Child maltreatment can lead to acute and long-term consequences, and it is important that at-risk children are identified early. Child healthcare (CHC) nurses in Sweden are in a position to identify child maltreatment, as they follow children and their parents from the child's birth to school age. Therefore, the aim was to describe CHC nurses' experiences when encountering families in which child maltreatment was identified or suspected. Individual open interviews with eight CHC nurses were performed and analysed using a qualitative content analysis. Findings revealed that keeping the child in focus, while supporting the family was essential for the nurses. This family-centred approach was assumed to benefit the child's interests. Meeting families where child maltreatment was identified or suspected influenced the nurses, emotionally in different ways. Nevertheless, it was important to keep an open mind and communication build on honesty. Furthermore, the nurses requested professional supervision in order to help them learn from the situation ahead of the next time. This knowledge about CHC nurses' experiences may form a basis for the development of interventions that aim to support the CHC nurses in their professional role, and thereby improve support to children and parents in the future.

Cancerrehabilitering ska vara en integrerad del av svensk cancervård och alla patienter med cancer och deras närstående ska få möjlighet till rehabiliteringsinsatser utifrån sina individuella behov. Försäkringskassans uppdrag är att besluta om och betala ut en stor del av de förmåner som ingår i socialförsäkringen. För att förbättra bemötandet av sjukskrivna personer med cancer, utsågs två handläggare på Försäkringskassan att inrikta sig på sjukskrivna personer med cancer. Dessa två handläggare fick extra utbildning i ämnet, och ett samarbete inleddes mellan Försäkringskassan och cancerrehabiliteringsmottagningen på Centralsjukhuset i Kristianstad. Det övergripandesyftet med studien var att undersöka patienters och medarbetares erfarenheter och upplevelser av Försäkringskassans och Cancerrehabiliteringsmottagningens insatser. Utvärderingens form har teoretiskt inspirerats av metoder som beskriver vikten av att forskningspersoner görs delaktiga i forskning och utvärdering och därmed bidrar till kunskapsutveckling. Datainsamlingen bestod av enkäter och fokusgruppsintervjuer och både kvantitativa och kvalitativa analyser har använts. Slutsatsen är att patienterna är övervägande nöjda med bemötandet från såväl handläggarna på Försäkringskassan och på Cancerrehabiliteringsmottagningen, men att mer insatser krävs för att nå alla patienter.

BACKGROUND: Follow-up for heterogeneous intensive care patients presents challenges for rehabilitation interventions and outcome measurements. The aim was to describe and explore characteristics and determinants for visiting/not visiting a nurse-led clinic (NLC) at different time-points, and to describe physical and mental health (HRQoL) over time.

METHODS: Patients with a length of stay (LOS) of ≥72 hours, discharged from a general intensive care unit 2004-2014, who participated in a six-month follow-up programme offering visits to NLC at two and six months were included. The register study includes information regarding patients' participation in NLC, clinical and demographic data from the Patient Administrative System within Intensive care, and data on two-, six- and 12- month HRQoL by using SF-36 from the Swedish Intensive care Registry.

RESULTS: Of 656 patients, 57% visited the NLC on some occasion. These patients were younger (P=0.000), had lower Simplified Acute Physiology scores (P=0.001) and higher SF-36 physical health domain scores at two months (P<0.05) compared to those not visiting at all. Visitors at two months only were younger, had shorter LOS and higher physical and mental domain scores than patients visiting at six months only. Patients visiting the NLC scored significantly higher in all domains from 2-12 months, whereas non-visiting-patients´ did this in four out of eight domains during the same time frame.

CONCLUSION: Individual patient's characteristics and current health conditions seem to influence visits to NLC or not. The findings may contribute to development of existing routines to match the diversity of patients' needs and life situations.

Aktionsforskning innebär ett möte mellan forskarens och praktikerns kunskapsfält. Det är genom deras samverkan som aktionsforskning sker. Praktiker kan sakna möjligheter och metoder för att synliggöra vardagsarbetet, medan forskare kan sakna att ingå i ett arbetslag och vara en del av en verksamhet. Aktionsforskning förenar praktik med teori och är ett användbart redskap i arbetet med att förändra och förbättra en verksamhet. 

I den här boken ges flera exempel på hur aktionsforskning har använts inom områden som vård och omsorg, t.ex. på en familjecentral eller vid matdistribution till äldre. Författarna ger en teoretisk introduktion till aktionsforskning och visar hur forskningsresultat kan implementeras i den dagliga verksamheten. Boken innehåller också reflektionsfrågor som utmanar läsaren att uppmärksamma både sitt eget arbete och verksamheten i stort och på så sätt hitta möjligheter till förbättring.

Aktionsforskning i vård och omsorg. Tillämpning och teori vänder sig till studerande på avancerad nivå och till yrkesverksamma inom vård, omvårdnad, socialt arbete och social omsorg.

Experiences from indwelling urinary catheter treatment periods were studied. Little is known of what is felt from a male perspective although catheter treatment is a common pre- and postoperative measure for men with prostate cancer and benign prostatic hyperplasia (BPH). Also studied were health-related quality of life (HRQOL) and sense of coherence (SOC). Men with catheter experience (prostate cancer n = 71, BPH n = 37) were selected from a larger questionnaire study. Assessment was made with study-specific questions together with the QLQ C-30 assessing HRQOL and the SOC questionnaire measuring sense of coherence. Data reduction method was applied to study specific variables to determine problem patterns. Correlation between HRQOL and SOC was determined. Results showed similar problem patterns in men with prostate cancer and BPH: discomfort in wearing catheter (e.g. uneasiness 48.2%), practical and psychosocial difficulties in handling and wearing catheter (e.g. attaching catheter 32.4%) and discomfort at installation (e.g. pain 29.7%). There was lack of knowledge about wearing and practical handling of the catheter. Having a cancer diagnosis did not add to uneasiness or practical problems. Life quality was correlated to SOC (p ≤ 0.001).

Prostate cancer is the most common cancer among men in Sweden, and treatment is negatively affecting the patients' quality of life. Even so, long term experiences are sparse and implications for nursing practice are little known. The aim of this study was to determine areas of functioning and factors impacting quality of life, QOL, during and five years after radical prostatectomy (RP) using a quality of life questionnaire and a specific module for prostate cancer. A longitudinal study was performed with consecutively included Swedish men from baseline and after RP treatment (n=222) from 2003 to 2011 to obtain their opinions on quality of life. Data was gathered through a mail out - mail in procedure at baseline, 3 months, 1-3 and 5 years after treatment with a response rate of 94.14% - 75.2%. One reminder was sent on each occasion. Identified areas with increased functioning after five years were emotional and social functioning. QOL ratings did not change over the years. Sexual activity and functioning decreased and hormonal treatment-related symptoms increased. Impact on QOL was found regarding emotional and social functioning, nausea/vomiting, pain and hormone-related symptoms. Increasing age, living with a partner and educational level had no significant impact on QOL. Implications for nursing are to initially focus on physical problems and at times for follow-up visits pay attention also to emotional and social aspects of life. To be able to make a difference in the patient's life, nurses need to bridge the gap between in-hospital treatment and everyday life outside hospital.

After a major cutback in the budget and staffing of a surgical clinic in southern Sweden there was intervention to improve the quality of nursing care and to evaluate the outcome. The intervention consisted of the implementation of: (1) nursing care organized in such a way that it would secure continuity of the nurse—patient relationship, (2) individually planned care by means of diagnostic reasoning, and (3) quality assurance for aspects believed to be connected with quality of care. Patient satisfaction before and after the intervention was assessed by means of a patient questionnaire survey (May 1991; n = 105 and May 1992; n = 137). Patient satisfaction improved significantly in variables related to nursing care viz. overall satisfaction and satisfaction with information and decision making; satisfaction with contact and staff-patient relationship; ward facilities and physical treatment or examinations; and satisfaction with physical nursing care. The results were interpreted to mean that the intervention may have counteracted any negative impact the reduced budget might have had such as the higher patient turn-over and the shorter in-patient periods, and thus seemed to have improved the quality of the nursing care in terms of patient satisfaction.

PURPOSE:

The purpose of this paper is to study patients' attitudes to nurses and investigate what hampering factors occur in the actual nursing situation and what patient features might affect cooperative climates.

DESIGN/METHODOLOGY/APPROACH:

In-depth interviews were conducted with 11 male inpatients suffering prostate cancer. The interviews were personal narrations based on open-ended questions. The theoretical basis is founded in sense-making, trust and competence.

FINDINGS:

Existential issues related to nursing care were interpreted by nurses as a need for (technical) information. However, respondents indicated a need for professional support regarding their whole life. The social climate seems not to be optimal for existential talk owing to hospital routines. Patients' personal traits also affect the propensity to cooperation, and three types were distinguished: cooperating patients; passive patients; and denying patients. Nurses' competence may be regarded as hierarchical levels from optimising single items, over system optimisation and to optimisation from the patient perspective. The study indicates that not even first-level requirements are met.

RESEARCH LIMITATIONS/IMPLICATIONS:

Only patients' views were studied. Nurses' perceptions would add additional insights. Lack of personal relations and cooperation between patient and nurse may decrease service quality. Patient attitudes seem to be a major obstacle. For some patients, passively receiving technical information may be an excuse for not wanting to participate in mutual sense-making. The supposed need for technical information may also be an excuse for nurses to avoid more sensitive issues.

ORIGINALITY/VALUE:

Better quality of care involves changing patient perceptions and attitudes to what constitutes nursing competence.

Purpose - Purpose - To study how changing information routines might influence patients’ service quality perceptions. A secondary aim was to test an instrument’s everyday feasibility for healthcare quality assessment.

Design/methodology/approach - Patients often show high grade satisfaction with general care although they display dissatisfaction with information they receive. A questionnaire survey is used to establish pa-tients’ satisfaction with an intervention consisting of introducing standardized guidelines for nursing performance and information provision. Patient satisfaction was assessed through a standardized questionnaire: ‘Quality from the Patient’s Perspective’ (QPP). A cross sectional interventional survey was applied to patients from gynaecological and haematological wards (n=71). A comparison group was used (n=67). Patients were given the questionnaire when their diagnosis was confirmed, after six months and 12 months. Data were collected succes-sively over 36-months.

Findings - Findings - The study group showed an increased satisfaction with information from nurses (p=0.001) but not physicians. However, patients tended to put greater emphasis on socio-cultural issues than information and some kind of cooperation seemed to represent high qual-ity from the patient’s perspective.

Research limitations/implications - Limitations – Successively lower response rate, mainly owing to cancer patients’ deteriorating medical conditions.

Practical implications - Implications for research, practice and/or society –The study seems to verify the concor-dance model’s relative merits and that the softer side of care appears to be more important to patients than specific improvements regarding information

Originality/value - Value - Result confirm that patients’ satisfaction with information had implications for overall quality; but social issues seemed more important and enhancing quality is best achieved through participation and cooperation.

The aim of the study was to investigate men with prostate cancer and benign prostatic hyperplasia (BPH) in comparison with men from the general population in aspects of presence and frequency of micturition problems in remembrance of prior to treatment and currently. Further, the aim was to investigate the impact of micturition problems on quality of life and the association with micturition problems, and quality of life and sense of coherence (SOC). The samples consisted of 155 men with prostate cancer, 131 with BPH, and 129 from the general population. Micturition problems were assessed with study-specific questions, modified International Prostate Symptom Score (IPSS), quality of life questionnare (QLQ C-30), and SOC questionnaires. Parametric and nonparametric statistics were applied. Most troublesome urinary problems were leakage, feelings of discomfort, and disrupted urinary function and frequency. Men with urological diagnosis had more micturition problems, fatigue, and sleeping difficulties than men from the general population, but the cancer diagnosis did not add to the problems. Role and social functioning (prostate cancer), emotional functioning (BPH), and grade of fatigue (general population) showed itself vital for overall quality of life. Thus, help in solving issues of micturition problems, fatigue, and sleeping disturbances may contribute to maintenance of role, social, and emotional aspects of life.

• In a questionnaire study, men with prostate cancer (n=155) or benign prostatic hyperplasia (n=131) identified more sexual problems than did men from the general population (n=129). Sexual dysfunction was acknowledged regarding sexual pleasure and attraction, erectile function and sexual satisfaction and sexual performance.

• Lowered rates of sexual desire, pleasure and attraction were found when comparing their situation in recollection of pre-treatment situation to the current situation. Lower intercourse frequency and sexual satisfaction were also found.

• Medication, masturbation and artificial aids to achieve erection were not used as substitutes for shortcomings of erectile function either by men with prostate cancer and benign prostatic hyperplasia nor by their partners.

• There seemed to be a lack of information about the illness and treatment consequences for sexual life, including what physical dysfunction to expect after surgery and also what possible help to expect to compensate for the shortcomings.

The purpose of the study was to to describe which factors of health related quality of life were associated with a high sense of coherence in a 5 year perspective. The sense of coherence, SOC-scale, EORTC QLQ C-30 and PR 25 questionnaires were applied to a sample of 222 men at baseline and over 5 years following radical prostatectomy. Result showed significant association to SOC in psychological aspects (emotional and cognitive functioning, p=<0.00-0.04 respectively 0.04) and for hormone treatment related symptoms (i.e. manhood p=<0.05). High SOC was associated with quality of life (index) in the early post treatment period and to aspects of general functioning (role-, emotional- respectively cognitive) in year 3 and 5. High sense of coherence was interpreted to be a health resource for experiencing life quality connected to different aspects at different time points of the data collection. The result showed stability in SOC and QoL scoring over 5 years.

BACKGROUND: Knowledge of experiences from prostate cancer is sparse in a longitudinal perspective. From a nursing perspective, results from combined qualitative and quantitative studies are lacking however would present the broadest knowledge base for best practice. Present descriptions of medical-physical symptoms such as urinary, bowel and sexual dysfunction from quantitative inquiries need be complemented with qualitative results. Such knowledge is essential in relation to treatment and communication with patients over the years and not only shortly after surgery.

METHODS: A longitudinal study was formatted to investigate general and specific health quality and sense of coherence quantitative alterations over three years. A general health quality module (EORTC QLC-C30) and a disease-specific module (EORTC PR-25) were applied for the longitudinal study together with the Orientation to life questionnaire (SOC), measuring a persons' sense of coherence. In order to strengthen reliability and compensate for low participation we used the Directed content analysis for interviewing and analysis. The method allows using findings from earlier research when interviewing along with detecting new areas. Twenty-one men were followed over three years and six of them, in the third year, accepted to be interviewed.

RESULTS: We found high quality of life ratings and extended the study with follow-up interviews in year three, to investigate whether questionnaire results were in line with interview findings. We found high life quality and functioning ratings that were in line with qualitative descriptions. Interview analysis showed retrieval of life as lived before, yet in a different way, the men never forgot the diagnosis event, had a unique illness history worth hearing, and had come to terms with most treatment-related shortcomings. Sense of coherence ratings were medium to high and confirmed stability over time in comprehensibility, manageability and meaningfulness after prostate cancer treatment.

CONCLUSIONS: Over the years, the men's negative experiences from shifted into 'a good life' though in a different way than before. The interpretation is supported in the study by quantitative results showing a high degree of functioning. The men's sense of coherence seamed to support their handling of life three years after prostate cancer treatment.

Eleven men with prostate cancer were randomly chosen and interviewed during an in-patient period at a southern Swedish hospital. The interview focused on functional health status in relation to daily life and life quality. In addition the sense of coherence scale was used, as well as the European Organization or Research and Treatment of Cancer (EORTC) QLQ C-30 questionnaire. The interview findings were analysed from a phenomenological-hermeneutic perspective and interpreted within the concept of transition. The entry to transition was marked by the men when experiencing an altered life continuum in terms of physical and existential fatigue, pain, micturition problems and an altered sex life. The passage phase was marked by descriptions of a new lifestyle where hope was a central internal resource, creating a positive illusion of life in order to endure. Their external resources were wives and family who supported physically (household matters, gardening) and psychologically (comfort, encouragement). The exit phase meant continuously adapting to a new life style, living with a slowly deteriorating functional health status, a new sense of dependency on others, daily life routine broken by in-patient hospital periods and contacts with primary health care. Thus the findings pointed more at continously facing new passages than a stable exit, i.e. an ongoing transition. The areas of life imbalance described may serve as a basis for care assessment and intervention as well as supplying support of the transitional process.

Men with prostate cancer (n=25) were interviewed, focusing on experiences of micturition problems, indwelling catheter treatment and sexual life consequences. Narrations were found to be practical and technical descriptions rather than emotional, and experiences were described with reduction and negligence regarding personal well-being and the impact of problems. Phenomenological-hermeneutic analysis was used and findings ordered in subthemes and themes of meaning. Micturition problems, catheter treatment and sexual life problems were all phenomena that radically affected the clients’ autonomy and life quality and changed the life continuum. Impact from the disease was either accepted or not and related to what had already been borne in life. Experiences were linked together, each of them giving rise to feelings of physical deterioration and fear of ridicule, and hidden from others. Maintaining self-image and social role was important and connected with the degree of perceived deprivation of life content. Responsibility for medical decisions was left to professionals while everyday problems with micturition, catheters and sexual life were regarded as the men’s sole responsibility. Findings were interpreted to mean that comparing the personal situation with that of others worse off made the life situation look better. The clinical implication of this study was that because the men came forward with their problems when given time to talk in their own way these areas should be given time and interest in the nursing care. Interpretation did not provide a unified picture of problems. Thus, nurses will have to seek men’s individual experience actively and give legitimacy to patients’ problems by opening up opportunities to speak about otherwise concealed problems. Then it may be possible to provide solutions that may ease the men’s burdens.

Men with prostate cancer (n = 11) were interviewed during an in-patient period at a urological clinic, about their experiences of met and unmet needs from health professionals. Their perception of quality of life and sense of coherence were also assessed. The findings were analysed from a phenemenological-hermeneutic perspective and interpreted within the concept of transition. It was interpreted that objective functional health needs were mostly met by health professionals and subjective existential needs were mostly not met. The analysis revealed patients as passive or active receivers of care. Passive receivers were explicitly and implicitly stating unmet needs, or explicitly stating satisfaction with nursing care at the same time as implicitly contradicting, referring to their needs as bagatelles, unimportant, whereas active receivers talked about their needs explicitly with the staff and did not state implicit unmet needs. This suggests that nurses need to be aware of and have sensitive ears to undertones in statements and actively seek for patients' needs. The most important nursing care areas seemed to be to provide solutions to physical problems together with staff support including information, and acting to increase confidence in staff and staff availability. This encourages patient, wives and families, in cooperation, towards a healthy exit of transition.

PURPOSE:

To describe Swedish men's experiences of becoming fathers to their preterm infants.

DESIGN:

A cross-sectional descriptive study.

SAMPLE AND METHOD:

Eight men participated in semistructured interviews with open-ended questions. The interviews were analyzed using manifest and latent content analysis.

MAIN OUTCOME VARIABLES:

The concepts of control and noncontrol.

RESULT:

The manifest analysis of the interview text produced six categories: concern, stress, helplessness, security, support, and happiness. The latent content interpretation indicated that the concepts of control and noncontrol were relevant to the fathers' experiences. The men's experiences of early fatherhood were influenced by their ability to experience control. When concern, stress, and helplessness dominated the fathers' experiences and coincided with low levels of happiness, support, and security, they experienced noncontrol. Conversely, when they experienced support, security, and happiness, they felt that they were in control and able to handle the situation.

Background: Patients who repeatedly seek care directly at hospital based somatic emergency

departments take up a large proportion of health care resources, at the same time they appear to experience low satisfaction with the care they receive. The purposes of this pilot study were to describe: I) the development of a team model for taking care of frequent visitors to a somatic hospital based ED; II) Eventual changes, over six months, in costs and patients’ health care utilization related to pilot testing the model and III), the team’s experiences of implementing the model.

Methods: A mixed method convergent parallel design was used.

Results: The development of the model began as a top-down process and later on into a bottom-up approach once the inter-professional team became involved. The new model functioned as a support for all 12 patients included in the study and collectively their visits decreased by a total of 73 visits (55%).

Conclusion: The inference quality description is that a management induced project may be accepted and actively applied when those involved experience freedom to structure the project. Increased communication between different professionals within the hospital and between different caregivers such as ED, primary health care and community social- and health-care, increases the possibility for the patients to be cared for in a sustainable and non-fragmented way.

Patients who repeatedly seek care directly at hospital based somatic emergency departments take up a large proportion of health care resources, at the same time they appear to experience low satisfaction with the care they receive  The purposes of this pilot study were to describe: I) the development of a team model for taking care of frequent visitors to  a somatic hospital based  ED; II) Eventual changes, over six months, in costs and patients’ health care utilization related to pilot testing the model and III), the team’s experiences of  implementing the model. A mixed method convergent parallel design was used. The development of the model began as a top-down process and later on in the process into a bottom-up approach once the inter-professional team became involved. The new model functioned as a support for all 12 patients included in the study and collectively their visits decreased by a total of 55%. The inference quality description is that such a management induced project may be accepted and actively applied when those involved experience freedom to structure the project. The freedom of being able to structure the model led to steps being taken that were beyond the project’s original limitations.

Introduction: The study explored cultural diversity in nursing teams and the internal and external conditions under which cultural differencesrepresent an asset or a liability for these teams.

Methods: A qualitative design with content analysis was employed. In total, 18 interviews were conducted with nurses and assistant nurseswith experience of working in culturally diverse teams in three distinct clinical settings.

Results: Three domains emerged in the study analysis: triggers, team process and contingencies. Each one encompassed a number of themesrelated to culturally diverse nursing team processes, triggers of team processes and context-specific contingencies, which represent the complexityof culturally diverse nursing team functioning.

Discussion/implications: The study suggests how cultural differences in nursing teams can be managed and further explored from within theteam and by individuals leading those teams, taking into account the disablers and enablers of their functioning.