Purpose: To explore and compare cancer patients' perceptions on the quality of nursing care in four European countries. Methods: Data were collected in Cyprus, Finland, Greece and Sweden. The sample comprised 596 hospitalized cancer patients. The quality of nursing care was measured using the "Oncology Patients' Perceptions of the Quality of Nursing Care Scale" (OPPQNCS). Patient characteristics were also collected. Analysis of variance was used to examine the effects of country on the perceptions of the quality of nursing care. Results: Patients' age ranged from 18 to 86 years, and 58% were male. The comparison of cancer patients' perceptions regarding the quality of nursing care between the four countries showed a statistically significant difference in the total OPPQNCS scores (p <0.001) as well as in the subscales responsiveness (p <0.001), individualization (p<0.001), co ordination (p<0.001) and proficiency (p<0.001). The Cronbach's alpha coefficient for the OPPQNCS ranged between 0.89 and 0.95. A multivariate analysis of variance for the OPPQNCS controlled by respondents' demographic characteristics revealed that only the patient's country was significantly related with the patients' perceptions of quality care. Conclusion: Quality of nursing care as perceived by cancer patients was high, but differed between the four countries. The impact of the clinical status of cancer patients on the quality of nursing care and managerial factors such as staffing/nursing care delivery models that influence the ability of nurses to offer high quality care should also be explored by more focused studies.

The aim of this study was to describe health care- and social service professionals' experiences of a quality-improvement program implemented in the south of Sweden. The focus of the program was to develop inter-professional collaboration to improve care and service to people with psychiatric disabilities in ordinary housing. Focus group interviews and a thematic analysis were used. The result was captured as themes along steps in process. (I) Entering the quality-improvement program: Lack of information about the program, The challenge of getting started, and Approaching the resources reluctantly. (II) Doing the practice-based improvement work: Facing unprepared workplaces, and Doing twice the work. (III) Looking back--evaluation over 1 year: Balancing theoretical knowledge with practical training, and Considering profound knowledge as an integral part of work. The improvement process in clinical practice was found to be both time and energy consuming, yet worth the effort. The findings also indicate that collaboration across organizational boundaries was broadened, and the care and service delivery were improved.

The aim of this study was to assess the reliability and validity of the Swedish version (HHI-S) of the Herth Hope Index (HHI), developed by K. Herth. The HHI-S is a 12-item Likert scale, arranged with scores from 1 to 4, where 1 is 'strongly disagree' and 4 is 'strongly agree'. The HHI-S together with the Miller Hope Scale (TMHS) and Beck's Hopelessness Scale (HS-S) were distributed to 85 adults, 40 patients with cancer in palliative care and 45 family members to patients with cancer in palliative care, recruited from four different in- and out-patient oncology clinics. The result showed an internal consistency alpha coefficient of 0.88 for the HHI-S. Concurrent criterion-related validity was assessed by correlating the HHI-S with the TMHS (r = 0.82) and the discriminant validity was assessed by correlating the HHI-S with the HS-S (r = −0.69). A varimax-rotated principal component factor analysis was performed and identified two factors; reconciliation with life situation and religiosity. Although the instrument shows sound reliability and validity, it should be used with care in clinical palliative care settings, because of linguistic, conceptual and cultural difficulties when transferring the instrument into Swedish. The result demands the work of developing an instrument measuring hope, based in the Swedish culture.

Hope, hopelessness and fatigue are important experiences for patients and family members in palliative care. The aim of the study was to describe the level of and relation between hope, hopelessness and fatigue in patients and family members in palliative care. Eighty-five participants completed the Herth Hope Index, Beck's Hopelessness Scale and rated their level of fatigue from none to severe. The level of hope proved to be significantly lower among the family members than among the patients. For the family members, correlations were found between hope and age (–0.358*), fatigue and hope (–0.439*), hopelessness and age (0.484**), age and fatigue (0.403**) and between hope and hopelessness (–0.723**). For the patients, correlations were found between age and hopelessness (0.555**) and between hopelessness and hope (–0.580**). Efforts to increase the experience of hope and decrease hopelessness and fatigue must include not only the patient but also the family members. (*=P<0.5, **=P<0.01).

This article describes the development and testing of a research instrument, Families' Importance in Nursing Care-Nurses' Attitudes (FINC-NA), designed to measure nurses' attitudes about the importance of involving families in nursing care. The instrument was inductively developed from a literature review and tested with a sample of Swedish nurses. An item-total correlation and a first principal component analysis were used to validate the final instrument, including a second principal component analysis to analyze dimensionality, and Cronbach's alpha was used to estimate internal consistency. The instrument consists of 26 items and reveals four factors: families as a resource in nursing care, family as a conversational partner, family as a burden, and family as its own resource. Cronbach's alpha was 0.88 for the total instrument and 0.69 to 0.80 for the subscales. The instrument requires further testing with other nurse populations.

Objective

The purpose of this study was to explore licensed practical nurses’ (LPNs’) views of being exposed to secondhand smoke in municipal home nursing care.

Design and sample

Using a qualitative approach, data were collected through three focus group interviews with 15 LPNs, smokers, and nonsmokers. Qualitative content analysis was used to interpret the interview text.

Results

Exposure to secondhand smoke during working hours, which presents a risk to the health and wellbeing of the LPNs, is a consequence of placing the interests of the smoking care recipients first and the employers’ reluctance to take action on behalf of the LPNs. These factors prompted LPNs to propose solutions aimed at resolving a major dilemma in routine home nursing care.

Conclusions

A combination of actions, particularly by managers, is required to improve the working environment for LPNs while concurrently respecting the care recipients’ right to take decisions in their own homes.

There are few investigations of the type and the outcome of interventions aimed at supporting nurses caring for psychiatric patients. Therefore a prepost–test design study was used in which 22 psychiatric nurses, on a general psychiatric ward were examined before, during and after one year of systematic clinical supervision combined with supervised documented, planned, individualized care. The methods used were the Sense of Coherence scale (SOC), the Creative Climate Questionnaire (CCQ), the Work-Related Strain Inventory and 34 statements from the Satisfaction with Nursing Care and Work Questionnaire (SNCW). In addition 14 statements were developed to evaluate the nurses' view of the effects from clinical supervision. The baseline values for the CCQ indicated a stagnant organization and a high score in the conflict dimension indicated personal and emotional tensions within the organization. The intervention led to a significantly increased creative and innovative climate in the dimensions for trust, idea time and reduced conflicts. However, the organizational climate remained stagnant. The nurses' view of the effects from clinical supervision also increased significantly. There were no significant changes in the nurses' SNCW, WRSI or SOC score. The result of the correlation analysis indicated that a strong sense of coherence was related to low work-related strain but not to unsatisfactory working conditions/milieu. The results gave some support to the idea that systematic clinical supervision and supervised nursing care plans constitute one type of support strategy that improves creativity and the organizational climate. It may, not, however, buffer for interpersonal problems. Further research is required to explore the need for and effects of various support systems depending on the circumstances in the organization.

To reveal the meaning of being a nurse working with inpatient care on a team psychiatric ward in Sweden, 22 psychiatric nurses were interviewed and the transcribed texts were analysed by means of latent content analysis. Three themes emerged from the analysis: developing a working relationship with the patient in everyday caregiving; encountering and handling the unforseeable in daily living; and struggling with professional independence and dependency. Developing a working relationship with the patient in everyday caregiving meant that the nurse–patient relationship was the foundation of the caregiving and included being with, as well as doing for, and with, the patient. Four different approaches in daily caregiving were revealed: networking, teaching, containing and protecting. The nurses' approaches in the nurse–patient relationship alternated between being an 'expert' and a 'collaborator'. Encountering and handling unforeseeable situations meant that the nurses were exposed to and had to be prepared for unpredictable situations where they were on their own, handling sometimes strong emotional reactions and relying on their own ability to act. Struggling with professional independence and dependency meant that the nurses seemed to lack professional confidence, although they had many responsibilities, but also less authority to decide about overall care planning. Contextual aspects such as organizational hindrance, unsatisfactory work-environment and co-operation difficulties were illuminated. The result indicates the need for a stable and predictable organizational structure if nurses are to manage the demanding nurse–patient relationships that everyday caregiving requires. A question highlighted by this study is whether multidisciplinary team organization has been effectively developed in Sweden, as uncertainty about the roles and responsibilities of nurses was apparent.

By interviewing 22 psychiatric nurses, the present study aimed to reveal the meaning and significance of systematic clinical group supervision and supervised individually planned nursing care, using latent content analysis. The interpreted meaning was 'confronting the complexity of ongoing life in daily nursing care' and the interpreted significance was 'strengthening the foundation for nursing care'. Reflection on action and confirmation seemed to be core components in the process of clinical supervision. Focusing on the relational and task aspects in nursing care within a group approach may have contributed to the positive experiences of development that occurred.

In this study the aim was, through interviews, to disclose 13 nurses personal knowledge about the patients, themselves, and care provision, using a phenomenological-hermeneutic analysing method. Caring for people with severe dementia meant an intertwined life world emanating from making and doing together and the delicate interpretative work that the care provision required. The intertwined life world consisted of the interaction between the nurses and the patients separate lives, their common life and the environment, culminating in mutual dependency. Making together signifies the relationship being based on the nurses knowledge and skills as nurses i.e. the task they had to perform. Doing together signifies the relationship being based on the oneness of the nurses and the patients with severe dementia as ordinary human beings. The delicate interpretation process required, to adapt care to the individual patient, was based on knowledge about the patients personality, life history and disease progression in combination with the nurses interpretation of the current situation. The nurses searched for meaning and that, in turn, meant that the patients inner world was determined by the nurses and thus the patient was seen as being in their hands. It seems important to further understand the human aspects of both the nurse and the patient and to examine this dynamic, ongoing, vulnerable interpretation process, critically, in order to achieve high quality nursing care for the patients with severe dementia, and an experience of well-being in nurses everyday working lives.

This exploratory study compares orthopaedic nurses’ perceptions of individualised nursing care with previously published orthopaedic patients’ perceptions. Orthopaedic nurses (N = 243) from one university, two central and two county hospitals working within in-patient care were surveyed using the Individualised Care Scale-Nurse (ICS-Nurse) in 2009 (response rate 74%, n = 180). The data were analysed using both descriptive and inferential statistics. About 60% of the nurses stated that it was very important that the care provided is individualised in comparison with 86% of the patients as previously reported (p-value <0.001). The highest rated assessment of individualised care was the clinical situation and the lowest the personal life situation which is in line with the patients’ experiences. This result demonstrates the need of managers in healthcare organisations to redouble their efforts in the implementation of individualised care by investigating nurses’ contemporary beliefs about, and forces that hinder the provision of individualised nursing care.

Aim The aim of the study was to explore the theoretical perspectives in use by approved clinical nursing supervisors in Sweden.

Background. For the time being, we know little of the theoretical perspectives in use on a daily basis by the clinical nursing supervisors in Sweden.

Methods. A questionnaire (n = 49) and follow-up telephone interviews (n = 14) were used. Data analysis was made by descriptive statistics and qualitative content analysis.

Results. The result from the questionnaire showed that the supervisors often used and combined different theoretical perspectives with origins in nursing, education and psychology. Surprisingly, one-fourth of the respondents did not state any nursing theoretical perspective in use during clinical nursing supervision. The result from the interviews revealed that the theory of Katie Eriksson (1987) was the most commonly used nursing perspective.

Conclusion. As the overall aim for clinical nursing supervision is to improve nursing for the patient/family, the supervisor's competence in nursing is essential. Given this fact, and that only three-quarters of the approved clinical nursing supervisors stated a use of theoretical nursing perspective when supervising, there is obviously a need for further investigations in this area. In addition, there is also a need for approved Swedish clinical nursing supervisors, to further become aware of the theoretical perspective in use that supports their clinical nursing supervision. Clinical nursing supervision is a multifaceted activity that needs to be supported by different nursing theoretical perspectives including physical, emotional, intellectual, spiritual as well as socio-cultural aspects.

Samhället ställer ökade krav på uppföljning av hälso- och sjukvårdens kvalitet. Individualiserad vård anges som något av det mest centrala i vården och omvårdnaden av patienten (ICN, 2006) och betonas i olika policy- och kvalitetsdokument både nationellt och internationellt (Nilsson, 2005, OECD, 2004). I närsjukvårdsprofileringen och utvecklingen som redovisats för Nordöstra Skåne betonas att vården skall utgå från patientens behov (Region Skåne, 2003) och innefatta utveckling av nya vård- och behandlingsformer där patienten och närstående står i fokus. Behovet av vård och omvårdnad och dess utförande varierar då en patient blir inlagd på sjukhus och det är viktigt att beakta att patienten och dennes närstående kan känna sig sårbara och utsatta (Hälso- och Sjukvårdsrapporten från 2001). Utvärderingar som belyser ett helhetsperspektiv på vårdtagarna är viktiga och måste innehålla både medicinska- och omvårdnadsdata. I föreliggande rapport är det det omvårdnadsperspektivet som står i centrum.

The aim of the study was to describe orthopaedic patients’ assessments of howindividuality in patient carewas supported during specific nursing interventions and how that individuality was perceived during hospitalisation. Orthopaedic inpatients (370) fromtwo central county and two county hospitals in Sweden were surveyed using the Individualised Care Scale (ICS) during 2004/2005, (response rate 74% n = 274). The data were analysed using both descriptive and inferential statistics. Eighty-six percent of the respondents stated that it was very important to be treated as an individual or unique person and 59% experienced this type of care. The lowest rated assessments concerned the personal life situation and the highest were concerned with the clinical situation and the decisional control over care. This analysis of patient assessments of individualised nursing care can be used to implement changes to individualise care processes in orthopaedic wards. This will be useful in the evaluation of health care quality improvement, planning and personnel management.

AimTo reveal 13 nurses' experiences of systematic clinical group supervision and supervised individually planned nursing care, while working with people suffering from severe dementia.

BackgroundClinical supervision is a major issue in nursing, however empirical knowledge of the subject is limited. Nurse's narrations about their experiences may extend the knowledge available and serve as a basis for creating models of support systems for nurses in their care provision.

MethodsOpen-ended interviews were performed and the text was analysed through content analysis. A questionnaire was used to evaluate the views of the effects of clinical supervision.

FindingsTwo main themes were found. Confirmed uniqueness included two sub-themes: confirming the nurses as a person and as a professional and confirming the patient as a unique human being. Consolidated sense of community included three sub-themes: closer relationship between the nurses, changed organization of nursing care and improved individualizing in routines of nursing care. The questionnaire result showed improvements in co-operation and in providing professional nursing care and personal development.

ConclusionInterventions to improve working conditions for the nurses and care quality for the patients may well focus the core process, i.e. feedback and support for the nurse–patient interaction and person-orientated nursing care, taking into account the constellation and conditions of the group.

The aim of this study was to study creativity and innovative climate, tedium and burnout among the nurses on two wards during 1 year of systematic clinic supervision combined with the implementation of individualized care on an experimental ward (EW) for severely demented patients, as compared with a similar control ward (CW) EW nurses had systematic clinic supervision and each patient had his/her nursing care carefully planned, documented and evaluated The intervention was evaluated by means of the Creative Climate Questionnaire, Burnout Measure and the Maslach Burnout Inventory Creativity and innovative climate improved significantly among the EW nurses (n= 19) in eight out of 10 factors during the year of intervention while there was no change on the control ward (n= 20) Tedium and burnout decreased significantly among the EW nurses while no change was seen in this respect among the CW nurses It seems reasonable to assume that systematic clinical supervision and individualized planned care decreases the negative outcome of stress caused by the psychological burden imposed by nursing care It also increases nurses' creativity, which, in turn, may benefit patient care The findings of this study point to the necessity for a support system that focuses on the work itself, i e the nursing care Individualized planned care and systematic clinical supervision may offer this kind of support.

Aim. To describe the characteristics of health promoting contacts with health professionals as encountered by individuals with head and neck cancer. Background. Head and neck cancer has a profound and chronic impact on the individual's everyday life, e.g. physical problems that hinder speaking, breathing, eating and drinking. Furthermore, fear and uncertainty can lead to long-term psychological and psychosocial problems. The National Institute of Public Health in Sweden advocates that all care contacts should improve the quality of the individual's health. Design. A qualitative descriptive and explorative design was used. Eight participants were interviewed in the year 2005 and a qualitative thematic content analysis of the data was performed. Findings. Health promoting contacts were defined as contacts where health care professionals contribute positively to the well-being of individual patients. Characteristics include being available, engaged, respectful and validating. Three themes were identified: being believed in one's illness story; having a working relationship with health professionals and receiving individualised, tailored care. Conclusions. Health promoting contacts were experienced mainly during the treatment phase, when patients had daily contact with specific, qualified health professionals. Although the interview questions focused on health promoting contacts, nearly half of the contacts were experienced as not health promoting. Feelings of abandonment were particularly manifested before and after treatment. The starting point for achieving health promoting contact lies in understanding the patient's lifeworld in relation to health, illness and suffering and focusing on the individual's personal strengths and health resources. Relevance to clinical practice. The findings highlighted the importance of ensuring that patient interests and concerns are core considerations in health care. The participants viewed continuing individualised, tailored care and access to ear, nose and throat healthcare professionals as highly important.

The aim of this study was to shed light on health promotion from the perspective of individuals living with head and neck cancer. Eight informants were interviewed and latent content analysis was used. Individuals living with head and neck cancer experienced many problems that had a negative impact on their health. One overarching main theme was demonstrated; the ability to regain control and empower oneself. Three themes emerged: (1) Being enabled by dialogue with one's inner self, including three sub-themes: transformed and improved self-esteem, recognising and embracing existentiality, and increased self-determination. (2) Being enabled by means of contact with a social network, including two sub-themes: emotional support and practical support. (3) Being enabled by means of contact with and a passion for the environment, including two sub-themes: nature, hobbies and activities. Empowerment, the goal of health promotion, was understood as an ongoing process, and the ability to promote health varied and was dependent on internal and external enabling of acting and doing. The interpretation of this ongoing process demonstrates interplay assisted by a dialogue with one's inner self, contact with a social network and a passion for the environment. Altogether, these findings may inspire nurses and other health care professionals to support the individual's empowerment process and pose non-pathology-oriented questions such as "what improves your health?" or "what makes you feel good?"

Aim. To illuminate what it means to live with head and neck cancer.

Background. Patients could experience head and neck cancer as more emotionally traumatic than other cancers because of visible disfigurement and its life-threatening impact on vital functions. This long-term illness often leads to lifestyle changes such as to physical function, work and everyday tasks, interpersonal relationships and social functioning.

Design. This study used a qualitative and explorative longitudinal and prospective design with semi-structured interviews and open-ended questions. Twenty-one interviews were conducted with six participants with newly diagnosed or newly recurrent head and neck cancer. The analysis was descriptive and interpretive.

Findings. The participants were living 'in captivity' in the sense that their symptoms were constant reminders of the disease. Our findings also revealed existential loneliness and spiritual growth, as interpreted within six themes: altered sense of affiliation; hostage of health care; locked up in a broken body, but with a free spirit; confined in a rogue body, forced dependency on others, and caught up in a permanent illness trajectory.

Conclusions. Living with head and neck cancer involves emotional and existential vulnerability. The participants and their next of kin experienced insufficient support from health services and inadequate coordination between phases of their lengthy illness trajectory. These findings call for changes in oncological rehabilitation and management. Patient care must take a holistic view of everyone involved, centring on the individual and the promotion of health. A care coordinator could navigate between the individual patient needs and appropriate health services, hopefully with results that lessen the individual's emotional and existential confinement.

Background: Providing high quality nursing care for patients with malignancies is complex and driven by many factors. Many of the associations between nursing care quality, trust, health status and individualized care remain obscure. Objective: To empirically test a model of association linking hospitalized cancer patients' health status, nursing care quality, perceived individuality in care and trust in nurses. Design: A cross-sectional, exploratory and correlational study design was used. Settings: This multi-site study was conducted in cancer care clinics, in-patient wards of five tertiary care hospitals in Cyprus, Finland, Greece and Sweden. Sample: Out of 876 hospitalized patients with a confirmed histopathological diagnosis of cancer approached to participate in the study in consecutive order, 599 (response rate 68%) agreed to participate and the data from 590 were used for path analysis. Methods: Data were collected in 2012-2013 with the Individualized Care Scale-Patient (ICS-Patient), the Oncology Patients' Perceptions of Quality Nursing Care Scale (OPPQNCS), the Euro-Qol (EQ-5D-3L) and the Trust in Nurses Scale. Data were analysed statistically using descriptive and inferential statistics. Mplus version 7.11 was used to determine the best Trust model with path analysis. Results: Although the model fit indices suggested that the hypothesized model did not perfectly to the data, a slightly modified model which includes the reciprocal path between individualized care and nursing care quality demonstrated a good fit. Conclusion: A model of trust in nurses was" developed. Health status, individualized care, and nursing care quality were found to be associated with trust. The model highlights the complexity of caring for cancer patients. Trust in nurses is influenced by the provision of individualized care. Generating and promoting trust requires interventions, which promote nursing care quality, individuality and patients' health status. 

Resultatet visar på betydelsen av att utveckla dokumentationen i skolhälsovårdsjournalen till såväl struktur som innehåll och med särskild betoning på den psykosociala hälsan. Resultatet visar även på betydelsen av att utveckla metoder och pröva modeller för att förbättra organisation och samverkan.

This study examines the effectiveness of therapeutic conversations with families (through family sessions) in alleviating health complaints among adolescent girls in a school setting. Four girls with recurrent, subjective health complaints and their families were included in the study. Three sessions were held with each family, using genograms, ecomaps, interventive questions, and other family nursing interventions; practicing school nurses were also present. A therapeutic letter was sent to each family at the end of the sessions. The Strengths and Difficulties Questionnaire was used as a pre- and posttest measure. Evaluative interviews were carried out with the families and with school nurses. The families reported feeling relief and described positive affective, behavioral, and cognitive changes as a consequence of the interventions. The school nurses experienced the family sessions as time-saving and easy-to-use tools in their work. Involving the family when schoolchildren's recurrent mental health problems are addressed may reduce future suffering.

Skolsköterskors utmaningar med att dokumentera skolbarns psykosociala hälsa – en kvalitativ studie

Syfte: Syftet med studien var att undersöka skolsköterskors utmaningar relaterat till dokumentation av skolbarns psykosociala hälsa

Metod: Sex fokusgruppsdiskussioner genomfördes. I diskussionerna ingick frågor om situationer som var särskilt utmanande att dokumentera samt vad som begränsar och/eller underlättar dokumentationen av den psykosociala hälsan. Kvalitativ innehållsanalys användes för att tolka data.  

Resultat: Analysen resulterade i ett övergripande tema: Att göra sin plikt och rädsla för att göra fel samt tre underteman: osäkerhet relaterat till den egna förmågan; rädsla för framtida konsekvenser och strategier för att hantera dokumentationen. 

Slutsats: Skolsköterskor som förlitar sig på sin intuition och som använder en strukturerad dokumentationsmodell ökar möjligheterna till en tillförlitlig dokumentation. För att ytterligare utveckla sina yrkeskunskaper kan regelbunden yrkesmässig handledning vara av stor betydelse. Detta kan i sin tur bidra till ökad forskning och utveckling till förmån för skolbarns psykosociala hälsa.

The aim of this study was to explore school nurses’ experience of challenges related to documenting schoolchildren’s psychosocial health in Sweden. Six focus group discussions were carried out. Areas for discussions included questions about situations, especially challenging to document as well as what constrains and/or facilitates documenting psychosocial health problem issues. Qualitative content analysis was used for interpreting the data. The analysis resulted in one overarching theme: having to do one’s duty and being afraid of doing wrong; and three subthemes: uncertainty related to one’s own ability, concerns related to future consequences, and strategies to handle the documentation. School nurses relying on their intuition and using a structured documentation model may increase the opportunities for a reliable documentation. To further develop their professional skills with regular, clinical supervision can be of great importance. This in turn may increase contributions to research and development for the benefit of schoolchildren’s psychosocial health.

This study explored Swedish school nurses' experiences of school health record documentation. Fifty per cent of a representative sample of Swedish school nurses (n = 129) reported difficulties with documenting mental and social health problems in family relationships, schoolchildren's behaviour, and school situations. Ethical considerations concerning fears of misinterpretation and practical barriers to documentation were expressed as reasons for their worries. Mental and social ill health is an increasing and often dominating problem among schoolchildren, thus proper documentation is a basic issue, both for individuals and for the population as a whole. School nurses obviously need professional guidance regarding documentation and ethical challenges. Systematic effort should be directed towards recognition and support of these nurses' unique opportunities to consider, follow and promote all aspects of schoolchildren's health.

AIMS: To use school nurses' knowledge and experience for a better understanding of schoolchildren's health problems and their association to socioeconomic background and gender. METHODS: Mail questionnaires were sent to a nationally representative, random sample of Swedish school nurses (n=129). The questionnaire included structured and open-ended questions asking for school nurses' judgement of schoolchildren's health status; changes over the previous two years; estimation of schoolchildren's most common reasons for consulting the school nurse; and estimation of factors influencing schoolchildren's health. RESULTS: Swedish school nurses judged schoolchildren's mental health to have deteriorated during the previous two years with increasing health complaints, especially among girls and in disadvantaged housing areas. Disturbed family relations were considered as one important explanatory factor. Girls were more inclined to consult school nurses with subjective health complaints. Boys more often consulted the nurses with physical injuries. CONCLUSIONS: School nurses work closely with the children and meet them continuously during the school age period. They have a genuine knowledge of schoolchildren's health, which should be used even more, both in research and practice. The results may be applicable in other countries with similarly organized school health systems.

This study highlights school nurses' view of schoolchildren's health and their attitude to document it in the school health records. A strategic sample of 12 school nurses was interviewed. The interviews were semistructured and analysed with qualitative content analysis. The findings showed that the school nurses' viewed schoolchildren as physical healthy although they called attention to growing problems related to a changed lifestyle. Psychosocial ill-health was however increasing and the most common reason for visiting the school nurse was psychosomatic expressions. According to the nurses' descriptions, health was related to the individual, the school and the family situation. The family situation was mentioned as one of the most important factors of schoolchildren's health. The nurses described no problem to document schoolchildren's physical health. Ethical consideration, tradition, lack of time and the structure of the record were however factors that were said to hinder the documentation of the psychosocial health. In order to promote, protect and recover schoolchildren's health, more research is needed about how beliefs, experience, ethical consideration and resources influence the school nurse's daily work with schoolchildren's health.

The aim of this study was to explore the perceptions of elder abuse held by older persons in Sweden. Six focus group interviews were conducted. Through qualitative content analysis, the text revealed four themes: causes of elder abuse, conceptions of elder abuse, consequences of elder abuse, and coping with elder abuse. Changing society and families, as well as individual determinants, were believed to be causes of elder abuse. The main conception of elder abuse was that of robbery or assault, and the main consequence was fear. Coping with abuse included individual strategies and improvements in society. Issues of age discrimination were intrinsic in the findings. Gender differences were evident in the group dynamics. Nurses and other health care personnel need to be aware of what older persons believe to be the cause of elder abuse and what they consider abusive. Awareness of the results of this study can help in refining interview and assessment techniques and in designing training manuals.

Background: Supporting positive mental health development in adolescents is a major public health concern worldwide. Although several school-based programs aimed at preventing depression have been launched, it is crucial to evaluate these programs and to obtain feedback from participating adolescents. This study aimed to explore adolescents’ experiences with a School-based cognitive-behavioral depression prevention program. Methods: Eighty-nine adolescents aged 13–15 years were divided into 12 focus groups. The focus group interviews were analyzed using qualitative content analysis. Results: Three categories and eight subcategories were found to be related to the experience of the school-based program. The first category, intrapersonal strategies, consisted of the subcategories of directed thinking, improved self-confidence, stress management, and positive activities. The second category, interpersonal awareness, consisted of the subcategories of trusting the group and considering others. The third category, structural constraints, consisted of the subcategories of negative framing and emphasis on performance. Conclusions: The school-based mental health program was perceived as beneficial and meaningful on both individual and group levels, but students expressed a desire for a more health-promoting approach.

Aim: The aim of this study was to test the psychometric properties of the Salutogenic Health Indicator Scale (SHIS) in an adolescent population. Methods: The investigation was performed among Swedish students aged 13–15 years (n = 817; 58% girls). The SHIS was assessed for respondent acceptability, and its psychometric properties were evaluated according to classical test theory (regarding unidimensionality, targeting, reliability, and external construct validity). Results: The adolescents found it easy to complete the questionnaire, which was completed in an average of 4 minutes. Exploratory factor analysis, which is based on polychoric correlations, identified one factor, supporting the instrument’s unidimensionality. Floor/ceiling effects were ⩽ 3.3%. Reliability estimates yielded a Cronbach’s alpha value of 0.93; the test–retest reliability (n = 50; 2-week interval) coefficients were 0.89 for the total SHIS score and 0.52–0.79 for item scores. Spearman correlations with other variables were based on a priori expectations (self-rated general health, 0.595; depressive symptoms, −0.773; anxiety, −0.577; and sleep problems, 0.519). Conclusions: Our observations support both the acceptability and the psychometric properties of the SHIS as a brief, unidimensional assessment tool for salutogenic health in adolescents. Further studies using modern test theory are needed to better understand the measurement properties of the SHIS, including the functioning of its response categories and its comparability between adolescents and adults.

Våra observationer stöder både acceptansen och de psykometriska egenskaperna för SHIS som ett kort, en-dimensionellt frågeformulär för att mäta salutogen hälsa hos ungdomar.

Background: Supporting positive mental health development in adolescents is an important school health concern, but there is a need to investigate the suitability of the interventions used.

Aim: The aim is to investigate the experiences of school health professionals in conducting a universal school-based programme aimed at preventing depressive symptoms in adolescents.

Methods: Twenty-two school health professionals participated in four focus groups. The interviews were analysed using qualitative content analysis.

Findings: The overall theme identified in the study consists of 'striking a balance between strictly following the manual and meeting the students' needs'. Three subthemes emerged: 'doing good and sowing seeds for the future', working with insufficient tools, and 'personal development as a professional and as an individual'.

Conclusions: School health professionals conducting the programme found it valuable in a school setting, but considered support from the school administration essential.

AIM: The aim of this study was to investigate the feasibility and cost-utility of a school-based cognitive-behavioral (CB) depression prevention program.

METHODS: A quasi-experimental trial with an intervention group and a control group, with follow-up measurements obtained at three and 12 months after baseline, was conducted. The setting was six Swedish municipalities. The participants were students in grade 8 (median age: 14). A total of 462 students (79% girls) were allocated to the school-based CB prevention program, and 486 students (46% girls) were allocated to the control group. The school-based CB prevention program, Depression in Swedish Adolescents (DISA), was presented by school health service staff and teachers once per week for 10 weeks.

RESULTS: The main outcome measures were self-reported depressive symptoms and self-rated health; the secondary outcome measures were adherence and cost-utility. The intervention group decreased their self-reported depressive symptoms (as measured by the Center for Epidemiological Studies Depression Scale) and improved their self-rated health (as measured by the visual analog scale) at the 12-month follow-up more than the control group ( p < .05).

CONCLUSIONS: Given the challenges of conducting a study in a complex, everyday school setting with baseline differences between the intervention and control group, it is difficult to make accurate interpretations of the effectiveness of the intervention. However, with these limitations in mind, the results indicate that the DISA program is a feasible school-based prevention program.

Depression och annan psykisk ohälsa hos ungdomar skapar stort lidande hos den enskilde och dess närstående, och har också ett samband med lägre studieresultat och ökade kostnader för samhället. Det är därför viktigt att undersöka om skolbaserade insatser för att förebygga depression har effekt.

Bakgrund: Att främja välmående och psykisk hälsa hos barn och ungdomar är en viktig uppgift för samhället. Psykisk ohälsa, t ex depression och ångest, innebär en försämrad livskvalitet som kan försvåra barnets kognitiva, sociala och känslomässiga funktioner. Att främja en positiv utveckling och förebygga barns och ungas psykiska ohälsa innebär både ett minskat individuellt lidande och minskade samhällskostnader. Förutsättningen är dock att förebyggande åtgärder är effektiva ur såväl hälsomässiga som ekonomiska perspektiv.

Syfte: Att utvärdera det skolbaserade programmet Disa som syftar till att förebygga depressiva symptom hos ungdomar.

Metod:

Studien, som har en kvasiexperimentell design, inkluderade pre-test, post-test och ett-års-uppföljning samt en illustrativ beräkning av interventionens implementeringskostnader. I studien deltog 62 elever i årskurs 8, samt 7 Disa-ledare.

Resultat: En majoritet av eleverna och samtliga ledare var nöjda med interventionen. Eleverna, både flickorna och pojkarna, skattade sina depressiva symtom signifikant lägre efter kursen, och för flickorna bestod denna effekt vid ett-års-uppföljningen. Implementeringskostnaderna för de första två åren var cirka 2000 kr per elev.

Slutsats: Positiva resultat av det skolbaserade programmet Disa påvisades, särskilt för flickor. Flera elever tyckte att de fått ett nytt sätt att tänka, och att stämningen förbättrades i klassen.  

Svar på frågan “Vad tyckte du om Disa-kursen?”

”Mycket bra! Bättre stämning i klassen efter det! Mysigt!” – Flicka

”Helt okej, märkte ingen skillnad efter. Mådde i och för sig inte dåligt innan heller.” – Flicka

”Den har varit bra, man har fått ett nytt sätt att tänka på.” – Flicka

”Intressant och gav perspektiv” – Pojke

”Tråkigt” - Pojke

”Bra att få tips hur man kan undvika negativa tankar snabbt!” – Pojke

The aim of this pilot study was to evaluate the implementation of a universal school-based cognitive behavioral program whose target is to prevent depressive symptoms in adolescents. The study had a quasi-experimental design with pretest, posttest, and a 1-year follow-up and provides an illustrative calculation for the implementation costs of the intervention. Sixty-two students (aged 14) and seven tutors participated. A majority of the students and all of the tutors were satisfied with the intervention. The students, both females and males, rated their depressed symptoms as significantly lower after the course; and for the females, this was maintained 1-year postintervention. The implementation costs for the initial 2 years were about US$300 per student. Positive effects of a universal school-based cognitive behavioral intervention aiming at preventing depressive symptoms in adolescents were found, especially among females.

Background: Supporting positive mental health development in adolescents is an important school health concern, but there is a need to investigate the suitability of the interventions used.

Aim: The aim is to investigate the experiences of school health professionals in conducting a universal school-based programme aimed at preventing depressive symptoms in adolescents.

Methods: Twenty-two school health professionals participated in four focus groups. The interviews were analysed using qualitative content analysis.

Findings: The overall theme identified in the study consists of ‘striking a balance between strictly following the manual and meeting the students’ needs’. Three subthemes emerged: ‘doing good and sowing seeds for the future’, working with insufficient tools, and ‘personal development as a professional and as an individual’.

Conclusions: School health professionals conducting the programme found it valuable in a school setting, but considered support from the school administration essential.

The authors analyze a male nurse's account of how he experienced his interaction with a female schizophrenic client during sessions of systematic clinical supervision. Notes taken during 15 sessions were analyzed by means of open coding. The analysis revealed the importance of being aware of the parallel process that occurs among the client, the primary nurse, and the unit staff.

The aim of this study was to explore the way in which traumatic childhood experiences influenced the daily life of women with Borderline Personality Disorder (BPD). An explorative design comprising in-depth interviews and a qualitative content analysis was used. The findings revealed one main theme—Longing for Reconciliation—comprising two themes: (1) Living with a sense of shame and guilt and (2) Struggling to be released from a sense of being trapped. Longing for reconciliation influenced the women's daily life as well as their search for the meaning of traumatic childhood experiences. New meaning can emerge through change, forgiveness, and reconciliation, thus helping women with BPD overcome their struggle and gain the insight and strength to look into their secret knowledge. Meaning can emerge and help them to develop an empathic understanding of themselves in the context of past and present relationships.

We used a 14-item patient questionnaire, Strategic and Clinical Quality Indicators in Postoperative Pain Management, to describe how orthopaedic patients assessed the quality of care they received. The patients highest and lowest assessments were compared to assessments by other groups of surgical patients as reported in studies being published. Our study included 300 inpatients from four different orthopaedic wards in two county councils in Sweden. Patients answered a questionnaire on the day of discharge. The response rate was 74%, and 44% of the respondents were male. Elective surgery was the main reason for admission, and the mean length of stay was 7.3 days. One of the items rated highest was that pain relief was given quickly when requested. A literature review showed that this item also received a high rating in other studies using the same patient questionnaire. The item rated lowest concerned the regular use of a pain assessment instrument, which also received a low rating from patient groups other than the orthopaedics in this study. In conclusion, we found that orthopaedic patients and other groups of surgical patients gave similar assessments concerning the highest and lowest assessments of postoperative pain management. Nevertheless, further improvement is needed.