Umeå University's logo

Background and aim: Social workers regularly encounter clients affected by substance use disorders (SUD), yet training in evidence-based assessment and interventions remains limited. In Sweden, municipal social workers have statutory responsibility for SUD assessment, intervention planning and client follow-up which underscores the need for targeted professional education. This study aimed to: (i) describe social workers’ baseline self-assessed competence in evidence-based practices for SUD and its associations with demographic and professional characteristics, and; (ii) examine knowledge gains associated with completion of an evidence-based educational intervention.

Methods: A non-randomized pre–post design included 173 municipal social workers recruited from 64 municipalities across five cohorts (2021–2023). Baseline self-assessed competence was analyzed using ordinal logistic regression, and knowledge gains were assessed using module-specific pre–post items with paired t-tests with Cohen’s d.

Results: Baseline competence was rated as low to moderate, with professional experience predicting higher perceived competence. Substantial baseline knowledge gaps were observed, particularly in evidence-based psychosocial interventions and use of digital technology in assessment and planning of treatment. Knowledge increased significantly across all modules after training completion (d = 0.26–1.41). The largest knowledge gains were for modules on use of technology in the assessment and treatment-planning, biopsychosocial interventions, research-informed use of the assessment tool Addiction Severity Index (ASI), and the professional role in assessment and care planning. Score variability decreased across several modules.

Conclusion: Completion of an immersive, online, evidence-based training was associated with meaningful improvements in social workers’ knowledge related to substance use assessment, intervention planning, and use of technology. Although causal inference is limited by the non-randomized single-group pre–post design, the findings support the potential of scalable educational interventions to address competence gaps in substance use services even in organizations with high caseloads, workforce turnover, and limited training opportunities.

While childhood vaccination programmes provide outstanding contributions to improving health, they can also pose challenges through the interactions between parents and healthcare. This paper focuses on the ethical dimensions of interactions between healthcare professionals and parents. Since the knowledge that professionals possess creates an asymmetrical relationship with parents, it can be helpful to analyse the situation from a power perspective. An example of ethical problem-solving using a simple model for discussing ethically difficult situations is demonstrated.

Forskning om insatser till personer med samsjuklighet mellan beroendetillstånd och andra psykiatriska tillstånd innehåller ett flertal etiskt relevanta frågor. Dessa är i många fall kopplade till den utsatta position i samhället som många personer i målgruppen är i.

Om beroendetillstånd ses som företrädesvis ett socialt problem eller ett medicinskt problem har betydelse både för vårdens och stödets organisering, och för forskning. Hur personerna i behov av vård och stöd själva ser på sin situation och vilken hjälp som önskas kan hamna i bakgrunden när vård­ och stödsystemets struktur och värdebaserade föreställningar är starka.

Förhållandena på verksamhetsområdet för vård och stöd till personer med samsjuklighet lever, i många fall, inte upp till de mål och värden som fram går ur lagstiftningen.

Flera kunskapsluckor har identifierats på detta insatsområde. Detta manar till förstärkta forskningsinsatser, som inte enbart bör innehålla interventionsforskning utan även vetenskapliga ansträngningar för att bland annat finna metoder för förbättrad implementering av befintlig kunskap.

Kunskapsluckorna bör förstås i relation till hur de uppstår:

• Om strikta inklusionskriterier används i syfte att uppnå hög vetenskaplig tillförlitlighet, kan det bli problematiskt att inkludera tillräckligt många individer med exakt inklusionsprofil då det rör sig om komplexa tillstånd. Strikta inklusionskriterier medför därmed få, men exakta, observationer.
• Omvänt kan man inkludera bredare, med en större variation i sammansättningen av den studerade populationen (mer likt den kliniska verkligheten) men med svagare vetenskaplig tillförlitlighet som följd. Detta medför hög power (statistisk styrka) men otydligare resultat.

Insatser som visats ge gynnsam effekt på näraliggande problemområden kan kanske överföras till den aktuella samsjukliga gruppen.

En kunskapslucka kan inte tas till intäkt för att avstå från att erbjuda insatser till personer som har behov av vård och stöd.

Background: Although shared decision-making (SDM) has been widely recommended in clinical guidelines, it is not implemented in practice. In early 2024, managers of a centre (home for care or residence, HVB) in Sweden decided to implement SDM. Researchers arranged an intensive course that included training in SDM, which was offered to all users, staff members and managers at the centre.

Aim: To explore the experiences of users, staff members and managers when SDM was introduced at a centre for women suffering from mental illness.

Method and Results: After introducing SDM, persons who had experience as users of mental health services conducted individual interviews with users, staff members and managers. The data were transcribed automatically during the video interviews. The data were analysed using thematic analysis, and the results represent three different aspects. Users: Previous experience is important, Attitudes to participation and What is needed for continuation. Staff: Ability to increase participation and SDM as an integrated way of working. Managers: Changes in the care atmosphere and Management during the introduction.

Relevance: Research concerning people staying at HVBs is scarce, as is research on SDM concerning adults with severe mental illness. It is important to highlight the needs of this group, as participation today and in the future is an important and often overlooked aspect for these users.

En sjuksköterskeutbildning av god kvalitet och med god genomströmning är en viktig välfärdsfråga för att tillgodose hälso- och sjukvårdens kompetensförsörjningsbehov. För att utöka antalet utbildningsplatser krävs platser för klinisk verksamhetsförlagd undervisning för den omfattande praktiska delen av utbildningen. Sådan verksamhetsförlagd utbildning sker på lärosätenas ansvar enligt den högskolerättsliga regleringen, men genomförs i hälso- och sjukvården. I denna artikel undersöks de komplexa rättsliga och pedagogiska förutsättningarna för verksamhetsförlagd utbildning på sjuksköterskeutbildningen i Sverige. En översiktlig utblick mot Danmark, Finland och Norge görs också. Undersökningen genomförs tvärvetenskapligt med rättsanalytisk metod samt genom analys av forskning om pedagogiskt utvecklingsarbete och lärosätenas lokala reglering. Här konstateras att förutsättningarna för verksamhetsförlagd utbildning i de nordiska länderna styrs av avtal mellan lärosätena och hälso- och sjukvården. Detta kräver omfattande samverkan mellan parterna, inte minst ur studenternas rättssäkerhetsperspektiv. Verksamhetsförlagd utbildning måste också vara anpassad till EU:s yrkeskvalifikationsdirektiv, som detaljreglerar sjuksköterskeutbildningen och innebär att minst hälften av utbildningens reglerade minimitid ska utgöra klinisk undervisning i direkt kontakt med patienter i hälso- och sjukvården. Slutsatsen är att direktivet begränsar metoder för genomförande av verksamhetsförlagd utbildning såsom simulering, trots att sådana övningsmöjligheter förekommer i många av EU:s medlemsstater och kan vara motiverade både ur pedagogisk och patientsäkerhetsmässig synvinkel.

Nursing education of good quality and with a high throughput is an important welfare issue to meet the need for competence supply in health care. In order to increase the number of clinical training positions, access to health care organizations where the extensive practical part of the nurse education can be carried out is required. The universities have a responsibility to arrange clinical training for nurse students in accordance with law, however practically carried out in health care. This article examines the complex legal and pedagogical conditions for clinical training in Swedish nursing education. A brief overview of the conditions in Denmark, Finland and Norway is also presented. An interdisciplinary approach is applied, combining legal method and analysis of pedagogical development research and the local regulation of nursing education at the universities. The authors conclude that the conditions for clinical training in the Nordic countries are governed by agreements between the universities and health care institutions. This requires an extensive cooperation between the parties, not least from the perspective of legal certainty for students. Clinical training must also fulfil the requirements according to EU law, which regulates nursing education in detail and requires at least half of the stipulated educational duration standards to be carried out clinically in direct contact with patients in health care. The conclusion is that EU law restricts methods for carrying out clinical training such as simulation, even though simulation is applied in many of the member states and can be justified both from a pedagogical and patient safety perspective.

To explore Swedish physicians' arguments and values for and against physician-assisted suicide (PAS) extracted from the free-text comments in a postal survey. A random selection of approximately 240 physicians from each of the following specialties: general practice, geriatrics, internal medicine, oncology, surgery and psychiatry. All 123 palliative care physicians in Sweden. A qualitative content analysis of free-text comments in a postal questionnaire commissioned by the Swedish Medical Society in collaboration with the Karolinska Institute in Stockholm. The total response rate was 59.2%. Of the 933 respondents, 1107 comments were provided. The free-text comments entailed both normative and factual arguments for and against PAS. The analysis resulted in two main categories: (1) "Safe implementation of PAS is unachievable" (with subcategories "Criteria of PAS difficult to fulfil" and "PAS puts societal norms and values at risk") and (2) "The role of PAS in healthcare" (with subcategories "No medical need for PAS", "PAS is not a task for physicians", "No ethical difference to other end-of-life decisions" and "PAS is in the patient's best interest"). The respondents brought up well-known arguments from academic and public debate on the subject. Comments from physicians against PAS were more often emotionally charged and used devices like dysphemisms and slippery-slope arguments.

Artikeln ger en kort bakgrund om svensk missbruksvård. De forskningsprojekt vars resultat detta temanummer bygger på har uppstått utifrån denna förståelse. Förkortningarna EPI och ESTR får också sina förklaringar och beskrivs. Det finns en rad svar på rubrikens fråga. Det vanligaste är att det skulle behövas en generell ambitionshöjning, något som anses kräva mer resurser, vilket inte är så enkelt att ordna. Ett annat svar är att huvudmännens ansvar borde förtydligas, vilket redan en nu 12 år gammal offentlig utredning föreslog via ett samlat huvudmannaskap hos sjukvårdshuvudmannen för behandling vid missbruk och beroende (SOU 2011:35). En aktuell utredning föreslår samma sak (SOU 2023:5). Hur det verkligen blir återstår att se. Alldeles oberoende av reformer så finns det möjligheter till kvalitetsförbättringar och effektiviseringar genom att planera och följa upp de insatser som erbjuds brukarna på ett systematiskt sätt.

Objective: To explore the experiences of acculturation into secular Swedish society of former members of cults, with particular focus on mental health, needs and resources.

Design: Qualitative method using the Cultural Formulation Interview (CFI) from the DSM-5 as an interview guide. Analysis of participants’ experiences of acculturation through systematic text condensation.

Participants: Eleven Swedish former members of ideological or religion-based cults.

Setting: Swedish mainstream, secular society.

Results: Former cult members experience an ‘in-between time’ in the period after leaving the cult and find themselves in a confusing, chaotic state. They describe having lived in an honor culture where acts of violence were normalized. In the cult, they felt disconnected from themselves, and post-cult they try to regain access to their own values and feelings as well as create new bonds with family members and friends outside the cult. They find it hard to talk about their cult background and find relief in communicating with other former cult members. In their post-cult life, they eventually start seeing the world in a brighter, more hopeful way than before. However, they are also at risk of re-experiencing cult-related traumatic events and of new traumatic experiences within the post-cult acculturation process, and of persistent psychological distress.

Conclusion: Former cult members face a challenging acculturation process, having lost a functioning worldview upon leaving the cult but not yet gained another to take its place. While the in-between time is often transient, they may need support from the healthcare system, especially regarding mental health concerns, while establishing themselves into mainstream society.