence, further described by three constituents. The essential meaning of the phenomenon is described as being in an oscillation between hope and despair. Ulcer management is challenging for the patient, who feels unseen and lives with doubts during the management period. This study is considered enriching as it puts words to the patients' suffering during ulcer management and shows that reliable relationships and competence can reduce patient doubts. This knowledge should enable improvement of patient care and treatment during ulcer management.

Background Venous leg ulcers take time to heal. It is advocated that physical activity plays a role in healing, and so does the patient’s nutritional status. Additionally, malnutrition influences the inflammatory processes, which extends the healing time. Therefore, the staff’s advising role is important for patient outcomes. Thus, this study aimed to investigate the associations between given self-care advice and healing time in patients with venous leg ulcers while controlling for demographic and ulcer-related factors.

Methods The sample consisted of patients registered in the Registry of Ulcer Treatment (RUT) which includes patient and ulcer-related and healing variables. The data was analyzed with descriptive statistics. Logistic regression models were performed to investigate the influence of self-care advice on healing time.

Results No associations between shorter healing time (less than 70 days) and the staff´s self-care advice on physical activity was identified, whilst pain (OR 1.90, CI 1.32–2.42, p < 0.001) and giving of nutrition advice (OR 1.55, CI 1.12–2.15, p = 0.009) showed an association with longer healing time.

Conclusions Neither self-care advice on nutrition and/or physical activity indicated to have a positive association with shorter healing time. However, information and counseling might not be enough. We emphasize the importance of continuously and systematically following up given advice throughout ulcer management, not only when having complicated ulcers.

Purpose: The study aimed to describe primary health care professionals lived experiences of supporting recovery in persons with stress-related disorders. Methods: This study was based on a phenomenological approach known as reflective lifeworld research (RLR). Seventeen health care professionals working in primary health care were included in the study. Lifeworld interviews were conducted to collect data. The data were analysed in accordance with the phenomenological RLR principles of openness, flexibility and bridling.

Results: Health care professionals experienced supporting recovery as a complex process with a need for a tailored approach, regardless of profession. In an alliance, the health care professionals encounter the persons where they are based on their own narratives about their life situation. In an interpersonal platform, the health care professionals use a lingering and flexible approach. Support is provided by encouraging existential reflection and learning as well as guiding the person to consider their own needs. This supports the person’s quest for a sustainable recovery process in his/her life situation.

Conclusions: We conclude that supporting recovery requires a genuinely person-centred care in which elements of existential care are crucial. Primary health care for persons with stress-related disorders could benefit from the development of additional research and models for such an approach

Major changes have taken place in psychiatric care in Sweden as well as in other countries. These changes, and the current climate of pressure and demands on the nursing staff in psychiatric in-patient care, make it important to be able to understand the relationship between environmental aspects and the nursing staff’s working conditions. The overall aim of the present thesis was to investigate perceptions of the ward atmosphere, the psychosocial work environment and stress among nursing staff working in psychiatric in-patient care. The findings were based on two questionnaire surveys (65 + 93 participants) and were analyzed using non-parametric statistics. The findings showed that a revised Swedish version of the Ward Atmosphere Scale involved some reliability problems that need to be addressed in future studies. Several aspects of the ward atmosphere were found to be related to the psychosocial work environment, and aspects of the ward atmosphere and the psychosocial work environment were related to the nursing staff’s Perceived Stress and Stress of Conscience. The nursing staff’s sense of Mastery was found to be a protective factor against Stress of Conscience, while a Sense of Moral Burden increased the vulnerability. Taking these aspects into consideration when making improvements in the workplace could help to prevent stress.

Aim

The aim of this study was to investigate the perceptions of registered nurse (RN) preceptors working in psychiatric care concerning the organisation of clinical placements and their own preceptor role with undergraduate nursing students.

Background

Clinical placements play a central role in undergraduate nursing education, and it is crucial that psychiatric care clinical placements are of high quality.

Methods

The RNs’ perceptions before and after the introduction of changes in the organisation of clinical placements were compared. A total of 103 surveys with quantitative and qualitative data were returned, from 59 RN preceptors at baseline and 44 RN preceptors at follow-up. Data were analysed with non-parametrical statistics and qualitative content analysis.

Results

The majority of RN preceptors perceived the changes to have been beneficial, but there was still a desire for the students to have more time in their psychiatric care clinical placements according to the RN preceptors. At follow-up, significantly more RN preceptors perceived that they had an intentional pedagogical foundation for their precepting.

Conclusions

We conclude that the changes introduced into the clinical placement are beneficial, but there is still need for further improvement in relation to the amount of time student nurses spend in psychiatric clinical placements and in the opportunities provided for RN preceptors to attend preceptor preparation courses.

Providing effective written feedback on nursing student's assignments can be a challenging task for any assessor. Additionally, as the student groups tend to become larger, written feedback is likely to gain an overall more prominent position than verbal feedback. Lack of formal training or regular discussion in the teaching faculty about the skill set needed to provide written feedback could negatively affect the students' learning abilities. In this brief paper, we discuss written feedback practices, whilst using the Bachelor of Science in Nursing thesis as an example. Our aim is to highlight the importance of an informed understanding of the impact written feedback can have on students. Creating awareness about this can facilitate the development of more strategic and successful written feedback strategies. We end by offering examples of some relatively simple strategies for improving this practice.

- This study investigated the interplay between nursing staff stress, Mastery, Moral Sensitivity, individual characteristics and the ward atmosphere in psychiatric in-patient care. Data were collected through five questionnaires from 93 nursing staff. Multivariate analysis showed that Moral Strength, Moral Burden, Internal Demands, Perceived Stress and age were related to several factors of the ward atmosphere. We conclude that efforts to reduce stress levels and create a supporting ethical climate on psychiatric wards would be beneficial for both psychiatric nursing staff and their nursing practice. © 2017 Taylor & Francis Group, LLC

The psychosocial work environment is an important factor in psychiatric in-patient care, and knowing more of its correlates might open up new paths for future workplace interventions. Thus, the aims of the present study were to investigate perceptions of the psychosocial work environment among nursing staff in psychiatric in-patient care and how individual characteristics—Mastery, Moral Sensitivity, Perceived Stress, and Stress of Conscience—are related to different aspects of the psychosocial work environment. A total of 93 nursing staff members filled out five questionnaires: the QPSNordic 34+, Perceived Stress Scale, Stress of Conscience Questionnaire, Moral Sensitivity Questionnaire, and Mastery scale. Multivariate analysis showed that Perceived Stress was important for Organisational Climate perceptions. The Stress of Conscience subscale Internal Demands and Experience in current units were indicators of Role Clarity. The other Stress of Conscience subscale, External Demands and Restrictions, was related to Control at Work. Two types of stress, Perceived Stress and Stress of Conscience, were particularly important for the nursing staff’s perception of the psychosocial work environment. Efforts to prevent stress may also contribute to improvements in the psychosocial work environment.

The aims of this study were to investigate (1) perceived stress as felt by the nursing staff working in psychiatric inpatient care, (2) possible differences between nurses and nurse assistants, and (3) associations among individual characteristics, the ward atmosphere, the psychosocial work environment, and perceived stress. Ninety-three members of the nursing staff completed three instruments--one each measuring perceived stress, the ward atmosphere, and the psychosocial work environment. There were no differences among the staff groups concerning perceived stress. Multivariate analysis showed that the ward atmosphere factor "Involvement" and the psychosocial work environment factor "Role Clarity" were indicators of perceived stress. Improvements in these factors could help to prevent stress among the staff.

The present study aimed at investigating the relationship between environmental and individual factors and Stress of Conscience among nursing staff in psychiatric in-patient care. A questionnaire involving six different instruments measuring Stress of Conscience, the ward atmosphere, the psychosocial work environment, Perceived Stress, Moral Sensitivity, and Mastery was answered by 93 nursing staff at 12 psychiatric in-patient wards in Sweden. The findings showed that Sense of Moral Burden, Mastery, Control at Work and Angry and Aggressive Behavior were related to Stress of Conscience. We conclude that Mastery and Control at Work seemed to work as protective factors, while Sense of Moral Burden and perceptions of Angry and Aggressive Behavior made the nursing staff more vulnerable to Stress of Conscience. Future research should investigate whether measures to increase the level of perceived control and being part of decision making will decrease the level of Stress of Conscience among the staff.

Background: Chronic somatic health conditions are a global public health challenge. Being engaged in one's own health management for such conditions is important, and mobile health (mHealth) solutions are often suggested as key to promoting engagement. Objective: The aim of this study was to review, critically appraise, and synthesize the available research regarding engagement through mHealth for persons with chronic somatic health conditions. Methods: An integrative literature review was conducted. The PubMed, CINAHL, and Inspec databases were used for literature searches. Quality assessment was done with the guidance of Critical Appraisal Skills Programme (CASP) checklists. We used a self-designed study protocol comprising 4 engagement aspects-cognitive, behavioral and emotional, interactional, and the usage of mHealth-as part of the synthesis and analysis. Results: A total of 44 articles met the inclusion criteria and were included in the analysis. mHealth usage was the most commonly occurring engagement aspect, behavioral and emotional aspects the second, cognitive aspects the third, and interactional aspects of engagement the least common aspect in the included articles. The results showed that there is a mix of enablers and barriers to engagement in relation to the 4 engagement aspects. The perceived meaningfulness and need for the solution and its content were important to create and maintain engagement. When perceived as meaningful, suitable, and usable, mHealth can support knowledge gain and learning, facilitate emotional and behavioral aspects such as a sense of confidence, and improve interactions and communications with health care professionals. Conclusions: mHealth solutions have the potential to support health care engagement for persons with chronic somatic conditions. More research is needed to further understand how, by which means, when, and among whom mHealth could further improve engagement for this population.

Objectives: This study aimed at investigating the point prevalence of life weariness and suicidal thoughts and their relationship with socio-demographic characteristics in a population of older adults in Sweden. Method: Data from 7913 individuals aged 60 years and older were drawn from the Swedish National Study on Aging and Care, a collaborative study in Sweden. Life weariness and suicidal thoughts were measured by one item derived from the Montgomery–Åsberg Depression Rating Scale. A multinomial regression model was used to investigate the relationships of socio-demographic characteristics with life weariness and suicidal thoughts. Results: Living in urban and semi-urban areas, being of advanced age, being divorced and having lower educational levels were related to life weariness. Living in a residential care facility, being widowed or unmarried, being born in a non-Nordic European country and experiencing financial difficulties were related to both life weariness and suicidal thoughts. Sex was found to be unrelated to either life weariness or suicidal thoughts. Conclusion: This study found that several socio-demographic variables were associated with life weariness and suicidal thoughts among older adults. Specific attention to older individuals with these characteristics may be warranted as they might be more vulnerable to life weariness and suicidal thoughts.

Aims: Suicidality in late life is a public health concern worldwide and suicidal thoughts may be an important risk factor for suicide in old age. The overall aim of the present study was to investigate the possible importance of demographic characteristics, especially sex and age, for suicidal thoughts in a Swedish population-based cohort of older adults aged 60+ years.

Methods: In this multicenter study, data from 7913 individuals aged 60+ years from the Swedish National Study on Aging and Care (SNAC) were used. One item of the Montgomery-Åsberg Depression Rating Scale was used to measure life weariness and suicidal thoughts. Logistic regression models were used to determine the relationship between socio-demographic characteristics and suicidal thoughts.

Findings: Multivariate analysis showed that suicidal thoughts independently increased with age. Sex was, however, found to be unrelated to suicidal thoughts after controlling for other socio-demographic factors. Living in an urban or midsize geographical area, being widowed/unmarried/divorced, born in an European country other than the Nordic countries, in a residential care facility and having financial difficulties was related to suicidal thoughts.

Conclusions: Taking these socio-demographic characteristics into consideration may aid in the design of prevention programs for late life suicidality.

Background:Today’s healthcare environment is often characterized by an ethically demanding worksituation, and nursing students need to prepare to meet ethical challenges in their future role. Moralsensitivity is an important aspect of the ethical decision-making process, but little is known regardingnursing students’ moral sensitivity and its possible development during nursing education.Objectives:The aims of this study were to investigate moral sensitivity among nursing students,differences in moral sensitivity according to sample sub-group, and the relation between demographiccharacteristics of nursing students and moral sensitivity.Research design:A convenience sample of 299 nursing students from one university completed aquestionnaire comprising questions about demographic information and the revised Moral SensitivityQuestionnaire. With the use of SPSS, non-parametric statistics, including logistic regression models,were used to investigate the relationship between demographic characteristics and moral sensitivity.Ethical considerations:The study followed the regulations according to the Swedish Ethical Review Actand was reviewed by the Ethics Committee of South-East Sweden.Findings:The findings showed that mean scores of nursing students’ moral sensitivity were found in themiddle to upper segment of the rating scale. Multivariate analysis showed that gender (odds ratio¼3.32),age (odds ratio¼2.09; 1.73), and parental status (odds ratio¼0.31) were of relevance to nursing students’moral sensitivity. Academic year was found to be unrelated to moral sensitivity.Discussion and conclusion:These demographic aspects should be considered when designing ethicseducation for nursing students. Future studies should continue to investigate moral sensitivity in nursingstudents, such as if and how various pedagogical strategies in ethics may contribute to moral sensitivity innursing students

BACKGROUND: The ward atmosphere of psychiatric care units has a major impact on treatment and satisfaction for both patients and staff. The Ward Atmosphere Scale (WAS) was developed to capture the ward atmosphere in different psychiatric settings and is a well-established instrument for this purpose. However, there is need for an update and revision of the WAS.

AIM: The aim of the present study was to test a Swedish version of the revised WAS in terms of its internal consistency, content and construct validity, and usability.

METHODS: Data collection took place at four psychiatric wards and 31 patients and 34 staff completed the WAS, as well as content and construct validity questions.

RESULTS: Results showed that the WAS had acceptable to satisfactory internal consistency for all subscales, except for autonomy. Low correlation values between the WAS and the Good Milieu Index were obtained, against which construct validity was discussed. Results of the content validity and usability questionnaires indicate that the WAS is easy to understand and complete, but some of the items were difficult for the respondents to understand and some of the subjects were missing aspects of the physical ward environment.

CONCLUSIONS: The present study confirms that the Swedish version of the revised WAS can be useful for examining the ward atmosphere in psychiatric care. However, more studies are needed in order to further test the psychometric properties of the WAS and the results of the usability questionnaire may indicate a need to use supplementary instruments in order to capture the physical ward environment as well.

BACKGROUND: The nursing staff working in psychiatric care have a demanding work situation, which may be reflected in how they view their psychosocial work environment and the ward atmosphere. The aims of the present study were to investigate in what way different aspects of the ward atmosphere were related to the psychosocial work environment, as perceived by nursing staff working in psychiatric in-patient care, and possible differences between nurses and nurse assistants.

METHODS: 93 nursing staff working at 12 general psychiatric in-patient wards in Sweden completed two questionnaires, the Ward Atmosphere Scale and the QPSNordic 34+. Data analyses included descriptive statistics, the Mann-Whitney U-test, Spearman rank correlations and forward stepwise conditional logistic regression analyses.

RESULTS: The data revealed that there were no differences between nurses and nurse assistants concerning perceptions of the psychosocial work environment and the ward atmosphere. The ward atmosphere subscales Personal Problem Orientation and Program Clarity were associated with a psychosocial work environment characterized by Empowering Leadership. Program Clarity was related to the staff's perceived Role Clarity, and Practical Orientation and Order and Organization were positively related to staff perceptions of the Organizational Climate.

CONCLUSIONS: The results from the present study indicate that several ward atmosphere subscales were related to the nursing staff's perceptions of the psychosocial work environment in terms of Empowering Leadership, Role Clarity and Organizational Climate. Improvements in the ward atmosphere could be another way to accomplish improvements in the working conditions of the staff, and such improvements would affect nurses and nurse assistants in similar ways.

Background: eHealth solutions such as digital decision support systems (DDSSs) have the potential to assist collaborationbetween health care staff to improve matters for specific patient groups. Patients with hard-to-heal ulcers have long healing timesbecause of a lack of guidelines for structured diagnosis, treatment, and follow-up. Multidisciplinary collaboration in woundmanagement teams is essential. A DDSS could offer a way of aiding improvement within wound management. The introductionof eHealth solutions into health care is complicated, and the engagement of the staff seems crucial. Factors influencing andaffecting engagement need to be understood and considered for the introduction of a DDSS to succeed.

Objective: This study aims to describe health care staff’s experiences of engagement and barriers to and influencers of engagementwhen introducing a DDSS for wound management.

Methods: This study uses a qualitative approach. Interviews were conducted with 11 health care staff within primary (n=4),community (n=6), and specialist (n=1) care during the start-up of the introduction of a DDSS for wound management. Theinterviews focused on the staff’s experiences of engagement. Content analysis by Burnard was used in the data analysis process.

Results: A total of 4 categories emerged describing the participants’ experiences of engagement: a personal liaison, a professionalcommitment, an extended togetherness, and an awareness and understanding of the circumstances.

Conclusions: This study identifies barriers to and influencers of engagement, reinforcing that staff experience engagementthrough feeling a personal liaison and a professional commitment to make things better for their patients. In addition, engagementis nourished by sharing with coworkers and by active support and understanding from leadership.

För att få en långsiktigt hållbar psykiatrisk vård krävs satsningar som underlättar för sjuksköterskor att specialistutbilda sig, skriver fyra debattörer.

Context: In service planning, indicators such as incidence can aid the development of strategies for service provision. The current systematic review was carried out to provide a general viewpoint on incidence, geographical and age distribution of gastrointestinal (GI) cancers in Iran.

Evidence Acquisition: A detailed Science Direct, PubMed, Scopus, Google Scholar, Iran Medex, Magiran and SID (scientific information databases) search was made from 2005 to 2015. The basic inclusion criteria were all relevant studies focused on GI cancers incidence and epidemiologic data from Iran.

Results: Overall incidence of cancer was 19.4 and 17.2 per 100 000 in males and females, respectively. The three most common GI cancers in males were: esophagus, stomach and colorectal and in females: colorectal, stomach and esophagus. The highest incidence rate was observed in Golestan province and in the age group over 65 years.

Conclusions: According to increasing incidence rate of GI cancers in Iran, development, establishment and implement of comprehensive national cancer control program should be the first priorities for health policy makers.