Introduction: Family centres in Sweden are integrated services that reach all prospective parents and parents with children up to their sixth year, because of the co-location of the health service with the social service and the open pre-school. The personnel on the multi-professional site work together to meet the needs of the target group. The article explores a program theory focused on the open pre-schools at family centres.

Method: A multi-case design is used and the sample consists of open pre-schools at six family centres. The hypothesis is based on previous research and evaluation data. It guides the data collection which is collected and analysed stepwise. Both parents and personnel are interviewed individually and in groups at each centre.

Findings: The hypothesis was expanded to a program theory. The compliance of the professionals was the most significant element that explained why the open access service facilitated positive parenting. The professionals act in a compliant manner to meet the needs of the children and parents as well as in creating good conditions for social networking and learning amongst the parents.

Conclusion: The compliance of the professionals in this program theory of open pre-schools at family centres can be a standard in integrated and open access services, whereas the organisation form can vary. The best way of increasing the number of integrative services is to support and encourage professionals that prefer to work in a compliant manner.

BACKGROUND: Menopause is a biopsychosocial phenomenon encompassing the transition in a woman's life from being fertile to infertile. Although menopause may result in extremely unpleasant physical symptoms there is evidence of a low rate of reported menopausal symptoms amongst women in Asian cultures. Women's experiences, views, and responses to menopause which influences women's daily life and well-being, may vary between different societies and cultures. This study aimed to explore and describe menopausal experiences among women in Sri Lanka.

METHODS: A qualitative exploratory research was conducted among postmenopausal women of 46-55 years of age in the western province of Sri Lanka. Individual interviews with a purposive sample of 20 women were conducted, and data analysis was done using manifest and latent content analysis.

RESULTS: The results consist of an overall theme, "Menopause is a natural stage of aging" and three categories "Entering a new stage", "Managing menopause" and "Not the end of life" which emerged from 34 codes. The overall theme highlights that changes in menopause were experienced as a natural change in life, with health problems that are normal for this change and handled with different self-care practices. The category "Entering a new stage" describes the women becoming aware of menopause and its bodily changes. The category "Managing menopause" describes women's experiences of being able to find their own remedies to ease the menopausal symptoms and by engaging in religious activities and focusing on interaction with people. The category, "Not the end of life" describes women's views of themselves as still valuable because menopause was experienced as a natural part of their lives.

CONCLUSION: Women in Sri Lanka managed menopausal problem mainly on their own as they viewed the menopause as a natural stage of aging risking unnecessary suffering and failure to detect preventable complications. Enabling support groups for menopausal women and improving on their health-seeking behaviour by encouraging them to take part in screening for cervical and breast cancer would improve their condition. Further information on additional hormone therapy with a, subsequent follow-up and evaluation by community health nurses and/or midwives, would facilitate Sri Lankan women's transition to menopause.

Objective: To explore midwifery-trained registered nurses’ perceptions of their own profession as maternity care providers and how they identify their role, tasks, and responsibilities within a multi-professional team.

Design: An exploratory qualitative study using focus group discussions and qualitative content analysis.

Setting: Three selected tertiary care hospitals in the Capital Province in Sri Lanka.

Participants: Twenty-two midwifery-trained RNs working in intra-partum and postpartum units.

Findings: The overriding theme of the analysis was identified as ‘competent but not allowed to blossom fully in their practice’, based on two main categories: ‘provision of competent care’ and ‘working with disappointments’. Each main category had four subcategories: ‘acting with compassion’, ‘cooperation in emergencies’, ‘exceeding one’s boundaries’, ‘taking full responsibility’ and ‘deprived of utilizing special knowledge and skills’, ‘role confusion with other professional groups’, ‘lack of professional identity’, and ‘not being appreciated by others’, respectively.

Conclusion: Midwifery-trained RNs conveyed a deep sense of disappointment regarding their profession as maternity care providers in Sri Lanka. Midwifery-trained RNs’ perceptions of their high proficiency are incongruent with their low sense of identity and belongingness within the multi-professional hospital-based maternity care team. This phenomenon warrants further study, considering its implications for team work and patient safety.

BACKGROUND: Stressful patient experiences during the intensive care unit (ICU) stay is associated with reduced satisfaction in High Income Countries (HICs) but has not been explored in Lower and Middle Income Countries (LMICs). This study describes the recalled experiences, stress and satisfaction as perceived by survivors of ICUs in a LMIC.

METHODS: This follow-up study was carried out in 32 state ICUs in Sri Lanka between July and December 2015.ICU survivors' experiences, stress factors encountered and level of satisfaction were collected 30 days after ICU discharge by a telephone questionnaire adapted from Granja and Wright.

RESULTS: Of 1665 eligible ICU survivors, 23.3% died after ICU discharge, 49.1% were uncontactable and 438 (26.3%) patients were included in the study. Whilst 78.1% (n = 349) of patients remembered their admission to the hospital, only 42.3% (n = 189) could recall their admission to the ICU. The most frequently reported stressful experiences were: being bedridden (34.2%), pain (34.0%), general discomfort (31.7%), daily needle punctures (32.9%), family worries (33.6%), fear of dying and uncertainty in the future (25.8%). The majority of patients (376, 84.12%) found the atmosphere of the ICU to be friendly and calm. Overall, the patients found the level of health care received in the ICU to be "very satisfactory" (93.8%, n = 411) with none of the survivors stating they were either "dissatisfied" or "very dissatisfied".

CONCLUSION: In common with HIC, survivors were very satisfied with their ICU care. In contrast to HIC settings, specific ICU experiences were frequently not recalled, but those remembered were reported as relatively stress-free. Stressful experiences, in common with HIC, were most frequently related to uncertainty about the future, dependency, family, and economic concerns.

Refugee families face a complex transition due to the nature of involuntary migration and the process of acculturation. There are several risk factors to the family adaptation process during the transition period, which are sociocontextually environmental dependant. Facilitating a healthy transition for refugee families, therefore, requires the role of nursing to incorporate sociopolitics into the discipline. This paper introduces a sociopolitically oriented and community-driven assessment and intervention model which is based on a family systematic approach. Interventions that aid the families in their acculturation process as well as empowers them to a well-functioning daily life, as per the SARFI model, should be adopted. As such, the future of nursing may provide additional primary health care services for refugee families; this is through a team-led “family nurse” who provides quality care for the family unit in collaboration with other health care professionals and societal authorities.

The refugee families face a complex transition due to the nature of the migration. This exposes them to vulnerability in cohesion and family function. Primary Health Care Nurses (PHCN) and Interpreters in Primary Health Care (PHC) play a vital role in their promotion of health because migrant health care is mainly carried out within PHC. The overall aim of this thesis was to reach a comprehensive understanding of involuntary migrant family health in order to facilitate a healthy transition for the aforementioned families in Sweden from a systems perspective. These findings are based on interviews representing 16 members from ten families from the Balkans, Kurdistan and Africa (study I), 34 PHCNs (study II & III) and ten Interpreters working within PHC and originating from the same countries as the families (study IV). This study was carried out in two municipalities in Sweden. Contextual analysis with reference to phenomenography was used in interpreting the data in studies I-III. A qualitative method and contextual analysis was used in study IV. The Neuman Systems Model was used to unravel environmental influences in all the four studies. The findings of study I & II illustrate the families’ transition experience through four different family profiles respectively describing the families’ wellbeing: A distressed family living under prolonged tension; a contented family who leads a satisfactory life; a frustrated family who cannot lead a fully satisfactory life and a dejected family who feels deserted (study I). Further, a mentally distressed family within the asylum-seeking process; an insecure family with immigrant status; a family with internal instability and being segregated from society; and a stable and well functioning family integrated in society (study II). Stress factors such as living in uncertainty, having traumas, change in family roles, frequent negative attitudes of the host country and social segregation was detrimental to the wellbeing of the family. In promoting their health, PHCNs approached the families through: an ethnocentric approach, an empathic and culturally relative approach, and a holistic approach enabling families to function well in their everyday life (study III). From the Interpreters’ perspective, promoting health was to improve psychological wellbeing by: promoting positive thoughts of a future, promoting consideration of one’s worth and promoting stability of the family unit. Social interactions within the host country together with the recognition and appreciation of the families’ cultural values and beliefs, and competence and proper and elucidative information regarding the functioning of the host country, was considered necessary. Facilitating a healthy transition is possible within PHC. This can be done through cooperation of the family, with other health professionals, community and ethnic organisations. A model was developed in order to help the aforementioned. Competence in intercultural communication and family focused nursing is required. Adequate skills ought to be included in the education of nurses.

Involuntary migration and adaptation to a new cultural environment is known to be a stress factor. The aim of the study was to explore the impact of involuntary migration on the family health in order to identify specific health care issues related to refugee families in transition living in Sweden. Data was collected through interviews with 16 members of 10 different refugee families from Balkan countries, Kurdistan and Africa for which permission was obtained from the chairman of the local ethnic organizations in a municipality in the southern part of Sweden. In interpreting the material, analysis was made using a contextual approach with reference to phenomenography. The analysis resulted in four qualitatively different descriptive categories characterizing the health of the families: a distressed family living under prolonged tension; a contented family who leads a satisfactory life; a frustrated family who cannot lead a fully satisfactory life and a dejected family who feels deserted. Stressors seeking asylum, facing unemployment and changed roles, interacted negatively within the family. A friendly and understanding attitude from the host country was the main factor in promoting the health of the refugee families. Nursing interventions should therefore assist the families accordingly in order to promote the stability of the family system.

Objective: To illustrate how nurses can promote family wellness and facilitate acculturation for involuntary migrant families as conceptualized by bilingual interpreters and cultural mediators with own past refugee experience.  Due to the nature of involuntary migration and accompanying acculturation, refugee families face a complex transition, exposing them to vulnerability in cohesion and family function. Involuntary migrant health needs are largely managed within the Primary Health Care sector where Primary Health Care Nurses (PHCN) play an important role. Additionally, bilingual interpreters and cultural mediators with personal experience of being refugees and subsequent acculturation play a critical role in bridging the language and cultural gap between migrant families and PHCNs.

Methods: The study is descriptive and explorative in design with a phenomenographic approach. Data was collected in Southern Sweden utilizing in-depth interviews with ten bilingual interpreters and cultural mediators originating from the Balkans, Kurdistan, Eritrea and Somalia. A contextual analysis with reference to phenomenography was used in interpreting the data material.

Results: Three separate themes illustrated the meaning of family wellness: a sense of belonging to the new homeland, the maintenance of self-esteem and stable family interrelationships. The analysis demonstrated that the way ex-refugee bilingual interpreters and cultural mediators perceived of how to promote family wellness, fell into three qualitative different conceptions: (1) Promotion of family wellness is the responsibility of the family itself, manifested in its attitude in wanting to adjust to change, (2) Promotion of family wellness is the consideration of those outside the family and is marked by understanding and respectful attitudes, (3) Promotion of family wellness is a societal responsibility to which successful integration is a prerequisite.

Conclusions: The promotion of health of involuntary migrant families in cultural transition is complex due to families, other members of the society and society at large all contributing to family wellness in the process of acculturation. For nurses to facilitate a healthy transition for involuntary migrant families, a holistic approach working with the entire family in a psychosocial way and cooperating with other health care professionals, community authorities and ethnic organizations maybe a future direction in encounters with involuntary migrant families with health problems. Adopting a family system approach will enable nurses to provide culturally and transition-competent quality care by enabling stabilizing interfamily relationships through supportive conversations about changes and its subsequent reactions and possible coping of the family as a unit. Further research in order to enhance health promotion would preferable take on a participatory approach.

Background: Involuntary migration and adaptation to a new cultural environment is known to be a factor of psychological stress. Primary Health Care Nurses (PHCNs) frequently interact with refugee families as migrant health needs are mainly managed within Primary Health Care.

Aim: To describe the health of the involuntary migrated family in transition as conceptualized by Swedish PHCNs.

 Method: Thirty-four PHCNs from two municipalities in Sweden were interviewed and phenomenographical contextual analysis was used in analysing the data.

 Findings: Four family profiles were created, each epitomizing the health characteristics of a migrated family in transition: (1) a mentally distressed family wedged in the asylum-seeking process, (2) an insecure family with immigrant status, (3) a family with internal instability and segregated from  society, and (4) a stable and wellfunctioning family integrated in society. Contextual socio-environmental stressors such as living in uncertainty awaiting asylum, having unprocessed traumas, change of family roles, attitudes of the host country and social segregation within society were found to be detrimental to the well-being of the family.

 Conclusion: Acceptance and a clear place in society as well as clearly defined family roles are crucial in facilitating a healthy transition for refugee families. Primary Health Care Nursing can facilitate this by adopting a family system perspective in strengthening the identity of the families and reducing the effects of socio-environmental stressors.

Background: Involuntary migrant families in cultural transition face a number of challenges to their health and to family cohesion. Primary health care nurses (PHCNs) therefore play a vital role in the assessment and promotion of their health.

Aim: The aim of this study was to describe the promotion of health in involuntary migrant families in cultural transition as conceptualized by Swedish PHCNs.

Method: Interviews were conducted with 34 strategically chosen PHCNs covering the entire range of the primary health care sector in two municipalities of Southern Sweden. A contextual approach with reference to phenomenography was used in interpreting the data.

Findings: There are three qualitatively different descriptive categories epitomizing the characteristics of the PHCNs' promotion of health: (1) an ethnocentric approach promoting physical health of the individual, (2) an empathic approach promoting mental health of the individual in a family context, and (3) a holistic approach empowering the family to function well in everyday life.

Conclusions: For nurses to promote involuntary migrant families'health in cultural transition, they need to adopt a holistic approach. Such an approach demands that nurses cooperate with other health care professionals and community authorities, and practise family-focused nursing; it also demands skills in intercultural communication paired with cultural self-awareness in interacting with these families. Adequate knowledge regarding these skills should therefore be included in the education of nurses, both at under- and at post-graduate level.

Background: Refugee families face a complex transition due to involuntary migration exposing them to vulnerability in cohesion and family function. Since migrant health care is mainly managed by the Primary Health Care sector, interpreters play a critical role in bridging the gap amongst these families and the Primary Health Care system. Aim: To explore and describe interpreters’ experiences of promoting health in involuntarily migrated families in cultural transition living in Sweden. Method: Ten interpreters from five ethnic groups were interviewed and contextual analysis was used in analysing the data. Result: Promoting health in refugee families was conceived as improving family members psychological wellness despite past experiences by promoting a future, promoting consideration of one’s worth and promoting stability of the family unit. Social interactions within the host country, recognition and appreciation of the families’ cultural values and beliefs as well as competence and proper and elucidative information regarding the functioning of the host country was considered necessary in the promotion of health of these families. Conclusion:  Promoting health in involuntarily migrated families will have to facilitate a healthy transition. Primary Health Care Nurses can do this by proper cooperation with community and ethnic organisations and by adopting a family system perspective in communicating the family’s transition experiences in a sensitive manner.