Background

Educational environments are considered important in strengthening students’ health status and knowledge, which are associated with good educational outcomes. It has been suggested to establish healthy universities based on a salutogenic approach – namely, health promotion. The aim of this study was to describe health-promoting resources and factors among first-semester students in higher education in healthcare and social work.

Methods

This cross-sectional study is based on a survey distributed among all students in seven healthcare and social work programmes at six universities in southern Sweden. The survey was carried out in 2018 using a self-reported, web-based questionnaire focussing on general health and well-being, lifestyle factors together with three validated instruments measuring health-promoting factors and processes: the Sense of Coherence (SOC) scale, Salutogenic Health Indicator Scale (SHIS) and Occupational Balance Questionnaire (OBQ).

Results

Of 2283 students, 851 (37.3%) completed the survey, of whom 742 (87.1%) were women; 722 (84.8%) were enrolled on healthcare programmes, and 129 (15.2%) were enrolled on social work programmes. Most reported good general health and well-being (88.1% and 83.7%, respectively). The total mean scores for the SOC scale, SHIS and OBQ were, respectively, 59.09 (SD = 11.78), 44.04 (SD = 9.38) and 26.40 (SD = 7.07). Well-being and several healthy lifestyles were related to better general health and higher SOC, SHIS and OBQ scores. Multiple linear and logistic regressions showed that perceived well-being and no sleeping problems significantly predicted higher general health and higher SOC, SHIS and OBQ scores. Being less sedentary and non-smoking habits were significant predictors of higher SOC.

Conclusions

Swedish students in higher education within the healthcare and social work sector report good general health and well-being in the first semester, as well as health-promoting resources (i.e. SOC, SHIS and OBQ), and in some aspects, a healthy lifestyle. High-intensity exercise, no sleeping problems and non-smoking seem to be of importance to both general health and health-promotive resources. This study contributes to knowledge about the health promotive characteristics of students in the healthcare and social work fields, which is of importance for planning universities with a salutogenic approach.

Introduction the early phase of stroke, minutes are critical. Since the majority of patients with stroke are transported by the Emergency Medical Service (EMS), the early handling and decision making by the EMS clinician is important. Problem The study aim was to evaluate the frequency of a documented suspicion of stroke by the EMS nurse, and to investigate differences in the clinical signs of stroke and clinical assessment in the prehospital setting among patients with regard to if there was a documented suspicion of stroke on EMS arrival or not, in patients with a final hospital diagnosis of stroke.

METHODS: The study had a retrospective observational design. Data were collected from reports on patients who were transported by the EMS and had a final diagnosis of stroke at a single hospital in western Sweden (630 beds) in 2015. The data sources were hospital and prehospital medical journals.

RESULTS: In total, 454 patients were included. Among them, the EMS clinician suspected stroke in 52%. The findings and documentation on patients with a suspected stroke differed from the remaining patients as follows: a) More frequently documented symptoms from the face, legs/arms, and speech; b) More frequently assessments of neurology, face, arms/legs, speech, and eyes; c) More frequently addressed the major complaint with regard to time and place of onset, duration, localization, and radiation; d) Less frequently documented symptoms of headache, vertigo, and nausea; and e) More frequently had an electrocardiogram (ECG) recorded and plasma glucose sampled. In addition to the 52% of patients who had a documented initial suspicion of stroke, seven percent of the patients had an initial suspicion of transitory ischemic attack (TIA) by the EMS clinician, and a neurologist was approached in another 10%.

CONCLUSION: Among 454 patients with a final diagnosis of stroke who were transported by the EMS, an initial suspicion of stroke was not documented in one-half of the cases. These patients differed from those in whom a suspicion of stroke was documented in terms of limited clinical signs of stroke, a less extensive clinical assessment, and fewer clinical investigations. Andersson E , Bohlin L , Herlitz J , Sundler AJ , Fekete Z , Andersson Hagiwara M . Prehospital identification of patients with a final hospital diagnosis of stroke.

Background: It is a challenge to promote exercise among older persons. Knowledge is needed regarding the maintenance of exercise aiming at preventing falls and promoting health and well-being in older persons.

Purpose: This descriptive study used a qualitative inductive approach to describe older persons’ experiences of a fall-preventive, home-based exercise program with support for behavioral change. Methods: Semi-structured interviews were conducted with 12 elderly persons aged 75 years or older, and a qualitative content analysis was performed.

Results: Four categories emerged: facilitators of performing exercise in everyday life, the importance of support, perceived gains from exercise, and the existential aspects of exercise.

Conclusion: With support from physiotherapists (PTs), home-based exercise can be adapted to individual circumstances in a meaningful way. Including exercises in everyday life and daily routines could support the experience of being stronger, result in better physical functioning, and give hope for an extended active life in old age. 

Suffering and well-being are significant aspects of human existence; in particular, suffering and well-being are important aspects of patients' experiences following diseases. Increased knowledge about existential dimensions of illness and healthcare experiences may be needed in order to improve care and reduce unnecessary suffering. Therefore, the aim of this paper is to illuminate the phenomenon of suffering experienced in relation to healthcare needs among patients in hospital settings in Sweden. In this study, we used a reflective lifeworld approach. The data were analysed with a focus on meanings. The results describe the essential meaning of the phenomenon of suffering in relation to healthcare needs. The patients were suffering during care-giving when they felt distrusted or mistreated and when their perspective on illness and health was overlooked. Suffering was found to arise due to healthcare actions that neglected a holistic and patient-centred approach to care. Unfortunately, healthcare experiences that cause patients to suffer seem to be something one needs to endure without being critical. The phenomenon can be described as having four constituents: to be mistreated; to struggle for one's healthcare needs and autonomy; to feel powerless; and to feel fragmented and objectified. The study concludes that there are problems associated with patients experiencing suffering at the hands of healthcare providers, even if this suffering may not have been caused deliberately to the patient. Consequently, conscious improvements are needed to lessen the suffering caused by care-giving, as are strategies that promote more patient-centred care and patient participation.

BACKGROUND: To effectively utilize available healthcare resources, integrated care models are recommended. According to such model's, registered nurses have the potential to increase patient access to health care services and alleviate organizational workload. Studies on acute home consultation assessments by registered nurses are sparse. The aim was to describe the reasons and actions for unscheduled same-day face-to-face registered nurse consultation at home offered to patients calling the national telephone helpline for healthcare in Sweden (SHD 1177), according to the integrated Collaborative Health Care model.

METHODS: A descriptive cross-sectional study was designed. Data from registered nurses (n = 259) working within the Collaborative Health Care model, who performed unscheduled consultations at home (n = 615) using a data collection tool from 2017 to 2018 were collected.

RESULTS: Among the 615 unscheduled home consultations performed by registered nurses, > 50% of the patients were managed at home as their health problems were not deemed as requiring a same-day referral to a clinic when assessed by the registered nurses. The most frequent health problems and reasons for contact were urinary tract problems, followed by medical and surgical conditions. Social factors, including living alone, impacted referral. Those living with a partner received care at home to a greater extent than those who lived alone.

CONCLUSION: An integrated model for healthcare involving registered nurses direct assessment, action and accountability seems to be an efficient option for providing integrated care at home and reducing acute clinic visits. © 2024. The Author(s).

Introduction Nursing students perform their clinical practice in different types of clinical settings. The clinical learning environment is important for students to be able to achieve desired learning outcomes. Knowledge is lacking about the learning environment in different clinical settings. Aim The aim was to compare the learning environment in different clinical settings from the perspective of the nursing students. Design A cross-sectional study with comparative design was conducted. Method Data was collected from 185 nursing students at three universities by means of a questionnaire involving the Clinical Learning Environment, Supervision and Nurse Teacher (CLES + T) evaluation scale. An open-ended question was added in order to ascertain reasons for dissatisfaction with the clinical placement. Results The nursing students' satisfaction with the placement did not differ between clinical settings. However, those with clinical placement in hospital departments agreed more strongly that sufficient meaningful learning situations occurred and that learning situations were multi-dimensional. Some students reported that the character of the clinical setting made it difficult to achieve the learning objectives. Conclusion In the planning of the clinical placement, attention must be paid to whether the setting offers the student a meaningful learning situation where the appropriate learning outcome may be achieved.

Purpose: The aim of this study was to illuminate parents' lived experiences of losing a child to cancer. Method: Interviews and a narrative about parents' experiences of losing a child to cancer were gathered from six parents of children whom had participated in a longitudinal study across the child's illness trajectory. The analysis of the data was inspired by van Manen's hermeneutic phenomenological approach. Results: One essential theme emerged: Like being covered in a wet and dark blanket, as well as six related themes: Feeling conflicting emotions, Preparing for the moment of death, Continuing parenting after death, Recollecting and sharing memories, Working through the sorrow and New perspectives in life. Conclusion: There is a need for good palliative care. If not, there is a risk that the parent will perseverate and blame themselves for not being a good parent during the suffering child's last time in life. Meetings with the parents six months and two years after the child's death might facilitate healing through the grief process.

AIM: The aim of this study was to explore participation and support as experienced by close relatives of patients at an intensive care unit (ICU).

METHOD: This study used the phenomenological approach as developed by Dahlberg et al. (2008) as a method for reflective lifeworld research. Seven close relatives of critically ill patients cared for at an ICU were interviewed. The data were analysed with a focus on meanings.

RESULTS: Being allowed to participate in the care of critically ill patients at an ICU is important for close relatives to the patients. Their experiences can be described as having four constituents: participation in the care of and being close to the patient; confidence in the care the patient receives; support needed for involvement in caregiving; and vulnerability.

CONCLUSION: Participation with and support from health-care professionals are important for the relatives' well-being and their ability to contribute to the patients' care. Health-care professionals, especially critical care nurses, need to create an atmosphere that invites relatives to participate in the care provided at an ICU.

AIMS AND OBJECTIVES: To describe nursing students' experience of stress during clinical practice and evaluate the risk of stress in relation to the clinical setting characteristics and the organisation of the clinical education. BACKGROUND: Stress during clinical practice is well documented, but there is a lack of knowledge concerning whether the clinical setting characteristics and the organisation of the education make a difference. DESIGN: A cross-sectional study with evaluative design. METHODS: Data were collected by means of a numerical rating scale for the assessment of stress and questions about the clinical setting characteristics and the organisation of the education. One hundred and eighty-four students who had completed their final year on the nursing programme at three universities in Sweden were included. RESULTS: Nearly half of the students (43%) experienced high level of stress during clinical practice. Measured by decision in the tree analysis, the absolute risk of stress was 57% in students with placements in hospital departments, as compared to 13% in students with placements in other clinical settings. The risk of stress increased to 71% if the students with placement in a hospital took the national clinical final examination. Performance of practice in a hospital department overcrowded with patients was also associated with increased risk of stress. The organisation of supervision and number of students at the clinical placement had an effect on the experience of stress, but did not prove to be risk factors in the analysis. CONCLUSIONS: The risk of stress in nursing students during their clinical practice differs depending on clinical setting characteristics. The taking of the national clinical final examination could be a source of stress, but this requires further investigation. RELEVANCE TO CLINICAL PRACTICE: It is important that supervisors are aware that students in hospital departments overcrowded with patients are at risk of stress and may have increased need of support.

The aim was to investigate occupational stress among newly graduated nurses in relation to the workplace and clinicla group supervision. Being a newly graduated nurse is particulary stressful. Whar remains unclear is wehter teh workplace and clinical group supervision affect the stress. A cross-sectional comperative study was performed. Data were collected by means of a numerical scale measuring occupational stress, questions about workplace and clinicla group supervision. One hundred and thirteen nusres were included in the study. Conclusions: Newly graduated nurses experience great strss and need support. Nusrse participating in clinical group supervision reported significantly less stress.

Effective antiretroviral therapy has extended the life expectancy of people living with HIV and in Western countries, with 50% of individuals in Western countries now aged 50 or older. The aim was to review empirical research on adults who are 60 years or older on their experiences of living with HIV and their healthcare needs. A scoping review with a systematic literature search in Cinahl, Psycinfo and PubMed was performed in February and March 2022. A total of 4757 references, published 2012-2022, were screened and 20 studies were included. The findings indicate that the experiences and needs of older adults living with HIV vary depending on whether they are in the younger or the eldest part of the cohort. Overall, the group lives with multiple chronic conditions, is at a higher risk of cognitive limitations and reports more loneliness than people with no HIV. Limited qualitative research was available. Thus, future research should describe the subjective experiences of older adults to understand psychosocial aspects that impact successful ageing. This knowledge can inform interventions and services to support the well-being of older adults living with HIV, not only in Western countries but globally as the ageing population living with HIV continues to grow.

Problem: Little is known about issues of patient-reported problems, in particular within psychiatric services for children with mental ill health. Child and family complaints related to child mental health services can be analyzed and discussed in light of the universal human right to health and healthcare. Therefore, the aim of this study was to analyze child and family complaints related to child mental health services. Methods: A retrospective, descriptive design was used. Child and family complaints were analyzed with a qualitative thematic analysis. Findings: The findings were described in three themes describing lack of access to care, inadequate communication between services and children with mental ill health and their families, and lack of clarity of who is responsible for care, leading to neglect of children's needs. These issues place a huge responsibility on parents or relatives. Conclusion: Better communication within mental health services, and better collaboration with other services such as school and social services, could limit children's suffering. Healthcare services with named professionals who specialize in child mental health and provide continuity in care, are required. General human rights principles should guide planning and care of children. 

Background

It has been suggested that the university environment, to improve students’ health status and educational outcomes, should be based on a health promoting approach. More knowledge is needed about health promoting resources and lifestyle factors that may be of value for students in higher education and their future work-life balance. The aim of this study was to explore health-promoting resources, general health and wellbeing, and health promoting lifestyle factors among fourth and final semester students in higher education in healthcare and social work.

Methods

This longitudinal study is based on self-reported data collected through a web-based questionnaire that included questions about general health, wellbeing, and healthy lifestyle factors and made use of instruments: the Sense of Coherence (SOC) scale, the Salutogenic Health Indicator Scale (SHIS), and five questions from the General Nordic Questionnaire (QPS Nordic). The questionnaire was distributed among students enrolled in seven different healthcare and social work programmes at six universities in Sweden. Data was collected when students were in their fourth (2019/2020) and final (2020/2021) semesters analysed with multiple linear and logistic regressions.

Results

The survey included responses from students during the fourth (n = 498) and the final (n = 343) semester of higher education programmes in health and social work. Total SOC scores decreased between the fourth semester and the final semester. The prevalence of the health promoting lifestyle factor of physical exercise decreased between the fourth and final semesters. Students in their final semester reported valuing group work more highly than did students in their fourth semester. Despite this, students in both the fourth and the final semester reported high SOC, low levels of good general health and perceived wellbeing, and sleeping problems.

Conclusions

Students’ report of good general health were associated with wellbeing, high-intensity physical training, and no sleeping problems A high SOC level was associated with good general health, perceived wellbeing, and no sleeping problems. A higher SHIS level was also associated with wellbeing and no sleeping problems. Therefore, we suggest further research focusing on how to prepare students in healthcare and social work during higher education for a future work-life in balance targeting effects on sleep quality.

OBJECTIVES: The aim was to describe and compare the clinical teacher's role in different models of clinical practice from the perspective of student nurses.

DESIGN AND SETTINGS: The study took place in collaboration with two Swedish universities that applied different educational models in clinical practice. A mixed method approach was used. The quantitative part had a comparative design and the qualitative part had a descriptive design.

PARTICIPANTS: The study group consisted of 114 student nurses (response rate 87%). Fifty-three of them had met clinical teachers employed at the university and not participating in the daily clinical work (University Nurse Teachers, UNTs), whilst 61 had met clinical teachers dividing their time between teaching and nursing (Clinical Nurse Teachers, CNTs). Eight students participated in the qualitative part of the study.

METHODS: A questionnaire including the CLES+T scale was used to ascertain the students' perception of the clinical teacher's role, complemented by interviews directed towards an enrichment of this perception.

RESULTS: Students meeting CNTs agreed more strongly than those meeting UNTs that the teacher had the ability to help them integrate theory and practice. Whilst spontaneous meetings between students and CNTs occurred, students mostly met UNTs in seminars. Students meeting UNTs felt alone but did appreciate having someone outside the clinical environment to provide support if they did not get along with their preceptor.

CONCLUSIONS: In the case of UNTs, it is important that they keep their knowledge of clinical issues updated and visit the clinical placement not only for seminars but also to give students emotional support. In the case of CNTs, it is important that they are members of the faculty at the university, take part in the planning of the clinical courses and are able to explain the learning goals to the students.

Background: 

The home care of older persons includes inter-personal interactions and communication needed to care for and respond to diverse needs of older people. Previous research has focused on emotional expressions of older persons and responses by nursing staff. Research on the meaning of the interaction in these sequences is sparse. Therefore, the aim of this study was to illuminate the meaning attached to sequences of emotional communication and the interaction during these sequences between older persons and nursing assistants during home care visits.

Methods: 

A descriptive observational design was used. The data consisted of 44 audio recordings of real-life conversations between older persons and nursing assistants during home care visits. A hermeneutic phenomenological analysis was conducted.

Findings: 

Preliminary results indicate sequences of emotional communication being a window of opportunities. The interaction that followed were linked to dual and sometimes incongruent meanings. Expressions being actively blocked or ignored could cause an increase of unpleasant emotions or distract away from negative feelings. Simultaneously, such conversations could both ease or add to the complexity of the interaction and communication. Conversations elaborating on the older persons’ emotions seemed to instill trust and create meaningfulness, at the same time as these situations contained unpleasant moments with sad or angry feelings. The risk for discomfort in these sequences could threaten the trust in the relationship.

Discussion: 

Conversations on older persons worries can be complex: the findings point to a fine line between meaningfulness and distress in these sequences. Unpleasant emotions call for attention and caution, these may need to be noticed at the same time as they cannot be forced out. 

Background: Communication is important for nurse assistants (NAs) when caring for older persons. There is limited research about how to improve the communication competence of NAs in home care. The aim was to describe NAs perception on learning in relation to an educational intervention on person-centred communication.

Methods: A qualitative descriptive study was conducted. Data consisted of four group interviews, five individual in-depth interviews and written reflection assignments from participants gathered during the web-based intervention. In total 23 NAs at two home care units participated. The data were analysed using a phenomenographic approach. This is a qualitative method for analysis developed from Nordic traditions of phenomenology. Phenomenography aims to describe individual perceptions of a certain phenomenon.

Preliminary findings points to the nurse assistants perceiving that the education supported their development of person-centred communication. They pointed out self-reflections as important for their learning as well as to get confirmation on what was already known. The NAs described that the intervention added to their knowledge and skills. Even though, there was more to learn and challenges that remained regarding communication in challenging situations such as caring for persons in end-of-life and supporting their relatives, caring for persons being aggressive or violent.

Preliminary implications of research: This study can provide knowledge on participants’ perspective on their learning process, which may be important to consider when conducting educational interventions in home care as well as other health care contexts.

Aim

To explore nursing assistants' (NAs') experiences of developing communication skills while participating in an educational intervention on person-centred communication.

Design

A descriptive qualitative study was conducted.

Methods

Data were collected from interviews and written assignments before, during and after an educational intervention on person-centred communication targeting NAs in home care services. The data were analysed using a phenomenological approach. A total of 25 NAs participated in the study.

Results

The findings describe NAs' experiences concerning the communication skills needed for building relationships with older persons and handling emotionally challenging situations. The educational intervention increased their knowledge and awareness of the importance of communication skills and how such skills are developed and refined.

An educational intervention to improve communication skills in home care – a feasibility study

Background

An educational intervention focused on person-centred communication with older persons in home care was developed. Twenty-three nursing assistants (NAs) from two home care units were offered the intervention. This feasibility study was conducted to capture benefits and pit falls with study processes before large scale interventions, such as acceptability and appropriateness of evaluation methods.

Aim

To explore the feasibility of proposed methods for evaluating a novel educational intervention on person-centered communication for NAs in home care.

Method

Feasibility study with pre- and post-assessments, including evaluation of data collection procedures, completion rates, and missing data for two questionnaires: Self-efficacy Questionnaire measuring communication skills and Measure of Job Satisfaction. Descriptive and statistical analysis was conducted. 

Results

The results showed a completion rate of 83% and 61% in pre- and post-assessment respectively, and a low proportion of missing data. The questionnaires were feasible and acceptable for NAs to complete and understand. Stress due to staff shortages and high workload negatively affected NAs’ participation in data collection. Overall, NAs rated their communication skills as high with a tendency towards higher communication self-efficacy after the intervention, however, this difference was not statistically significant. Job satisfaction remained unchanged pre- and post-intervention.

Conclusion

Low follow-up rates suggest that the data collection procedures need refinement. Although the outcomes are preliminary at this point, they indicate a ceiling effect in NAs’ self-efficacy ratings. The ceiling effect limits possibilities for improvement and suggests that studies with a larger sample is needed.

Implications for caring in a changing world

In a changing world, where a rapid aging population challenges home care services, there is a need for innovative interventions that support and strengthen health care professionals’ communication skills, aiming at improving older persons’ well-being This study contributes with knowledge to the complexity of developing and evaluating complex interventions on communication in home care.

Aim

To explore the feasibility of evaluating a novel educational intervention on person-centered communication for nursing assistants (NAs) in home care.

Design

A feasibility study with pre- and post-assessments.

Methods

Feasibility was assessed pre- and post-intervention, including evaluation of data collection procedures, completion rates and missing data in two questionnaires: Self-efficacy Questionnaire measuring communication skills and Measure of Job Satisfaction, analysed descriptively and statistically.

Results

The questionnaires were feasible and acceptable for the NAs to complete and understand. The pre- and post-assessments showed 83% and 61% completion rates, respectively, and a low proportion of missing data. Barriers for not participating in data collection were stress caused by staff shortages and high workload. Preliminary analysis of the questionnaires showed no significant difference pre- and post-intervention, even though an overall tendency of increased communication self-efficacy was observed. The NAs' self-efficacy ratings also revealed a ceiling effect.

Background: There is currently a strong emphasis on person-centred care (PCC) and communication; however, little research has been conducted on how to implement person-centred communication in home care settings. Therefore, the ACTION (A person-centred CommunicaTION) programme, which is a web-based education programme focusing on person-centred communication developed for nurse assistants (NAs) providing home care for older persons, was implemented. This paper reports on the process evaluation conducted with the aim to describe and evaluate the implementation of the ACTION programme. Methods: A descriptive design with a mixed method approach was used. Twenty-seven NAs from two units in Sweden were recruited, and 23 of them were offered the educational intervention. Quantitative and qualitative data were collected from multiple sources before, during and after the implementation. Quantitative data were used to analyse demographics, attendance and participation, while qualitative data were used to evaluate experiences of the implementation and contextual factors influencing the implementation. Results: The evaluation showed a high degree of NA participation in the first five education modules, and a decrease in the three remaining modules. Overall, the NAs perceived the web format to be easy to use and appreciated the flexibility and accessibility. The content was described as important. Challenges included time constraints; the heavy workload; and a lack of interaction, space and equipment to complete the programme. Conclusions: The results suggest that web-based education seems to be an appropriate strategy in home care settings; however, areas for improvement were identified. Our findings show that participants appreciated the web-based learning format in terms of accessibility and flexibility, as well as the face-to-face group discussions. The critical importance of organizational support and available resources are highlighted, such as management involvement and local facilitation. In addition, the findings report on the implementation challenges specific to the dynamic home care context. Trial registration: This intervention was implemented with nursing assistants, and the evaluation only involved nursing staff. Patients were not part of this study. According to the ICMJE, registration was not necessary (). © 2021, The Author(s).

Background: The aging population and the number of older persons living at home are increasing. Some have extensive needs for care, which leads to increased demands on professionals in home care settings. Professionals’ need to have sufficient competency to promote health and wellbeing among older persons. For sustainable care, there is a need for efficient educational efforts in the home care context. Person-centred communication may increase the quality of care and improve older persons independence.

Aim: To develop, test and evaluate a web based educational intervention on person-centred communication targeting nurse assistants (NA) in home care setting.

Method: A stepwise web based education, consisting of eight modules, was developed and tested. The education was evaluated using both quantitative and qualitative data.

Results: In all, 23 NAs participated in the education. The majority of the NAs (n=21) participated in five or more modules. Overall, the education was experienced as feasible and accessible. Challenges emerged during the time of the intervention, such as time constrains, technical problems, and participants´ engagement.

Conclusion: The web-based education was found to be a feasible way to offer education to home care staff, although successful implementation requires adaptations to the current context. Engagement from managers, especially considering the NAs motivation to complete the education is important for accomplishment by participants.

Implications: This study can contribute to the knowledge regarding how to develop, test and evaluate an educational intervention, and considerations found to be important during the implementation process for success.

Background

Person-centred communication is important to assure the quality of home care services and to promote older persons´ independence and influence over their lives. Previous research indicates challenges regarding communication between professionals and home care recipients, and how to deliver efficient educational efforts in the home care context.

Aim

The aim was to describe the development and process evaluation of a web-based education intervention in person-centred communication for nurse assistants (NA) in home care.

Method

The intervention consisted of a step-wise education, with eight modules that included short video based lectures and movies, one group supervision, and reflective assignments. The content was based on previous research on health care communication and person-centred care. Data were collected from multiple sources before, during and after the implementation, and analysed by a combination of quantitative and qualitative approaches.

Results

A complex intervention was conducted to improve the communication competency wanted for person-centred care. The intervention was offered to 23 nurse assistants (NA). Of those, 91% (n=21) participated, in total or in parts, in five or more modules. The findings address participants’ experiences of expectations and worries before the intervention, experiences from the implementation process, and their experiences from taking part of the intervention. During the implementation changes were made according to local circumstances. Overall, the education was experienced as feasible. The web-based design was found to be accessible and the content relevant.

Conclusion

From this study, it can be concluded that the key features for successful implementation of the intervention was the format, educational content, and technical facilities provided. In addition to this, participant involvement, resources and constructive practical circumstances for NAs to participate in the intervention are crucial.

BACKGROUND

Person-centred communication is important to assure the quality of home care services and to promote older persons´ independence and influence over their lives. Previous research indicates challenges regarding communication between professionals and home care recipients, and how to deliver efficient educational efforts in the home care context.

AIM

The aim was to describe the development and process evaluation of a web-based education intervention in person-centred communication for nurse assistants (NA) in home care.

METHODS

The intervention consisted of a step-wise education, with eight modules that included short video based lectures and movies, one group supervision, and reflective assignments. The content was based on previous research on health care communication and person-centred care. Data were collected from multiple sources before, during and after the implementation, and analysed by a combination of quantitative and qualitative approaches.

RESULTS

A complex intervention was conducted to improve the communication competency wanted for person-centred care. The intervention was offered to 23 nurse assistants (NA). Of those, 91% (n=21) participated, in total or in parts, in five or more modules. The findings address participants’ experiences of expectations and worries before the intervention, experiences from the implementation process, and their experiences from taking part of the intervention. During the implementation changes were made according to local circumstances. Overall, the education was experienced as feasible. The web-based design was found to be accessible and the content relevant. 

CONCLUSION

Our findings show that the benefits of the web-based educational intervention included the short and focused lectures as well as its accessibility. Challenges with the implementation process included gaining access to the NAs and motivating and involving the NAs. This study emphasizes the environmental support needed to successfully conduct complex interventions, including physical, organizational and cultural aspects.

Background: Person-centred communication is important to assure the quality of home care services and to promote older persons independence and influence over their lives. Previous research indicates challenges regarding communication between professionals and home care recipients, and how to deliver efficient educational efforts in the home care context. Hitherto, research on design and implementation of this type of intervention is scarce.

Aims and objectives: To describe the development and process evaluation of an education intervention in person-centred communication for nursing staff (NS) in home care.

Method: The web-based education consisted of eight modules, including short video based lectures and movies, one group supervision, and reflective assignments. The content was based on previous research of health care communication and person-centred care. Data was collected from multiple sources (web analytics, interviews, evaluation forms, and field notes), before, during and after the implementation, and analysed by a combination of quantitative and qualitative approaches.

Results: In all, 23 NS participated in the education. Initial analysis indicate that a majority of the participants completed six or more modules. Overall, the content was experienced as relevant and interesting. The flexibility and accessibility of the web-based format was appreciated, as well as the mix of lectures, short movies, reflective assignments and group supervision. Challenges included developing content relevant to work teams with diverse competence levels and individual differences (e.g. age, language, motivation). Furthermore, time constrains and structure of work emerged as barriers for implementing the education, in some cases adding stress and fragmentation to NS´ work.

Conclusions: This type of intervention seems to be a feasible approach for flexible educations in person-centred communication for NS. Engagement and commitment from managers and team leaders may be key factors in succeeding, with impact on participants´ motivation to fulfil the education.

INTRODUCTION: This paper presents an international cross-sectional study on person-centred communication with older people receiving healthcare (COMHOME). Person-centred care relies on effective communication, but few studies have explored this with a specific focus on older people. The main aim of the COMHOME study is to generate knowledge on person-centred communication with older people (>65 years) in home healthcare services, radiographic and optometric practice.

METHODS AND ANALYSIS: This study will explore the communication between care providers and older persons in home care services. Home healthcare visits will be audiorecorded (n=500) in Norway, the Netherlands and Sweden. Analyses will be performed with the Verona Coding Definitions for Emotional Sequences (VR-CoDES), the Roter Interaction Analysis System (RIAS) and qualitative methods. The content of the communication, communicative challenging situations as well as empathy, power distance, decision-making, preservation of dignity and respect will be explored. In Norway, an additional 100 encounters, 50 in optometric practice (video recorded) and 50 in radiographic practice (audiorecorded), will be analysed. Furthermore, healthcare providers' self-reported communication skills, empathy, mindfulness and emotional intelligence in relation to observed person-centred communication skills will be assessed using well-established standardised instruments.

ETHICS AND DISSEMINATION: Depending on national legislation, approval of either the central ethical committees (eg, nation or university), the national data protection officials or the local ethical committees (eg, units of home healthcare) was obtained. Study findings will be disseminated widely through peer-reviewed publications and conference presentations. The research findings will add knowledge to improve services provided to this vulnerable group of patients. Additionally, the findings will underpin a training programme for healthcare students and care providers focusing on communication with older people.

BACKGROUND: Undergraduate 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.

OBJECTIVE: The aim of this study was to investigate student nurses' views on the care of and communication with older people.

DESIGN: A descriptive study with a mixed-method approach was conducted.

METHODS: Quantitative and qualitative data were collected from a questionnaire completed by third-year Swedish student nurses in 2015.

RESULTS: The 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.

CONCLUSIONS: Despite 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.

BACKGROUND: To become a parent is an emotionally life-changing experience. Paternal depression during the postnatal period has been associated with emotional and behavioral problems in children. The condition has predominantly been related to mothers, and the recognition of paternal postnatal depression (PND) has been paid less attention to. PND in fathers may be difficult to detect. However, nurses in pediatric services meet a lot of fathers and are in a position to detect a father who is suffering from PND. Therefore, the aim of this study was (a) to explore Child Health Center nurses' experiences of observing depression in fathers during the postnatal period; and (b) to explore hindrances of observing these fathers.

METHODS: A qualitative descriptive study was conducted. Ten nurses were interviewed in 2014. A thematic data analysis was performed and data were analyzed for meaning.

RESULTS: Paternal PND was experienced as being vague and difficult to detect. Experiences of fathers with such problems were limited, and it was hard to grasp the health status of the fathers, something which was further complicated when routines were lacking or when gender attitudes influenced the daily work of the nurses.

CONCLUSION: This study contributes to an increased awareness of hindrances to the recognition of PND in fathers. The importance to detect all signals of paternal health status in fathers suffering from PND needs to be acknowledged. Overall, more attention needs to be paid to PND in fathers where a part of the solution for this is that they are screened just like the mothers.

BACKGROUND: Nurses' attitudes toward caring for dying persons need to be explored. The Frommelt Attitude Toward Care of the Dying (FATCOD) scale has not previously been used in Swedish language.

OBJECTIVES: The objectives of this study were to compare FATCOD scores among Swedish nurses and nursing students with those from other languages, to explore the existence of 2 subscales, and to evaluate influences of experiences on attitudes toward care of dying patients.

METHODS: A descriptive, cross-sectional, and predictive design was used. The FATCOD scores of Swedish nurses from hospice, oncology, surgery clinics, and palliative home care and nursing students were compared with published scores from the United States, Israel, and Japan. Descriptive statistics, t tests, and factor and regression analyses were used.

RESULTS: The sample consisted of 213 persons: 71 registered nurses, 42 enrolled nurses, and 100 nursing students. Swedish FATCOD mean scores did not differ from published means from the United States and Israel, but were significantly more positive than Japanese means. In line with Japanese studies, factor analyses yielded a 2-factor solution. Total FATCOD and subscales had low Cronbach α's. Hospice and palliative team nurses were more positive than oncology and surgery nurses to care for dying patients.

CONCLUSIONS: Although our results suggest that the Swedish FATCOD may comprise 2 distinct scales, the total scale may be the most adequate and applicable for use in Sweden. Professional experience was associated with nurses' attitudes toward caring for dying patients.

IMPLICATION FOR PRACTICE: Care culture might influence nurses' attitudes toward caring for dying patients; the benefits of education need to be explored.

AIMS AND OBJECTIVES: The aim of the study was to explore older persons' experiences of telephone advice nursing at primary healthcare centres.

BACKGROUND: Telephone advice nursing is expanding worldwide, and the older population is increasing. Little is known about older persons' experiences of telephone advice nursing provided by primary healthcare.

DESIGN: This study has a descriptive design with a qualitative inductive approach.

METHODS: Data were collected via interviews with a purposive sample of 10 older persons in 2014. The data were analysed using qualitative content analysis.

RESULTS: The older persons' experiences were described in two themes: the patient-friendly aspects of telephone advice nursing and the patient-unfriendly aspects of telephone advice nursing. The themes can be understood as two sides of the same coin; the differences point to both the advantages and disadvantages of the service and are further illuminated through seven subthemes.

CONCLUSIONS: This study contributes to increased awareness of the advantages and disadvantages of the telephone advice nursing system as experienced by older persons. To be the focus of attention during calls was highlighted as important; and clear communication was deemed crucial. When the communication between the nurse and the older persons was perceived as good and the perspective of the caller was the focus, an experience of safety and satisfaction was described. Older persons had great confidence in the telephone nurses' competence and perceived their ability to access the service as mostly good, even if it was sometimes difficult to use the service.

RELEVANCE TO CLINICAL PRACTICE: The communicative competence of telephone nurses is essential when providing telephone advice nursing to older persons. In addition, a person-centred approach is important to provide optimal care in telephone advice nursing.

AIM:

To: (a) describe how telephone nurses define a frequent caller; and (b) describe their experiences with calls from frequent callers to primary healthcare centres.

BACKGROUND:

Telephone nursing has been noted to be a cost-effective method to enhance access to and use of health care. Some patients use these services extensively and are called 'frequent callers'. Little is known about this group of callers, the reasons behind these calls and telephone nurses' experiences and strategies to manage the calls.

DESIGN:

Descriptive design with a qualitative inductive approach.

METHODS:

Interviews were conducted with ten telephone nurses in Sweden in 2015. Qualitative content analysis was conducted.

RESULTS:

A main theme was established, called 'Balancing between the experienced and assessed needs', which described the telephone nurses' experiences with calls made by frequent callers to primary healthcare centres and was further described in five categories with 15 subcategories. The categories described telephone nurses' definitions of frequent callers, telephone nurses' views of the underlying reasons for the calls, challenges related to frequent callers, experiences with an increased work load and strategies used to manage and help frequent callers.

CONCLUSION:

Frequent callers were commonly encountered by telephone nurses' in this study. Their calls were experienced as complex and demanding to manage. The findings point to needs for guidelines and routines to improve the care of frequent callers. In addition, support and training in communication skills to encounter this group of callers in an optimal and safe way may be required.

Objective

To provide a synthesis of already synthesized literature on person-centered care and patient-centered care in order to identify similarities and differences between the two concepts.

Methods

A synthesis of reviews was conducted to locate synthesized literature published between January 2000 and March 2017. A total of 21 articles deemed relevant to this overview were synthesized using a thematic analysis.

Results

The analysis resulted in nine themes present in person-centered as well as in patient-centered care: (1) empathy, (2), respect (3), engagement, (4), relationship, (5) communication, (6) shared decision-making, (7) holistic focus, (8), individualized focus, and (9) coordinated care. The analysis also revealed that the goal of person-centered care is a meaningful life while the goal of patient-centered care is a functional life.

Conclusions

While there are a number of similarities between the two concepts, the goals for person-centered and patient-centered care differ. The similarities are at the surface and there are important differences when the concepts are regarded in light of their different goals.

Practice implications

Clarification of the concepts may assist practitioners to develop the relevant aspects of care. Person-centered care broadens and extends the perspective of patient-centered care by considering the whole life of the patient.

Aim: Empathy is a crucial component of the nurse-patient relationship, but knowledge is lacking as to when empathy develops during nursing education. The aim of the present study was to compare empathy levels at different stages of undergraduate nursing education and different master's nursing programmes.

Design: The design was a comparative cross-sectional study.

Methods: A total of 329 participants in Sweden, comprised of nursing students in their second and sixth semesters in an undergraduate nursing programme as well as master's nursing students, rated their own empathy using the Jefferson Scale of Physician Empathy.

Results: Students in their sixth semester in an undergraduate nursing programme expressed more empathy than did students in their second semester and master's nursing students. Among the five master's programmes, public-health nursing students expressed the most empathy and intensive-care nursing students the least.

AIM: This study aims to explore nurse assistants' and Registered Nurses' responses to older persons' expressions of emotional needs during home care visits.

BACKGROUND: Communication is a central aspect of care. Older persons might express different emotions and needs during home care visits and such expressions can be challenging to respond to. Little is known about communication in home care or nursing staff responses to older persons' expressed emotional needs.

DESIGN: Descriptive, cross-sectional design on nursing staff responses to older persons' negative emotions in home care.

METHODS: Collected data consisted of audio recordings of home care visits between older persons and nursing staff. Data were collected between August 2014-November 2015. The nursing staff responses to older persons' negative emotions in the communication were analysed with the Verona Coding Definitions of Emotional Sequences (VR-CoDES).

RESULTS: The nursing staff most often give non-explicit responses, providing space for further disclosure of older persons' expressed negative emotions. Such responses were more frequent if the nursing staff had elicited the older persons' expressions of a negative emotion than if such expressions were elicited by the older persons themselves. Most frequent types of responses were backchannel, active invitation or information advice.

CONCLUSION: The nursing staff responses were mainly non-explicit responses providing space for older persons to tell more about their experiences. Such responses can be discussed in terms of person-centred communication and is important for the comfort of emotional concerns.

Background: Communication is a cornerstone in nursing and aims at both information exchange and relationship building. To date, little is known about the naturally occurring communication between older persons and nurses in home care. Communication might heal through different pathways and a patient- or person-centered communication could be important for health and well-being of older persons. However, the delivery of individualized home care is challenged by routines and organizational demands such as time constraints. Therefore, the aim of this study was to explore the patient-centered aspects of home care communication between older persons and registered nurses.

Methods: In total 37 older persons (aged 65 years or older) and eleven RNs participated in 50 audio-recorded home care visits. Roter Interaction Analysis System (RIAS) was used to code verbal communication. A ratio from these codes, establishing the degree of patient-centeredness, was analyzed using a Generalized Linear Mixed Model.

Results: The present home care communication contained more socio-emotional than task-oriented communication and the emotional tone was largely positive. The global affect ratings reflected an overall positive tone (m = 39.88, sd = 7.65), with higher ratings on dimensions of, for example, responsiveness/engagement and interactivity or interest were more frequent than those that may be considered as less-positive emotions (m = 15.56, sd = 3.91), e.g. hurried, dominance or anger. The ratio of the degree of patient-centered communication in the home care visits was an average of 1.53, revealing that the communication could be considered as patient-centered. The length of the visits was the only characteristic significantly associated with the degree of patient-centeredness in the communication, with a peak in patient-centeredness in visits 8-9 min long. Sex, age or procedural focus showed no significant effects on the degree of patient-centeredness.

Conclusion: Overall, the degree of patient-centeredness and a positive emotional tone, which might have a positive outcome on older persons' health, was high. Longer visits provided a higher degree of patient-centeredness, but no linear increase in patient-centeredness due to length of visit could be observed. The findings can be used for education and training of nurses, and for providing individualized care, e.g. patient- or person-centered care.

Background: In this study, the focus is on how to support the competence development needed for nursing assistants in home care. Home care services for older persons can be challenging concerning the nature of the interpersonal interaction and communication needed to care for and respond to the diverse needs of older people who seek to live well in our communities. This implies a need to offer more person-centred care (PCC) to older persons. However, there is a lack of knowledge on how to develop such competence. We, therefore, developed A Person-centred CommunicaTION (ACTION) programme, which is a web-based educational intervention aimed at supporting competence development for nursing assistants. The research objective is to evaluate the ACTION programme with respect to participants’ responses to and the effect of the intervention. Methods: A multicentre case–control study with pre- and post-assessments was designed. The ACTION programme will be implemented at home care units, in two different geographic areas in Sweden. A total of 300 nursing assistants will be recruited: 150 for the intervention group and 150 for the control group. We will evaluate the impact measures and the process. Pre- and post-assessments will be performed with data collected via a) audio recordings of communication, b) a questionnaire on self-efficacy communication skills, PCC, empathy and job satisfaction, c) user data, evaluation forms, field notes and observations, and d) interviews. The data will be analysed with descriptive and analytic statistics and/or qualitative methods for meanings. Discussion: This study has the potential to contribute to the evidence supporting competence development required to offer person-centred and quality home care to older persons and to meet upcoming needs for flexible and easily accessible competence development. Trial registration: ISRCTN64890826. Registered 10 January 2022, https://www.isrctn.com/ISRCTN64890826 

Aim

To explore communication research in nursing by investigating the theoretical approaches, methods, content and perspectives in research on real-time registered nurse (RN)–patient communication.

Design

An integrative review of real-time communication between RNs and patients.

Data Sources

Empirical research papers were searched in PubMed, CINAHL Plus and Medline. The results from the database searches were supplemented with results from manual searches in reference lists.

Review Methods

A total of 1369 articles published between January 1996 and December 2021 were screened, which resulted in the inclusion of 52 articles.

Results

The integration of various theories, such as nursing or communication theories, is weak in most of the included studies. RN–patient communication appears to influence relationship building. Even when nurses strive to meet patients' needs, they often focus primarily on nursing routines and physical care. The topic of the communication varies depending on the situation and different communication styles are used. When a patient-centred approach is adopted, the interpersonal communication becomes quite symmetrical, with complementary roles of nurses and patients. Within a more asymmetric communication context, nurses dominate communication, choose topics and function as instructors. How the nurses communicated subsequently influenced the patients' communication styles and strategies.

Conclusion

Communication is multifaceted, contains different strategies and is important for building trust and facilitating patient-centred care. The importance of RNs' communication for interaction and relationship-building seems to be well established within research, but few studies focused on patients' communication with RNs.

Impact

This integrative review gives an overview of the width and depth of observational studies on RN–patient communication research. The variety of studies indicates that this area is a less well-grounded field of research. Future research is warranted to support nurses in their communication, especially regarding the exploration of patients' communication and desired communication skills in nurse–patient interactions.

Patient or Public Contribution

No patient or public contribution was included in this integrative review.

The aim of this study was to explore the influence of characteristics of nurses and older people on emotional communication in home care settings. A generalized, linear, mixed model was used to analyze 188 audio-recorded home care visits coded with Verona Coding Definitions of Emotional Sequences. The results showed that most emotional distress was expressed by older females or with female nurses. The elicitation of an expression of emotional distress was influenced by the nurses' native language and profession. Older women aged 65-84 years were given the most space for emotional expression. We found that emotional communication was primarily influenced by sex for nurses and older people, with an impact on the frequency of expressions of and responses to emotional distress. Expressions of emotional distress by older males were less common and could risk being missed in communication. The results have implications for students' and health professionals' education in increasing their knowledge of and attentiveness to the impacts of their and others' characteristics and stereotypes on emotional communication with older people.

Den här rapporten är en kartläggande litteraturöversikt av forskning om hälsa, livsvillkor, livskvalitet och utmaningar för personer som lever med hiv och är 60 år eller äldre. Rapporten baseras på 20 studier.

Litteratursökningen genomfördes i februari och mars 2022 i tre databaser. Sökningarna var riktade dels mot äldre som lever med hiv och deras livskvalitet, dels mot vård för äldre med hiv. Sökningarna resulterade i totalt 6 304 sökträffar. Efter kontroll för dubbletter, kvarstod 4 757 sökträffar. Efter granskning inkluderades 20 studier.

Den här rapporten presenterar resultaten från en intervjustudie med personer över 65 års ålder som lever med hiv i Sverige. Livslängden för personer med hiv har ökat och utvecklingen av effektiv hivbehandling har skapat nya livsförutsättningar.

Denna studie har fokus på vad ett gott liv kan innebära för personer som är äldre och som lever med hiv, samt vad som upplevs viktigt för hälsa. Intervjupersonerna berättar om sina egna erfarenheter av att vara äldre och åldras med hiv, och om möten med hälso- och sjukvården. Centrala forskningsfrågor handlar om livsvillkor, behov och vad som är ett gott liv. Studien bidrar till ökad kunskap om vad som kan bidra till hälsa och välmående och hur ett hälsosamt åldrande kan stödjas och stärkas.

Introduction

The aim of this study was to describe children's self-identified strategies for dealing with fear and pain during hospital care and treatment

Background: Children often report both fear and pain in conjunction with clinical care and treatment. Interventions developed in the field have still not been sufficient to prevent and relieve children’s fear and pain. More knowledge, from children’s own perspectives, is needed about how they deal with their experiences.

Aim: To explore child-identified strategies that children use to manage fear and pain during needle-related medical procedures in hospital.

Methods: Interviews with children, age 4–12 years, with experience of hospital care were analysed qualitatively using content analysis.

Results: Children have self-identified strategies for dealing with fear and pain during hospital care and treatment. The strategies vary depending on examination or treatment and on how the child felt at that particular day. Children describe what they can do themselves, how adults can empower them and support from surroundings as strategies that give them a choice and a voice. Children wished to have influence, decide when and how information should be given, scream out loud or squeeze something hard, to deal with fear and pain. The results also show that children tried to be brave, gain control and think positively. Something nice to look at and opportunities to play with others also contributed.

Conclusions: Strategies vary between children and are used differently on different occasions. Healthcare professionals pose a threat to the child’s needs and ability to use their strategies due to lack of knowledge of the child’s chosen strategies.

Objective

This study explores children’s expressions of emotional cues and concerns during needle procedures, nurses’ responses and findings in relation to children’s age and sex.

Methods

Twenty-six children aged 6–12 years were video recorded during a preoperative needle procedure. Emotional communication was analyzed using Verona Coding Definitions of Emotional Sequences.

Results

A total of 111 cues or concerns were identified in the observed needle procedures, with a distribution of 77 cues and 34 concerns. A majority of children (85%) expressed emotional cues through non-verbal communication. No differences between child age or sex related to expressed emotion were found. The child elicited the communicated emotion in 98% of sequences. Nurses' responses were coded as not providing space for communication in 75% of sequences.

Conclusion

Children are capable of expressing their emotional distress, primarily non-verbally, during needle procedures. A child showing less overt expressions during a needle procedure does not necessarily experience less fear or pain. The nurses’ communication focused on practical information during the needle procedure, with less attention to the child’s distress.

Practice implications

Nurses need to develop strategies to be aware of emotions the child communicates before, during and after a needle procedure.

To examine whether children experience less fear or pain using a child-centered intervention and if there were differences between the intervention group and the control group regarding heart rate, time required for the procedure, success rate for the cannula insertion, and patient satisfaction. A controlled single-center case study of observational design, with one control and one intervention group. Child self-reported fear or pain levels did not reveal any differences for those receiving the intervention compared with controls. However, according to a behavioral observation measure with the Procedure Behavior Check List, effects of the intervention were lower distress in relation to fear and pain during the cannula insertion. The time it took to perform the cannula insertion also decreased significantly in the intervention group. More children in the intervention group reported that they were satisfied with the needle procedure compared with the children in the control group. The child-centered intervention provides reduced observed distress related to fear and pain in children undergoing a cannula insertion and reduced total time by more than 50%. This study found that child involvement in care strengthen their ability to manage a needle procedure. 

AIMS AND OBJECTIVES: To describe the characteristics of communication practice in home care visits between older people (over 65 years old) and nurse assistants and to discuss the findings from a person-centered perspective.

BACKGROUND: The older population is increasing worldwide, along with the need for healthcare services in the person's home. To achieve a high-quality care, person-centered communication is crucial.

DESIGN: A descriptive design with a qualitative inductive approach was used.

METHOD: Fifteen audio recordings of naturally occurring conversations between 12 nurse assistants and 13 older people in Norway were analysed by qualitative content analysis.

RESULTS: Four categories were revealed through analysis: (i) supporting older people's connection to everyday life; (ii) supporting older people's involvement in their own care; (iii) attention to older people's bodily and existential needs; and (iv) the impact of continuity and predictability on older people's well-being.

CONCLUSIONS: The communication between the older people and the nurse assistants during home care visits was mainly task-oriented, but also related to the person. The older people were involved in the tasks to be carried out and humour was part of the communication. Greater attention was paid to bodily than existential needs. The communication was connected with the older people's everyday life in several ways. Time frames and interruptions concern the older people; hearing and speech impairments were a challenge to communication. To enhance person-centred communication, further studies are needed, especially intervention studies for healthcare professionals and students.

RELEVANCE TO CLINICAL PRACTICE: Being responsive to older people's subjective experiences is important in meeting their needs in home care. Communication that addresses the need for trust and predictability is important for older people. Responding to existential needs require more attention. The home care setting has an impact on communication.

Objective

The aim was to explore whether occupational balance is associated with health, health-promoting resources, healthy lifestyle and social study factors among students during higher education within healthcare and social work.

Design

The study has a multicentre repeated cross-sectional design. Data were collected via a self-reported, web-based questionnaire based on the validated instruments: the 11-item Occupational Balance Questionnaire (OBQ11), the Sense of Coherence (SOC) Scale, the Salutogenic Health Indicator Scale (SHIS) and five questions from the General Nordic Questionnaire (QPS Nordic) together with questions about general health and lifestyle factors.

Setting

Students at six universities in western Sweden at one of the following healthcare or social work programmes: biomedical scientists, dental hygienists, nurses, occupational therapists, physiotherapists, radiology nurses and social workers. Participants Of 2283 students, 851 (37.3%) participated.

Results

The students experienced that occupational balance increased during education. The total OBQ11 score was higher among students in semesters 4 and 6/7, compared with semester 1 students. Students with higher OBQ11 also reported higher SOC throughout their education, while health seemed to decrease. Students who reported higher levels of OBQ11 reported lower levels of health and well-being in semesters 4 and 6/7, compared with semester 1. There was an opposite pattern for students reporting lower levels of OBQ11.

Conclusions

The association between higher levels of OBQ11 and lower levels of health and well-being is remarkable. There is a need for more research on this contradiction and what it means for students’ health and well-being in the long run.