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  • 1. Bray, Lucy
    et al.
    Blake, Lucy
    Protheroe, Jo
    Nafria, Begonya
    Garcia de Avila, Marla Andreia
    Ångström-Brännström, Charlotte
    Umeå University, Faculty of Medicine, Department of Nursing.
    Forsner, Maria
    Umeå University, Faculty of Medicine, Department of Nursing.
    Campbell, Steve
    Ford, Karen
    Rullander, Anna-Clara
    Umeå University, Faculty of Medicine, Department of Nursing.
    Robichaud, Fanny
    Jenholt Nolbris, Margaretha
    Saron, Holly
    Kirton, Jennifer A.
    Carter, Bernie
    Children’s pictures of COVID-19 and measures to mitigate its spread: an international qualitative study2021In: Health Education Journal, ISSN 0017-8969, E-ISSN 1748-8176, Vol. 80, no 7, p. 811-832Article in journal (Refereed)
    Abstract [en]

    Objectives: To gain insight into children's health-related knowledge and understanding of Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV2) and COVID-19, and measures adopted to mitigate transmission.

    Design: A child-centred qualitative creative element embedded in an online mixed-methods survey of children aged 7–12 years. 

    Setting: Children participated in the study in six countries – the UK, Australia, Sweden, Brazil, Spain and Canada.

    Method: A qualitative creative component, embedded in an online survey, prompted children to draw and label a picture. Children were recruited via their parents using the researchers' professional social media accounts, through known contacts, media and websites from health organisations within each country. Analysis of the form and content of the children's pictures took place.

    Results: A total of 128 children (mean age 9.2 years) submitted either a hand-drawn (n = 111) or digitally created (n = 17) picture. Four main themes were identified which related to children's health-related knowledge of (1) COVID-19 and how it is transmitted; (2) measures and actions to mitigate transmission; (3) places of safety during the pandemic; and (4) children’s role in mitigating COVID-19 transmission.

    Conclusion: Children's pictures indicated a good understanding of the virus, how it spreads and how to mitigate transmission. Children depicted their actions during the pandemic as protecting themselves, their families and wider society.

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  • 2. Bray, Lucy
    et al.
    Carter, Bernie
    Blake, Lucy
    Saron, Holly
    Kirton, Jennifer A.
    Robichaud, Fanny
    Avila, Marla
    Ford, Karen
    Nafria, Begonya
    Forsner, Maria
    Umeå University, Faculty of Medicine, Department of Nursing.
    Nilsson, Stefan
    Chelkowski, Andrea
    Middleton, Andrea
    Rullander, Anna-Clara
    Umeå University, Faculty of Medicine, Department of Nursing.
    Mattsson, Janet
    Protheroe, Joanne
    "People play it down and tell me it can't kill people, but I know people are dying each day". Children's health literacy relating to a global pandemic (COVID-19); an international cross sectional study.2021In: PLOS ONE, E-ISSN 1932-6203, Vol. 16, no 2, article id e0246405Article in journal (Refereed)
    Abstract [en]

    The aim of this study was to examine aspects of children's health literacy; the information sources they were accessing, their information preferences, their perceived understanding of and their reported information needs in relation to COVID-19. An online survey for children aged 7-12 years of age and parent/caregivers from the UK, Sweden, Brazil, Spain, Canada and Australia was conducted between 6th of April and the 1st of June 2020. The surveys included demographic questions and both closed and open questions focussing on access to and understanding of COVID-19 information. Descriptive statistics and qualitative content analysis procedures were conducted. The findings show that parents are the main source of information for children during the pandemic in most countries (89%, n = 347), except in Sweden where school was the main source of information. However, in many cases parents chose to shield, filter or adapt their child's access to information about COVID-19, especially in relation to the death rates within each country. Despite this, children in this study reported knowing that COVID-19 was deadly and spreads quickly. This paper argues for a community rather than individual approach to addressing children's health literacy needs during a pandemic.

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  • 3.
    Bray, Lucy
    et al.
    Edge Hill University, Ormskirk, United Kingdom.
    Carter, Bernie
    Edge Hill University, Ormskirk, United Kingdom.
    Kiernan, Joann
    Edge Hill University and Alder Hey Children’s Hospital, Liverpool, United Kingdom.
    Horowicz, Ed
    University of Liverpool, Liverpool, United Kingdom.
    Dixon, Katie
    Expert by Experience, Liverpool, United Kingdom.
    Ridley, James
    Edge Hill University and National Restraint Reduction Network, Ormskirk, United Kingdom.
    Robinson, Carol
    University of Strathclyde, Glasglow, United Kingdom.
    Simmons, Anna
    Alder Hey Children’s Hospital, Liverpool, United Kingdom.
    Craske, Jennie
    Alder Hey Children’s Hospital, Liverpool, United Kingdom.
    Sinha, Stephanie
    Alder Hey Children’s Hospital, Liverpool, United Kingdom.
    Morton, Liza
    University of Glasgow, Glasgow, United Kingdom.
    Nafria, Begonya
    Sant Joan de Déu Children’s Hospital, Barcelona, Spain.
    Forsner, Maria
    Umeå University, Faculty of Medicine, Department of Nursing.
    Rullander, Anna-Clara
    Umeå University, Faculty of Medicine, Department of Nursing.
    Nilsson, Stefan
    University of Gothenburg, Gothenburg, Sweden.
    Darcy, Laura
    University of Borås, Borås, Sweden.
    Karlsson, Katarina
    University of Borås, Borås, Sweden.
    Hubbuck, Cath
    Great Ormond Street Hospital, London, United Kingdom.
    Brenner, Maria
    Trinity College, Dublin, Ireland.
    Spencer-Little, Sian
    Great Ormond Street Hospital, London, United Kingdom.
    Evans, Kath
    Barts Health NHS Trust, London, United Kingdom.
    Rowland, Andrew
    The University of Salford, Salford, United Kingdom.
    Hilliard, Carol
    Children’s Health Ireland (CHI) at Crumlin, Dublin, Ireland.
    Preston, Jennifer
    University of Liverpool, Liverpool, United Kingdom.
    Leroy, Piet L.
    Maastricht University Medical Centre / Maastricht University, Maastricht, Netherlands.
    Roland, Damian
    University Hospitals of Leicester NHS Trust and Leicester University, Leicester, United Kingdom.
    Booth, Lisa
    University of Cumbria, Cumbria, United Kingdom.
    Davies, Jean
    Bangor University, Bangor, United Kingdom.
    Saron, Holly
    Edge Hill University, Ormskirk, United Kingdom.
    Mansson, Marie Edwinson
    Paediatric RN, HSC, Lund University, Lund, Sweden.
    Cox, Ann
    Midlands Partnership NHS Foundation Trust & Keele University, Keele, United Kingdom.
    Ford, Karen
    University of Tasmania and the Royal Hobart Hospital, Tasmani, Australia.
    Campbell, Steven
    University of Tasmania, TAS, Australia.
    Blamires, Julie
    Auckland University of Technology, Auckland, New Zealand.
    Dickinson, Annette
    Auckland University of Technology, Auckland, New Zealand.
    Neufeld, Michael
    Auckland University of Technology, Auckland, New Zealand.
    Peck, Blake
    Federation University, VIC, Australia.
    de Avila, Marla
    São Paulo State University, São Paulo, Brazil.
    Feeg, Veronica
    Molloy College in Rockville Centre, New York City, United States.
    Mediani, Henny Suzana
    Universitas Padjadjaran, Bandung Ciry, Indonesia.
    Atout, Maha
    Philadelphia University, Amman, Jordan.
    Majamanda, Maureen D.
    University of Malawi, Kamuzu College of Nursing, Malawi, South Africa.
    North, Natasha
    The Harry Crossley Children’s Nursing Development Unit, University of Cape Town, Cape Town, South Africa.
    Chambers, Christine
    Dalhousie University, Halifax, Canada.
    Robichaud, Fanny
    Ulluriaq, Ungava Tulattavik Health Center and UQAM UQO, QC, Canada.
    Developing rights-based standards for children having tests, treatments, examinations and interventions: using a collaborative, multi-phased, multi-method and multi-stakeholder approach to build consensus2023In: European Journal of Pediatrics, ISSN 0340-6199, E-ISSN 1432-1076, Vol. 182, no 10, p. 4707-4721Article in journal (Refereed)
    Abstract [en]

    Children continue to experience harm when undergoing clinical procedures despite increased evidence of the need to improve the provision of child-centred care. The international ISupport collaboration aimed to develop standards to outline and explain good procedural practice and the rights of children within the context of a clinical procedure. The rights-based standards for children undergoing tests, treatments, investigations, examinations and interventions were developed using an iterative, multi-phased, multi-method and multi-stakeholder consensus building approach. This consensus approach used a range of online and face to face methods across three phases to ensure ongoing engagement with multiple stakeholders. The views and perspectives of 203 children and young people, 78 parents and 418 multi-disciplinary professionals gathered over a two year period (2020–2022) informed the development of international rights-based standards for the care of children having tests, treatments, examinations and interventions. The standards are the first to reach international multi-stakeholder consensus on definitions of supportive and restraining holds.

    Conclusion: This is the first study of its kind which outlines international rights-based procedural care standards from multi-stakeholder perspectives. The standards offer health professionals and educators clear evidence-based tools to support discussions and practice changes to challenge prevailing assumptions about holding or restraining children and instead encourage a focus on the interests and rights of the child.

    What is Known:

    • Children continue to experience short and long-term harm when undergoing clinical procedures despite increased evidence of the need to improve the provision of child-centred care.
    • Professionals report uncertainty and tensions in applying evidence-based practice to children’s procedural care.

    What is New:

    • This is the first study of its kind which has developed international rights-based procedural care standards from multi-stakeholder perspectives.
    • The standards are the first to reach international multi-stakeholder consensus on definitions of supportive and restraining holds.
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  • 4.
    Forsner, Maria
    et al.
    Umeå University, Faculty of Medicine, Department of Nursing.
    Cyrén, Monika
    Gävle Sjukhus, Gävle, Sweden.
    Gerdin, Anna
    Gävle Sjukhus, Gävle, Sweden.
    Rullander, Anna-Clara
    Umeå University, Faculty of Medicine, Department of Nursing.
    It hurts to get forced: Children's narratives about restraint during medical procedures2023In: Paediatric and Neonatal Pain, ISSN 2637-3807, Vol. 5, no 4, p. 110-118Article in journal (Refereed)
    Abstract [en]

    According to the UN Convention on the Rights of the Child (UNCRC), children have the right to be involved in decisions about medical procedures affecting them. However, research has shown that healthcare professionals sometimes find this difficult to achieve and those procedures then are performed against the will of the child. The aim was to illuminate restraint from the perspective of children’s and young people’s experiences of feeling forced during medical procedures. Following the phenomenological hermeneutic method, a secondary qualitative analysis of narrative data from four datasets collected between 2001 and 2020 was performed. Twelve children and young people aged 6-19 years (three male, nine female) from central and northern Sweden narrated their experiences of restraint related to medical procedures in nine narrative interviews and three short written narratives. The analysis revealed that it hurts to get forced, this being illustrated in six themes: bodily misery, emotional rebellion, feeling disregarded, physically limited, desiring escape, and leaving deep traces. From the perspective of children and young people, restraint was interpreted with inspiration from the philosopher Michel Foucault, as being overpowered - not voluntary submission but offering resistance - and according to the theory of caring and uncaring, a relationship in which the healthcare professional is perceived as indifferent to the patient as a person. In conclusion restraint hurts and means powerlessness to the child, leaving deep traces that remain for a long time. The findings call the healthcare profession to take action to support children’s self-determination, participation, and integrity in healthcare. How children experience restraint in healthcare merits further investigation from the children’s own perspective.

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  • 5.
    Forsner, Maria
    et al.
    Umeå University, Faculty of Medicine, Department of Nursing.
    Edwinson Månsson, Marie
    Rullander, Anna-Clara
    Umeå University, Faculty of Medicine, Department of Nursing. Norrlands universitetssjukhus.
    Omvårdnad vid procedurer2023In: Pediatrisk omvårdnad / [ed] Inger Kristensson Hallström; Mariette Derwig, Stockholm: Liber, 2023, 3, p. 129-147Chapter in book (Refereed)
  • 6. ISupport Team,
    Forsner, Maria (Contributor)
    Umeå University, Faculty of Medicine, Department of Nursing.
    Getting it right first time and every time; re-thinking children's rights when they have a clinical procedure2021In: Journal of Pediatric Nursing: Nursing Care of Children and Families, ISSN 0882-5963, E-ISSN 1532-8449, Vol. 61, p. A10-A12Article in journal (Refereed)
  • 7.
    Jakobsson, Johan
    et al.
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Section of Physiotherapy.
    De Brandt, Jana
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Section of Physiotherapy.
    Hedlund, Mattias
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Section of Physiotherapy.
    Rullander, Anna-Clara
    Umeå University, Faculty of Medicine, Department of Nursing.
    Nyberg, Andre
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Section of Physiotherapy.
    Acute physiological effects of supramaximal high-intensity interval training in people with or without COPD2023In: Medicine & Science in Sports & Exercise, ISSN 0195-9131, E-ISSN 1530-0315, Vol. 55, p. 549-549Article in journal (Refereed)
    Abstract [en]

    High-intensity exercise is essential for optimal development of cardiorespiratory fitness and health. This is, however, challenging for most people with chronic obstructive pulmonary disease (COPD) due to ventilatory limitations, leading to exercise at lower intensities accompanied by suboptimal stress on the cardiovascular and muscular system.

    PURPOSE: To compare the acute effects of a novel concept of short-duration supramaximal high-intensity interval training (HIIT) vs. moderate-intensity continuous training (MICT) in people with COPD and matched healthy controls (HC).

    METHODS: Sixteen people with mild to severe COPD (75 ± 6 yr; 8 males; 73 ± 13 FEV1%pred; 119 ± 37 W max aerobic power [MAP]) and 14 HC (74 ± 5 yr; 8 males; 106 ± 14 FEV1%pred; 169 ± 38 W MAP) performed HIIT and MICT on a cycle ergometer in a randomized order. HIIT consisted of 10x6s sprints interspersed with 1-min recovery and was performed at two intensities: 60% of max mean power output for 6-sec (MPO6) and 80%MPO6, estimated from the Borg cycle strength test. MICT consisted of 20-min at 60% of MAP, derived from a cardiopulmonary exercise test. Cardiorespiratory parameters, blood lactate concentration, ratings of exertion/symptoms, and exercise modality preference were obtained.

    RESULTS: Exercise characteristics and physiological data collected at the end of exercise are shown in Table 1. All HIIT sessions were completed, while 1 in 3 people with COPD did not complete MICT. The HIIT modality was preferred by 13/16 (COPD) and 12/14 (HC).

    CONCLUSION: Short-duration supramaximal HIIT was feasible and enabled a 3.5-fold increase in exercise intensity vs. MICT in people with COPD and HC. Notably, despite the higher exercise intensities, the cardiorespiratory demand during HIIT was similar to MICT and clinically relevant reductions in symptoms were seen in favor of HIIT, in people with COPD. Also, >80% of participants preferred HIIT over MICT.

  • 8.
    Jakobsson, Johan
    et al.
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Section of Physiotherapy.
    De Brandt, Jana
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Section of Physiotherapy.
    Hedlund, Mattias
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Section of Physiotherapy.
    Rullander, Anna-Clara
    Umeå University, Faculty of Medicine, Department of Nursing.
    Nyberg, Andre
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Section of Physiotherapy.
    Innovative exercise for optimizing exercise intensity in COPD2022In: European Respiratory Journal, ISSN 0903-1936, E-ISSN 1399-3003, Vol. 60, no Suppl. 66, article id 4654Article in journal (Refereed)
    Abstract [en]

    Background: High-intensity exercise is essential for optimal physiological exercise adaptations but challenging to perform for most people with COPD due to ventilatory limitations, leading to use of lower exercise intensities accompanied by suboptimal stress on the cardiovascular and muscular system. This study compared the acute effects of a novel concept of short-duration supramaximal high-intensity interval training (HIIT) vs. traditional moderate-intensity continuous training (MICT) in people with COPD.

    Methods: Thirteen people with COPD (75±6 yr; 8 males; 72±13 FEV1%pred; 124±37 Wpeak) performed short-duration supramaximal HIIT and MICT on a cycle ergometer in a randomized order. HIIT consisted of 10x6s sprints interspersed with 1-min recovery and was performed at two intensities (HIIT60% & HIIT80%). MICT consisted of 20-min at 60% of CPET Wpeak. Cardiorespiratory parameters, blood lactate concentration, ratings of exertion/symptoms, and exercise modality preference were obtained.

    Results: Exercise characteristics and physiological data are seen in Table 1. All patients completed HIIT, while 4 out of 13 stopped MICT prematurely. Notably, 85% preferred HIIT over MICT.

    Conclusion: The novel concept of short-duration supramaximal HIIT enabled a 3 to 4-fold increase in exercise intensity vs. MICT. Notably, the cardiorespiratory demand during HIIT was similar to MICT, and clinically relevant reductions in symptoms were even seen in favor of HIIT.

  • 9.
    Jenholt Nolbris, M.
    et al.
    Institute of Health and Care Sciences, University of Gothenburg, Sweden; The Queen Silivia Children’s Hospital Sahlgrenska University Hospital, Sweden.
    Ragnarsson, Susanne
    Umeå University, Faculty of Medicine, Department of Epidemiology and Global Health. Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Sweden.
    Brorsson, A.-L.
    Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Sweden.
    Garcia de Avila, M.
    Department of Nursing, Botucatu Medical School - UNESP, Brazil.
    Forsner, Maria
    Umeå University, Faculty of Medicine, Department of Nursing. Department of Biosciences and Nutrition, Karolinska Institutet, Sweden.
    Kull, I.
    Department of Clinical Science and Education, Karolinska Institutet, Sweden; Sachs’ Children and Youth’s Hospital, Södersjukhuset, Sweden.
    Olinder, A.L.
    Department of Clinical Science and Education, Karolinska Institutet, Sweden; Sachs’ Children and Youth’s Hospital, Södersjukhuset, Sweden.
    Mattson, J.
    Department of Health Science, The Swedish Red Cross University College, Sweden; Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, Sweden.
    Nilsson, S.
    Institute of Health and Care Sciences, University of Gothenburg, Sweden; Centre for Person-Centred Care, University of Gothenburg, Sweden.
    Rullander, Anna-Clara
    Umeå University, Faculty of Medicine, Department of Nursing.
    Rydström, L.-L.
    Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Sweden.
    Olaya-Contreras, P.
    Institute of Health and Care Sciences, University of Gothenburg, Sweden; Centre for Person-Centred Care, University of Gothenburg, Sweden.
    Berghammer, M.
    The Queen Silivia Children’s Hospital Sahlgrenska University Hospital, Sweden; Department of Health Sciences, University West, Sweden.
    Young children’s voices in an unlocked Sweden during the COVID-19 pandemic2022In: Scandinavian Journal of Public Health, ISSN 1403-4948, E-ISSN 1651-1905, Vol. 50, no 6, p. 693-702Article in journal (Refereed)
    Abstract [en]

    Aims: During the COVID-19 pandemic, Sweden was one of the few countries that rejected lockdowns in favour of recommendations for restrictions, including careful hand hygiene and social distancing. Preschools and primary schools remained open. Several studies have shown negative impacts of the pandemic on children, particularly high levels of anxiety. The study aim was to explore how Swedish school-aged children aged 6–14 years, experienced the COVID-19 pandemic and their perceived anxiety.

    Methods: In total, 774 children aged 6–14 years and their guardians answered an online questionnaire containing 24 questions, along with two instruments measuring anxiety: the Children’s Anxiety Questionnaire and the Numerical Rating Scale. A convergent parallel mixed-methods design was used for analysing the quantitative and qualitative data. Each data source was first analysed separately, followed by a merged interpretative analysis.

    Results: The results showed generally low levels of anxiety, with no significant sex differences. Children who refrained from normal social activities or group activities (n=377) had significantly higher levels of anxiety. Most of the children were able to appreciate the bright side of life, despite the social distancing and refraining from activities, which prevented them from meeting and hugging their loved ones.

    Conclusions: These Swedish children generally experienced low levels of anxiety, except those who refrained from social activities. Life was nonetheless mostly experienced as normal, largely because schools remained open. Keeping life as normal as possible could be one important factor in preventing higher anxiety and depression levels in children during a pandemic.

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  • 10.
    Neyra Marklund, Isabel
    et al.
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Paediatrics.
    Rullander, Anna-Clara
    Umeå University, Faculty of Medicine, Department of Nursing.
    Lindberg, Karolina
    Umeå University, Faculty of Medicine, Department of Nursing.
    Ringnér, Anders
    Umeå University, Faculty of Medicine, Department of Nursing.
    Initial education for families with children diagnosed with type 1 diabetes: Consensus from experts in a Delphi study2022In: Comprehensive Child and Adolescent Nursing, ISSN 2469-4207, E-ISSN 2469-4193, Vol. 45, no 3, p. 310-319Article in journal (Refereed)
    Abstract [en]

    A child’s diagnosis of type 1 diabetes can create major challenges for the family, and early education about the disease is crucial. The aim of this study was to identify and reach expert consensus about the priority of topics for the two initial weeks of education of families with a child diagnosed with type 1 diabetes. Specialist nurses (n = 15) working with children and adolescents with diabetes at Swedish pediatric clinics participated in a Delphi study. We sent these experts three rounds of a web survey and analyzed their answers using qualitative content analysis and descriptive statistics. The results show the experts’ consensus on the most important educational topics for families of a child diagnosed with type 1 diabetes. The highest priority topics were actions for hypo-/hyperglycemia, blood-glucose monitoring, symptoms of hypo-/hyperglycemia and adjustment of insulin. The experts’ top-ranked educational topics were in line with the International Society for Pediatric and Adolescent Diabetes guidelines for educating children with type 1 diabetes and also considered important by children and their families. The topics identified here can help nurses educate children with type 1 diabetes, contribute to further research into type 1 diabetes education, and inform the development of national guidelines.

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  • 11. Nilsson, S.
    et al.
    Mattson, J.
    Berghammer, M.
    Brorsson, A-L.
    Forsner, Maria
    Umeå University, Faculty of Medicine, Department of Nursing. Karolinska Institutet, Department of Biosciences and Nutrition, Stockholm, Sweden.
    Jenholt Nolbris, M.
    Kull, I.
    Lindholm Olinder, A.
    Ragnarsson, Susanne
    Umeå University, Faculty of Medicine, Department of Epidemiology and Global Health. Umeå University, Faculty of Medicine, Department of Nursing.
    Rullander, Anna-Clara
    Umeå University, Faculty of Medicine, Department of Nursing.
    Rydström, L-L.
    Andréia Garcia de Avila, M.
    Olaya-Contreras, P.
    To be or not to be vaccinated against COVID-19 - the adolescents' perspective: a mixed-methods study in Sweden2021In: Vaccine: X, E-ISSN 2590-1362, Vol. 9, article id 100117Article in journal (Refereed)
    Abstract [en]

    Vaccination of the population seems to be an important strategy in halting the COVID-19 pandemic in both local and global society. The aim of this study was to explore Swedish adolescents' willingness to be vaccinated against COVID-19 and its association with sociodemographic and other possible factors. A survey was distributed in Sweden between 7 July and 8 November 2020. The main qualitative question concerned adolescents' thoughts on vaccination against COVID-19 and evaluated whether the adolescents would like to be vaccinated when a COVID-19 vaccine is made available. In total, 702 adolescents aged between 15-19 responded to the questionnaire. A convergent parallel mixed-methods design was used. The results showed that nearly one in three adolescents had not decided if they wanted to get a COVID-19 vaccine, i.e. 30.5%: n=214. Of the participants 54.3% (n=381) were willing to be vaccinated. Girls had higher levels of anxiety about the vaccine compared to boys. In addition, high levels of anxiety impacted on the participants' willingness to be vaccinated. One reason for being undecided about the vaccine was that participants felt they did not know enough about it. Practising social distancing increased willingness to be vaccinated, as reflected in the qualitative results which showed participants wanted to be vaccinated to protect others. The results impart important knowledge to healthcare professionals and contribute to their communication with adolescents about vaccine hesitancy.

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  • 12.
    Ringnér, Anders
    et al.
    Umeå University, Faculty of Medicine, Department of Nursing. Norrlands universitetssjukhus, Umeå, Sverige; Karlstads universitet, Karlstad, Sverige.
    Rullander, Anna-Clara
    Umeå University, Faculty of Medicine, Department of Nursing. Norrlands universitetssjukhus, Umeå, Sverige.
    Barnortopedi2024In: Omvårdnad för barn och unga - på avancerad nivå / [ed] Katarina Patriksson; Helena Wigert, Lund: Studentlitteratur AB, 2024, 1, p. 403-420Chapter in book (Other academic)
  • 13.
    Rullander, Anna-Clara
    Umeå University, Faculty of Medicine, Department of Nursing. Umeå University, Faculty of Medicine, Department of Clinical Sciences.
    Adolescents' experiences of undergoing scoliosis surgery: psychological aspects and patterns of pain2015Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    Background: Adolescent idiopathic scoliosis (AIS) affects 1 – 3% of all children aged 10 – 16 years; of these approximately 80% are girls. Scoliosis surgery is a major (one of the most extensive) elective paediatric orthopaedic procedure and is known to cause severe and excruciating pain that requires advanced postoperative pain management. Until now, scoliosis surgery has mainly been studied in terms of corrective surgical outcomes, and techniques for surgery and pain management. Adolescents’ narratives and experiences of recovery after scoliosis surgery, as well as psychological aspects in correlation to postoperative pain have seldom been studied.

    Aim: The overall aim of this thesis was to explore adolescents’ experiences of undergoing scoliosis surgery, experiences and self-reporting of pain, and psychological consequences.

    Methods: This thesis comprises four studies. The participants in Studies I and II belonged to the same cohort, all of whom underwent corrective surgery in the period from 2004 to 2007. In Study I there was a cohort of 87 adolescents and young adults with different types of scoliosis, some of whom had impaired verbal communication. The patients and their parents/caregivers were asked to complete a survey with questions regarding experienced pain, nausea and overall satisfaction with the hospital stay. Study II was a qualitative study in which six adolescents from the cohort in Study I were interviewed. The adolescents included in Study II had idiopathic scoliosis, and the interviews took place about two years after they had undergone surgery. Study III, which included 37 adolescents, was a prospective study of adolescents with idiopathic scoliosis (AIS) from four spine centres in Sweden. They completed two psychometric instruments and one structured interview both before surgery and about six months afterward. They also self-measured pain on the third postoperative day. In Study IV the adolescents included belonged to the same cohort as in Study III. In this prospective, mixed-method study, the participants self-reported pain before surgery, every four hours for the first five days after surgery, once a day for the first fourteen days at home after discharge from the hospital, and finally at the six-month follow-up. They were also asked to keep a diary during the first two weeks at home after discharge from the hospital. At the six-month follow-up they were interviewed about the overall experience of undergoing scoliosis surgery: how they experienced the time before surgery, during the hospital stay and the recovery period up through the date of the interview. iv

    Results: Study I showed that the patients experienced severe pain and nausea postoperatively during the hospital stay. The parents/caregivers felt helpless and sometimes lacked confidence in the nurses. Despite this, overall satisfaction with the hospital stay was rated as good. Study II showed that the adolescents experienced nervousness and fear before surgery, severe pain and postoperative nausea and vomiting (PONV) during the hospital stay, had problems with the scars and experienced social difficulties during recovery. Nightmares were reported for up to two years after surgery. In Study III, the ratings of stress symptoms were higher before surgery than after. There were significant correlations between stress symptoms before surgery and levels of postoperative pain. There were also significant correlations between levels of postoperative pain and stress symptoms at the six-month follow-up. In Study IV, postoperative pain ratings showed great individual variation, and in the analysis of drop-outs it was found that those who did not keep a diary at home self-reported higher levels of pain at the six-month follow-up as well as higher levels of stress symptoms and internalizing symptoms. The participants described experiences of severe pain at the hospital and also during recovery. Nausea, constipation and lack of energy emerged from the narratives - but so did the desire to get back to school, sports and friends. The adolescents described how they were hovering between suffering and control and also striving towards normality. Conclusion: The results indicate a need for interventions among adolescent patients to reduce stress symptoms before major surgery. Nurses need to identify adolescents with stress symptoms, use stress-reduction techniques, and support adolescent patients with coping strategies aimed at reducing preoperative stress and managing postoperative pain. Postoperative pain management needs to be improved, both as regards pain assessment and pharmacological and non-pharmacological pain management. Nurses need to improve their medical technical skills in order to optimize pain treatment. After discharge from the hospital adolescents have to struggle with difficulties at home such as pain, nausea, constipation, mobilization and a lack of energy. An intervention with follow-up telephone calls during the second week at home could reduce stress and help resolve difficulties. Since this study indicates stress symptoms at the six-month follow-up, there should also be a nurse interview to check on well-being and to see if any further intervention is needed at that time. If preoperative stress can be reduced, postoperative pain management optimized and the recovery period better supported, the overall experience of going through scoliosis surgery should improve.

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  • 14.
    Rullander, Anna-Clara
    Umeå University, Faculty of Medicine, Department of Nursing.
    Urogenitala sjukdomar2024In: Omvårdnad för barn och unga: på avancerad nivå / [ed] Katarina Patriksson; Helena Wigert, Lund: Studentlitteratur AB, 2024, 1, , p. 474p. 395-402Chapter in book (Refereed)
  • 15.
    Rullander, Anna-Clara
    et al.
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Paediatrics.
    Isberg, Stefan
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Anaesthesiology.
    Karling, Mats
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Anaesthesiology.
    Jonsson, Håkan
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Orthopaedics.
    Lindh, Viveca
    Umeå University, Faculty of Medicine, Department of Nursing.
    Adolescents' experience with Scoliosis Surgery: A Qualitative Study2013In: Pain Management Nursing, ISSN 1524-9042, E-ISSN 1532-8635, Vol. 14, no 1, p. 50-59Article in journal (Refereed)
    Abstract [en]

    This article reports a study of adolescents' narrated experiences of undergoing scoliosis surgery. Six adolescents were interviewed. Open and semistructured questions were asked, and a qualitative content analysis of the text was performed. The results are presented in three main categories followed by subcategories. The three main categories of experience were emotional, physical, and social. The emotional aspects that emerged were fear, nightmares, nervousness, and helplessness. These had a great impact on adolescents' well-being before, during, and after the hospital visit. The physical aspects were mobilization, scars, different hip levels, pain, nausea, appetite, and urinary catheter. These aspects caused much discomfort, mostly during the hospital visit. The social aspects were friends, power, coaching and comfort, and sports. Some of the social aspects had a strong negative impact on the adolescents' well-being mostly after the hospital visit. This study suggests that both before and long after the surgery adolescents have strong emotions that they should be better prepared and helped to manage. To optimize perioperative care an interdisciplinary, a holistic approach must be taken that incorporates the complexity and whole of the adolescent's experiences. The findings of this study suggest that perioperative care of adolescents during scoliosis surgery needs to be optimized. To improve patients' psychologic preparation before surgery pediatric nurses should learn more about the individual patient and make care plans from a holistic perspective. Follow-up after discharge should address emotional, social, and physical aspects of the adolescent's health. (C) 2013 by the American Society for Pain Management Nursing

  • 16.
    Rullander, Anna-Clara
    et al.
    Umeå University, Faculty of Medicine, Department of Nursing.
    Jonsson, Håkan
    Lundström, Mats
    Umeå University, Faculty of Medicine, Department of Nursing.
    Lindh, Viveca
    Umeå University, Faculty of Medicine, Department of Nursing.
    Young People's Experiences With Scoliosis Surgery: A Survey of Pain, Nausea, and Global Satisfaction2013In: Orthopedic Nursing, ISSN 0744-6020, E-ISSN 1542-538X, Vol. 32, no 6, p. 327-333Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Scoliosis surgery is one of the most extensive elective surgical processes performed on young people. Although there is a great store of knowledge of surgical techniques, patients' experiences of going through surgery have not been extensively studied. PURPOSE: The aim of this study is to describe how a cohort of young people and their parents retrospectively rate postoperative pain and nausea and describe their experiences of scoliosis surgery. METHODS: In a retrospective cohort study, 87 young people aged 8-25 years with scoliosis who underwent corrective surgery from 2004 to 2007 were invited to complete a questionnaire, as were their parents. The semistructured questionnaire dealt with experiences of pain, nausea, and global satisfaction pre- and posthospitalization, assessed by visual analogue scales. The free text commentaries were analyzed using qualitative content analysis. RESULTS: A total of 51 patients (59%) and 65 parents (75%) answered the questionnaires. Out of the completed questionnaires, 41 had idiopathic, 23 neuromuscular, and 6 other types of scoliosis. Postoperative patient-rated pain was severe 7.3 (median, interquartile range 5-8.4, visual analogue scale 0-10 cm), and the severe pain lasted for 5 (median, 2.7-7.0) days. Nausea was rated to a median of 5 (1.1-7.3) and lasted for a median of 3 (1-5.2) days. Global satisfaction was rated to a median of 3.2 (1.5-5.2). Postoperative pain was the most prominent issue, and present pain was found in 51% of respondents. Nausea and loss of appetite were common during the entire hospital stay. Waiting for the nurses' assistance, lack of control, and technical failures with the analgesia equipment caused discomfort. Parents experienced a lack of confidence in the nurses and felt helpless to support their child or relieve the child's suffering. CONCLUSION: Young people who underwent scoliosis surgery reported severe postoperative pain and nausea during the hospitalization period and persistent and recent onset pain after discharge, although they did not indicate global dissatisfaction with the hospital stay.

  • 17.
    Rullander, Anna-Clara
    et al.
    Umeå University, Faculty of Medicine, Department of Nursing.
    Lundström, Mats
    Umeå University, Faculty of Medicine, Department of Nursing.
    Lindkvist, Marie
    Umeå University, Faculty of Social Sciences, Umeå School of Business and Economics (USBE), Statistics. Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Hägglöf, Bruno
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Child and Adolescent Psychiatry.
    Lindh, Viveca
    Umeå University, Faculty of Medicine, Department of Nursing.
    Stress symptoms among adolescents before and after scoliosis surgery: correlations with postoperative pain2016In: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702, Vol. 25, no 7-8, p. 1086-1094Article in journal (Refereed)
    Abstract [en]

    AIMS AND OBJECTIVES: The aim of this study was to describe stress symptoms among adolescents before and after scoliosis surgery and to explore correlations with postoperative pain.

    BACKGROUND: Scoliosis surgery is a major surgical procedure. Adolescent patients suffer from preoperative stress and severe postoperative pain. Previous studies indicate that there is a risk of traumatisation and psychological complications during the recovery period.

    DESIGN: A prospective quantitative cohort study with consecutive inclusion of participants.

    METHODS: A cohort of 37 adolescent patients aged 13-18. To assess the adolescents' experiences before surgery and at six to eight months after surgery, the Trauma Symptom Checklist for Children - Alternative version, Youth Self-Report and Kiddie Schedule for Affective Disorder and Schizophrenia for children 12-18 were used. The Visual Analogue Scale was used for self-report of postoperative pain on day three.

    RESULTS: Rates of anxiety/depression and internalising behaviour were significantly higher before surgery than six months after. Preoperative anger, social problems and attention problems correlated significantly with postoperative pain on day three. At follow-up, postoperative pain correlated significantly with anxiety, social problems and attention problems.

    CONCLUSIONS: The results of this study indicate a need for interventions to reduce perioperative stress and postoperative pain to improve the quality of nursing care.

    RELEVANCE TO CLINICAL PRACTICE: Attention to preoperative stress and implementation of interventions to decrease stress symptoms could ameliorate the perioperative process by reducing levels of postoperative pain, anxiety, social and attention problems in the recovery period.

  • 18.
    Rullander, Anna-Clara
    et al.
    Umeå University, Faculty of Medicine, Department of Nursing.
    Lundström, Mats O
    Umeå University, Faculty of Medicine, Department of Nursing.
    Östlund, Ulrika
    Lindh, Viveca
    Umeå University, Faculty of Medicine, Department of Nursing.
    Adolescents' experiences of scoliosis surgery and the trajectory of self-reported pain: a mixed-methods study2017In: Orthopedic Nursing, ISSN 0744-6020, E-ISSN 1542-538X, Vol. 36, no 6, p. 414-423Article in journal (Refereed)
    Abstract [en]

    Scoliosis surgery for adolescents is a major surgery with a diffi cult recovery. In this study, a mixed-methods design was used to broaden the scope of adolescents' experiences of surgery for idiopathic scoliosis and the trajectory of self-reported pain during the hospital stay and through the fi rst 6 months of recovery at home. Self-reports of pain, diaries, and interviews were analyzed separately. The results were then integrated with each other. The trajectory of self-reported pain varied hugely between individuals. Adolescents experienced physical suffering and struggled to not be overwhelmed. The adolescents described the environmental and supportive factors that enabled them to cope and how they hovered between suffering and control as they strived toward normality. This study highlights areas of potential improvement in perioperative scoliosis care in terms of nursing support and pain management.

  • 19. Rydström, Lise-Lott
    et al.
    Ångström-Brännström, Charlotte
    Umeå University, Faculty of Medicine, Department of Nursing. Department of Women’s and Children’s Health, Uppsala University, Sweden.
    Blake, Lucy
    Brayl, Lucy
    Carter, Bernie
    Forsner, Maria
    Umeå University, Faculty of Medicine, Department of Nursing. Department of Biosciences and Nutrition, Karolinska Institutet, Sweden.
    Matsson, Janet
    Nilsson, Stefan
    Jenholt Nolbris, Margaretha
    Kirton, Jennifer
    Kull, Inger
    Protheroe, Joanne
    Rullander, Anna-Clara
    Umeå University, Faculty of Medicine, Department of Nursing.
    Saron, Holly
    Lindholm Olinder, Anna
    How children in Sweden accessed and perceived information during the first phase of the Covid-19 pandemic2022In: Scandinavian Journal of Public Health, ISSN 1403-4948, E-ISSN 1651-1905, Vol. 50, p. 144-151Article in journal (Refereed)
    Abstract [en]

    AIM: To describe how children in Sweden accessed and perceived information about SARS-CoV2 and Covid-19 during the first phase of the outbreak.

    METHODS: This study is a substudy of an international cross-sectional online mixed methods survey examining elements of children's health literacy in relation to Covid-19. The survey included multiple-choice questions, open-ended questions and drawings and collected information from 50 Swedish children (7-12 years). Data were analysed concurrently on a descriptive level using statistics and content analysis. Quantitative and qualitative data, including the drawings, were considered equally important and resulted in six categories, illuminating how children accessed and perceived information about the pandemic.

    RESULTS: The survey showed that children accessed information mainly from school but also from TV. They preferred information from reliable sources. Children reported the information they accessed as easy to understand and it prompted them to ask new questions. They reported they knew a lot about the pandemic, for example, the potential danger to themselves and others and how to act to protect themselves and others. They perceived the pandemic as an intrusion on their lives.

    CONCLUSIONS: This study indicates that Swedish children between 7 and 12 years old were well informed about SARS-CoV2 and Covid-19 during the first phase of the pandemic. School was shown to be an important source of information. The children could explain how to act to protect themselves and others from becoming infected by the virus.

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