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The aim of the study was to describe nurses' experiences of touch and especially touch when assisting older adult patients in hospital context. The interviewed nurses described 2 ways of assisting by touch: striving to be present and not being there. This study shows that touching and assisting by touch can constitute the core of the act of holistic caring in nursing, in which the most important content is a real encounter with the patient.

Background: Self-determination has been shown to be an important factor in mental health and wellbeing, but from the homecare recipients' point of view, autonomy and self-determination is not fully integrated into homecare services. The aim of this study was to explore older adults’ experiences of self-determination when needing homecare services.

Methods: In 2018, a qualitative descriptive study was conducted and a convenience sample of 15 older adults from 3 homecare service facilities were invited to participate in individual interviews. Data were analysed using qualitative content analyse.

Results: The theme Transitioning from self-determination as independence towards self-determination as shared decision-making emerged through the older adults' narratives. This ‘transition’ is one in which older adult’s understanding of self-determination and self-esteem was transitioning towards the acceptance of shared decision-making. The person's inner strength and willingness to make decisions was promoting to enact and preserve independence. Accepting one's dependence on others and being in a positive atmosphere were described as promoting self-determination and shared decision-making, and vice versa. The above overarching theme permeated all subthemes, which included: mobilising inner strength to enact independence; accepting increasing dependence on others; and being influenced by the atmosphere.

Conclusions: The study contributes increased understanding of older adults' experiences of self-determination. The results can act as a guide when planning future person-centred care interventions in the context of homecare services and help improve homecare services' ability to meet the needs of older adults. To summarise, older adults' reflections on their own self-determination highlighted relationships with other people as important for shared decision-making, which could help preserve older adults’ autonomy and self-esteem.

Introduction: Newly trained nurses experience a lack of preparedness in practical skills, and research shows  that students and newly trained nurses have deficiencies in performing practical skills such as venous blood specimen collection. There is a lack of knowledge regarding the level of accuracy reached by students after training at clinical training centres and before entering clinical practice. The aim of this study was to assess the performance of venous blood specimen collection among nursing students after regular education and training at the clinical training centre but before starting an internship. 

Methods: Twenty-three nursing students were observed and video-recorded. An observation protocol was developed based on a validated questionnaire measuring adherence to valid guidelines, and a model for practical skills performance. Data were analysed using descriptive statistics. 

Results: A large variation was found in students’ performance with respect to information provided to the patient, patient identification procedures, and tourniquet procedures. The students gave adequate information in 39% of cases, accurately performed patient identification in 83% of cases, and accurately performed the tourniquet procedure in 22% of cases. 

Conclusions: Many nursing students are not prepared to practice on real patients. It is therefore important for university lecturers to develop more efficient teaching methods and to communicate students’ skill levels to the supervisor at the clinic, in order for the clinical training to be adapted to a suitable level. There is a need for further research on how to close the gap between the university and internship in order to ensure patient safety.

BACKGROUND AND PURPOSE: Many newly graduated nurses lack proficiency in practical skill performance. Presently, nursing students' practical skill is assessed by summative instruments with overarching items. The purpose of this study was to develop a more detailed instrument to use in summative assessment of nursing students' practical skill performance and to assess its psychometric properties.

METHODS: A 50-item instrument was developed. Video-recorded performances were rated by experienced clinical supervisors. A multifacet measurement design was developed. Relevant parameters were estimated by generalizability analysis.

RESULTS: Findings indicated that error of measurement were mainly caused by raters far more than by items.

CONCLUSIONS: The present study suggested that summative assessment in realistic settings may not apply one rater only. Two to three/four raters appear necessary to dependably measure most skills.

Background: Home care recipients have reported little self-determination and opportunity to influence their own care. Person-centred care focusing on involvement has improved the quality of life of older adults in health care and nursing homes; however, knowledge about the effects of person-centred interventions in aged care at home is sparse. The aim of this study was to study the effects of a person-centred and health-promoting intervention, compared with usual care, on health-related quality of life, thriving and self-determination among older adults, and on job satisfaction, stress of conscience and level of person-centred care among care staff.

Methods: This is a non-randomized controlled trial with a before/after design. Participants from five home care districts in one municipality in northern Sweden were recruited to an intervention or control group. We evaluated health-related quality of life, thriving and self-determination among older home care recipients, and job satisfaction, person-centred care and stress of conscience among care staff. Evaluation was performed by questionnaires and responses were analysed using parametric and non-parametric statistical analyses.

Results: Eighty-one older adults and 48 staff were included in the study. A clinically moderate and statistically significant difference between the intervention and control groups was found in thriving and negative emotions among older adults. The intervention contributed to maintaining high thriving levels, in contrast to decreased thriving in the control group (intervention: + 1, control: − 4, p 0.026, CI: − 10. 766, − 0.717). However, the intervention group rated an increase in negative emotions, while the control group was unchanged (intervention: − 7 control: + − 0, p 0.048, CI: − 17.435, − 0.098). No significant effects were found among staff.

Conclusions: The intervention contributed to maintaining high levels of thriving in contrast to low levels found in the control group, and it seems reasonable to consider the intervention focus on staff as more person-centred and health-promoting. The finding that the intervention group had increase in negative emotions is difficult to interpret, and warrants further exploration. Even though the results are sparse, the challenges discussed may be of importance for future studies in the context of HCS.

Trial registration: NCT02846246. Date of registration: 27 July 2016.

Background: In general, adults with congenital heart disease have reduced exercise capacity and many do not reach the recommended level of physical activity. A physically active lifestyle is essential to maintain health and to counteract acquired cardiovascular disease, therefore enablers and barriers for being physically active are important to identify.

Aim: To describe what adults with complex congenital heart diseases consider as physical activity, and what they experience as enablers and barriers for being physically active.

Methods: A qualitative study using semi-structured interviews in which 14 adults with complex congenital heart disease (seven women) participated. The interviews were analysed using qualitative content analysis.

Results: The analysis revealed four categories considered enablers and barriers – encouragement, energy level, approach and environment. The following is exemplified by the category encouragement as an enabler: if one had experienced support and encouragement to be physically active as a child, they were more positive to be physically active as an adult. In contrast, as a barrier, if the child lacked support and encouragement from others, they had never had the opportunity to learn to be physically active.

Conclusion: It is important for adults with congenital heart disease to have the opportunity to identify barriers and enablers for being physically active. They need knowledge about their own exercise capacity and need to feel safe that physical activity is not harmful. This knowledge can be used by healthcare professionals to promote, support and eliminate misconceptions about physical activity. Barriers can potentially be transformed into enablers through increased knowledge about attitudes and prerequisites.

Background: Globally, family members account for the main source of caregiving of persons with dementia living at home. Providing care to family members with dementia often has negative health consequences for caregivers such as stress, depression and low quality of life. Yet, formal support for family caregivers (FCs) is limited. Telehealth technology has the potential to provide health care and social support to FCs. This study aims to assess the effectiveness of providing support by healthcare professionals (HPs) through a mobile app in reducing stress, depressive symptoms and loneliness, and improving mental health and quality of life of FCs of persons with dementia.

Methods: Using a pragmatic intervention design, this study will use pre- and post-intervention assessment to evaluate the effectiveness of the proposed intervention in a sample of 78 FCs of persons with dementia (PWD). The intervention will be implemented by approximately 5 HPs specialized in dementia care based in the municipalities in Sweden. The main thrust of the intervention is to provide professional support, with help of an interactive mobile app, to family members in their caregiving role for PWDs. Qualitative interviews with HPs and FCs form the groundwork of the development of the mobile app. By using the app on smart phone or tablet, the FC, in groups of 8-10, will communicate with peers and a HP exchanging ideas on how to deal with PWD's behavioral and cognitive changes and get support. They will also be able to discuss stressful events and access mindfulness exercises focused on themselves. Quantitative data will be collected before and at three time points after the 8-week intervention to assess changes in the health outcomes of the FCs. In-depth interviews will be conducted after the intervention to capture the experiences of FCs and HPs regarding the ease of use and acceptability of the app.

Discussion: This tailor-made mobile app has the high potential to be a practical platform for supporting FCs to alleviate stress and improve mental health irrespective of distance to the nearest health care or social service center.

Objective: We evaluated school nurses' attitudes towards family involvement in school healthcare when children exhibit signs of mental health problems.

Methods: In a cross-sectional study, the Families' Importance in Nursing Care-Nurses' Attitudes (FINC-NA) instrument was used to measure school nurses' (N = 133) attitudes towards family involvement. Data were analyzed with the Mann-Whitney U-test.

Results: School nurses (95%) encountered students with mental health problems every day or every week. Overall, school nurses were positive towards family involvement in school healthcare. Primary school nurses were more positive compared to secondary school nurses, seeing the family as a resource and a conversation partner. School nurses who felt that they had insufficient tools to work with children with mental health problems saw the family as a burden compared to school nurses who reported they have sufficient tools.

Conclusion: School nurses' attitudes toward involving families as a resource are promising. However, when nurses perceive themselves as lacking sufficient tools to respond to children's mental health problems, they are more likely to experience the family as a burden than a resource. Cooperation between school nurses and families may be crucial. Therefore, we suggest a Family Health Conversations model to improve nurse-family collaboration

AIM: To explore the level of thriving and associated factors among older adults living at home with support from home care services.

DESIGN: An exploratory, cross-sectional survey design.

METHOD: A sample of 136 participants (mean 82 years) responded to a survey about thriving, health, psychosocial and care-related factors in 2016. Descriptive analysis and multiple logistic regression analysis with a stepwise backwards elimination procedure were performed.

RESULT: The results showed that the level of thriving was relatively high among adults living at home with support from home care services, with dimensions concerning engaging in activities and peer relations and keeping in touch with people and places being rated the lowest. Regression analysis showed that participating in social relations and experiencing self-determination in activities in and around the house were associated with thriving.

CONCLUSION: Facilitating social relations and creating opportunities for self-determination seem necessary to support thriving among older adults living at home with support from home care services.

IMPACT: The findings in this study add important knowledge about place-related well-being when living at home with home care services.

Background: Constipation is a common condition among older people, particularly among people living in nursing homes, and the use of drugs such as opioids is one of many factors that contribute to its high prevalence. The aim of this study was to compare the prevalence of constipation and the use of laxatives between 2007 and 2013, to analyze constipation and laxative use among people who are prescribed opioids, and to identify factors associated with constipation. Methods: In 2007 and 2013, two surveys were performed in the county of Vasterbotten in Northern Sweden, comprising all those living in nursing homes. The Multi-Dimensional Dementia Assessment Scale was used to collect data regarding laxative, opioid and anticholinergic drug use, functioning in activities of daily living (ADL), cognition and symptoms of constipation. A comparison was made between 2820 people from 2007 and 1902 people from 2013. Results: The prevalence of symptoms of constipation among people living in nursing homes increased from 36% in 2007 to 40% in 2013. After controlling for age, sex, ADL, cognitive impairment and use of opioid and anticholinergic drugs, this difference was found to be statistically significant. When controlled for demographic changes, there was a statistically significant difference in the regular use of laxatives between the respective years, from 46% in 2007 to 59% in 2013. People prescribed opioids and anticholinergic drugs were at increased risk of constipation, while people with a higher ADL score were at decreased risk. Further, among people prescribed opioids and rated as constipated, 35% in 2007 and 20% in 2013 were not prescribed laxatives for regular use, a difference that was found to be statistically significant. Conclusions: The prevalence of symptoms of constipation increased between 2007 and 2013. Although there was a decrease between the years, there were still a number of people being prescribed with opioids and rated as constipated who were not treated with laxatives. This study therefore indicates that constipation remains a significant problem among people in nursing homes and also indicates that those prescribed opioids could benefit from an increased awareness of the risk of constipation and treatment, if required.