Swedish Units Research Articles

Patients' physical activity in stroke units in Latvia and Sweden.

ObjectiveA prospective, observational study to describe levels of physical activity in patients with stroke in a comprehensive stroke unit in Sweden and Latvia, comparing data between countries.MethodsThe study was performed at stroke units in one hospital in Sweden (data were acquired over a 2‐month period in 2017) and two hospitals in Latvia (data were acquired over a 3‐month period between 2016 and 2017). Patients with stroke were observed for 1 min every 10 min. The level of physical activity, location, and the people present were noted at each time‐point.ResultsA total of 27 patients were observed in Latvia and 25 patients in Sweden. Patients from both countries were in bed half of the time and spent the majority of the day in their bedroom and alone. Patients in Sweden had higher physical activity levels, spent more time outside their bedroom and spent more time with rehabilitation specialists and visitors.ConclusionPatients are inactive and alone for a majority of the time during hospitalization at a comprehensive stroke unit in both countries. There are differences in environment in the stroke unit between countries.

Taxane-induced pain in breast cancer patients as perceived by nurses

Introduction Treatment with taxane-containing chemotherapy regimens is crucial for improving survival in patients with early-stage invasive breast cancer. Recent literature describes a high incidence of taxane-induced neuropathic pain or/and muscle and joint pain. For patients, oncology nurses can play an integral role as a resource for pain control. There is a knowledge gap regarding how nurses perceive patients’ experienced taxane-induced pain and support from their organizations when caring for patients with such pain. Aim Investigate nurses’ perceptions of occurrence of taxane-induced pain and identify organizational support for managing such pain. Material and methods A cross-sectional observation study, conducted in 2017–2018, with a web-based questionnaire to 240 nurses working at oncology outpatient units in Sweden. The areas of concern were start-decline, duration, prevalence, intensity, and bodily distribution of taxane-induced pain. Patient information, guidelines, prophylactic analgesia, and perceived support were used to counteract such pain. Data were analyzed using descriptive statistics and a logistic regression model to estimate associations. Results One hundred sixty-one nurses completed the questionnaire, describing their perceptions of taxane-induced pain in patients with breast cancer. The prevalence and intensity of taxane-induced pain were experienced as divergent. Some consensus was found among the nurses regarding the start of the pain, but not when declined. The body areas where pain was expected to occur were the muscles, joints, legs, feet, and mainly the back of the trunk. Low use of local/national guidelines for managing taxane-induced pain was described. No relationship was found between factors related to the nurses’ characteristics (age, work experience in oncology care, or specialist education in oncology) that significantly affected their perceptions regarding the occurrence of taxane-induced pain or pain intensity. Conclusion: This study highlights a need for attention to education and guidelines for how to observe, treat, and evaluate this particular type of pain.

The Risk of Necrotizing Enterocolitis following the Administration of Hyperosmolar Enteral Medications to Extremely Preterm Infants

Introduction: Necrotizing enterocolitis (NEC) is a disease predominantly affecting preterm infants. The administration of hyperosmolar solutions could lead to the development of NEC. The objective of this study was to measure the osmolality of enteral medications used in clinical practice and to assess the risk of NEC following exposure to hyperosmolar medications. Methods: A retrospective cohort study in extremely preterm infants (gestational age <28 weeks) born between 2010 and 2016 at a tertiary neonatal intensive care unit in Sweden. 465 infants were identified via the Swedish Neonatal Quality register. Data relating to enteral administrations received during a two-week period were collected from the medical records. The osmolalities of medications were measured using an osmometer. Logistic regression was used to calculate the odds ratio of developing NEC. Results: A total of 253 patients met the inclusion criteria. The osmolalities of 5 commonly used medications significantly exceeded the recommended limit of 450 mOsm/kg set by the American Academy of Paediatrics (AAP). Most patients (94%) received at least one hyperosmolar medication. No significant risk of developing NEC could be found. Conclusion: The medications used in clinical practice can significantly exceed the limit set by the AAP. This study does not indicate an increased risk of developing NEC in extremely preterm infants following exposure to hyperosmolar medications. Further studies in larger cohorts are needed to determine the specific cut-off level of osmolality in relation to the pathogenesis of NEC.

Levels of education and technical skills in registered nurses working in post-anaesthesia care units in Sweden.

Specialized nursing care should be provided by nurses working in post-anaesthesia care units to ensure safe and successful recovery after surgery and anaesthesia. However, there is no consensus regarding the competence and education needed by nurses working in post-anaesthesia care units. The aim of this study is to describe and compare levels of education and technical skills in registered nurses working in post-anaesthesia care units in Sweden, as well as the education that post-anaesthesia care unit nurse managers' desire for registered nurses working in post-anaesthesia care units. This descriptive cross-sectional study was conducted in Sweden between September and December of 2019. A web-based survey was developed that included questions about the levels of education and technical skills possessed by registered nurses working in Swedish post-anaesthesia care units and desired by nurse managers for these nurses. The survey was evaluated for content validity by four experts. The survey was distributed to the nurse manager of each studied post-anaesthesia care unit. All nurse managers received written information and were informed that submitting the survey was considered as consenting to participate in the study. Most surveyed nurses held a postgraduate diploma in specialist nursing. Registered nurses performed many tasks autonomously; however, there was a significant difference between specialist nurses and registered nurses, with specialist nurses being more autonomous than registered nurses. Most of the nurse managers (n=31/45) wanted the registered nurses in their units to have education in postoperative care. The relatively low overall response rate of 58% is a study limitation. Registered nurses working in post-anaesthesia care units in Sweden must have various technical skills. Some of these skills are only performed by specialist nurses, indicating that postoperative care is an advanced level of nursing care.

Low fraction of fetal haemoglobin is associated with retinopathy of prematurity in the very preterm infant

BackgroundBlood loss and adult blood transfusions are common during the neonatal period in preterm infants. The objective of the study was to clarify if degree of loss of fetal haemoglobin...

No Apparent Increase in Treatment Uptake for Gambling Disorder during Ten Months of the COVID-19 Pandemic-Analysis of a Regional Specialized Treatment Unit in Sweden.

The COVID-19 pandemic and its impact on society has been suspected to affect gambling behaviors. Potentially, the pandemic crisis may result in increased problem gambling, for example, due to COVID-19-related psychological distress, unemployment, and financial difficulties. In addition, the cancellation of sports in early parts of the crisis has been suspected to alter gambling behaviors. Policy makers have called for action and, in some cases, have changed regulations, and media have reported possible increases in treatment seeking. However, research data are hitherto lacking. The present study assessed the treatment uptake at a regional specialized gambling-disorder unit in the healthcare system of Region Skåne, Sweden. Number of patients, treatment contacts, and patterns of rescheduling or cancellations of appointments were quantified for each month, January–December 2020, and compared to corresponding months of 2018 and 2019. Possible trends were analyzed, using an interrupted time-series analysis. Results did not indicate an increase in treatment uptake for gambling disorder during the months of COVID-19 impact in Sweden. The proportion of digital treatment increased, but total treatment uptake was unaffected by the pandemic. In conclusion, during the first ten months of the pandemic in Sweden, no obvious increase in treatment uptake for gambling disorder could be seen. Moreover, longer follow-up may be necessary in order to see if effects of worsening socioeconomic conditions may be a possible long-term risk factor of increased gambling after COVID-19.

Ways to implement preschool inclusion: A multiple-case study

This study is about preschool inclusion. It concentrates on ways to implement inclusion, on support for children with disabilities, and on the quality of inclusion practices, and it adopts a mixed method approach and a multiple-case study design. Participating in the study were twenty-five staff members and fourteen children aged three to five with different disabilities from six inclusive preschool units in Sweden. Observations and focus group interviews were conducted and analyzed. The preschool units in the study have a specialised or comprehensive organisational typology; they implement full inclusion, partial inclusion, or outdoor inclusion; and they provide various types of support to facilitate the children's sense of belonging, involvement, and development. As well, the preschool units incorporate a number of inclusive practices that are of nearly good, good, or nearly excellent overall quality. This study can form a basis for interesting discussions on preschool inclusion and the ways it can be implemented.

A Cognitive Linguistic Study of Comparative Set Phrases in Russian and Swedish

This paper examines the linguistic-cognitive potential of comparative set phrases based on the material of two languages. The originality of the study lies in the consideration of two groups of phraseological units (fixed comparisons and paremias that explicitly or implicitly verbalize comparisons) and the identification of similarities and differences both between these groups in each language and individually between Russian and Swedish. The object of study was Russian and Swedish fixed comparisons characterizing a smart and stupid person, as well as comparative paremia, expressing the opposition ‘intelligencestupidity’. The aim of the study was to identify common and culturally conditioned mental attitudes and standards of comparison. The sources of material for study included dictionaries of Russian fixed comparisons, Vladimir Dal’s collection of proverbs, a phraseological dictionary of the Swedish language and dictionaries of Swedish proverbs. A thematic classification is offered of the standards of fixed comparisons with the bases ‘stupid’ and ‘smart’ in both languages. Structural models of the paremias of the thematic group ‘intelligence-stupidity’, expressing a comparison in both languages, are highlighted; mental attitudes verbalized by these units are described. The study found that the Russian language has a closer relationship between units within set comparisons and comparative paremias than in Swedish. In both languages, zoonyms are the predominant thematic group of standards. The differences include the presence in the Russian units of standards related to the household sphere and mythologems. Swedish comparative paremias are structurally different from Russian ones. While Russian paremias express the ideas that an excessively direct and simple person is stupid; a stupid person is like a child; and it is useless to teach a person stupid by nature, Swedish units offer a logical and philosophical comparison of intelligence and stupidity. The culture-specific components of Russian paremias include a large body of household vocabulary while words denoting old measures of weight serve the same function in Swedish.

External barriers for including parents of preterm infants in a randomised clinical trial in the neonatal intensive care unit in Sweden: a descriptive study

ObjectivesPerforming randomised controlled trials (RCTs) in neonatal intensive care is challenging in many ways. While restrictive inclusion criteria or busy study protocols are obvious barriers, external barriers leading to termination...

Risk Factors for Sexual Offending in Self-Referred Men With Pedophilic Disorder: A Swedish Case-Control Study.

BackgroundThe risk of child sexual abuse among non-forensic, non-correctional patients with Pedophilic Disorder (PD) is largely unknown.MethodsWe recruited a consecutive sample of 55 help-seeking, non-correctional adult men diagnosed with DSM-5 PD at a university-affiliated sexual medicine outpatient unit in Sweden. PD participants were compared with 57 age-matched, non-clinical control men on four literature-based dynamic risk domains and self-rated child sexual abuse risk.ResultsPD participants scored higher than controls on all tested domains (0–3 points); expectedly so for pedophilic attraction (2.5 vs. 0.0, Cohen’s d = 2.40, 95% confidence interval (CI): [1.91–2.89]), but also for sexual preoccupation (1.6 vs. 1.0, d = 1.11, 95% CI: [0.71–1.51]), impaired self-regulation (1.4 vs. 1.0, d = 0.44, 95% CI: [0.06 to 0.81]), impaired cognitive empathy and antisocial traits (0.9 vs. 0.1, d = 1.18, 95% CI: [0.78–1.59]), and self-rated child sexual abuse risk (1.0 vs. 0.0, d = 1.56, 95% CI: [1.13–1.98]). When summarizing all five domains into a pre-specified composite score (0–15 points), PD subjects scored substantially higher than matched control men (7.5 vs. 2.1, d = 2.12, 95% CI: [1.65–2.59]). Five (9%) PD participants self-reported any previous conviction for a contact child sexual offense and eight (15%) for possession of child sexual abuse material or non-contact sexual offending (adult or child victim). Eighteen subjects (34%) acknowledged past week, child-related sexual behaviors.ConclusionSelf-referred, help-seeking men with PD scored higher (small to very large effect sizes) than non-clinical control men on psychiatric measures of dynamic risk of child sexual abuse suggested in prior research with correctional samples diagnosed with PD. Our findings, including the composite risk measure, might inform clinical practice, but needs validation against actual sexual offending behavior.

Flourishing at work: Nurses' motivation through daily communication - An ethnographic approach.

Shortage and turnover of registered nurses are worldwide challenges, and work motivation is one factor in retaining staff in the healthcare sector. The aim of this study was to explore registered nurses' motivation expressed in daily communication, using the basic needs in self‐determination theory as a framework. A secondary analysis of ethnographic data, collected through participant observations, informal interviews during observations, and individual interviews, was used. A total sample of all registered nurses employed at a hospital unit in Sweden (n = 10) participated. The data were analyzed thematically through the lens of the basic needs in self‐determination theory: autonomy, competence, and relatedness. Self‐regulation of learning, the possibilities to discuss work‐related challenges with colleagues, and having registered nurses lead dialogues with physicians were factors connected to autonomy. Having a registered nurse and physician solve problems together was a factor connected to competence. A sense of belonging and security in a permissive climate between registered nurses was connected to relatedness. This paper has implications for increased awareness of the three basic motivational needs, which could be used in the development of attractive workplaces.

Learning Processes as Key for Success in Workplace Health Promotion Interventions in Health Care.

There is limited previous research on how learning processes contribute to the outcomes of workplace health promotion (WHP) leadership interventions. The aim of this study was to identify the outcomes of a system-based WPH education program for managers and investigated what impact the intervention program had on health-oriented leadership, improvement work, and employee well-being, as well as what factors (i.e., how manager's active work following the intervention and organizational learning climate) contributed to these outcomes. A mixed-methods approach was applied, including qualitative interviews with 23 managers and process leaders, as well as questionnaires to employees and managers representing 17 public health care units in Sweden. The results showed that health-oriented leadership, improvement work, work satisfaction, and vitality increased at workplaces that worked actively to implement WHP following the program. Working actively with WHP and health-oriented leadership was of central importance for success and was a covariate with improved social learning climate, improved developmental leadership, and increased degree of improvement work. All included factors of learning during the intervention were associated with improved job satisfaction, while the increase in vitality seemed unrelated to program implementation. In conclusion, successful outcomes of WHP interventions interact with dimensions of organizational learning climate in the workplace.

Effects of In-Bed Cycle Exercise in Patients With Acute Stroke: A Randomized Controlled Trial

ObjectiveTo investigate the effects of in-bed cycle exercise in addition to usual care in patients with acute stroke, National Institutes of Health Stroke Scale (NIHSS) 7-42, regarding walking ability, functional outcomes, and inpatient care days. DesignRandomized controlled trial. SettingHospital care. ParticipantsPatients (N=56) with stroke NIHSS 7-42 were recruited 24-48 hours after stroke onset from 2 stroke units in Sweden. InterventionsBoth groups received usual care. The intervention group also received 20 minutes bed cycling 5 days per week with a maximum of 15 sessions. Main Outcome MeasuresThe primary outcome was median change in walking ability measured with the 6-minute walk test (6MWT). Secondary outcome measures included the median change in modified Rankin Scale (mRS), Barthel Index (BI) for activities of daily living, and inpatient care days. Measurements were performed at baseline, post intervention (3 weeks), and at 3-month follow-up. ResultsThere was no significant difference in change of walking ability (6MWT) from baseline to follow-up between the intervention and control groups (median, 105m [interquartile range [IQR, 220m] vs 30m [IQR, 118m], respectively, P=.147, d=0.401). There were no significant differences between groups regarding mRS, BI, or inpatient care days. Patients with less serious stroke (NIHSS 7-12) seemed to benefit from the intervention. ConclusionAlthough this study may have been underpowered, patients with stroke NIHSS 7-42 did not benefit from in-bed cycle exercise in addition to usual care after acute stroke. A larger study is needed to confirm our results.

A Pilot Evaluation of a Rapid Screening Test for Nosocomial Infection at a Neurosurgical Intensive Care Unit in Sweden

A Pilot Evaluation of a Rapid Screening Test for Nosocomial Infection at a Neurosurgical Intensive Care Unit in Sweden

Working with national quality registries in older people care: A qualitative study of perceived impact on assistant nurses' work situation.

AimThe aim was to investigate assistant nurses’ perceptions of how working with national quality registries affected their work situation in care of older people.DesignQualitative interview study.MethodsSixteen semi‐structured interviews were conducted at four special housing units in Sweden, and a conventional content analysis, with elements of thematic analysis, was applied.ResultsThe introduction of national quality registries contributed to role clarifications and the development of new formal work procedures in terms of documentation and arenas and routines for communication. The increased systematics and effectiveness gained from these changes had a perceived positive effect on the work situation, workload, work satisfaction, staff interactions and learning and reflection.

Critical care nurses’ lived experiences of interhospital intensive care unit-to-unit transfers: A phenomenological hermeneutical study

ObjectiveTo explore critical care nurses’ lived experiences of transferring intensive care patients between hospitals. MethodsA phenomenological hermeneutic approach using data generated through individual interviews with 11 critical care registered nurses. SettingTwo general intensive care units in Sweden. FindingsFive themes were identified: it depends on me; your care makes a difference; being exposed; depending on interprofessional relationships; and sensing professional growth. These themes were synthesised into a comprehensive understanding showing how transferring intensive care patients between hospitals meant being on an ambivalent journey together with the patient but also on a journey within yourself in your own development and growth, where you, as a nurse, constantly are torn between contradictory feelings and experiences. ConclusionInterhospital intensive care unit-to-unit transfers can be a challenging task for critical care nurses but also an important opportunity for professional growth. During the transfer, nurses become responsible for the patient, their colleagues and the entire transfer process. In a time of an increasing number of interhospital intensive care unit-to-unit transfers, this study illuminates the risk for missed nursing care, showing that the critical care nurse has an important role in protecting the patient from harm and safeguarding dignified care.

Critical care nurses' experiences of nursing intoxicated patients after abuse of drugs.

Patients intoxicated after abusing illicit drugs constitute a significant proportion of patients cared for in intensive care units. Intensive critical care nurses who nurse accidentally intoxicated patients face complex and demanding situations, and there is a lack of studies regarding this topic. To illuminate Swedish intensive critical care nurses' experiences of nursing accidentally intoxicated patients after abuse of illicit drugs. A qualitative design with an inductive approach was used. Semi-structured interviews were conducted with eight intensive critical care nurses at an intensive care unit in Sweden. Data were analysed using qualitative content analysis. The themes found illuminate intensive critical care nurses' experiences of nursing accidentally intoxicated patients after their abuse of illicit drugs: feeling empathy and a wish to provide dignified care; dreading nursing the patient and feeling a lack of empathy; feeling frustration and questioning the care; lacking knowledge about a complex and challenging situation. It is essential to respond to intoxicated patients with empathy and dignity. Intensive critical care nurses should learn how to identify factors that lead to provocation and agitation in order to reduce the occurrence of dangerous situations in intensive care units. To create a caring environment where the interaction becomes more positive and harmonious, an intensive care nurse needs a deep understanding of what a drug abuse disorder means. Moreover, the ability to see the person behind the abuse and to provide non-judgemental support is required. What is known about this topic Patients intoxicated after abuse of illicit drugs constitute a significant proportion of patients cared for in ICUs worldwide. Intensive critical nurses who nurse accidentally intoxicated patients face complex and demanding situations, and few studies have addressed this topic. What this paper contributes It is essential to respond to intoxicated patients who are admitted to the ICU with empathy and dignity, as well as to learn how to identify factors that lead to provocation and agitation in order to reduce the occurrence of dangerous situations. Education is warranted and must be enhanced, including knowledge about drug abuse and training in communication and empathy Nursing should include an understanding of what the disease of drug abuse means and the development of the ability to see the person behind the abuse and to provide non-judgemental support.

The Use of Complementary and Alternative Medicine (CAM) in Psychiatric Units in Sweden

Mental ill-health has been termed the pandemic of the 21st century, and a large share of those exposed do not receive treatment. Many people with depression, anxiety and other mental health problems consult complementary or alternative medicine (CAM), and CAM is used in conventional psychiatric care, in Sweden and in other countries. However, the extent to which CAM is used in psychiatric care, and for what purposes, are largely unknown. This study is based on a survey distributed to all heads of regional, municipal, private and governmental health care units treating persons with psychiatric symptoms across Sweden in 2019. CAM was reportedly used by 62% of the 489 responding health care units, for symptoms including anxiety, sleep disturbances and depression. Main motivations for CAM use were symptom relief, meeting patients’ requests and reduced demand for pharmaceutical medication. Very few respondents reported side effects. The most common reason for interrupting CAM use at a unit was a lack of trained professionals. This study confirms the need for further research about CAM, and for CAM education and training among healthcare professionals.

Midwives’ experiences as preceptors and the development of good preceptorships in obstetric units

ObjectiveTo study midwives’ experience in their role as a preceptor and their perception on how to best support midwifery students in obstetrics units. Obstetric units are an important learning area for student midwives but knowledge on how to become a good midwife preceptor is limited. DesignThis qualitative study explores midwife preceptors’ experience of supervising midwifery students in three obstetric units in Sweden. Following ethical approval seventeen midwife preceptors were interviewed and data were analysed thematically. FindingsThematic analysis of the interviews resulted in the identification of two themes and five subthemes: (1) self-efficacy in the preceptor role which involves (a) being confident in the professional position and (b) having the support of management and colleagues and (2) supporting the student to attain self-confidence and independence which entails (a) helping the student to grow, (b) facilitating reflection in learning situations, and (c) “taking a step back”. Key conclusionGood preceptorship occurs when midwives achieve full self-efficacy, when they master the preceptor role, and when they have enhanced their abilities to help, the student reach confidence and independence. Implications for practiceHealth care organisations needs to develop and support midwifery preceptorships.

Mortality Prediction After Cardiac Surgery: Higgins’ Intensive Care Unit Admission Score Revisited

This study was performed to develop and validate a cardiac surgical intensive care risk adjustment model for mixed cardiac surgery based on a few preoperative laboratory tests, extracorporeal circulation time, and measurements at arrival to the intensive care unit. This was a retrospective study of admissions to 5 cardiac surgical intensive care units in Sweden that submitted data to the Swedish Intensive Care Registry. Admissions from 2008 to 2014 (n= 21,450) were used for model development, whereas admissions from 2015 to 2016 (n= 6463) were used for validation. Models were built using logistic regression with transformation of raw values or categorization into groups. The final model showed good performance, with an area under the receiver operating characteristics curve of 0.86 (95% confidence interval, 0.83-0.89), a Cox calibration intercept of -0.16 (95% confidence interval, -0.47 to 0.19), and a slope of 1.01 (95% confidence interval, 0.89-1.13) in the validation cohort. Eleven variables available on admission to the intensive care unit can be used to predict 30-day mortality after cardiac surgery. The model performance was better than those of general intensive care risk adjustment models used in cardiac surgical intensive care and also avoided the subjective assessment of the cause of admission. The standardized mortality ratio improves over time in Swedish cardiac surgical intensive care.