Introduction This realist literature review, regarding active patient involvement in healthcare quality improvement (QI), seeks to identify possible mechanisms that contribute to success or failure. Furthermore, the paper outlines key considerations for organising and supporting patient involvement in healthcare QI efforts.

Methods Two literature searches were performed. Altogether, 1,204 articles from a healthcare context were screened, focusing on improvement efforts that involve patients, healthcare professionals and/or managers and leaders. Among these, 107 articles fulfilled the chosen study selection criteria and were further analysed. 18 articles underwent a full realist review. In the realist synthesis, context-mechanism-outcome configurations were articulated as middle-range theories and organised thematically to generate a program theory on how active patient involvement in QI efforts might work.

Results The articles exhibited a diversity of patient involvement approaches at different levels of healthcare organisations. To be successful, organisations’ support of QI efforts that actively involved patients tailored the QI efforts to their context to achieve the desired outcomes, and involved the relevant microsystem members. Furthermore, it promoted interaction and partnership within the microsystem, and supported the behavioural change that follows.

Conclusion This realist synthesis generates a program theory for active patient involvement in QI efforts; active patient involvement can be a tool (resource), if tailored for interaction and partnership (reasoning), that leads to behaviour change (outcome) within healthcare QI efforts. The theory explains essential resource and reasoning mechanisms, and outcomes that together form guidance for healthcare organisations when managing active patient involvement in QI efforts.

Background: Next of kin to older adults over 65 years in municipal home care are concerned whether their older adults’ needs are being met. In municipal home care, the registered nurses’ leadership is important and complex, entailing multi-artist skills involving the older adults and their next of kin. Yet, little is known about next of kin’s experiences of registered nurses’ leadership. Thus, the aim of this study was to explore next of kin’s experiences of registered nurses’ leadership close to older adults in municipal home care. Methods: Individual telephone interviews were conducted with next of kin (n = 11) of older adults from April to September 2020 in two municipalities in western Sweden. Data were analysed using qualitative content analysis. Results: The results are presented with the theme, registered nurses do what they can, including two categories, interaction and competence, and the subcategories, relationship, communication, availability, responsibility, team leadership and cooperation. Registered nurses’ leadership was experienced as a balancing act between their commitments and what they were able to achieve. Conclusions: Next of kin’s experiences of registered nurses’ leadership can contribute knowledge that will strengthen and prepare registered nurses for their leadership roles. This knowledge can support the development of policies for organisational preconditions that ensure quality and safe care to older adults in municipal home care. © 2021, The Author(s).

Aim

To explore older people's experiences of registered nurses? leadership close to them in community home care.

Introduction

In Sweden and throughout the world, the number of people 65 years and older is increasing. While older people are living for more years, living longer can bring more diseases and disabilities, which might lead to the need for home care. Registered nurses are responsible for older people's care needs in their leadership in community home care; this is a part of their professional role as registered nurses, and it implies that they must be multi-artists.

Design

An explorative and inductive design was used in two communities in western Sweden.

Methods

Individual interviews were conducted with older people (n = 12) with at least one year of experience with community home care. Data were analysed using qualitative content analysis. Results The results are presented in the theme "my registered nurse", including five categories - relationship, professional competence, nursing interventions, coordination and collaboration and organisation - and 15 sub-categories.

Conclusions

These findings are based on older people's own experiences. This is specific, as the phenomenon of the RNs leadership is rarely explored from the perspective of older people.

Implications for practice

There is a need for organisations to create more opportunities for older people to have their own registered nurses leading close to them. This is because registered nurses have specific competences for meeting older people's individual needs and involving them as competent partners in satisfying their care needs.

Title. What implies registered nurses leadership close to older adults in the municipality home health care?

Objective. The objective was to explore how the literature describes the registered nurses’ leadership near to older adults in municipal home care.

Background. Home health care in Sweden and world-wide is affected by the increasing number of older adults, 65 years and over. One challenge is that older adults report more health problems compared with health professionals’ needs assessments. The primary task of care is to support and strengthen people’s health processes to as good health as possible by alleviating the effects of disease and suffering. The registered nurse may be the one who contributes or makes a difference to the older adults’ experience of health. According to this; great demands are placed on the registered nurse's leadership close to the patient. There is a common agreement that registered nurses’ leadership is important. However, research is limited of what implies registered nurses’ leadership close to older adults in municipal home care.

Method. A systematic literature review. The literature search was performed in CINAHL and PubMed during February to April, 2018. A total of 37 articles were identified and nine articles were screened in full text. Quality valuation and analyses of articles were performed doing qualitative research synthesis based of the PRISMA statement.

Results. The results will be presented for the first time at the 9th IAGG-ER Congress, May 23-25, 2019, Gothenburg, Sweden.

Contact information of authors.

Maria Claesson, Lecturer, PhD. maria.claesson@hb.se

Lise-Lotte Jonasson, Senior lecturer. lise-lotte.jonasson@hb.se 

Elisabeth Lindberg, Senior lecturer. elisabeth.lindberg@hb.se

Karin Josefsson, Professor, karin.josefsson@hb.se

All authors works at the Faculty of Caring Science, Work Life and Social Welfare, University of Borås, Sweden.

Background: Registered nurses are key figures in municipal home health care for older adults. Thus, registerednurses’ leadership is crucial to a successful and preventive care process as well as a supportive organization in orderto achieve safe care. However, there is limited research on what registered nurses’ leadership implies close to olderadults in municipal home health care. Thus, the aim is to compile and critically evaluate how international researchresults describe registered nurses’ leadership close to older adults in municipal home health care.

Methods: A systematic literature review was performed in accordance with a qualitative research study. The mainsearch was conducted on 20 April 2018. The review was reported according to the PRISMA guidelines and is registeredin the PROSPERO database (ID# CRD42019109206). Nine articles from PubMed and CINAHL meet the quality criteria. Asynthesis of data was performed in four stages according to qualitative research synthesis.

Results: Ten themes describe what registered nurses’ leadership close to older adults in municipal home health careentails: trust and control; continuous learning; competence through knowledge and ability; nursing responsibility on anorganizational level; application of skills; awareness of the individual’s needs and wholeness; mutual support; mutualrelationships; collaborating on organizational and interpersonal levels; and exposure to challenges.

Conclusions: Registered nurses leading close to older adults in municipal home health care implies being multi-artists.Nursing education, including specialist education for registered nurses, should prepare individuals for their unique andcomplex leadership role as a multi-artist. Municipal employers require knowledge about what registered nurses’leadership implies in order to create adequate conditions for their leadership objectives to achieve safe care. Furtherresearch is warranted to explore registered nurses’ leadership close to older adults in municipal home health care fromdifferent perspectives, such as older adults and next of kin.

Background: Support from the family positively affects self-management, patient outcomes and the incidence of hospitalizations among patients with heart failure (HF). To involve family members in HF care is thus valuable for the patients. Registered nurses (RNs) frequently meet family members to patients with HF and the quality of these encounters are likely to be influenced by the attitudes RNs hold toward families. Aims: To explore RNs' attitudes toward the importance of families' involvement in HF nursing care and to identify factors that predict the most supportive attitudes. Methods: Cross-sectional, multicentre web-survey study. A sample of 303 RNs from 47 hospitals and 30 primary health care centres (PHCC) completed the instrument Families’ Importance in Nursing Care - Nurses’ Attitudes. Results: Overall, RNs were supportive of families' involvement. Nonetheless, attitudes toward inviting families to actively take part in HF nursing care and involve families in planning of care were less supportive. Factors predicting the most supportive attitudes were to work in a PHCC, a HF clinic, a workplace with a general approach toward families, to have a postgraduate specialization, education in cardiac and or HF nursing care, and a competence to work with families. Conclusions: Experienced RNs in HF nursing care can be encouraged to mentor their younger and less experienced colleagues to strengthen their supportive attitudes toward families. RNs who have designated consultation time with patients and families, as in a nurse-led HF clinic, may have the most favourable condition for implementing a more supportive approach to families.

Background: Support from the family positively affects self-management, patient outcomes and the incidence of hospitalizations among patients with heart failure (HF). To involve family members in HF care is thus valuable for the patients. Registered nurses (RNs) frequently meet family members to patients with HF and the quality of these encounters are likely to be influenced by the attitudes RNs hold toward families. Aims: To explore RNs' attitudes toward the importance of families' involvement in HF nursing care and to identify factors that predict the most supportive attitudes. Methods: Cross-sectional, multicentre web-survey study. A sample of 303 RNs from 47 hospitals and 30 primary health care centres (PHCC) completed the instrument Families’ Importance in Nursing Care - Nurses’ Attitudes. Results: Overall, RNs were supportive of families' involvement. Nonetheless, attitudes toward inviting families to actively take part in HF nursing care and involve families in planning of care were less supportive. Factors predicting the most supportive attitudes were to work in a PHCC, a HF clinic, a workplace with a general approach toward families, to have a postgraduate specialization, education in cardiac and or HF nursing care, and a competence to work with families. Conclusions: Experienced RNs in HF nursing care can be encouraged to mentor their younger and less experienced colleagues to strengthen their supportive attitudes toward families. RNs who have designated consultation time with patients and families, as in a nurse-led HF clinic, may have the most favourable condition for implementing a more supportive approach to families.

Registered nurses (RNs) in heart failure (HF) nursing care have a key role in providing family support, which positively affects the outcome for the patient. Telephone interventions conducted by RNs have been reported to be successful in HF nursing care, but Family Health Conversations (FamHCs) involving the patient and the family, have not previously been tested. The purpose of the current study was to explore the experiences and feasibility of nurse-led FamHCs conducted by telephone with patients and their family caregivers. A single-group intervention study with a pretest–posttest design was conducted in three regional hospitals that had a nurse-led HF clinic. Five RNs, eight patients, and eight family caregivers participated. Three FamHCs were conducted by telephone with each family every 2 weeks. Qualitative and quantitative data were collected through semi structured interviews and questionnaires. FamHCs improved the nurse–family relationships and relationships within the families and provided RNs with new knowledge about the families. FamHCs conducted by telephone were considered to be feasible for both families and RNs, although RNs preferred fewer and shorter FamHCs. The RNs preferred meeting face-to-face with the families as nonverbal communication between the family members could be missed because of lack of visual input. On the other hand, RNs appreciated to focus entirely on the conversation without the need to perform illness-related routine checks. In conclusion, the advantages of FamHCs conducted by telephone outweighed the disadvantages. Visual contact, provided by video telephony, and a shorter version of the tested FamHC would facilitate the use in HFnursing care.

Introduction

Heart failure is a growing public health problem associated with poor quality of life and significant morbidity and mortality. The majority of heart failure care is provided by family caregivers, and is associated with caregiver burden and reduced quality of life. Research emphasizes that future nursing interventions should recognize the importance of involving family caregivers to achieve optimal outcomes.

Aims

The aims of this study are to explore registered nurses’ perceptions about the situation of family caregivers to patients with heart failure, and registered nurses’ interventions, in order to improve family caregivers’ situation.

Methods

The study has a qualitative design with an inductive approach. Six focus group interviews were held with 23 registered nurses in three hospitals and three primary health care centres. Data were analysed using qualitative content analysis.

Results

Two content areas were identified by the a priori study aims. Four categories and nine subcategories emerged in the analysis process. The content area “Family caregivers' situation” includes two categories: “To be unburdened” and “To comprehend the heart failure condition and its consequences”. The content area “Interventions to improve family caregivers' situation” includes two categories: “Individualized support and information” and “Bridging contact”.

Abstract

Background: Informal caregivers play an important role for persons with heart failure in strengthening medication adherence, encouraging self-care, and identifying deterioration in health status. Caring for a relative with heart failure can affect informal caregivers' well-being and cause caregiver burden.

Objective: The objective of this study was to explore informal caregivers' experiences and needs when caring for a relative with heart failure living in their own home.

Methods: The study has a qualitative design with an inductive approach. Interviews were conducted with 14 informal caregivers. Data were analyzed using qualitative content analysis.

Results: Two themes emerged: "living in a changed existence" and "struggling and sharing with healthcare." The first theme describes informal caregivers' experiences, needs, and ways of moving forward when living in a changed existence with their relative. Informal caregivers were responsible for the functioning of everyday life, which challenged earlier established roles and lifestyle. They experienced an ever-present uncertainty related to the relative's impending sudden deterioration and to lack of knowledge about the condition. Incongruence was expressed between their own and their relative's understanding and acceptance of the heart failure condition. They also expressed being at peace with their relative and managed to restore new strength and motivation to care. The second theme describes informal caregivers' experiences, needs, and ways in which they handled the healthcare. They felt counted upon but not accounted for, as their care was taken for granted while their need to be seen and acknowledged by healthcare professionals was not met. Informal caregivers experienced an ever-present uncertainty regarding their lack of involvement with healthcare. The lack of involvement with healthcare had a negative impact on the relationship between informal caregivers and their relative due to the mutual loss of important information about changes in medication regimens and the relative's symptoms and well-being. Another cause of negative impact was the lack of opportunity to talk with healthcare professionals about the emotional and relational consequences of heart failure. Healthcare professionals had provided them neither with knowledge on heart failure nor with information on support groups in the municipality. Informal caregivers captured their own mandate through acting as deputies for their relative and claiming their rights of involvement in their relative's healthcare. They also felt confident despite difficult circumstances. The direct access to the medical clinic was a source of relief and they appreciated the contacts with the registered nurses specialized in heart failure. Informal caregivers' own initiatives to participate in meetings were positively received by healthcare professionals.

Conclusions: Informal caregivers' daily life involves decisive changes that are experienced as burdensome. They handled their new situations using different strategies to preserve a sense of "self" and of "us." Informal caregivers express a need for more involvement with healthcare professionals, which may facilitate informal caregivers' situation and improve the dyadic congruence in the relation with their relative.

Background: Support from the family positively affects self-management, patient outcomes and the incidence ofhospitalizations among patients with heart failure. To involve family members in heart failure care is thus valuable forthe patients. Registered nurses frequently meet family members of patients with heart failure and the quality of theseencounters is likely to be influenced by the attitudes registered nurses hold toward families.Aims: To explore registered nurses’ attitudes toward the importance of families’ involvement in heart failure nursingcare and to identify factors that predict the most supportive attitudes.Methods: Cross-sectional, multicentre web-survey study. A sample of 303 registered nurses from 47 hospitalsand 30 primary health care centres completed the instrument Families’ Importance in Nursing Care – Nurses’Attitudes.Results: Overall, registered nurses were supportive of families’ involvement. Nonetheless, attitudes toward invitingfamilies to actively take part in heart failure nursing care and involve families in planning of care were less supportive.Factors predicting the most supportive attitudes were to work in a primary health care centre, a heart failure clinic, aworkplace with a general approach toward families, to have a postgraduate specialization, education in cardiac and/orheart failure nursing care, and a competence to work with families.Conclusions: Experienced registered nurses in heart failure nursing care can be encouraged to mentor their youngerand less experienced colleagues to strengthen their supportive attitudes toward families. Registered nurses who havedesignated consultation time with patients and families, as in a nurse-led heart failure clinic, may have the most favourablecondition for implementing a more supportive approach to families.

Sleeping difficulties are increasingly prevalent among adolescents and have negative consequences for their health, well-being, and education. The aim of this study was to illuminate the meanings of adolescents’ lived experiences of sleeping difficulties. The data were obtained from narrative interviews with 16 adolescents aged 14–15 in a Swedish city and were analyzed using the phenomenological hermeneutic method. The findings revealed four themes: feeling dejected when not falling asleep, experiencing the night as a struggle, searching for better sleep, and being affected the next day. The comprehensive understanding illuminates that being an adolescent with sleeping difficulties means it is challenging to go through the night and to cope the next day. It also means a feeling of being trapped by circumstances. As the adolescents’ lived experiences become apparent, the possibility for parents, school nurses, and other professional caregivers to support adolescents’ sleep increases.

Sleeping difficulties among adolescents constitute a pressing public health issue, and it is of the utmost importance that these are approached from a health-promotion perspective. This study explores adolescents' suggestions on how their sleep could be supported. Data were collected via eight focus group interviews with 43 adolescents aged 15-16, in Sweden, and analyzed using qualitative content analysis. The results describe the adolescents' suggestions on how their sleep could be supported in three themes: being supported by involved parents- routines, engagement, and warmth are vital; being supported to achieve knowledge on the "whys" and "hows" of sleep-increased knowledge gives the ability to make well-grounded sleep choices; and being guided into finding balance-balance in life is difficult to achieve and adolescents desire support. Parents, school nurses, health professionals, and anyone who has the opportunity to improve and promote sleep should consider adolescents' suggestions.

Background

Sleeping difficulties are increasingly prevalent among adolescents worldwide and have negative consequences for health, well-being, and education. In order to develop and implement health promotion about sleep, additional knowledge is required, especially knowledge based on adolescent´s own experiences. This kind of research is currently limited. This study aimed to describe reasons for sleeping difficulties as perceived by adolescents.

Methods

This was a descriptive study, analyzing the data with qualitative and quantitative content analysis. Data was collected using an open ended question in a questionnaire; If you experience that you sleep too short, have trouble falling asleep, wake up at night or sleep not rested, please write what you think your sleeping difficulties may be due to. The participants consisted of 475 adolescents in grade nine (15-16 year), in 13 secondary schools, in a Swedish city.

Results

The adolescent´s descriptions of reasons for sleeping difficulties are understood as an imbalance between requirements and preconditions. Requirements are about performing at school, doing activities, being social both digitally and in real life, having fun, taking care of their health, reflecting on the existence and the future. Preconditions can be about having time, structure and parental support, but also an ability to set your own limits. When the preconditions are insufficient to match the requirements, an imbalance occurs where sleep loses out. Six different categories described reasons for adolescents sleeping difficulties. The most prominent reason was stress followed by technology use and then poor sleep habits, existential thoughts, needs, and suffering.

Conclusions

In order to avoid sleeping difficulties, adolescents need to deal with reasons such as stress, technology use, non-existent sleeping habits, existential considerations, needs and various forms of suffering. Adolescents need support to find a functioning balance in everyday life, dealing with these reasons. The support is needed from especially parents but also from professional caregivers. All health professionals caring for adolescents should remain vigilant regarding the important issue of sleeping difficulties, as good sleep hygiene optimizes adolescents’ capability for health and development.

Objectives/Introduction: Sleeping difficulties are increasingly prevalent among adolescents worldwide and have negative consequences for health, well‐being, and education. In order to develop and implement health promotion about sleep, additional knowledge is required, especially knowledge based on adolescent´s own experiences. This kind of research is currently limited. This study aimed to describe reasons for sleeping difficulties as perceived by adolescents.

Methods: This was a descriptive study, analyzing the data with qualitative and quantitative content analysis. Data was collected using an open ended question in a questionnaire; If you experience that you sleep too short, have trouble falling asleep, wake up at night or sleep not rested, please write what you think your sleeping difficulties may be due to. The participants consisted of 475 adolescents in grade nine (15–16 year), in 13 secondary schools, in a Swedish city.

Results: The adolescent´s descriptions of reasons for sleeping difficulties are understood as an imbalance between requirements and preconditions. Requirements are about performing at school, doing activities, being social both digitally and in real life, having fun, taking care of their health, reflecting on the existence and the future. Preconditions can be about having time, structure and parental support, but also an ability to set your own limits. When the preconditions are insufficient to match the requirements, an imbalance occurs where sleep loses out. Six different categories described reasons for adolescents sleeping difficulties. The most prominent reason was stress followed by technology use and then poor sleep habits, existential thoughts, needs, and suffering.

Conclusions: In order to avoid sleeping difficulties, adolescents need to deal with reasons such as stress, technology use, non‐existent sleeping habits, existential considerations, needs and various forms of suffering. Adolescents need support to find a functioning balance in everyday life, dealing with these reasons. The support is needed from especially parents but also from professional caregivers. All health professionals caring for adolescents should remain vigilant regarding the important issue of sleeping difficulties, as good sleep hygiene optimizes adolescents’ capability for health and development.

Sleeping difficulties are increasingly prevalent among adolescents worldwide and have negative consequences for adolescent health and education. The aim of this study was to describe the reasons for sleeping difficulties as perceived by adolescents. Sleeping difficulties include insufficient sleep, trouble falling asleep, waking up at night, or sleep that does not leave an individual rested. Data were collected in 2015 using an open-ended question. The sample consisted of n = 475 adolescents from a city in Sweden, aged 15–16 years, with self-assessed sleeping difficulties. The results described the reasons for the adolescents’ sleeping difficulties, at a general, thematic level, as an imbalance between requirements and preconditions, distributed to stress, technology use, poor sleep habits, existential thoughts, needs, and suffering. To find a balance in their daily lives, adolescents may need support from parents, school nurses, and school health services to deal with their sleeping difficulties.

Background

Sleeping difficulties are growing among adolescents worldwide. Research shows relationships between sleeping difficulties and reduced learning ability, memory impairment, hyperactivity, poorer school performance, lower grades, and increased risk of depression and anxiety. In order to develop and implement health promotion about sleep, additional knowledge is required, especially knowledge based on adolescent´s own experiences. This kind of research is currently limited both nationally and internationally. This study aimed to describe reasons for sleeping difficulties as perceived by adolescents.

Methods

This was a descriptive study, analyzing the data with qualitative and quantitative content analysis. Data was collected using an open ended question in a questionnaire; If you experience that you sleep too short, have trouble falling asleep, wake up at night or sleep not rested, please write what you think your sleeping difficulties may be due to. Background information, such as gender, housing, ethnicity and grades were collected too. The participants consisted of 475 adolescents in grade nine (15-16 year), in 13 secondary schools, in a Swedish city.

Results

The adolescent´s descriptions of reasons for sleeping difficulties are understood as an imbalance between requirements and preconditions. Requirements are about performing at school, doing activities, being social both digitally and in real life, having fun, taking care of their health, reflecting on the existence and the future. Preconditions can be about having time, structure and parental support, but also an ability to set your own limits. When the preconditions are insufficient to match the requirements, an imbalance occurs where sleep loses out. Six different categories described reasons for adolescents sleeping difficulties. The most prominent reason was stress followed by technology use and then poor sleep habits, existential thoughts, needs, and suffering.

Conclusions

In order to avoid sleeping difficulties, adolescents need to deal with reasons such as stress, technology use, non-existent sleeping habits, existential considerations, needs and various forms of suffering. Adolescents need support to find a functioning balance in everyday life, dealing with these reasons. The support is needed from especially parents but also from the school nurse and school health services. The school nurses has an important role to prevent sleeping difficulties by addressing reasons for sleeping difficulties.

Sleep duration and sleeping difficulties among adolescents: exploring associations with school stress, self-perception and technology use

Sleeping problems are increasing among adolescents worldwide. This study aimed to describe the prevalence of self-reported sleep duration and sleeping difficulties, as well as to explore their associations with school stress, self-perception, that is how adolescents perceive their appearance and happiness, and technology use among adolescents. Data were collected in 2015 using a questionnaire. A total of 937 ninth grade adolescents, 15–16 years, from a city in western Sweden participated, resulting in a response rate of 83%. The result showed that 55% of the adolescents slept less than the recommended 8 hours per night and 11% had sleeping difficulties. School stress and technology use were associated with short sleep duration. School stress and self-perception were associated with sleeping difficulties. The girls had worse outcomes for sleeping difficulties, school stress, self-perception and technology use than the boys. Based on the results, there is a need for school nurses to implement preventive measures to improve adolescents’ sleep.

Introduction: Sleeping difficulties, including insufficient sleep, trouble falling asleep, waking up at night, or sleep that does not leave an individual rested, are increasingly prevalent among adolescents and have negative consequences for their’ health, well-being, and education. It is of utmost importance to research adolescents’ sleep. A range of studies with different methodological perspectives are needed to inform and understand adolescents’ sleep. To date, there are few studies in sleep research that take a qualitative approach. Therefore, it is important to illuminate adolescents’ own experience of sleeping difficulties to acquire broader knowledge and the necessary evidence in order to provide preventive care interventions.

Method: The data were obtained from narrative interviews with 16 adolescents aged 14–15 in a Swedish city and were analyzed using the phenomenological hermeneutic method.

Results: Four themes that illustrate the meaning of adolescents experience of sleeping difficulties emerged: feeling dejected when not falling asleep, experiencing the night as a struggle, searching for better sleep, and being affected the next day. The comprehensive understanding illuminates what being an adolescent with sleeping difficulties means; it is a challenge to go through the night; cope with the next day; and to harbor a panorama of emotions that emerge during the night, such as frustration, annoyance, concern, dejection, sadness, and fear. These emotions arise when the adolescent is unable to unwind and has concerns that grow during the night. The adolescent experience a feeling of being trapped in circumstances, all of which are incompatible with getting a good night’s sleep.

Conclusions: In order to understand adolescents’ sleeping difficulties, a comprehensive understanding of the context in which the adolescents live is needed. Adolescents need to navigate and find balance in relation to circumstances that may affect their sleep and that are often beyond their control, such as norms and values in society, in social media, in school, and in family and friend groups. By genuinely listening to the adolescents’ narratives about their sleeping difficulties and the context in which they interact will parents, professional caregivers, and researchers increase their understanding.

Objectives/Introduction: Sleeping difficulties, including insufficient sleep, trouble falling asleep, waking up at night, or sleep that does not leave an individual rested, are increasingly prevalent among adolescents and have negative consequences for their’ health, well‐being, and education. It is of utmost importance to research adolescents’ sleep. A range of studies with different methodological perspectives are needed to inform and understand adolescents’ sleep. To date, there are few studies in sleep research that take a qualitative approach. Therefore, it is important to illuminate adolescents’ own experience of sleeping difficulties to acquire broader knowledge and the necessary evidence in order to provide preventive care interventions.

Methods: The data were obtained from narrative interviews with 16 adolescents aged 14–15 in a Swedish city and were analyzed using the phenomenological hermeneutic method.

Results: Four themes that illustrate the meaning of adolescents experience of sleeping difficulties emerged: feeling dejected when not falling asleep, experiencing the night as a struggle, searching for better sleep, and being affected the next day. The comprehensive understanding illuminates what being an adolescent with sleeping difficulties means; it is a challenge to go through the night; cope with the next day; and to harbor a panorama of emotions that emerge during the night, such as frustration, annoyance, concern, dejection, sadness, and fear. These emotions arise when the adolescent is unable to unwind and has concerns that grow during the night. The adolescent experience a feeling of being trapped in circumstances, all of which are incompatible with getting a good night's sleep.

Conclusions: In order to understand adolescents’ sleeping difficulties, a comprehensive understanding of the context in which the adolescents live is needed. Adolescents need to navigate and find balance in relation to circumstances that may affect their sleep and that are often beyond their control, such as norms and values in society, in social media, in school, and in family and friend groups. By genuinely listening to the adolescents’ narratives about their sleeping difficulties and the context in which they interact will parents, professional caregivers, and researchers increase their understanding.

En vanlig uppfattning i samhället är att ungdomar som sover för lite är slarviga med rutiner och att skärmarna tar deras tid. Men är problematiken så enkel? Hur är det egentligen att ha sömnsvårigheter? En ny studie från Högskolan Borås ger en inblick i ungdomars egna upplevelser.

Objective: This study describes empirical ethical values promoting good caring encounters with older patients 65, relatives, and care staff in a geriatric clinic.  Methods: Hermeneutic method was used in a secondary analysis, a re-analysis, of data already collected in three previous studies describing empirical ethical values. Data in the previous studies was collected in a geriatric clinic at a county hospital in a medium-sized city in Sweden. In study I were older patients (n = 22) with registered nurses and enrolled nurses observed during caring encounters (n = 57). Study II was an interview study with older patients´ relatives (n = 14). Study III observed encounters with registered nurses (n = 20) who cared for older patients. Result: Empirical ethical values promoting good caring encounters comprising a welcoming environment, moral actions in physical and social movements, showing respect, participation, security, and a worthy start, middle, and end of caring encounters. Conclusion: Bearing these empirical ethical values in mind should help care staff to focus on patient safety and their own ethical values, with the aim to promote good caring encounters with older patients and relatives. Respect establishes the basis for reciprocity, when people in caring encounters trust one another, security ensues and the fundamentals for patient safety fall into place. 

Background. Urinary incontinence is a complex public health problem for older adults both in Sweden and internationally. It is estimated that 50-80% of older adults in residential care facility have problems with urinary incontinence. Several studies illuminate staffs’ attitudes that incontinence is as a natural consequence of aging, which means that assessment and treatment are overlooked. There is also a lack of knowledge and compliance in relation to whether care staff is followed guidelines or not. Therefore, the aim of the present study was to describe staffs’ experiences of the management of older adults with urinary incontinence in residential care facility.

 Methods. The design was explorative with an inductive approach with 17 individual interviews. Data were analyzed using qualitative content analysis.

Results. The analysis led to following three categories: Staffs’ management; The organization’s impact; and Creating wellbeing factors for older adults with urinary incontinence. The staff had different views of what an investigation is and what measures are needed to be done. To achieve a good individual patient care there is need of a greater knowledge about good nursing, communication and dialogue between the various working groups.

 Conclusions. Staffs’ management, the organization’s impact, and creating wellbeing factors are central to older adults’ influence and to experience quality of life. Implementing an evidence-based practice requires a long-term process-focused approach in order to improve the structure of daily work and to encourage staffs’ learning and competence development.

Background: Many patients are currently cared for at the end-of-life stage at home, and the number is expected to increase. The patient’s participation is a prerequisite for good care, which also relates to ethical principles and evidence-based action. Aim: To describe adult patients’ experiences of their life situation and their participation in palliative home care. Method: A reflective lifeworld approach and a phenomenological meaning analysis were conducted. Six adult patients in palliative home care were interviewed in Sweden during 2018. Results: One essential meaning and five elements of that meaning describe adult patients’ life situations and participation in their palliative home care. The essential meaning referred to needing and endeavouring to live as usual and taking responsibility for life. The five essential elements were: The home should be my home, where I know who is coming through the door; I should know when help is coming and be included when decisions are made; routines should be maintained, but without booking up tomorrow; accept death, feel hope, and plan for relatives after my death; and be aware that death is imminent, but not know when it will come. Conclusions: Participation in palliative home care can be maintained and improved by caregivers behaving as guests in the patient’s home, building up the patient’s trust, showing consideration for patients and their relatives, promoting patients living everyday life as they previously had, asking about the patient’s habits, and giving patients time and continuity in the caregiving relationship. Education should focus on how to have supportive conversations with a patient who is dying and preparing for death.

Background: Home care was previously included in healthcare centers in county councils in Sweden. Today,home care is the responsibility of municipalities. Consequently, the work of district nurses from healthcarecenters has changed, and they face a new mission and new challenges. The aim of this study was to exploredistrict nurses’ experiences of working in home care after the municipalization.Methods: The design was descriptive with an inductive approach. Five district nurses working in differentmunicipalities were interviewed. Qualitative content analysis was used.Results: The district nurses experienced their work through the following themes: organization, localenvironment and leading the team, and defined the themes in terms of inadequacy, collaboration, control,comfort, continuity and own competence. Their work was free and pleasant with more time for the patients. Atthe same time they at time had difficulties to carry out their work. Recipients’ condition in municipality homecare experienced as better as a consequence of cross-border cooperation, compared to earlier organisation ofhome care. District nurses work involved a great nursing responsibility and required leadership. Theyexperienced losses of competence as well as new competence.Conclusions: District nurses’ work was at times difficult because of organisational barriers. There is need ofimprovements and tools for district nurses to carry out their work and to promote their competence development.The organisation is not functioning optimally in municipal home care. Cooperation between municipality,primary care and inpatient care needs improvement.

Background: There has been an evolution from district nurses previously providing patients with the opportunity to contact health services, to them now providing medical assessments and advice via telephone counselling. Telephone counselling is governed by laws that strengthen patient safety, something which may be complicated to accomplish when the call is made via a third party.

Aim: The aim was to describe district nurses' experiences of giving telephone advice to young people via a third party.

Methods: The design had an inductive approach. Ten district nurses were interviewed and the interviews were analysed using qualitative content analysis.

Findings: The district nurses' wanted to avoid calls via a third party. They experienced that third party felt responsible for young people. At the same time, the district nurses' wanted to protect young people, make safe decisions and avoid misleading information. The district nurses' experienced difficulties in making accurate assessments and found it difficult to obtain the correct information.

Conclusion: District nurses want to avoid telephone counselling for young people via a third party as they experienced it as difficult. Misleading information from a third party may compromise the safety of patients. Good skills are needed to cope with giving advice to young people on the phone via a third party. Employers should arrange for training in telephone counselling.

Background: Informal caregivers play an important role for persons with heart failure in strengthening medication adherence, encouraging self-care, and identifying deterioration in health status. Caring for a relative with heart failure can affect informal caregivers' well-being and cause caregiver burden.

Objective: The objective of this study was to explore informal caregivers' experiences and needs when caring for a relative with heart failure living in their own home.

Methods: The study has a qualitative design with an inductive approach. Interviews were conducted with 14 informal caregivers. Data were analyzed using qualitative content analysis.

Results: Two themes emerged: "living in a changed existence" and "struggling and sharing with healthcare." The first theme describes informal caregivers' experiences, needs, and ways of moving forward when living in a changed existence with their relative. Informal caregivers were responsible for the functioning of everyday life, which challenged earlier established roles and lifestyle. They experienced an ever-present uncertainty related to the relative's impending sudden deterioration and to lack of knowledge about the condition. Incongruence was expressed between their own and their relative's understanding and acceptance of the heart failure condition. They also expressed being at peace with their relative and managed to restore new strength and motivation to care. The second theme describes informal caregivers' experiences, needs, and ways in which they handled the healthcare. They felt counted upon but not accounted for, as their care was taken for granted while their need to be seen and acknowledged by healthcare professionals was not met. Informal caregivers experienced an ever-present uncertainty regarding their lack of involvement with healthcare. The lack of involvement with healthcare had a negative impact on the relationship between informal caregivers and their relative due to the mutual loss of important information about changes in medication regimens and the relative's symptoms and well-being. Another cause of negative impact was the lack of opportunity to talk with healthcare professionals about the emotional and relational consequences of heart failure. Healthcare professionals had provided them neither with knowledge on heart failure nor with information on support groups in the municipality. Informal caregivers captured their own mandate through acting as deputies for their relative and claiming their rights of involvement in their relative's healthcare. They also felt confident despite difficult circumstances. The direct access to the medical clinic was a source of relief and they appreciated the contacts with the registered nurses specialized in heart failure. Informal caregivers' own initiatives to participate in meetings were positively received by healthcare professionals.

Conclusions: Informal caregivers' daily life involves decisive changes that are experienced as burdensome. They handled their new situations using different strategies to preserve a sense of "self" and of "us." Informal caregivers express a need for more involvement with healthcare professionals, which may facilitate informal caregivers' situation and improve the dyadic congruence in the relation with their relative.

Background

Hypertension is common and may lead to cerebrovascular and cardiovascular events and mortality. District nurses frequently encounter patients requiring blood pressure monitoring, lifestyle counsel and support. Empowerment as a method enables patients to both increase their control over their health and improve it.

Aim

This study aims to describe the effects of the counsel and support from district nurses to patients with hypertension.

Methods

A randomized controlled intervention trial. Questionnaires were answered by patients with hypertension before and after the intervention comprising district nurses' counsel and support based upon empowerment. A specially developed card for blood pressure monitoring was also used.

Results

Blood pressure decreased in intervention and the control groups. The intervention group experienced significantly improved health, with better emotional and physical health, and reduced stress. Living habits did not change significantly in either group. Satisfaction with knowledge of hypertension increased significantly in both groups. The intervention group reported that their care was based upon their health needs.

Limitations

Conducting large multi-centre studies with long follow-ups is complicated and results sometimes have a tendency to decline with time. A shorter follow-up might have shown a greater difference between the groups.

Conclusion

Nursing interventions through district nurses' counsel and support with empowerment improved patients' health. More research is needed to evaluate nursing interventions' effect on hypertension.

Implications for nursing and health policy

This study highlighted that district nurses' counsel and support increased patients' health and decreased stress by focusing on empowerment.

Background: Primary care physicians have a responsibility to inform older adults about the drugs and drug treatments they are prescribed so as to increase patients’ compliance. However, this need is not always met. Use of a ‘study circle’ exercise may help older adults to obtain and increase their knowledge in a community setting, having the opportunity to share experiences with others in similar situations. The aim of this study was to describe older adults’ experiences of taking part in a study circle about aging and drugs. Methods: The study was designed to be descriptive with an inductive approach. Eleven older adults took part in focus group interviews in 2014, and the content of these interviews was analysed. Results: Participants felt the design of the study circle exercise was good; having a syllabus to follow but at the same time allowing individuals’ problems to be discussed. They described the leader of the study circle to be competent, with characteristics they appreciated. Participants found the study circle material informative, and it could be used as a reference for reflection. Participants’ knowledge of natural and pathological aging was increased, as was their knowledge of drugs and their formulations. Participants felt more confident; they dared to ask questions, challenged new drugs, and proactively took action by seeking care when needed. The study circle format was recommended to other older adults. Participants suggested that in future the study circle could be extended and repeated, and that they could be provided with supplementary educational materials or exercises. Conclusions: Use of a study circle about aging and drugs increased older adults’ knowledge, and empowered them to ask questions and take an active part in their drug treatment. We believe that older adults have a desire to want to know more about the drugs they are prescribed, and want to be involved with their treatment, not simply passive recipients.

Nursing home patients with dementia were videotaped in three previous studies. Sixty sequences of nine patients exhibiting agitated behaviors were examined to identify the most probable antecedents to agitation. Probable reasons were interpreted and applied to the Progressively Lowered Stress Threshold model, which suggests that agitation is stress related. Analysis suggests that agitation often serves as form of communication. Two underlying reasons seem to be that the patient had loss of control over the situation and deficient autonomy. The most common causes for expressed agitation were interpreted as discomfort, a wish to be served immediately, conflict between patients or with nursing staff, reactions to environmental noises or sound, and invasion of personal space. It is recommended that nursing staff promote autonomy and independency for this group of patients whenever possible. By evaluating probable reasons for expressed agitation, the nursing staff can take steps to prevent or alleviate agitation.

Aim:  To describe registered nurses' (RNs) ratings of their work-related health problems, sickness presence and sickness absence in community care of older people. To describe RNs' perceptions of time, competence and emotional pressure at work. To describe associations between time, knowledge and emotional pressure with RNs' perceptions of work-related health problems, sickness presence and sickness absence.

Background:  There is a global nursing shortage. It is a challenge to provide working conditions that enable RNs to deliver quality nursing care.

Method:  A descriptive design and a structured questionnaire were used. 213 RNs in 60 care homes for older people participated, with a response rate of 62%.

Findings:  RNs' reported work-related health problems, such as neck/back disorders, dry skin/dry mucous membranes, muscles/joints disorders, sleep disorders and headache. They had periods of fatigue/unhappiness/sadness because of their work (37%). Most of the RNs felt at times psychologically exhausted after work, with difficulties leaving their thoughts of work behind. RNs stated high sickness presence (68%) and high sickness absence (63%). They perceived high time pressure, adequate competence and emotional pressure at work. There was a weak to moderate correlation between RNs' health problems and time pressure.

Discussion:  We cannot afford a greater shortage of RNs in community care of older people. Politicians and employers need to develop a coordinated package of policies that provide a long-term and sustainable solution with healthy workplaces.

Conclusion:  It is important to prevent RNs' work-related health problems and time pressure at work.

Aim: To deepen the knowledge of difficulties in registered nurses telephone advice and identify possibilities to master these.

Background: Telephone advice increases the accessibility to health care and the streamlined work at primary health care centres. The goal of telephone advice nursing is to give a correct advice, adapted to the caller’s situation, in order to reach correct care level. However, nurses’ telephone advice includes risks for misjudgement and may risk the patient safety.

Methods: A systematic and manual literature study was used in CINAHL and Pubmed. A total of 38 studies were identified and 13 articles were screened in full text.

Findings: Nurses’ had difficulties in telephone advice in following areas: computerized decision aids, non-visual communication, third-part communication, limited resources, the nurses’ vulnerability, genus and ethnicity, and also ethical questions.

Conclusion: Nurses perceived difficulties in telephone advice. They should take part in the development of computerized decision support and receive continuous training in communication skills. Nurses’ telephone advice should be facilitated by the existence of an open climate at the workplace, to discuss and to reflect on difficulties, in order to reach patient safety.