Mental health emergencies now constitute a routine part of prehospital emergency care. Yet Emergency Medical Services (EMS) systems remain structurally organised around somatic interventions. We argue that this persistent imbalance reflects a structural design failure in contemporary EMS systems, leaving clinicians inadequately prepared for one of the most common and complex patient groups they encounter. Drawing on Swedish EMS as an illustrative case, we argue that this gap is not an individual competence issue but a structural design problem. We propose educational reform, guideline redesign and stronger feedback systems to reposition mental health competence as a core requirement for safe and equitable prehospital nursing practice.

Background

Driver incapacitation due to sudden illness (e.g., cardiac arrest, seizures, diabetic events) poses a serious traffic safety concern. However, knowledge is limited regarding how such medical events manifest in drivers and affect their behavior. This study therefore aimed to investigate drivers' vehicle handling and signs of illness in crashes caused by sudden illness.

Methods

Crashes were identified in Volvo Cars' Internal Accident Database and the Swedish Transport Administration's register. Descriptions of drivers' vehicle handling and signs of illness were compiled from pre-crash vehicle signal recordings, mail survey responses, and in-depth crash investigations. The analysis included descriptive statistics of driver and crash characteristics, as well as an exploratory analysis of pre-crash vehicle handling and signs of illness.

Results

A total of 138 cases were included in the analysis. Most were single-vehicle crashes occurring in various traffic environments, with posted speed limits ranging from 30 to 110 km/h. The crashes were caused by a variety of medical conditions, typically resulting in loss of consciousness. A notable finding was that most drivers pressed the accelerator pedal after becoming ill and losing consciousness. Signs of illness varied: drivers' posture commonly collapsed, while some drivers remained upright with their hands on the steering wheel and eyes on the road despite being unconscious.

Conclusion

This study provides new and important insights into pre-crash driver behaviors in crashes caused by sudden illness. The findings underscore the need for multiple detection methods and rapid intervention strategies to mitigate the consequences of medical incapacitation and unintended driver actions.

This study investigates the localisation of P/CVE policy in Sweden and explores the sociocultural mechanisms shaping this process. By moving beyond formal political explanations, it examines how nonelected public administrators across different governance levels understood and responded to the emerging expectations of P/CVE. Drawing on new institutional theory and 19 semi-structured interviews, this study shows that the localisation of P/CVE was not driven by legal mandates or local security needs but by normative and mimetic pressures. The national coordinator’s office played a central role by aggressively promoting municipal action plans and coordinators as legitimate responses. Owing to the uncertainty regarding how to act, most municipalities felt compelled to conform, often out of the fear of reputational damage. Many responded by rapidly adopting action plans, often through uncritical imitation, resulting in superficial and poorly contextualised policies. These findings contribute to the P/CVE literature by offering a detailed analysis of how the institutional context and embedded sociocultural forces shape local P/CVE policymaking.

Historically, patients have predominantly been cared for under deep sedation during mechanical ventilation. In recent years, sedation practices have changed, as research has shown that patients who are cared for while awake or lightly sedated often experience a shorter course of care with fewer complications. This places greater demands on the intensive care nurse’s responsiveness in order to reduce the risk of suffering. The aim of the literature review was to describe patients’ experiences of nursing care in intensive care in connection with being awake or lightly sedated during mechanical ventilation. The study was conducted as a systematic literature review based on research with a qualitative approach. During the data analysis, three themes were identified: Bodily experiences of mechanical ventilation, being in an intensive care environment, and the importance of communication. These three themes were built up from ten subthemes. The results showed that patients’ experiences were characterized by suffering, vulnerability, and feelings of exposure. Patients experienced the intensive care environment as unfamiliar, where the technical equipment was perceived as lifesustaining and necessary but at the same time caused feelings of anxiety and fear as it deprived the patients of their voice. The importance of a functioning caring relationship, in which the intensive care nurse showed interest in and responsiveness to the patients’ needs, became evident, as a lack of confirmation evoked feelings of powerlessness and anger. Although the results were largely characterized by negative emotions, feelings of hope, confidence, and participation also emerged. As patients developed coping strategies and experienced support from the intensive care nurse, the suffering became easier to endure. Communication appears to be a central component in alleviating suffering among patients who have been cared for while awake or lightly sedated during mechanical ventilation. A person-centred approach appears to be crucial for the patient's perceived well-being.

Background: Disasters affect societal functions and can cause significant humanitarian and economic consequences. In 2024, over 167 million people were affected globally, mainly by floods, storms, and extreme heat. Resource shortages arise in the emergency department during disasters which require prioritization of life-saving care and good collaboration. Nurses often experience a lack of competence, making education and preparedness important. Aim: The purpose was to compile available literature to examine the competencies a nurse in the emergency department needs to be prepared for a disaster. Method: A systematic integrative literature review was conducted to compile both qualitative and quantitative research on the subject. Results: Disaster competence includes triage, clinical assessment, treatment and prioritization of patients with limited time and resources. Nurses also need practical skills, decision-making ability, adaptability, and psychosocial competence to provide safe care in chaotic situations. Triage is central when prioritizing care and is clearly improved through education, training, and simulations. Communication, collaboration, and leadership are also important parts of disaster work. Education and experience significantly strengthen nurses’ knowledge, skills, and confidence, while knowledge gaps still exist in certain areas such as chemical, biological, radiological, nuclear (CBRN) events and psychological support. Conclusion: Disaster care is based on triage, clinical assessment, and emergency interventions. Nurses need to be able to make quick decisions, work under pressure, and manage multiple critically ill patients at the same time. Education and training improve knowledge, skills, and confidence. Overall, effective disaster care requires practical, clinical, and psychosocial skills as well as continuous training where person-centered care and ethics in the emergency department are important aspects of the care provided to patients.

Sexuality and identity is a subject that is supposed to be addressed with the school nurse, but it is rarely addressed. Youth experience major changes during puberty, and the changes might be even harder for those who are gendernonconforming. These students are in need to be able to talk to a school nurse that makes them feel safe. The purpose of the study was to examine how school nurses experience having conversations with students regarding identity and sexuality. The chosen method was a literature review based on qualitative studies. The result includes 14 articles. Three main themes have been identified each with two subthemes. Prerequisites for conversations with two subthemes; Create trustworthy conversations and Be aware of norms which shows how the school nurse's own values and how they chose to act affects the conversation. The school nurse´s supportive and collaborative role with two subthemes; The parents in the conversations and Cooperate for the students which means that more people than the nurse and the student were needed to have a good conversation. The school nurse’s challenges; Lack of education and Organizational obstacles which summarize the need for education and a supporting work environment. The conclusion was that conversations about sexuality and identity were complex and more components than the two having the conversations affects the conversation. By being open, sensitive and by using an inclusive language the conversation can improve and cooperation with other professionals and parents might be needed. There was also a lack of education and guidelines which made the conversations harder.

Abstract Background: Ambulance services have evolved from a transport service to an advanced medical unit. The general public's ability to choose the correct level of care for different types of onsets of illness is central to an efficient care chain including a high accessibility for the most critically ill patients. Problem Statement: A lack of knowledge regarding the most appropriate level of care leads to an increased burden on the emergency number 112 for non-emergency conditions. At the same time, life-threatening conditions risk being misinterpreted and undergoing delayed treatment, which threatens patient safety. There is a lack of studies specifically comparing the general public with that of healthcare professionals regarding the ability to choose the most appropriate level of care in various types of illness. Aim: The study aims to investigate the general public's knowledge of the most appropriate healthcare facility for various types of illnesses (medical conditions or accidents) requiring assessment and potential care. Is there any difference between healthcare professionals and the general public regarding their views on the choice of care level? Method: A quantitative crosssectional study was conducted via a digital survey consisting of 17 different patient cases. The responses were compared against an expert assessment by an emergency physician. The sample consisted of 177 respondents, of whom 92 had professional experience in healthcare and 85 belonged to the general public. Data were analyzed using the Mann-Whitney U-test, chi-square test, and z-test. Results: Healthcare professionals performed significantly better than the general public (p <0.001) with a higher proportion of correct answers. The general public tended to choose 1177 (the national healthcare advisory service) for time-critical conditions such as pulmonary embolism and pregnancy complications. For injuries that were not life-threatening, such as children with fractures, were ambulances chosen more often than recommended by the expert assessment. Conclusion: Professional experience from healthcare strengthens the ability to choose the correct level of care, and significant knowledge gaps appear to exist among the general public regarding various types of conditions. The results suggest the possible need for specific educational interventions to increase the public's knowledge, which may strengthen patient safety, and ensure efficient resource utilization within the ambulance services.

The daily work as an ambulance nurse involves assessment and caring for patients of all ages with different care needs. Critically ill children are unusual in prehospital care, as only 4.5–6.9% of all ambulance assignments involve children. These cases place high demands on the ambulance nurse's knowledge, communication and clinical skills. Care meetings are often complex, and decisions can have impacts on the child’s prognosis. The aim of the study was to illustrate ambulance nurses’ experiences of caring for critically ill children. The study was implemented using a qualitative method with an inductive content. A total of 10 specialized ambulance nurses participated, each with at least two years of experience in prehospital care and experience of caring for critically ill children. Data was collected through interviews. A qualitative analysis was carried out of the interviews where the data was divided into meaning units, condensed meaning units, codes, subcategories, and categories. The results were presented in the form of four categories and nine subcategories. The developed categories were psychophysiological reactions, responsibility and expectations, the meaning of competence and experience, and adaptations in care of critical ill children. The conclusion of the study shows that ambulance nurses’ experiences of caring for critical ill children are stamped by the combination of psychological and physiological reactions, a great responsibility and expectations from the environment. Experience and higher competence in the field contribute to increased confidence in the care meeting. Furthermore, there is a greater need for adaptation in care with children. Overall, the study highlights the need for education to promote patient safety and the well-being of the ambulance nurses.

Background and problem statement: Anaphylaxis is an acute and potentially life threatening condition that requires prompt treatment with adrenaline. Despite clear clinical guidelines, research shows that prehospital healthcare personnel often experience difficulties in identifying the condition and administering the correct dose in time. Aim: The aim of this systematic literature review was to map the factors influencing ambulance nurses’ preparedness for anaphylaxis in prehospital care. Method: A systematic literature review was conducted focusing on prehospital management of anaphylaxis. Database searches were performed in Scopus AI, PubMed and Cinahl. Seventeen original articles published between 2004 and 2026, were included following quality appraisal. The results were graded for evidence strength using a four level scale from very low to high. Results: Four main themes were identified: identification and assessment of anaphylaxis; how prehospital administration of adrenaline affects the time from symptom onset to treatment; educational interventions and simulation methods; and organisational and clinical conditions for adrenaline administration. Prehospital administration of adrenaline shortened the time from symptom onset to treatment and reduced the risk of biphasic reactions. Factors such as education, equipment, personnel and context influenced how quickly and accurately adrenaline was administered. Conclusion: The findings indicate that early identification and correct administration of adrenaline are crucial for the prognosis of anaphylaxis. Improved education, access to auto injectors and greater adherence to guidelines may strengthen patient safety and reduce suffering in prehospital care.

Paediatric out-of-hospital cardiac arrests is rare but complex and stressful, placing high demand on medical competence, prioritisation and the ability to support families in crisis. Previous studies show that situations involving children cause high stress and mental strain. Ambulance personnel are at high risk of developing mental health problems from experiencing traumatic events at work. Knowledge about ambulance nurses' experiences in these situations is limited. The purpose of this study was to explore ambulance nurses' experiences of these situations. The study was approached with an inductive qualitative design, where ten specialist trained ambulance nurses were interviewed. The data was analysed according to qualitative content analysis, which generated nine sub-categories and three main categories. The results showed strong stress reactions and insecurities in the ambulance nurses but mental and practical preparation, clear routines and support from colleagues and other professions contributed to feelings of control and safety. Meeting with families was further experienced as difficult and the ambulance nurses had to prioritize between life-saving interventions and giving families the opportunity to participate. After the cardiac arrest ambulance nurses experienced emotions such as sorrow, emptiness and mental exhaustion as well as needing rest. Collegial support was described as particularly important, while employer-support was varied between the different cases. This study concluded that pediatric cardiac arrests are often associated with emotional strain for ambulance nurses, both before and after the event. Continual education, routines and support are important factors for handling these events well in a sustainable way.

In healthcare for children and adolescents, family centered care is an approach that includes both children and their relatives, that the pediatric nurse has a crucial role in. For the care at a neonatal unit to be family centered, the child’s parents need to be made involved, with encouragement through a caring communication. A lack of communication in neonatal care makes obstacles for family-centered care and can be a negative way to affect both parents and the child’s wellbeing, development and health. To highlight parent’s experiences of communication in family centered care in neonatal care, a qualitative systematic literature study with an inductive approach was carried out. The data collection was made in three databases and analyzed with thematic method. Three themes, a need for information and knowledge, listening and being listen to and parents need for support, distance and attachment and eight subthemes were identified. The results show that parents perceive good communication as a prerequisite for family-centered care. Through communication, parents get information and valuable knowledge, which often was experienced as insufficient. Conversations with others who have experienced similar situations generate support for parents in many ways, in a turbulent situation. Lack of communication was found to impact on the parent’s wellbeing and attachment to the child. Communication with health care professionals is crucial for getting to know their child, gaining understanding and feeling secure. At the same time parents have experience of inadequate communication, health care professionals who are hard to reach and who don’t create conditions that are necessary for a caring conversation. These findings could be used in healthcare to develop pediatric nurses’ knowledge of communication and family centered care.

Background: In recent years, ambulance care has developed from simpler assessments and care measures with transport to the hospital to being able to carry out more extensive assessments and examinations. This has resulted in increased demands on prehospital care, where patients are now examined and assessed to the appropriate level of care. Alongside the medical assessment, the ambulance nurse also takes the whole patient into account and adopts a holistic perspective to ensure and promote the patients' integrity, autonomy, and independence in their assessment and decision regarding referral to a lower level of care. In prehospital operations, the caring encounter is an important aspect to consider. The meaning of the caring encounter involves making patients feel acknowledged and seen based on their needs and suffering. The aim is to highlight the ambulance nurse's experience of referring patients to a lower level of care. The method for data collection was interviews, which were analyzed using qualitative content analysis. The interviews were conducted in two regions in southern Sweden. A convenience sample was used, resulting in ten ambulance nurses participating in the study. The results revealed three main categories: the experience of different conditions for making decisions about referring patients, the experience of the impact of structural factors on decision-making when referring patients, and the experience of partnership in referring patients. The discussion addresses the chosen method as well as parts of the results that are considered significant. Conclusion: Ambulance nurses find it difficult and complex to refer patients to a lower level of care. Several factors influence whether the experience feels safe or uncertain. However, a sense of professional pride and satisfaction is described when a referral is successful.

Cardiac arrest is a time-critical and complex condition. Survival depends on early cardiopulmonary resuscitation, effective teamwork and good communication. Nurses in the emergency department play a central role in the care of patients experiencing cardiac arrest, however, their work is characterized by ethical, technical and emotional challenges. The aim of this study was to compile available literature to examine factors influencing nurses’ care of patients with cardiac arrest in the emergency department. The study was conducted as an integrative literature review with a systematic approach. Both qualitative and quantitative studies were included to achieve a comprehensive understanding of the factors influencing nurses’ caring during cardiac arrest. The results show that nurses perceive a need for continuous education and practical training in order to maintain competence and self-confidence. Experience, communication, and leadership emerged as crucial factors for effective teamwork. Organizational factors including staffing, clear guidelines and debriefing influenced both quality of care and nurses’ work environment. Cardiac arrest situations were described as ethically and emotionally demanding, particularly in the presence of relatives and when communication was unclear. Nursing care of patients experiencing cardiac arrest requires clear routines, adequate equipment, and regular training to strengthen nurses’ confidence and contribute to safer care for the affected patient.

Background

High-fidelity simulation (HFS) provides a controlled environment for training, allowing ambulance clinicians’(ACs) to practice and refine their skills without risking patient safety. Additionally, it enables the replication of complex scenarios, ensuring comprehensive preparedness for real-life emergencies. However, there remains a need to understand how frontline professionals in ambulance services experience these simulation-based activities. This is especially true when using high-fidelity modalities that aim to replicate real-world scenarios for research purposes.

Aim

To explore clinically active ACs´ experiences of participating in HFS.

Methods

A qualitative design involving dyadic interviews with 16 ACs participating in a simulation scenario was conducted. The data were analyzed using the inductive content analysis method outlined by Elo and Kyngäs.

Results

Participants emphasized the importance of adopting the right mindset from the start of the scenario, as mental readiness was crucial for immersion. Although the scenario felt realistic, achieving full psychological fidelity remained challenging, as participants’ awareness of the simulation setup influenced their behavior during the scenario.

Conclusions

The study underscores the importance of carefully designed HFS scenarios that prioritize psychological and environmental fidelity to support authentic engagement among clinically active ACs. This is particularly important in pre-hospital care, where direct access to real clinical situations is often restricted by ethical, practical, and organizational constraints. The findings indicate that well constructed simulations with coherent workflow sequences, professional actor–based patient representation, and realistic settings can function as a methodological bridge for capturing complex cognitive and emotional processes that are otherwise difficult to study in real world practice. Further refinement of simulation design, focusing on psychological presence rather than complete physical or technical realism, may strengthen simulation-based research as a method for investigating experiential aspects of pre-hospital care.

Chefers möjlighet att upprätthålla ett hållbart ledarskap är beroende av stabila organisatoriska förutsättningar. Samtidigt präglas hälso- och sjukvården av komplexa arbetsförhållanden och omfattande behov, vilket ställer krav på chefers ledarskap. Tillgången till, och utformningen av ledarskapsutbildningar varierar mellan mottagningar där möjligheten att omsätta kunskap från utbildningarna påverkas av rådande organisatoriska förutsättningar. Syftet med föreliggande studie var att belysa chefers upplevelser av ledarskapsutbildningars betydelse för deras egen hållbarhet, samt hur organisatoriska förutsättningar påverkar möjligheten att utöva ett hållbart ledarskap. Studien är gjord i en svensk kontext och har inspirerats av en hermeneutisk ansats. Utifrån semistrukturerade intervjuer har åtta intervjuer genomförts. Urvalet har främst varit strategiskt och insamlat material har analyserats induktivt utifrån kvalitativ innehållsanalys. Resultatet visade att ledarskapsutbildningar bidrog till både individuell och professionell utveckling i chefsrollen genom tillhandahållandet av konkreta verktyg i kombination med reflektioner om lärande i organisationen. Samtidigt framträdde organisatoriska förutsättningar som avgörande där cheferna upplevde att ett större ansvar hamnade på individen. Resultatet indikerar att ledarskapsutbildningar är betydelsefulla för chefers hållbarhet, men att utbildningsinsatsernas effekter påverkas av den organisatoriska miljön.

Background: Disasters include everything from climate-related incidents, armed conflicts, and pandemics. The emergency department is the unit that constitutes the first link in the hospital care chain and faces challenges such as increased patient flow with limited resources during disaster situations. Higher demands are placed on healthcare disaster preparedness and the healthcare system’s ability to manage increased care needs with limited resources. Emergency nurses are responsible for initial assessments and prioritizations. More studies on emergency nurses’ preparedness to manage disaster situations are therefore relevant from both a national and international perspective. Aim: The aim was to compile available literature regarding factors affecting emergency nurses’ preparedness to manage disaster situations. Method: A systematic integrative literature review was conducted, in which ten scientific articles with both qualitative and quantitative approaches were included. Results: Two themes emerged; factors that support emergency nurses’ preparedness to manage disaster situations, and factors that limit emergency nurses’ preparedness to manage disaster situations. From these two themes, five subthemes were identified. The result showed that emergency nurses’ disaster preparedness is moderate. Several key factors influencing preparedness were identified: education and training, professional experience, psychological preparedness and stress management, communication and teamwork, and resources and organizational support. Conclusion: Emergency nurses rate their own level of preparedness as moderate in disaster situations. Education and professional experience were two central factors that strengthened preparedness and contributed to safer and more sustainable emergency care.

Sjuksköterskebristen utgör ett genomgripande problem inom svensk hälso- och sjukvård och får konsekvenser för vårdkvalitet, arbetsmiljö samt verksamheternas långsiktiga hållbarhet. Den höga personalomsättningen innebär särskilda utmaningar för första linjens chefer vars uppdrag i stor utsträckning präglas av frågor kopplade till rekrytering, bemanning och arbetsmiljö. Första linjens chefer besitter därmed centrala erfarenheter av strategier för att behålla sjuksköterskor inom dygnet-runt-verksamheter. Syftet var att genom en kvalitativ intervjustudie undersöka första linjens chefers erfarenheter av strategier för att behålla sjuksköterskor i den regionala vården. Studien har en kvalitativ ansats och bygger på semistrukturerade intervjuer med tio första linjens chefer verksamma inom dygnet-runtverksamheter vid regionala sjukhus i västra Sverige. Det empiriska materialet analyserades genom kvalitativ innehållsanalys. Resultatet visar att första linjens chefer tillämpar flera samverkande strategier i arbetet med att behålla sjuksköterskor. Framträdande strategier är att främja en god arbetsmiljö genom rimlig arbetsbelastning, flexibel schemaläggning och en stark teamkänsla. Att erbjuda en trygg och strukturerad introduktion i kombination med mentorskap samt att skapa möjligheter till kompetens- och karriärutveckling. Ledarskapet framstår som en central faktor, där närvaro, delaktighet och ett relationsbaserat samt transformativt ledarskap fungerar som betydelsefulla strategier. Samtidigt begränsas första linjens chefers handlingsutrymme av organisatoriska villkor såsom personalpolitiska beslut, ekonomiska ramar och bristande organisatoriskt stöd. Studien synliggör att första linjens chefers strategiska arbete för att behålla sjuksköterskor sker i ett komplext samspel mellan professionella ambitioner och strukturella begränsningar.

The global prevalence of neurodevelopment disorders (NDDs) among children and adolescents is estimated at 7–15%. NDDs are associated with impaired functioning and increased health risks, making early identification and intervention crucial for child development and long-term health. Child- and school health services are mandated to identify health, developmental, and psychosocial needs at an early stage, it is also within these settings that difficulties related to NDD are often first recognized. District nurses play a central role in these services, making this area highly relevant to clinical practice. Aim: The aim was to describe district nurses’ experiences of meeting children and parents within child- and school health services when NDD is suspected or diagnosed. Method: A qualitative literature review with a systematic approach was conducted. Literature searches were carried out in CINAHL, PubMed, PsycINFO, Scopus, and Web of Science. Eight peer-reviewed articles were included and analyzed using qualitative content analysis according to Elo och Kyngäs (2008). Results: The analysis resulted in four categories: Creating safety and understanding; Seeing the whole picture in a complex process; The importance of collaboration and organizational conditions; and The significance of experience and knowledge. Safety, communication, and a holistic approach were central in encounters with children and parents when NDD was suspected or diagnosed. Conclusion: Through their professional approach, district nurses can foster caring relationships and encounters. A family-centered approach needs to be combined with a childcentered perspective. Language barriers, parental attitudes, and long waiting times may contribute to inequitable care. Shorter and more flexible care pathways, NDD-specific screening tools, clearer guidelines, and continuous professional development for district nurses are needed to strengthen quality of care, patient safety, and equity in the early identification of NDDs.

The intensive care unit cares for the most critically ill patients, oftentimes with organ failure in one or more organs. A particularly vulnerable group is pediatric patients, mainly because most research is based on adult subjects, even though children differ significantly from adults anatomically, physiologically and cognitively. Additionally, the intensive care nurse not only needs to take care of the patient but also empathize with the needs of the parents or caregivers, which contributes to the complexity of the situation. The aim of this study was therefore to illuminate nurses’ experience of caring for children in an intensive care unit. A literature review with a qualitative approach was conducted to address this aim. The results were based on 13 nursing science articles, and the data analysis resulted in three themes: The importance of relationships in caregiving, The emotional consequences of caregiving and Caring in a complex and unpredictable care environment. The findings show that parents can function as a valuable resource in caregiving, but may also be experienced as challenging, particularly in cases of disagreements and conflicts. Furthermore, nurses’ emotional investment in the child and family can lead to negative emotions and impact their own well-being. Finally, it emerges that children receiving intensive care, despite their specific needs, are often cared for based on adult structures and perspectives. In summary, the need for strengthened organizational support, clearer guidelines, as well as education and emotional support is highlighted to improve nurses’ conditions for delivering safe and sustainable care.

Threats and violence in psychiatric care are a widespread workplace problem, and nurses are among the most vulnerable professional groups in the healthcare sector. This violence can be verbal, psychological, or physical, and it affects nurses’ health and the quality of care. Threats and violence are normalized in psychiatric care, yet the science regarding their consequences is often overlooked, and they are viewed as part of daily work. The purpose of this systematic literature review was to examine nurses’ experiences of threats and violence in psychiatric care, with a focus on risk factors for violence, how violent situations are experienced and managed, and the consequences of these events for nurses and patient care. The method was based on a qualitative approach, and the analysis was conducted using thematic content analysis of 23 nursing science articles. The results encompass three main themes: Risks and relationships in the care environment, Nurses’ exposure and vulnerability, and Recovery and need for support. Eight subcategories were presented. The care relationship, conversation, and a low-affect approach were considered important factors in preventing and managing outward aggression. Threats and violence lead to both physical and psychological effects such as fear, stress, anxiety, sleep difficulties, and exhaustion. The nurse experienced feelings of guilt and inadequacy, which negatively affected their professionalism. Collegial support, reflection, supervision, and experience were perceived as supportive and provided a sense of security during recovery. Several nurses expressed a desire for training, clear procedures, and better organizational support in their efforts to prevent and manage threats and violence. To create a sustainable work environment in psychiatric care, the organization, management, and nurses need to collaborate to reduce the normalization of violence and strengthen the work environment, as well as to provide training and support for nurses in psychiatric care.

Background and problem formulation: Low energy falls are common trauma mechanism among older patients and may lead to significant health-care needs, even when the injury mechanism is considered to be minor. Prehospital assessment is complex, as older patients often present with comorbidities and altered physiological compensatory mechanisms. Aim: The aim was to study the prehospital process for patients affected by low-energy falls, from emergency medical dispatch assessment and ambulance care interventions to patient outcomes. Method: A retrospective observational study based on ambulance medical records from 2019 in southwestern Sweden. A total of 5235 trauma patients were included, of whom 2509 had sustained falls on the same level. Data were analysed descriptively using IBM Statistical Package for the Social Sciences (SPSS). Results: The patient group with falls in the same plane consisted mainly of older women, and the median age was 79 years. Most falls occurred in the home environment. Hypertension and arrythmia were common pre-existing medical conditions. Most patients received ambulance-priority level 2 and were transported to an emergency department. Assessment according to the XABCDE approach was documented in the majority of patients, and opioids were the most common prehospital pharmacological treatment. More than half of the patients were admitted to hospital, and mortality increased from 3,1% after 30 days to 7,4% after one year. Conclusion: The study demonstrates that older patients affected by low-energy falls often have extensive healthcare needs despite the low-energy mechanism of injury. Low-energy falls among older patients are associated with substantial healthcare needs and a risk of adverse outcomes. The findings highlight the importance of structured prehospital assessment and the need for continued development of decision-support tools for older trauma patients.

Type 1 diabetes is a chronic condition that requires continuous self-management and places extensive demands on children and adolescents in everyday life. Self-management involves medical, practical, and psychosocial components that affect quality of life, well-being, and the sense of control. Previous research indicates that self-management is not solely a medical process but is also shaped by emotional and social factors, which underscores the need to highlight children’s and adolescents’ own experiences. The aim was to explore children’s and adolescents’ experiences of self-management in type 1 diabetes. A systematic literature review with a qualitative approach was conducted. Data were collected through structured searches in the databases CINAHL, PsycInfo, and Scopus. Articles were included based on criteria such as studies involving children and adolescents aged 10–18 years with type 1 diabetes and their experiences of self-management, published between 2021 and 2026. The material was analyzed using inductive qualitative content analysis. The results are presented in three main themes: living in a body that cannot be controlled, feeling different among others, and becoming independent but never free. Self-management is experienced as complex. Injections and daily treatment are described as practically and emotionally challenging. Children and adolescents experience fear, shame, and a sense of deviation. Unpredictable blood glucose levels contribute to experiences of lack of control. Support from family, school, and healthcare is important but can be experienced as both supportive and restrictive. Self-management develops over time and is characterized by increasing independence, while the need for support remains. Self-management in type 1 diabetes can thus be understood as a complex process that affects multiple aspects of life. This highlights the need for a child-centered approach that considers medical, emotional, and social dimensions.

Background: Mass-casualty incidents are becoming increasingly common, including in Sweden. These events rapidly overwhelm emergency department resources and place high demands on emergency nurses’ triage, prioritization, and nursing care abilities. Research indicates insufficient education and limited experience among emergency nurses regarding mass-casualty situations, which affects their ability to provide safe, high-quality care. Consequently, the quality of nursing care risks being significantly compromised, with potentially severe consequences for patient health and survival. Therefore, knowledge of emergency nurses’ experiences is essential for developing future training initiatives and strengthening disaster preparedness. Aim: To synthesize emergency nurses’ experiences of caring during mass-casualty incidents and illuminate how these experiences, alongside various influencing factors, shape their ability to provide safe and effective care under extreme pressure. Method: An integrative literature review was conducted with searches in CINAHL, PubMed, and Scopus. Study selection followed PRISMA guidelines. Data were analyzed using Whittemore and Knafl’s five-stage model. Results: Eleven studies were included, revealing two main themes: Caring in chaos and Factors influencing care, each with four subcategories. These showed that emergency nurses experience mass-casualty incidents as chaotic, emotionally demanding, and ethically complex. Care delivery is hindered by limited resources, unclear guidelines, and insufficient training, complicating triage and prioritization. Clinical experience, teamwork, and adaptability are central to maintaining safe, effective care. Conclusion: Emergency nurses’ experiences are shaped by emotional reactions, ethical difficulties, and organizational constraints affecting safe care delivery. Prior experience can be both a resource or a limitation. Mental preparedness, education, and simulation training are central, while resource scarcity and complex triage decisions highlight the need for strengthened triage training.

Background and problem statement: Trauma is a leading cause of death worldwide and represents a substantial proportion of ambulance care assignments in Sweden. Because severe trauma cases are relatively rare in Sweden, healthcare professionals may experience uncertainty about patient assessments. To increase patient safety in trauma care, the Swedish national trauma team activation criteria were developed and implemented. Despite the implementation of these criteria in Sweden, there is still ambiguity and uncertainty regarding which patients are covered by the criteria. Aim: To describe the occurrence and characteristics of prehospital trauma patients who have been covered by the national trauma team activation criteria and to explain the prehospital assessment and the subsequent course of care after arrival at the hospital. Method: A quantitative retrospective cohort study in which patient records have been studied. The data material was collected during 2019 from a region in southwestern Sweden. Results: The study included 380 patients. The majority were men (63.2 %) and car accidents were the most common accident (52.6 %). The primary assessment was performed on 90.8 % of the patients and the majority (84.7 %) were transported by ambulance to an emergency department (83.9 %). One third (36.8 %) required hospitalization, 9.5 % needed intensive care and 0.8 % died within 30 days. The results also show a high overtriage (87,5 %) but also a high undertriage (74,1 %). Conclusion: It seems difficult for ambulance professionals to assess severe traumas and assign the correct ESS code. The National Trauma Triage Criteria seems complex and not modified to all ages. Further research in the area is needed, as well as possible modification and clarification of the criteria to increase its accuracy. In addition to this, there is also a need for training for prehospital personnel regarding the assessment of severe trauma.

Substance use disorder is a complex health condition that affects the individuals physical, psychological, and social well-being. Patients with substance use disorder are particularly vulnerable and often encounter stigma, distrust, and negative attitudes in healthcare, which can affect their experience of the care relationship. The aim of this study was to describe nurses ‘experiences and approaches in encounters with patients with substance use disorder and how this affects the care relationship. The study was conducted as a systematic literature review with a qualitative approach. Data collection included eleven scientific articles that were quality appraised and analysed using thematic analysis. The results were presented in three main themes with associated subthemes. The findings show that care relationship is characterized by complexity and influenced by several factors. Uncertainty in assessments contributes to distrust and affects trust in the relationship. Emotional burden can lead to a more distant approach. Furthermore, stigma, and negative attitudes affect both care and quality of care, while nurses strive for a person-centered and empathetic approach. Organizational factors, such as lack of time and insufficient knowledge, make it more difficult to establish a trusting care relationship. The conclusion shows that the care relationship is influenced by individual, relational and organizational factors. To strengthen the care relationship, increased knowledge, reflection on attitudes, and organizational conditions that enable person-centered care are required. The competence of specialist nurses is central in this work.

The competence of psychiatric specialist nurses (hereafter referred to as psychiatric nurses) is in high demand. Approximately 5,450 psychiatric nurses were employed in Sweden in 2024, but this number is insufficient. A shortage of psychiatric nurses threatens patient safety, while research on how their specialist competence is utilized remains limited. The aim of this study was to describe psychiatric nurses’ experiences of how their specialist competence is utilized within inpatient psychiatric care. Semi-structured interviews were conducted with eight participants. The interviews were analyzed using Elo and Kyngäs’ method for qualitative content analysis. The analysis resulted in three main categories: organizational conditions, role and responsibility, and specialist professional competence, including eight subcategories. The findings revealed insufficient organizational conditions for maximizing the use of specialist competence. Staff shortages, unclear distribution of responsibilities, and a lack of guidelines and structures limited its utilization. Consequently, specialist nurses felt a personal responsibility for ensuring that their competence was utilized. Participants also described that continuing professional education often had to be pursued during their own free time due to limited opportunities during working hours. The psychiatric nurses were described as having a multifaceted role, included educating and supervising other staff, which reduced time available for other tasks. They experienced increased motivation, satisfaction, confidence, knowledge, and professional development when their competence was acknowledged and utilized. However, high workload, staff turnover, and organizational barriers limited the use of specialist competence. Clearer guidelines, organizational support, and opportunities for professional development are needed to fully utilize psychiatric nurses’ competence.

Undersköterskor som arbetar i äldreomsorgen har länge haft större problem med psykisk och fysisk hälsa jämfört med andra yrkeskategorier, vilket för det mesta relateras till höga arbetskrav och begränsade resurser. Samtidigt ska vård av personer med demenssjukdom ha tillgång till ett personcentrerat arbetssätt för att säkerställa rätt omsorg, att arbeta personcentrerat ställer krav på arbetsmiljö men också på de organisatoriska förutsättningarna. Ledarskapet har en central betydelse för undersköterskornas förutsättningar att hantera de krav och belastningar som arbetet inom demensboende innebär. Syftet var att undersöka hur undersköterskor på demensboende upplever förutsättningar för ett personcentrerat arbetssätt. Studien genomfördes med en kvalitativ metod och data samlades in genom semistrukturerade intervjuer där resultatet analyserades genom explorativ tematisk analys. Studiens resultat visade på variationer i upplevelsen av arbetsmiljön, där både främjande och hindrande faktorer identifierades för personcentrerad vård. Ett närvarande och stödjande ledarskap framträdde som avgörande för den främjande faktorn. Vidare betonades vikten av bemanning, kontinuitet och organisatorisk kännedom. Samtidigt identifierades hinder såsom resursbegränsningar och tidsbrist. Sammanfattningsvis visar studien att beroende på hur ledarskapet utövas, i kombination med de organisatoriska förutsättningarna, har betydelse för möjligheten att bedriva personcentrerad vård samt för undersköterskornas arbetsmiljö.

Hot och våld är ett växande problem inom ambulanssjukvården. Varje år utsätts flertalet ambulanssjuksköterskor för arbetsrelaterat våld vilket utgör ett betydande arbetsmiljöproblem samt förhindrar möjligheten till att bedriva en god och säker vård. Oförutsägbarhet och komplexa vårdsituationer utgör delar av den prehospitala miljön vilket kan medföra en ökad risk för hot och våldsamma händelser i möten med patienter och närstående. Syftet med studien var att beskriva ambulanssjuksköterskors upplevelse av hot och våld i vårdmötet för att belysa problematiken och klargöra åtgärder som behövs för att förbättra arbetsmiljön. Studien har genomförts som en kvalitativ intervjustudie med induktiv ansats. Resultatet mynnade ut i tre huvudkategorier: otrygghet i det prehospitala vårdmötet, anpassning av det vårdande mötet samt ambulanssjuksköterskans erfarenhet och påverkan i arbetslivet. Resultatet indikerade att hot och våld väckte känslor som stress, rädsla och otrygghet, särskilt i vårdmöten med personer som var påverkade av substanser eller led av psykisk ohälsa. Erfarenhet och intuition spelade en viktig roll för att identifiera och hantera riskfyllda situationer. Hot och våld kunde orsaka emotionella konsekvenser samt påverka vårdkvalitén och arbetsmiljön. Upplevda brister gällande organisatoriskt stöd, utbildning och samverkan framkom.

Background: First-line managers in the healthcare sector work within complex organisations characterised by high demands and limited resources, which contributes to many leaving their posts. However, there is limited knowledge of how second-line managers work to support their retention in managerial roles. Aim: The aim of the study was to investigate the strategies and working methods used by second-line managers to support the retention of first-line managers in healthcare. Method: Data collection was carried out via seven semi-structured interviews with second-line managers from various acute hospitals in the Stockholm Region. Empirical data were analysed using reflexive thematic analysis. Results: The analysis yielded five overarching themes: Trust and confidence in the manager-manager relationship, Collegial support and shared learning, Governance, responsibility and decision-making scope, Organisational conditions and barriers, and Competence and personal conditions. Conclusions: Second-line managers describe their leadership as crucial to the retention of first-line managers, with trust, presence and individual support being key factors. The most important strategies are personalised leadership, regular check-ins, collegial support and shared learning, clear frameworks, support with prioritisation and workload relief. Organisational factors such as high workloads, unclear roles and a lack of administrative support resources limit the ability to provide sufficient support. The results show that retention in the managerial role cannot be understood based on a single factor but is shaped by the interplay between relational leadership and individual and organisational conditions.

Background: There is a lack of clear guidelines, regulations, and national consensus regarding the role of ambulance services in psychiatric dispatchable incidents. Furthermore, there is no clear definition of what prehospital psychiatry entails. Challenges arise because both ambulance personnel and police officers perceive themselves as having limited competence in psychiatric care, as well as uncertainty regarding the responsibilities of their respective organizations in such cases. The police and ambulance services operate under different legal frameworks, which can create challenges in interagency collaboration during psychiatric incidents. This may, in turn, affect the patient's experience of care, as ambulance nurses focus on collaboration with other agencies rather than on the patient and the patient's experience of the situation. The aim of this study was to explore factors influencing ambulance nurses’ experiences of collaborating with the police in cases categorized as psychiatric by the emergency dispatch center. Method: A qualitative approach was chosen to address the aim of the study. Data being collected through ten open-ended interviews with ambulance nurses from two different regions. Results: Eight subcategories were identified through the analysis, which were subsequently grouped into three main categories: collaboration at the management level, the ambulance service's prerequisites for collaboration, and the impact of legal frameworks on collaboration. The findings show that ambulance nurses’ experiences of collaborating with the police in psychiatric dispatchable cases are influenced by several factors, which include decisionmaking at the management level, organizational and resource-related conditions within the ambulance service, and legal frameworks and their application in specific situations. Conclusion: Collaboration between ambulance nurses and the police in psychiatric cases is influenced by factors that are partly difficult to change during the acute phase of care. The results indicate a need for clearer representation of ambulance services at the management level, as well as strengthened psychiatric resources within prehospital care, for example through psychiatric ambulance units or mobile healthcare teams, in order to improve collaboration and patient care.

This work examines sustainable organizing and leadership in emergency hospital settings, addressing the growing need to reconcile high quality standards, work environment, and efficient resource utilization within a complex context. Emergency hospital settings are characterized by a high pace and competing demands, where middle managers play a key role in translating strategic sustainability objectives into daily practice. Previous research has predominantly addressed sustainability from a strategic perspective, while knowledge of how organizational conditions and leadership are experienced in practice remains limited, particularly among second-line managers. The aim of this study is to investigate how second-line managers in emergency care experience organizational conditions, strategies, and challenges in relation to sustainable organizing. A qualitative research design was applied, using in-depth interviews with ten second-line managers. The data were analyzed using inductive content analysis. The findings reveal three main themes: relational and organizational resources, emotional and structural barriers, and individual and collective drivers. Enabling factors include trust, mandate, structure, and participation in leadership, whereas barriers comprise dual representation roles, insufficient support, and inadequate system support. Driving forces are associated with vision, motivation, and a commitment to safeguarding the individual. The discussion highlights the interplay between structural and relational factors, as well as the need to balance governance, autonomy, and support. The study contributes to an enhanced understanding of the organizational conditions that enable or hinder sustainable organizing and underscores the importance of leadership as a practical and relational craft.

Background: Chest pain is one of the most common search reasons in prehospital emergency care, where ECG is a central component for diagnostics. The ability to interpret ECG is crucial for the patients further health care and to secure safe patient care. Aim: The aim of the study is to describe nurses, which are specialized in prehospital emergency care, and their experiences of nursing in relation to ECG-interpretation within the prehospital setting. Method: A qualitative study with an inductive approach was performed and data was collected through eight semi-structured interviews within prehospital care in the region of Västra Götaland, Sweden Result: The result shows that ECG-interpretation and decision making is a complex and challenging process where confidence and uncertainty are affected by experience, education, team work and organizational factors. Support from colleagues stands out as particularly important for safe patient care and professional development. Conclusion: The study enlightens the need of mentorship for new colleagues, ongoing education within ECG-interpretation and organizational support for incidents related to incorrect ECGinterpretation. Clinical experience and education needs to be combined with a systematic way of working to secure a safe and efficient prehospital emergency care.

Den globala bristen på sjuksköterskor utgör en stor utmaning för hälso- och sjukvården. Många sjuksköterskor lämnar yrket i förtid där organisatoriska faktorer såsom hög arbetsbelastning, bristande stöd från chefer och begränsad autonomi framstår som centrala orsaker. Jobbtillfredsställelse har en viktig betydelse för att skapa en hållbar kompetensförsörjning. Tidigare forskning visar att ett transformativt ledarskap återkommande kopplas till positiva arbetsrelaterade utfall men kunskapen om hur detta samband kan förstås i relation till sjuksköterskors jobbtillfredsställelse är fortfarande begränsad. Syftet med denna integrativa systematiska litteraturöversikt var att belysa hur första linjens chefers transformativa ledarskap påverkar sjuksköterskors jobbtillfredsställelse samt vilka faktorer som framträder som centrala i detta samband. Studien vägleddes även av forskningsfrågan hur sambandet mellan transformativt ledarskap och sjuksköterskors jobbtillfredsställelse kan förstås utifrån Herzbergs tvåfaktorsteori. Studien genomfördes som en integrativ systematisk litteraturöversikt med induktiv ansats. Litteratursökningar utfördes i PubMed och CINAHL utifrån PEOT-modellen. Totalt inkluderades 18 empiriska studier som kvalitetsgranskades med Joanna Briggs Institutes granskningsmallar och analyserades genom induktiv kodning och kategorisering, dessa var av kvalitativa, kvantitativa och mixad metod. Resultatet visade att ett transformativt ledarskap hade en genomgående positiv påverkan på sjuksköterskors jobbtillfredsställelse. Tre huvudteman identifierades; transformativt ledarskap som stärker motivation och jobbtillfredsställelse; organisatoriska förutsättningar för jobbtillfredsställelse samt psykosocialt välbefinnande och motivation i arbetet. Transformativt ledarskap var relaterat till bekräftelse, professionell utveckling, meningsfullhet, autonomi, organisatoriskt stöd, rättvisa, kommunikation, minskad stress samt ökad arbetsglädje och motivation. Slutsatsen är att första linjens chefers transformativa ledarskap har en tydlig betydelse för sjuksköterskors jobbtillfredsställelse, men att effekterna är beroende av organisatoriska förutsättningar. Studiens teoretiska bidrag är att Herzbergs tvåfaktorsteori kan behöva kompletteras eller förstås i relation till organisatoriska förutsättningar. Studiens praktiska bidrag är att synliggöra hur satsningar på ledarskapsutveckling och förbättrade organisatoriska villkor kan bidra till en mer hållbar hälso- och sjukvård.

Background and problem statement: Threats and violence towards ambulance personnel are a growing work environment problem within ambulance healthcare. The prehospital environment is characterized by unpredictability, where threatening and violent situations may arise suddenly and unexpectedly in encounters with patients, relatives or bystanders. There is a lack of research regarding ambulance nurses’ experiences in these situations. Aim: The aim of the study was to describe ambulance nurses’ experiences of threats and violence in connection with ambulance assignments. Method: The study was conducted using a qualitative method with an inductive approach. A total of ten semistructured interviews were conducted with specialist educated ambulance nurses from a region in southern Sweden. The data material was analyzed using qualitative content analysis. Results: Based on the findings, three generic categories and nine subcategories emerged. The results showed that societal changes, including an increased prevalence of drugs, weapons and mental illness, contributed to a more unpredictable work environment. Threatening situations evoked strong emotions among ambulance personnel, such as fear, insecurity, loneliness and feelings of losing control and being caught off guard. Experiences from previous incidents contributed to increased risk awareness and a more cautious approach. Safety emerged as a central aspect where communication and collegial consensus were considered important. Collaboration with the police was perceived as both complex and situation dependent. Conclusion: Threats and violence in connection with ambulance assignments affect ambulance nurses´ sense of safety, work environment and professional practice both in the moment and in the long term. The findings highlight the need for continued development of safety routines and training in order to create a sense of security and be able to provide safe care.

Studien tar sin utgångspunkt i första linjens chefers arbetssituation inom hälso- och sjukvård, där uppdraget ofta präglas av höga krav, begränsade resurser och komplexa avvägningar. Tidigare forskning beskriver rollen som en mellanposition, men det finns ett behov av fördjupad förståelse för hur dessa villkor erfars i praktiken och hur de relaterar till hållbarhet i uppdraget. Syftet med studien är att undersöka hur första linjens chefer inom hälso- och sjukvården erfar och ger mening åt sitt uppdrag i en kontext präglad av höga krav, begränsade resurser och värdekonflikter, samt hur detta relaterar till deras upplevelse av hållbarhet i ledarskapet. Studien genomfördes med en kvalitativ ansats och baseras på individuella, semistrukturerade intervjuer med åtta första linjens chefer. Det empiriska materialet analyserades med reflexiv tematisk analys enligt Braun och Clarke (2006), med en induktiv ansats. Informanternas beskrivningar tolkades i ett senare skede genom det teoretiska ramverket jobb-krav-resursmodellen (JDR-modellen). Resultatet visar att cheferna upplever ett begränsat handlingsutrymme i relation till centrala beslut, samtidigt som de har ett omfattande ansvar för verksamhetens utfall. För att hantera detta försöker de aktivt skapa handlingsutrymme inom givna ramar. Vidare framträder ett starkt värdebaserat engagemang som en central drivkraft, men också som en sårbarhet i situationer där organisatoriska krav står i konflikt med professionella värderingar. Återkommande värdekonflikter kan bidra till etisk stress och påverka upplevelsen av hållbarhet i uppdraget. Sammantaget visar studien att hållbarhet i chefsuppdraget inte enbart handlar om balansen mellan krav och resurser, utan också om möjligheten att påverka sitt uppdrag samt att kunna agera i linje med egna och professionella värderingar. Resultaten pekar på behovet av organisatoriska förutsättningar som möjliggör detta.

Vinasse, a high-strength byproduct of the sugar–ethanol industry, was simultaneously valorized and remediated using the edible filamentous fungus Neurospora intermedia. Optimal cultivation conditions (6°Brix vinasse, pH 7, 0.5 g/L KNO₃, 1% inoculum, and 1 g/L diammonium citrate) produced 14.9 g/L fungal biomass enriched with carotenoids (76.38 μg/g) and vitamins B1, B2, B3, and B6. The process reduced vinasse COD by 63% and enabled substantial minerals bioaccumulation, removing up to ∼65% of Mn and Ca. FTIR analysis confirmed melanoidin adsorption, while SEM revealed thinner, highly branched hyphae under vinasse stress. Post-treatment with activated carbon or Purolite A502PS resin achieved >94% decolorization. This integrated system converts a problematic effluent into nutrient-rich biomass while improving wastewater quality, offering a practical circular-bioeconomy strategy for the sugar–ethanol sector.

Background

Internationally, interest in the expanding role of registered nurse–led consultations in primary care is increasing. This role requires effective communication to support triage and clinical decision-making. While physician‒patient communication has been extensively studied, research on registered nurse‒patient communication remains limited, particularly in primary care. Therefore, the aim of this scoping review was to map and describe how registered nurse–patient communication and decision-making in primary care consultations are characterised in the existing literature, based on observations of clinical practice.

Methods

This scoping review included a systematic literature search conducted in March 2025 in the PubMed, CINAHL, Web of Science and Scopus databases. A total of 12,066 records were identified and screened. The review followed the methodological framework of Arksey and O’Malley and adhered to the PRISMA-ScR reporting guidelines.

Results

A total of 16 studies were included. Registered nurse‒patient communication was observed using audio- and video-recorded observations and participant observations during telephone consultations (n = 5), chronic disease management consultations (n = 3), mental health consultations (n = 1) and walk-in clinic consultations (n = 7). Findings on communication and decision-making were organised into four themes related to the key characteristics of exploring patients’ concerns, observing and assessing patients’ health status, tailoring communication, and facilitating decision-making with patients.

Conclusion

The findings indicate that registered nurses use various communication skills during different phases of consultations. However, comprehensive studies on registered nurse–patient communication and decision-making in primary care are lacking. This highlights the need for future in-depth and comprehensive studies on registered nurse–patient communication in primary care to inform both clinical practices and nursing education.

Background

Suicide attempts can lead to life-threatening conditions that require intensive care. In such situations, patients often experience existential fear when cared for in highly technological and unfamiliar environments such as the intensive care unit. The circumstances surrounding the suicide attempt, together with their critical condition, may further influence their ability to cope and shape their experience of care. Understanding these experiences is important to ensure that the therapeutic relationship supports the recovery process. Interprofessional collaboration and communication are essential for coordinated, recovery-oriented care.

Aim

To map the existing evidence on how patients, family members and healthcare personnel experience care in intensive care units following a suicide attempt, to identify key themes, knowledge gaps and implications for clinical practice and future research.

Study Design

This scoping review was conducted using the Arksey and O'Malley methodology and the PRISMA-ScR list. Six databases were systematically searched using predefined keywords. All English-language studies addressing the review aim were included.

Results

The search yielded 1107 articles. After screening, 13 were assessed in full, and five met the inclusion criteria. These studies, published between 1985 and 2011, comprised four surveys and one qualitative interview study. Findings indicate that patients felt misunderstood, families lacked information and support, and personnel experienced emotional strain. Attitudes varied widely, and healthcare personnel expressed a need for further education and reflective practice in suicide care.

Conclusions

Only five relevant studies were identified, all published between 1985 and 2011, with just one including patient or family perspectives. This limited and dated research highlights a clear gap in research on intensive care following suicide attempts and precludes firm conclusions about care experience. With these constraints, the findings tentatively suggest the importance of compassionate, holistic and collaborative approaches to care, as well as the potential value of personnel's support and training and policies that attend to the mental health needs of suicidal patients and their families.

Relevance to Clinical Practice

The findings may suggest the potential relevance of a holistic approach to caring for patients after a suicide in ICU practice, where physical, psychological, social and emotional aspects of care are considered in supporting recovery and well-being.

Hybridarbete har blivit en allt vanligare arbetsform i dagens arbetsliv, där arbete kombineras mellan hemmet och den fysiska arbetsplatsen. Tidigare forskning visar att hybridarbete kan innebära både möjligheter och utmaningar i relation till arbetsmiljö, organisatoriska förutsättningar och balansen mellan arbete och privatliv. Samtidigt efterfrågas en ökad förståelse för hur dessa aspekter samspelar i praktiken och hur hybridarbete upplevs i vardagen. Syftet med studien är att undersöka hur medarbetare upplever hybridarbete i relation till arbetsmiljö, organisatoriska förutsättningar och balansen mellan arbete och privatliv. Studien utgår från teorierna om upplevt organisatoriskt stöd, JD-R-modellen och boundary theory för att analysera respondenternas erfarenheter. Studien bygger på en kvalitativ metod där empiriskt material och teoretiska perspektiv har analyserats i relation till varandra. Datainsamlingen genomfördes genom semistrukturerade intervjuer med sex personer som har erfarenhet av hybridarbete inom olika verksamheter och yrkesroller. Materialet analyserades genom kvalitativ tematisk innehållsanalys. Resultatet visar att hybridarbete upplevs som en flexibel arbetsform som kan skapa bättre förutsättningar för koncentration, självständighet och balans mellan arbete och privatliv. Samtidigt framkommer utmaningar kopplade till social isolering, gränsdragning mellan arbete och privatliv samt upplevelser av ständig tillgänglighet. Resultatet visar även att organisatoriskt stöd, tydliga strukturer och fungerande digitala verktyg har stor betydelse för hur hybridarbete upplevs. Respondenternas erfarenheter varierade beroende på arbetsuppgifter, individuella behov och organisatoriska förutsättningar. Sammantaget visar studien att hybridarbete är en komplex arbetsform där individuella, organisatoriska och teknologiska faktorer samverkar. Resultatet indikerar att hybridarbete inte enbart påverkar var arbetet utförs, utan även hur arbetet organiseras och upplevs i vardagen.

Diabetes typ 2 är ett växande folkhälsoproblem där fysisk aktivitet utgör en central behandlingsform, på grund av dess goda blodsockersänkande effekt. Samtidigt visar det sig att följsamheten till fysisk aktivitet är låg bland patienter. Syftet med det litteraturbaserade examensarbetet är därmed att belysa patienters upplevelser av faktorer som påverkar utförandet av fysisk aktivitet. Metoden som har valts för att besvara syftet är en kvalitativ litteraturöversikt baserad på sökningar i databaserna CINAHL, Pubmed och Medline. Studierna som har valts utifrån databaserna kvalitetsgranskades utifrån Statens beredning för medicinsk och social utvärderings mall för kvalitetsgranskning. Studierna analyserades enligt Fribergs fem steg, vilket resulterade i att 13 artiklar inkluderades i examensarbetet. Resultatet utifrån dessa artiklar genererade fem teman; kroppsliga upplevelser vid fysisk aktivitet, kunskapens betydelse för fysisk aktivitet, miljöfaktorernas funktion vid fysisk aktivitet, socioekonomiska faktorer som påverkar fysisk aktivitet och sociala relationers funktion vid fysisk aktivitet. Slutsatsen är att följsamheten till fysisk aktivitet kräver att allmänsjuksköterskan anpassar stödet efter patientens livsvärld. Genom att kartlägga faktorer som påverkar individens livsvärld såsom kroppsliga förutsättningar, kunskap, miljö, arbete och sociala relationer, kan personanpassade rekommendationer skapas. Denna information ökar möjligheten till en hållbar förändring, vilken kan öka följsamheten till fysisk aktivitet.

Venösa bensår uppstår ofta till följd av grundläggande venös hypertension. Uppkomsten av det venösa bensåret bör fastställas för att hitta rätt behandling för patienten. För patienter med venösa bensår som inte får rätt behandling kan det medföra svårigheter med exempelvis smärta och onödigt lidande. Omvårdnaden behöver utgå från patientens livsvärld, erfarenheter och individuella behov för att främja en personcentrerad vård av hög kvalité. Litteraturöversiktens syfte var att belysa patienters erfarenheter av att leva med venösa bensår. Studien genomfördes som en allmän litteraturöversikt med såväl kvalitativa som kvantitativa artiklar. Elva artiklar från databaserna CINAHL och PubMed inkluderades, kvalitetsgranskades och analyserades enligt Fribergs modell i denna allmänna litteraturöversikt. Två teman och sex subteman framkom. Resultatet påvisade att smärtan som patienten upplevde fick negativa konsekvenser på livskvaliteten. Deltagandet i aktiviteter och den generella rörlighetsförmågan minskade på grund av ödem och smärta. Behovet av att byta förband mer frekvent ledde till att patienter isolerade sig på grund av rädsla och skamkänslor. Slutsatserna vi tagit är att studiens resultat styrker tidigare forskning som påtalar patientupplevelser vid bemötande ifrån hälso- och sjukvården. Bristande känsla av trygghet och delaktighet i vårdbeslut har visat sig vara viktiga. För att patienten ska uppleva en god vård behövs förändringar med medvetenhet om hur mottagandet och delgivandet av kunskap överförs ifrån hälso-och sjukvården.

Cytostatikabehandling är en vanlig behandlingsmetod vid cancersjukdom som används både i botande, livsförlängande och palliativt syfte. Behandlingen kan medföra flera fysiologiska och psykologiska symtom som påverkar patientens upplevda hälsa och välbefinnande. Förändringar i kroppen, lidande samt en förändrad livssituation kan påverka patienten även på ett existentiellt plan. Kommunikation och socialt stöd har betydelse för hur patienter upplever sin hälsa under behandlingen. Studiens syfte var att belysa patienters upplevda hälsa under cytostatikabehandling vid cancersjukdom, där av valdes kvalitativ metod. I litteraturöversikten användes databaser som var inriktade mot medicin och omvårdnadsvetenskap. Resultatet presenteras i tre huvudteman och sex subteman som beskriver patienters upplevda hälsa under cytostatikabehandling. Tio artiklar inkluderades där både fysiologiska, psyko-logiska och existentiella aspekter av hälsa framkom. Symtom som trötthet, illamående, smärta, oro och ångest påverkade patienternas vardag och välbefinnande. Resultatet vi-sade även att kroppsliga förändringar kunde påverka identitet och självbild. Socialt stöd, god kommunikation och olika copingstrategier framkom som betydelsefulla faktorer för att hantera behandlingens konsekvenser och främja upplevelsen av hälsa. Genom indivi-danpassad vård och ett vårdande bemötande kan sjuksköterskan bidra till att främja patientens hälsa och välbefinnande under behandlingen.

Background: Cervical cancer is a global public health concern and often diagnosed at an advanced stage, making treatment both extensive and demanding. The treatment affects women's lifes in multiple ways, including physical, psychological and social aspects. Aim: To describe women's experiences of undergoing treatment for cervical cancer. Method: This study was conducted as a literature review based on qualitative studies. The databases used were PubMed and CINAHL. Results: The findings included 11 articles describing women´s experiences of treatment. The analysis resulted in three main themes: physical consequences of treatment, emotional impact, and the need for information as well as change of sexuality and relationships. This resulted in six further subthemes. Conclusion: To adequately care for these women, it is essential that nurses adopt a person-centered approach. Adequate information and continuous support are crucial for improving women´s experience during treatment.

I denna studie analyserar vi hur utbildningsinflation påverkar nyexaminerades möjligheter att etablera sig på arbetsmarknaden samt hur idén om hur högre utbildning som en garanti för arbete ifrågasätts. Vi undersöker även varför individer väljer att studera vidare trots en osäker arbetsmarknad och ökad konkurrens om kvalificerade tjänster. Studien bygger på en kvalitativ metod med semistrukturerade intervjuer där åtta nyexaminerade har deltagit. Materialet analyserades sedan genom tematisk analys utifrån ett fenomenologiskt perspektiv. Resultatet visar att en akademisk examen sällan upplevs som tillräcklig i sig, då arbetsgivare även lägger stor vikt vid arbetslivserfarenhet, social kompetens och andra kompletterande meriter. Utbildning framstår därmed främst som en grundläggande sorteringsmekanism i rekryteringsprocessen snarare än en garanti för arbete. Vidare framkommer det att individers beslut att studera vidare påverkas av sociala normer, familjens förväntningar samt föreställningar om en stabil och trygg framtid. Studiens slutsats är bland annat att utbildningsinflation påverkar nyexaminerade olika beroende på utbildningsområde. Vissa etableras snabbt på arbetsmarknaden medan andra möter hög konkurrens, osäkerhet och krav på kompletterande erfarenheter. Vidare visar studien att utbildning ofta fungerar som ett formellt grundkrav för anställningsbarhet och legitimitet. Samtidigt som dessa betydelser varierar mellan yrken där den i vissa fall är helt avgörande för yrkesutövning.

Bakgrund: Typ 2-diabetes är ett globalt växande problem och den ökande prevalensen beror på bland annat faktorer som minskad fysisk aktivitet, ökad fetma och en åldrande befolkning. Att leva med denna sjukdom innebär en ändrad livsvärld, särskilt på grund av kravet på livsstilsändringar och egenvård. Egenvård är en central del av behandlingen vid typ 2-diabetes och följsamhet till egenvård har stor betydelse för att förebygga komplikationer. Detta arbete utgår från Orems teori om egenvård som beskriver patientens ansvar i att utföra egenvård och teorin om egenvårdsbrist där sjuksköterskans ansvar är att kliva in och stödja patienten när egenvården brister. Syftet: Att belysa faktorer som påverkar följsamhet till egenvård vid typ 2-diabetes. Metod: Genom ett litteraturbaserat examensarbete med kvalitativ design, kunde examenarbetets författare lyfta fram erfarenheter av följsamhet till egenvård. Analys av data gjordes i enlighet med Fribergs femstegsmodell och resultatet baserades på elva artiklar. Resultat: Resultatet visade att följsamheten till egenvård påverkas av flera faktorer. Sociokulturella faktorer, särskilt relaterade till kost, utgjorde betydande hinder. Även psykosociala faktorer såsom känslomässiga reaktioner samt bristande kunskap och missuppfattningar om sjukdomen påverkade följsamheten negativt. Slutsats: För att stärka följsamheten till egenvård krävs individanpassade insatser som utgår från patientens livsvärld. Ökad kunskap, stöd och förståelse för patientens sociokulturella och psykosociala förutsättningar är avgörande för en hållbar egenvård över tid.

Bröstcancer är en av de vanligaste cancerformerna bland kvinnor. En vanlig behandlingsmetod är mastektomi, vilket innebär att delar av eller hela brösten opereras bort. Syftet med denna litteraturöversikt är att belysa kvinnors upplevelser av att genomgå mastektomi vid bröstcancer. Litteraturöversikten baserades på tolv kvalitativa vetenskapliga artiklar som identifierades genom sökningar i databaserna CINAHL och PubMed. Resultaten visar att mastektomi påverkar kvinnors självbild, och vardag, där lidande och välbefinnande kan samexistera. Kvinnor beskriver även olika strategier för att hantera förlusten av bröstet och anpassa sig till livet efter operationen. Resultaten visar även att kvinnor upplever förändringar i självkänsla och kroppsuppfattning, samt ett behov av stöd från både sjuksköterska och anhöriga. Copingstrategier framkommer som en viktig resurs i hanteringen av den förändrade livssituationen. Kunskapen från denna litteraturöversikt kan bidra till en ökad förståelse för kvinnors upplevelser av mastektomi och ge vägledning för hur sjuksköterskan kan erbjuda ett mer individanpassat stöd i vården.

Denna studie belyser sjuksköterskans upplevelse av att vårda patienter i livet slutskede. Vård i livet slutskede är ett stadium när botande behandling inte längre är möjligt och den palliativa vården övergår till vård i livet slut. Sjukvården fokuserar då på att lindra patientens lidande och främja välbefinnandet hos patienten. Studien utformades som en litteraturöversikt och baserades på systematiska sökningar i databaserna CINAHL och PubMed. Kvalitativa, artiklar som genomgått peer-review publicerade mellan 2016 och 2026 inkluderades. Efter kvalitetsgranskning valdes totalt nio artiklar ut som uppfyllde samtliga inklusionskriterier och därmed ingick i översikt. Resultatet visade att sjuksköterskans arbete med patienter i livet slutskede präglas av komplexa situationer. I mötet med anhöriga kunde de uppleva meningsskiljaktigheter kring patientens behandling och anhörigas önskemål om fortsatt livsuppehållande behandling, vilket skapade en inre konflikt hos sjuksköterskan. Bristande kunskap inom vård i livet slutskede leder till osäkerhet i vårdandet och svårigheter för sjuksköterskan att fatta kliniska beslut. När kommunikationen mellan olika professioner, patienten och anhöriga brister upplevde sjuksköterskorna ett hinder i vårdandet och en ökad arbetsbelastning och stress. Slutsats: Organisatoriskt stöd och vidare utbildning kan bidra till att utveckla sjuksköterskans kompetens och stärka förmågan att hantera de känslomässiga och komplexa utmaningarna vård i livet slutskede innebär, vilket i sin tur främjar en god vård.

Substansmissbruksyndrom är ett multifaktoriellt tillstånd som innefattar skadligt bruk av substanser och innebär ofta en medsjuklighet med andra somatiska tillstånd. Sjuksköterskor inom den somatiska vården vårdar därmed ofta patienter med samsjuklighet i substansmissbruk. Sjuksköterskor kan uppleva vårdandet av dessa patienter som utmanande i form av säkerhetsrisker eller på grund av fördomar. Sjuksköterskans ansvar innefattar att tillhandahålla personcentrerad vård där patientens värdighet och integritet bevaras. Vårdens kvalité kan äventyras om sjuksköterskan inte har tillräcklig kompetens eller saknar förståelse och kan medföra stort lidande för patienten såväl som emotionella utmaningar för sig själv. Således är det viktigt att fördjupa kunskapen kring sjuksköterskors vårdande av patienter med substansmissbruk. Syftet är därmed att belysa sjuksköterskors erfarenheter av att vårda patienter med substansmissbruk inom somatisk vård. Metoden är en integrativ litteraturstudie som är baserad på elva vetenskapliga studier. Databassökningar är genomförda i Cinahl, Pubmed samt PsycInfo. Åtta artiklar är av kvalitativ ansats, två är av mixad metod och en är en kvantitativ studie. Dataanalysen gjordes enligt Fribergs metod i fyra steg där fokus låg på att identifiera data som svarade an på syftet och att sedan kategorisera relevant innehåll enligt olika innebörder. Analysen resulterade i åtta subteman och tre teman. Resultatet visar att sjuksköterskor har förmåga att arbeta personcentrerat men att de samtidigt bär på fördomar och stigmatisering. Sjuksköterskor identifierar svårigheter, bland annat smärtlindring och de tyngs av oro för patientens framtid. Slutsatser visar att både organisationer och sjuksköterskor behöver ta ett ansvar för att integrera patientperspektivet i omvårdnaden.

Diabetes mellitus is a group of metabolic diseases that is increasing worldwide and requires extensive self-care and treatment, where blood glucose monitoring is an essential part. Continuous glucose monitoring (CGM) enables wireless glucose measurement and is increasingly used by people with diabetes. Nurses encounter the sepatients in all healthcare settings and therefore need knowledge about how CGM affects daily life. The aim of this study was to illuminate adults’ experiences of using CGM in diabetes care. The study was conducted as a literature review based on qualitative research inspired by metasynthesis. Data were collected from relevant databases, and ten high-quality qualitative articles were selected and analyzed according to Friberg’s five-step analysis method. The results showed that CGM changed participants’ relationship with their disease by increasing their understanding and knowledge of diabetes. This contributed to more conscious decisions in daily life, improved self-care, and a greater sense of freedom and security. At the same time, several challenges related to CGM use were identified. Alarms and continuous measurements could create stress and frustration, while the sensor itself and technical problems sometimes caused feelings of limitation in everyday life. Participants also described insufficient support from healthcare professionals regarding these difficulties. The conclusion is that CGM was experienced not only as a technical aid, but as part of the person’s lifeworld that influenced everyday life as a whole. The ability to fully benefit from CGM depended on the support provided, highlighting the importance of nurses understanding the individual experience of CGM.

This qualitative study examines the experience of work-life balance among female leaders and mothers. Based on Hirdman's (1988) gender system, Clark's boundary theory (2000) and Greenhaus and Beutell's (1985) work-life conflict theory, the specific demands and expectations that can affect women's balance are analyzed. Furthermore, the strategies that women apply to create and manage this balance are explored. The empirical data has been collected through seven semi-structured interviews with female leaders with small children. The central finding is that it is the possibility of mental disconnection that affects balance to the greatest extent. The results also show that this experience of balance is not a static state, but rather changeable and situational and is influenced by demands, responsibilities and expectations in both roles. At the same time, the results indicate a relatively one-sided influence, where work affects private life to a greater extent than vice versa. The results indicate that the fact that women have small children does not constitute an obstacle to good balance, but rather functions as a prerequisite for creating clear boundaries between work and private life. Furthermore, the women describe both practical and mental strategies that are important for both creating and maintaining balance. These strategies appear to be crucial when the absence of, or difficulties in applying them, coincided with a poorer perceived balance.