Swedish Nurses Research Articles

Perioperative PONV Management, a Survey from Swedish Nurse Anesthetists' Perspectives

Perioperative PONV Management, a Survey from Swedish Nurse Anesthetists' Perspectives

Perceptions of perioperative nursing competence: a cross-country comparison

BackgroundThroughout many countries, professional bodies rely on yearly self-assessment of competence for ongoing registration; therefore, nursing competence is pivotal to safe clinical practice. Our aim was to describe and compare perioperative nurses’ perceptions of competence in four countries, while examining the effect of specialist education and years of experience in the operating room.MethodsWe conducted a secondary analysis of cross-sectional surveys from four countries including; Australia, Canada, Scotland, and Sweden. The 40-item Perceived Perioperative Competence Scale-Revised (PPCS-R), was used with a total sample of 768 respondents. We used a factorial design to examine the influence of country, years of experience in the operating room and specialist education on nurses’ reported perceived perioperative competence.ResultsRegardless of country origin, nurses with specialist qualifications reported higher perceived perioperative competence when compared to nurses without specialist education. However, cross-country differences were dependent on nurses’ number of years of experience in the operating room. Nurses from Sweden with 6–10 years of experience in the operating room reported lower perceived perioperative competence when compared to Australian nurses. In comparing nurses with > 10 years of experience, Swedish nurses reported significantly lower perceived perioperative competence when compared to nurses from Australia, Canada and Scotland.ConclusionResearchers need to consider educational level and years of experience in the perioperative context when examining constructs such as competence.

From denial to awareness: a conceptual model for obtaining equity in healthcare

BackgroundAlthough Swedish legislation prescribes equity in healthcare, studies have reported inequalities, both in face-to-face encounters and in telephone nursing. Research has suggested that telephone nursing has the capability to increase equity in healthcare, as it is open to all and not limited by long distances. However, this requires an increased awareness of equity in healthcare among telephone nurses.The aim of this study was to explore and describe perceptions of equity in healthcare among Swedish telephone nurses who had participated in an educational intervention on equity in health, including which of the power constructs gender, ethnicity and age they commented upon most frequently. Further, the aim was to develop a conceptual model for obtaining equity in healthcare, based on the results of the empirical investigation.MethodA qualitative method was used. Free text comments from questionnaires filled out by 133 telephone nurses before and after an educational intervention on equity in health, as well as individual interviews with five participants, were analyzed qualitatively. The number of comments related to inequity based on gender, ethnicity or age in the free text comments was counted descriptively.ResultsGender was the factor commented upon the least and ethnicity the most. Four concepts were found through the qualitative analysis: Denial, Defense, Openness, and Awareness. Some informants denied inequity in healthcare in general, and in telephone nursing in particular. Others acknowledged it, but argued that they had workplace routines that protected against it. There were also examples of an openness to the fact that inequity existed and a willingness to learn and prevent it, as well as an already high awareness of inequity in healthcare.ConclusionA conceptual model was developed in which the four concepts were divided into two qualitatively different blocks, with Denial and Defense on one side of a continuum and Openness and Awareness on the other. In order to reach equity in healthcare, action is also needed, and that concept was therefore added to the model. The result can be used as a starting point when developing educational interventions for healthcare personnel.

School nurses' perceptions of using the physical environment of their office to support wellbeing

Background: The physical environment has an impact on wellbeing. School nurses can use this to promote students' health. Aim: The aim of this study is to elucidate school nurses' perceptions of using the physical environment at their office, as a tool in nursing. Method: A qualitative interview study was conducted with five Swedish school nurses, using semi-structured questions. Data were analysed using qualitative content analysis. Results: Three categories (offering a health environment for wellbeing, being present in the environment for the children and using the environment for health education) and six subcategories emerged during analysis. Conclusions: School nurses made their office a place for wellbeing by using it for health information, as a sanctuary and as an environment that supports children's need for integrity. How the school nurses used their environment depended on their personality. Obstacles included people in the school who had little knowledge of what school nurses' work consists of and also the difficulty of appearing available to the children.

Developing the role of Swedish advanced practice nurse (APN) through a blended learning master's program: Consequences of knowledge organisation

This paper reports on a research study conducted with a group of nurses in Sweden enrolled in a newly developed blended learning master's programme to become advanced practice nurses (APNs). As background, the paper presents the regional needs the programme is intended to address and describes how the programme was designed. The aim was to understand how, from students' perspective, the nurse master's programme structured knowledge for their future position as APNs. The research question focuses on how the master's programme prepares students by meeting their diverse needs for knowledge. Empirical material was collected at two times during the students' first and second years of study through semi-structured qualitative interviews. The findings highlight the process in which these master's students gained a more advanced identity of becoming APNs. This process demonstrates how students perceive their current position as nurses based on a discourse of knowledge in relation to the practical and theoretical knowledge they encounter in the master's programme. This article concludes by recommending that attention should be paid to developing APN role models in the current Swedish healthcare system.

Swedish primary healthcare nurses' perceptions of using digital eHealth services in support of patient self-management.

Nurses have expressed doubts about the ongoing digitalisation of Swedish primary health care. Given the potential role of eHealth in primary health care, including supporting interactive self-management for people with chronic conditions, it is important to highlight nurses' experiences. This study is part of a larger project aimed at implementing person-centred interactive self-management support (iSMS) in primary health care. The aim of this study was to describe Swedish primary healthcare nurses' perceptions of using digital eHealth systems and services to support patient self-management. Focus group interviews were conducted with primary healthcare nurses (n = 20). The interview transcriptions were analysed using qualitative content analysis. Three themes emerged from the content analysis: caregiving in the midst of digital chaos; a lack of overview and control in daily work; and mixed feelings towards digitalisation. Each theme was subdivided into three subthemes. The results of this study provide insight into a number of concerns that stand in the way of success when it comes to the implementation and use of digital technology. If nurses are to adapt to the new policies and practices that accompany the current digitalised development in Swedish primary health care, the concept of a nurse's traditional work role needs to be amended in terms of the scope of work tasks and established views of traditional nursing. The study also highlights the need for more research to enable eHealth systems/services to be designed to fulfil multiple requirements. The digitised systems should be a tool for achieving good quality self-management support as well as giving the primary healthcare nurses adequate resources to support patients' self-management while still maintaining the values associated with person-centred care.

Meanings of troubled conscience and how to deal with it: expressions of Persian-speaking enrolled nurses in Sweden.

A feature of the healthcare system in Sweden, particularly in the care of older people, is its cultural diversity in terms of having considerable numbers of both caregivers and care recipients with an immigrant background. Considering the influence of culture in ethical decision-making processes, the idea of conscience and the adverse effects of a troubled conscience, it is important to study the concepts of conscience and troubled conscience in culturally diverse populations. There is no published study regarding troubled conscience among immigrant populations that includes enrolled nurses. To illuminate the meanings of troubled conscience and how to deal with it among enrolled nurses with Iranian backgrounds working in Swedish residential care for Persian-speaking people with dementia who have emigrated from Iran. The study was conducted with a phenomenological hermeneutic design. Ten enrolled nurses with an Iranian background, with at least one year's experience of taking care of older people with dementia, were interviewed. The study was reviewed by the Regional Ethical Review Board for ethical vetting of research involving humans. Appropriate measures were taken to ensure confidentiality and voluntary participation. The meanings of having a troubled conscience for the participants comprise not being a good person, including being an uncaring person, not acting according to one's values and living in a state of unease. Dealing with a troubled conscience involves trying to compensate for the harm one has caused and trying to prevent similar situations by being a responsible caregiver. The enrolled nurses understood themselves as caring people and not only caregivers. They knew that they should hear their conscience and respond to it by trying to be a caring person and acting according to their values. The findings should be interpreted in the given specific context.

Telephone nursing in Sweden: A narrative literature review.

Telephone nursing services are expanding globally. Swedish Healthcare Direct is the largest healthcare provider in Sweden. This paper provides a comprehensive understanding of telephone nursing, as reflected by research on Swedish national telephone nursing, and discusses the findings in relation to international literature. A descriptive, mixed-studies literature review was conducted. Twenty-four articles from January 2003 to April 2015 were identified from PubMed, Scopus, and CINAHL, and included. The issues explored in this study are how telephone nursing is perceived by callers, telephone nurses, and managers, and what characterizes such calls. Callers value reassurance, support, respect and satisfaction and involvement in decisions can increase their adherence. The telephone nurses' perspective focused on problems and ethical dilemmas, communication, the decision support tool, and working tasks. The managers' perspective focused on nursing work goals and malpractice claims. Concerning call characteristics, authentic calls, incident reports, and threats to patient safety were considered. Telephone nursing seems safe, but gender can play a role in calls. Future research on caller access, equity, and efficiency, healthcare cost-effectiveness, distribution, and patient safety is needed.

Swedish school nurses’ perspectives on caring for and promoting the health of adolescents with mental health problems – A qualitative study the Health of Adolescents with Mental Health Problems – A Qualitative Study

Background: Over the last few decades, there has been an increase in mental health problems among adolescents, manifested as physical symptoms, such as stomach pain, headaches, feelings of anxiety, worry, stress and sleeping problems. Surveys among school nurses’ have revealed that mental health work now forms a key part of their role. Although an increasing number of adolescents are suffering from mental health problems in upper-secondary schools (16-19 years), there are few studies focusing on this matter. Therefore we wanted to explore the matter from the school nurses’ point of view. The aim of this study was to explore Swedish school nurses’ experiences of caring for and promoting the health of students suffering from mental health problems.Methods: The present study had a descriptive design and a qualitative approach. A purposeful sample of eight (n = 8) school nurses was interviewed. Their working experience varied between 4 and 29 years. The data were analysed using content analysis. The ethical principles stipulated by the Swedish Research Council were carefully followed throughout the study.Results: Three main themes with sub-themes were found: A caring relationship as the foundation for health promotion, organizing health-promoting work and interprofessional cooperation as a prerequisite for good caring.Conclusions: The findings strengthen the evidence of the importance of the health dialogue as a tool for the school nurses to identify students with mental health problems. Creating a caring relationship with the students is a prerequisite for caring and health promotion. Further education concerning mental health and evidence-based-practice should be arranged on regular basis. More research and cooperation between different stakeholders is needed.

Receiving early information and trusting Swedish child health centre nurses increased parents' willingness to vaccinate against rotavirus infections.

Rotavirus vaccines are effective against severe infections, but have a modest impact on mortality in high-income countries. Parental knowledge and attitudes towards vaccines are crucial for high vaccination coverage. This study aimed to identify why parents refused to let their infant have the vaccination or were unsure. This cross-sectional study was based on 1,063 questionnaires completed by the parents of newborn children in 2014. Stepwise logistic regression was used to identify the main predictors. Most (81%) parents intended to vaccinate their child against the rotavirus, while 19% were unwilling or uncertain. Parents with less education and children up to five weeks of age were more likely to be unwilling or uncertain about vaccinating their child. Factors associated with a refusal or uncertainty about vaccinating were not having enough information about the vaccine, no intention of accepting other vaccines, paying little heed to the child health nurses' recommendations, thinking that the rotavirus was not a serious illness and not believing that the vaccine provided protection against serious forms of gastroenteritis. Early information, extra information for parents with less education and close positive relationships between parents and child health nurses were important factors in high rotavirus vaccination rates.

Ethical dilemmas during cardiac arrest incidents in the patient's home.

The majority (70%) of cardiac arrests in Sweden are experienced in the patient's home. In these situations, the ambulance nurses may encounter several ethical dilemmas. The aim was to investigate Swedish specialist ambulance nurses' experiences of ethical dilemmas associated with cardiac arrest situations in adult patients' homes. Nine interviews were conducted with specialist ambulance nurses at four different ambulance stations in the southeast region of Sweden. Data were analysed using content analysis. Ethical principles mandated by the Swedish Research Council were carefully followed during the whole process. Two main themes with six sub-themes were identified: The scene - creating a sheltered space for caring and Ethical decision-making. The results showed that ethical dilemmas might occur when trying to create a sheltered space to preserve the patients' integrity and dignity. A dilemma could be whether or not to invite significant others to be present during the medical treatment. Ethical decision-making was dependent on good communication and ethical reasoning among all parties. In certain situations, decisions were made not to commence or to terminate care despite guidelines. The decision was guided by combining the medical/nursing perspectives and ethical competence with respect to the human being's dignity and a will to do good for the patient. The nurses followed the voice of their heart and had the courage to be truly human. The ambulance nurses were guided by their ethos, including the basic motive to care for the patient, to alleviate suffering, to confirm the patient's dignity and to serve life and health.

Swedish child health nurses treat fathers more equally in 2014 than 2004, but mothers remain their primary focus.

This study focused on Swedish child health nurses' attitudes and the support they provided to fathers and mothers, highlighting changes from 2004 to 2014. In 2014, 363 child health nurses in Stockholm County completed a 23-item questionnaire, similar to the questionnaire by Massoudi et al. in 2004, on their attitudes and the support they gave to fathers and mothers. Analyses were completed using chi-square tests of nurses' attitudes and support to fathers and mothers, and the results from the 2004 and 2014 studies were compared. In 2014, the vast majority of nurses fully agreed that it was important to have close contact with both parents, but more than two-thirds did not feel they had the same competencies for mothers and fathers and three quarters found it complicated to support both parents. The majority viewed fathers more equally in 2014 than in 2004 and although they did provide more support to both parents, mothers in 2014 still received more support than fathers. While Swedish child health nurses viewed fathers as more equal to mothers in 2014 than 2004, mothers still received the majority of the parenting support.

Dignity-conserving care actions in palliative care: an integrative review of Swedish research.

Previous research has proposed that persons in need of palliative care often have a loss of functions and roles that affects social and existential self-image. Moreover, these individuals also commonly suffer from complex multisymptoms. This, together with the situation of facing an impending death, can lead to a loss of dignity. Therefore, supporting these persons' dignity is a crucial challenge for professional nurses. The 'Dignity Care Intervention' addresses the multidimensionality of dignity by identifying patients' dignity-related concerns and suggests care actions to address them. At the present, the Dignity Care Intervention is adapted for implementation in Swedish care settings. Because expressions of dignity are influenced by culture, and an overview of care actions in a Swedish context is lacking, this integrative review aimed to find suggestions from Swedish research literature on what kind of care actions can preserve dignity. An integrative literature review was conducted using the databases SwePub and SweMed+. Articles published from 2006 to 2015 and theses published from 2000 to 2015 were searched for using the terms 'dignity' and 'palliative care'. Result sections of articles and theses were reviewed for dignity-conserving care actions synthesised by thematic analysis and categorised under themes and subthemes in Chochinov's model of dignity. Fifteen articles and 18 theses were included together providing suggestions of care actions in all themes and subthemes in the dignity model. Suggested care actions included listening, communication, information, symptom control, facilitating daily living and including patients in decision-making. Additionally, nurses' perceptiveness towards the patients was a core approach. The review offers culturally relevant suggestions on how to address specific dignity-related concerns. The adapted Dignity Care Intervention will be a way for Swedish nurses to provide person-centred palliative care that will conserve patients' dignity.

Aspects of Swedish ophthalmic nurses’ attitudes towards research

The aim of this study was to explore attitudes towards research among a subgroup of Swedish nurses specializing in ophthalmic care and to compare the results with the findings of a similar study from 2001. A cross-sectional survey was conducted with a convenience sample of 250 Swedish nurses. A factor analysis was performed on the responses to a web-based questionnaire to discern the factors underlying the ophthalmic nurses’ attitudes. Responses to open-ended questions were analysed using content analysis. A five-factor solution accounted for 47% of the cumulative variance, with Cronbach’s alpha values ranging from 0.56 to 0.8. The responses to the open-ended questions indicated that among the nurses interested in conducting research, lack of time was the most prominent cause for not doing so, whereas older age and time constraints were the most important factors for those who were not interested in research, largely consistent with previous studies. Furthermore, the nurses mentioned frustration and bad experiences related to conducting research during their education programmes. Overall, however, the participating ophthalmic nurses were more reluctant to engage in research, perhaps because of their significantly older age compared to a previous study cohort. The results reveal new information implying that further qualitative studies would be beneficial to the planning of nursing education and to the integration of nurses in clinical scientific work.

Psychometric Validation of the Perceived Perioperative Competence Scale-Revised in the Swedish Context

To psychometrically test the Perceived Perioperative Competence Scale-Revised (PPCS-R) in the Swedish context. Cross-sectional survey. The 40-item PPCS-R was translated into Swedish using a forward-translation approach. A census of 2,902 registered nurse anesthetists (RNAs) and operating room (OR) nurses was drawn from a database of a national association in Sweden. The response rate was 39% (n = 1,033; 528 RNAs and 505 OR nurses). Cronbach alpha for each factor was 0.78 to 0.89 among OR nurses and 0.79 to 0.88 among RNAs. Confirmatory factor analysis showed good model fit in the six-factor model. Psychometric testing of the Swedish translation of the PPCS-R suggests a good construct validity, and the construct and its six factors are conceptually relevant among the Swedish OR nurses and RNAs.

The care of and communication with older people from the perspective of student nurses. A mixed method study

BackgroundUndergraduate nurse education needs to prepare student nurses to meet the demands and to have the necessary communication skills for caring for an increasing older population. The challenges involve how best to support and empower student nurses to learn the communication skills needed to care for older people. ObjectiveThe aim of this study was to investigate student nurses' views on the care of and communication with older people. DesignA descriptive study with a mixed-method approach was conducted. MethodsQuantitative and qualitative data were collected from a questionnaire completed by third-year Swedish student nurses in 2015. ResultsThe student nurses reported positive attitudes to the care of and communication with older people. The findings focus on the central aspects related to relationship building, techniques for communication and external prerequisites. ConclusionsDespite positive attitudes, student nurses had a limited view of communication with older people. Educators need to increase student nurses' capacity to communicate effectively with older people. Educational interventions to improve and evaluate the communication competency of nurses and student nurses are needed.

Professional confidence in the roles as ambulance and medical incident commander

The aim was to investigate professional confidence in the roles of ambulance and medical incident commander (AIC and MIC), and how it influences achievement of performance indicators at an incident site. A web survey based on theoretical constructs (e.g., social identity, efficacy, accountability) and questions about prehospital emergency care connected to the roles were used (n = 426 Swedish ambulance nurses and emergency medical technicians). The results showed that social identity, independence and occupation were moderators for professional confidence. Organizational support, relational trust and independence were moderators for achieving performance indicators. Strengthening group identification and independence as MIC and independence and support for women as AIC together with a stronger organizational support can increase professional confidence and improve performance.

Keeping the child in focus while supporting the family: Swedish child healthcare nurses experiences of encountering families where child maltreatment is present or suspected.

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.

Assessment and decision-making of Swedish primary care nurses in relation to the use of interpreters

Communicating with immigrants in primary care can be a challenge for nurses who must assess language proficiency and decide whether to use an interpreter. The aim of this study was to examine primary care nurses' experiences of assessment and decision-making in relation to the use of interpreters. A qualitative inductive research design was chosen and nurses with experience of professional interpreters were recruited for focus group interviews. The study results showed that primary care nurses respected immigrants as human beings and recognised their right to decline an interpreter in sensitive situations. The purpose of primary care nurses' experiences of assessment and decision-making in relation to the use of interpreters was ensuring patient safety, the importance of reciprocal information and respect for patient autonomy.

Health Among Schoolchildren From the School Nurse's Perspective.

The aim of the study was to investigate Swedish school nurses' perceptions of schoolchildren's health. The study is based on two national surveys in which school nurses responded to questions about schoolchildren's health in 2015 ( n = 181) and 2005 ( n = 129). A statistical comparison showed that physical and mental health of schoolchildren in high-risk areas was perceived as worse than that of children in low-risk areas. There were no differences regarding the number of spontaneous visits or consulting reasons related to gender in high- and low-risk areas. A national framework for data collection and reporting of schoolchildren's health may be important for school nurses to demonstrate the need for increased support in, for example, high-risk areas. By paying attention to factors that can affect schoolchildren's health, school nurses can also direct health promotion to areas where it is needed. Increased cooperation among school health professionals may also prevent illness and improve health.