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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.

Denna kvantitativa studie utvärderar kunskapsförändringar hos deltagare i EPI universitetskursen. Majoriteten av deltagarna var socialsekreterare inom miss-bruksområdet. Kursen resulterade i betydande förbättringar av deltagarnas kunskap, särskilt vad gäller insats- och vårdkontinuitetsmodeller samt använd-ning av motivationshöjande intervjutekniker. Kunskapen om äldre personer med beroendeproblem och fördelarna med ASI-uppföljningar för socialarbe-tare och klienter förbättrades också.

This quantitative study assesses knowledge improvement among partici-pants of the EPI university course. The majority were social workers in sub-stance abuse. The course led to significant enhancements in participants’ knowledge, particularly concerning intervention and care continuity and the use of motivational interview techniques. Knowledge about older individuals with substance dependencies and benefits of ASI follow-up interviews for social workers and clients also improved.

Purpose: The purpose of this study is to describe participation in decision-making among service users with severe mental illness.

Design/methodology/approach: Service users want to participate in decision-making and in the planning of their care. There are widely known methods, such as shared decision-making, that could be used to facilitate service user participation. Three focus group interviews were conducted with the participation of 14 persons with mental illness and/or substance abuse who were service users at two Swedish Homes for Care and Residence (HVB). Data were analyzed by qualitative content analysis.

Findings: Two themes emerged: service users’ involvement in decisions is hampered by the professionals’ approach and adequate information and experience of participation means greater empowerment.

Research limitations/implications: Although it is known that service users would like to have more influence, and that methods like shared decision-making are recommended to empower service users and improve the decision process, research on these matters is limited.

Practical implications: This study reveals that there is a need of more systematic decisional support, such as shared decision-making, so that service users can be seen as important persons not only in guidelines and policy documents but also in clinical practice.

Social implications: The findings indicate that service users do not participate in decisions systematically, although policies, guidelines and laws providing that service users should be offered an active part in decision-making with regard to their care and treatment.

Originality/value: Although it is known that service users would like to have more influence, and that methods like shared decision-making are recommended to empower service users and improve their decision process, research on these matters is limited. The findings indicate that service users do not participate in decisions systematically, even though policies, guidelines and laws are in place stipulating that service users should be offered an active part in decision-making with regard to their own care and treatment. The results of this project bring improvement opportunities to light.