Aim

To practise emergency care situations during the education can be stressful. The aim of this study is to identify factors that cause stress in simulated emergency care.

Design

A descriptive observational study.

Methods

Video recordings (N = 26) subjected to observation with written field notes in turn subjected to interpretive qualitative content analysis.

Results

To assess the patient's condition and decide what measures to take trigger stress reactions. If the students failed to connect the correct and relevant information in the conversation with the physician, the students showed signs of stress. Also, to calculate medication dosages stress the students.

PURPOSE: Health care focus is shifting from solely looking at surviving cancer to elements of attention relating to living with it on a daily basis.The young child's experiences are crucial to providing evidence based care. The aim of this study was to explore the everyday life of young children as expressed by the child and parents at six months and one year post diagnosis.

METHODS: Interviews were conducted with children and their parents connected to a paediatric oncology unit in Southern Sweden. A qualitative content analysis of interview data from two time points, six months and one year post diagnosis, was carried out.

RESULTS: The process of living with cancer at six months and at one year post diagnosis revealed the child's striving for an ordinary, everyday life. Experiences over time of gaining control, making a normality of the illness and treatment and feeling lonely were described.

CONCLUSION: Nurses have a major role to play in the process of striving for a new normal in the world post-diagnosis, and provide essential roles by giving the young child information, making them participatory in their care and encouraging access to both parents and peers. Understanding this role and addressing these issues regularly can assist the young child in the transition to living with cancer. Longitudinal studies with young children are vital in capturing their experiences through the cancer trajectory and necessary to ensure quality care.

Background: Knowledge of living with childhood cancer, through the trajectory, is sparse.

Aim: The aim of this study was to follow young children’s health and functioning in everyday life through their cancer trajectory.

Methods: Data were gathered longitudinally from a group of 13 young children and their parents connected to a pediatric oncology unit in Sweden. The International Classification of Functioning, Disability and Health for Children and Youth structure was used to identify difficulties in health and functioning in everyday life, in interview and questionnaire data. Descriptive statistical analysis was performed to show patterns of difficulty over a 3-year period from diagnosis.

Results: Difficulties experienced by children declined and changed over time. An increase in difficulties with personal interactions with others and access to and support from health care professionals was seen 2 to 3 years after diagnosis and start of treatment. Similar patterns are seen within individual children’s trajectories in relation to diagnosis but individual patterns were seen for each child.

Conclusions and Clinical Implications: Health care professionals need to plan for ongoing contact with school services and information and support pathways, beyond the treatment period. A person-centered philosophy of care is required throughout the cancer trajectory.

Background: Providing qualified, evidence-based healthcare to children requires increased knowledge of how cancer affects the young child's life. There is a dearth of research focusing on the young child's experience of everyday life.

Objective: The purpose of this study was to explore young children's and their parents' perceptions of how cancer affects the child's health and everyday life shortly after diagnosis.

Methods: Thirteen children with newly diagnosed cancer aged 1 to 6 years and their parents, connected to a pediatric oncology unit in Southern Sweden, participated in this study through semistructured interviews. Child and parent data were analyzed as a family unit, using qualitative content analysis.

Results: Everyday life was spent at hospital or at home waiting to go back to hospital. Analysis led to the following categories: feeling like a stranger, feeling powerless, and feeling isolated.

Conclusions: The child wants to be seen as a competent individual requiring information and participation in care. Parents need to be a safe haven for their child and not feel forced to legitimize painful and traumatic procedures by assisting with them. Nurses play a major role in the lives of children. Research with and on the young child is necessary and a way of making them visible and promoting their health and well-being.

Implications for practice: Nurses need to reevaluate the newly diagnosed child's care routines so as to shift focus from the illness to the child. This requires competent nurses, secure in their caring role.

Background

Provision of developmentally appropriate support for child visitors in adult intensive care units (ICUs) would benefit patients and young visitors. Research on best practices for child visitation in adult ICUs is limited.

Objectives

To explore the perceptions and practices of nurses working in adult ICUs in the United States regarding child visitation and the role of child life specialists in this setting.

Methods

Data were collected from 446 adult ICU nurses via a cross-sectional survey. The survey explored perceptions and practices regarding child visitation, access to child-friendly resources, and the feasibility of having a child life specialist in adult ICUs.

Results

Several participants (303, 67.9%) felt that children were at risk for psychological trauma from visiting an adult ICU. Some participants (122, 27.4%) reported that their ICUs did not have policies for child visitation. Logistic regression showed that nurses with a master’s degree were 1.8 times (P < .05) more likely to believe that young children (0-5 years) should visit. Nurses (105 of 197, 53.3%) were more likely to allow young children to visit if the patient was the child’s parent or if the patient was dying. Child-friendly resources were not routinely available. Nurses expressed that adult ICUs could benefit from child life specialists facilitating child visitation.

Conclusions

Nurses were inconsistently open to child visitation. Exceptions for older children (> 6 years), children whose parent was the patient, patients’ illness severity, and end of life allowed more child visitation. Ways to facilitate child-friendly visitation in adult ICUs are discussed.

Background

Antepartum hemorrhage (APH) is an obstetric emergency that complicates pregnancy worldwide and continues to lead to hemorrhagic conditions in parts of Tanzania. Midwifery education received by midwives consists theoretical knowledge on the subject but with no or minimal practical skills in the laboratory, which may reduce their practical capacity as graduated midwives. This study therefore aimed to explore midwives' clinical actions and experiences regarding the care of women with APH in Mwanza region.

Method

Qualitative, inductive approach with critical incident technique was used. Data were analysed using the critical incident technique, and a question guide consisting of eleven open-ended questions was used to collect data from 44 out of 60 midwives who graduated not less than one year. A total of 522 critical incidents, with 199 actions and 323 experiences, were identified and categorized into five main areas. Ethical approval was obtained.

Results

Midwives' clinical actions and experiences in caring for women with APH are affected by the knowledge and skills obtained during training at school. They have insufficient theoretical knowledge and practical skills, leading to inadequate identification of the problem and the implementation of care. A need for additional preventive care is described and structural issues, such as co-operation, referral to other instances, access to equipment and relevant treatments need to be improved.

Conclusion

The actions taken to provide care for women with APH were related to their ability to identify problems, implement care and carry out structural initiatives. However, the midwives' experience was influenced by an attempt to understand the seriousness of the situation and the existence of an organizational challenge. The results can provide knowledge and tools to improve midwives' education and clinical practice and in the long run, prevent complications, improves health and minimize suffering in women with APH.

PURPOSE: A dramatic improvement in outcomes of survival rates of childhood cancer has been seen. Caring science research is central in providing skills and knowledge to the health care sector, but few overviews of the content of published research have been carried out. The aim of this review was to investigate the content and methodology of published studies in paediatric oncology relevant to caring science, and also to compare possible differences in content and method of the published studies from the nursing and psychosocial perspectives.

METHOD: A systematic literature review was performed of 137 published articles on paediatric oncology relevant to caring science in Sweden.

RESULTS: The results show that most of the studies were descriptive or comparative ones with a quantitative design. Most of them focused on parents (43%) or children (28%). Most of the studies investigated wellbeing (88%), using questionnaires (54%) or interviews (38%). Several different measurement instruments had been used. While the results were often clearly presented, the clinical implications were more diffuse. The most acknowledged research fund was the Swedish Childhood Foundation (75%).

CONCLUSIONS: To reflect the children' perspectives in paediatric oncology require that future researchers take on the challenge of including children (even young ones) in research. The use of a limited number of agreed measurement instruments is desirable. The biggest challenge for the future is to make a shift from explorative to intervention studies. There is an urgent need to transform research results into clinical practice.

Children with cancer require repeated hospitalizations and the family's everyday life and routines undergo change. Concrete descriptions of how nurses act when caring for children with cancer throughout the various phases of care and treatment are sparsely highlighted in the literature. The aim of this study was to describe young children with cancer and their parents' experiences of nurses' caring practices over a 3-year period, from diagnosis to follow-up. This study is based on semistructured interviews with 25 children newly diagnosed with cancer, aged 1 to 6 years, and their parents, connected to a pediatric oncology unit in Sweden. Child and parent data were analyzed with a deductive content analysis using Swanson's theory of caring. The result shows that nurse care practices directed toward young children with cancer and their parents are to some extent similar across a 3-year period from diagnosis to follow-up but also differ in some ways. Nurses' caring practices aim to support children and parents in the transition to a "new normal." Child- and family-friendly care processes include the following: creating hope and a trustful relationship, asking rather than assuming, providing knowledge and information, performing tasks skillfully, displaying an interest in the child's and parents' life outside the hospital, and helping the family to trust in the future and other health care providers. Based on these results, we recommend the development of a standardized and structured nursing care plan or clinical guideline with detailed information on how to carry out clinical nurse care practices in the different phases.

The purpose of this manuscript is to analyze researchers' suggestions for clinical implications of their findings as stated in recent published articles on nursing and psychosocial research within the setting of Swedish pediatric oncology. Identified categories included staff awareness of the effects of child illness on families; systems for care improvement; provision of quality of care, education and support; and empowerment of children and families. In order to be able to realize these clinical suggestions, expanded research is needed as well as continued education and support for staff. 

The body of research-based knowledge in paediatric caring science has been increasing leading to dramaticimprovements in treatment. The purpose of this manuscript was to analyze results as stated by the researchers', inrecently published articles on nursing and psychosocial research, within Swedish pediatric oncology setting. Thiswas done through a review of 137 published articles about paediatric oncology related to caring science in Sweden.The result shows that the illness has affected, in both positive and negative ways, the wellbeing of everyone cominginto contact with the child. The cancer also causes distress related to all aspects of life including physical,psychological, existential and social. Mediating factors for the experience of distress and wellbeing are: disease andtreatment severity, age, gender and ethnicity of the participant, time since diagnosis, the use of internal and externalsupport, and the identity of the person reporting the data. Health promoting aspects frequently reported are: familytogetherness, coping strategies, engaging in normal life and activities, and quality of care which includes emotionalsupport, information and family participation in care. The hospital staff has to be aware of the psychosocial issuesexperienced by children with cancer and their families, and they have to acknowledge the value of formalinterventions, reporting benefits for children, families, and themselves.

Aim: To explore how school nurses perceive their assignment when caring for children having parents with serious physical illness.

Design: An explorative inductive qualitative design.

Method: The study is based on interviews with 16 school nurses. The interviews were subjected to qualitative content analysis.

Results: The main category, “Contribute in making the school a safe place for the child”, reveals how the school nurses try to contribute to making the school a safe place for a child when his/her parent has a serious physical illness. They support children through individual support, as well as at an overall level in the school health team to make the school, as an organization, a safe place. Routines and collaboration to recognize the child when his/her parent has become ill is described as crucial to accomplishing this assignment

Purpose:

Research has shown that a child's knowledge about what is happening to a parent when he/she has a cancer disease is crucial to the child's health and wellbeing. Therefore the purpose of this study was to explore parents’ perceptions of how nurses in clinical practice care for children as relatives when one parent in the family has a cancer disease.

Method:

A qualitative explorative design with interviews was used. Altogether 28 parents (17 patients and 11 partners) were interviewed. The transcripts from the interviews were subjected to qualitative content analysis.

Results:

The parents perceive that the nurses make efforts to support the child as well as them as parents, but feel that the care needs to be more tailored to the specific child and his/her situation. The children are initially invited, generally informed and seen by the nurses, but the parents perceive that they themselves need repeated support and advice over time to uphold their parental responsibility for caring for their children during the illness trajectory.

Conclusion:

The parents argue for the importance of receiving repeated advice and support for how to talk to their children about the disease and treatment. The parents describe how the nurses were helpful by asking after the children and explaining the value of their visiting the hospital.

Purpose: The purpose of this study was to elucidate how nurses perceive their role in caring for children as relatives to a parent with a serious physical illness.

Method: A qualitative explorative design with focus group interviews was used. In total, 22 nurses working at one neurological, one haematological and two oncological wards were interviewed. The transcripts from the interviews were analysed in steps in accordance with inductive qualitative content analysis.

Results: This study revealed six variations in how nurses perceived their role in the encounter with child relatives, ranging from being convinced that it is not their responsibility to being aware of the children's situation and working systematically to support them.

Conclusion: Nurses should consider whether their patients have children who might be affected by their parent's illness. The nurses' self-confidence when meeting these children must be increased by education in order to strengthen their professional role. Furthermore, guidelines on how to encounter child relatives are required.

Purpose

This study was carried out in order to evaluate children's experiences after taking part in the pilot clinical intervention “See Me” aimed at supporting children as relatives.

Method

A qualitative explorative design with interviews was chosen, with analyses using an inductive approach. Interviews were conducted with 19 children (9 aged 7–12 years and 10 aged 13–18 years). The younger children were asked to draw a picture of a person in hospital, using the Child Drawing: hospital (CD:H) instrument to measure the child's level of anxiety. The older children completed the Caring Professional Scale (CPS) as a measure of the caring approach in their encounter with the nurse.

Results

The interviews with the children show that: they felt expected and welcomed at the hospital; they needed knowledge about their parent's situation; they needed information and participation based on their individual situation; and they needed the nurse to offer them information and support. The results from the pictures showed that one child had above-average levels of anxiety. The older children reported that the nurses were Competent Practitioners, but to a lesser degree that they were Compassionate Healers.

Conclusions

The results of this pilot study indicate that the structure of “See Me” could be used as a starting point to ensure that children as relatives receive information, advice, and support. Further the results indicate that both CD:H and CPS could be used to evaluated children's experiences of support when a parent has a long-term illness.

Introduction: The acoustic environment in the intensive care unit patient room, with high sound levels and unpredictable sounds, is known to be poor and stressful. Therefore, the present study had two aims: to investigate staff knowledge concerning noise in the intensive care unit and: to identify staff suggestions for improving the sound environment in the intensive care unit patient room.

Method: A web-based knowledge questionnaire including 10 questions was distributed to 1047 staff members at nine intensive care unit. Moreover, 20 physicians, nurses and enrolled nurses were interviewed and asked to give suggestions for improvement.

Results: None of the respondents answered the whole questionnaire correctly; mean value was four correct answers. In the interview part, three categories emerged: improving staff's own care actions and behaviour; improving strategies requiring staff interaction; and improving physical space and technical design.

Conclusion: The results from the questionnaire showed that the staff had low theoretical knowledge concerning sound and noise in the intensive care unit. However, the staff suggested many improvement measures, but also described difficulties and barriers. The results from this study can be used in the design of future interventions to reduce noise in the intensive care unit as well as in other settings.

OBJECTIVES:

To describe and understand children's thoughts and feelings related to visiting critically ill relatives or family members in an adult intensive care unit.

DESIGN:

A qualitative descriptive study.

METHOD:

Twenty-eight children (14 girls; 14 boys) that had visited a critically ill relative or family member in an adult intensive care unit were invited to participate in an interview. The material was analysed inspired by Gadamer's hermeneutic philosophy and Doverborg and Pramling Samuelsson's method about interviews and dialogues with children.

RESULTS:

Children with a seriously ill/injured relative suffer. However, visiting seems to alleviate suffering. Visiting and being present as a part of the situation brought positive feelings of involvement and made it possible to show that they wanted to care for the relative. The sick relative was always on the child's mind and seeing and being with them in the intensive care unit resulted in relief and calmness, even if the relative's situation sometimes evoked feelings of despair and fear.

CONCLUSION:

Knowledge and awareness of the fact that children are affected by the relative's condition and for their wellbeing needs to visit, caring actions must focus on helping the child become involved in the relative's situation in order to alleviate suffering.

AIMS AND OBJECTIVES: To describe custodians' experiences of their child's visit to an ill/injured nearest being cared for at an adult intensive care unit (ICU), their thoughts about the visit in relation to the child's health/well being and who initiated the visit.

BACKGROUND: Custodians can feel undecided about whether to allow their children to visit the ICU or not. They wonder how important it is for the child to visit, as well as the consequences, and attempt to protect the child from information/experiences that could provoke anxiety or threaten the child's health.

DESIGN: Quantitative and descriptive.

METHOD: Thirty custodians answered a questionnaire.

RESULTS: It was mainly custodians and their children and not staff who initiated the children's visits. Many children were not informed by staff and the responsibility lay instead with the custodians. The importance of giving children adequate information before, during and after the visit was pointed out. The custodians reported that their child's reactions to the visit differed, i.e. reactions reflecting happiness but also sadness; the visit was good for the child, increased awareness of the nearest's condition and appreciation of the hospital staff and their work; if the visit did not take place the child would be left with thoughts and conjectures; their children were not frightened when they saw the equipment and instead they became curious; older children were more focused on the patient while younger children were interested in both the equipment and the patient. Many children asked questions/made comments during the visit. Many custodians were of the opinion that visiting is not a risk to future health and well being.

CONCLUSIONS: This issue must be addressed and discussed and strategies need to be developed to improve the nurses' obligation to involve visiting children in the care that is/should be provided to a member of the patient's family.

RELEVANCE TO CLINICAL PRACTICE: Nurses need to take more initiative when discussing children's visits with the custodians. Nurses also need to discuss how to meet, inform, support and care for visiting children and their custodians in relation to health and well being. Recommendations/guidelines about children visiting that take both the patient's and child's needs into consideration needs to be developed based on scientific knowledge. Findings from this study may draw attention to children visiting ICUs and encourage nurses to discuss children visiting with custodians and to develop family-centred care at the ICU that includes children.

Allowing children to visit adult intensive care units (ICUs) has been an area of controversy. There is a lack of recent research dealing with visits by children and physicians' views and whether differences exist between the views held by nurses and physicians regarding visits by children. The aim of this study was to describe and compare reasons given by nurses and physicians for restricting visits by children to a relative hospitalized in an adult ICU. This was a quantitative, descriptive multicentre study. Nurses and physicians (n = 291) at 72 general adult ICUs participated, each completing a questionnaire. A majority of the nurses and physicians were positive to children visiting patients in ICU, but they also imposed restrictions. The most common reasons were: severity of the patient's injury (50%); the environment was frightening for the child (50%); the infection risk for the child (36%) and the patient (56%). Children <7 years were restricted more than those >7 years. Nurses were more positive than physicians to visits by younger children. Physicians were more positive to visits if the patient was tired and critically ill/injured or was a friend/cousin. More physicians refused visits due to the fact that children are too noisy for the staff. Risks of negative effects on the children's health by visiting patients were also stated. Nurses and physicians still restrict children's visits to adult ICUs for a number of reasons, and nurses' and physicians' views on children visiting differ and so also the views within each professional group. The differences in views show that the dynamics are complicated and this could be attributed to a lack of a common view of care, which prevents family-centred care that includes children from being practised.

AIM: This paper is a report of a study of children's experiences of visiting a seriously ill/injured relative in an intensive care unit.

BACKGROUND: Little attention has been paid to children's experiences and needs when visiting a relative being cared for at a high technological adult intensive care unit. Instead, the focus has been on adult's experiences and needs.

METHOD: In 2004, 28 children (14 girls, 14 boys) aged 4-17 years who had visited an adult relative were interviewed 3 months after the visit. A hermeneutic approach was used when interpreting and analysing the text.

FINDINGS: Four themes were generated from the data: It meant waiting, It was strange, It was white and It was good. Waiting was experienced as difficult, increasing the feeling of uncertainty, exclusion and separation, which in turn led to tension and concern. 'It was strange' was perceived as unfamiliar but also with interest and curiosity. The experience of the intensive care unit was that it was white. Everything in the patient's room was experienced as white and gloomy. It lacked joy. 'It was good' was stated about the outcome of the visit because through this they were given the opportunity to meet and see the relative by themselves. This evoked feelings of relief and joy. The visit did not seem to frighten the child; instead it generated feelings of release and relief.

CONCLUSION: Children's experiences of visiting an adult intensive care unit seem to support theories that emphasize the involvement and participation of children in family matters.

Annually, throughout the world, more than 800,000 primary total hip replacement surgery procedures are performed on patients suffering from hip joint arthrosis. Since 1991, approximately 11,000 of these procedures are performed annually in Sweden. This study aimed to investigate any changes in the patients' life quality 6 weeks and 6 months after their total hip replacement surgery had been performed, compared to that immediately prior to the operation. It also aimed to examine the reason for surgery, the types of prostheses used, postoperative pain, complications and the actual usage of ambulation support. The Sickness Impact Profile self-appraisal instrument, together with personal patient interviews have been used as the basis of the research. A total of 51 patients responded to the quality of life instrument prior to their operation, 47 of these participated 6 weeks after the operation, and 40 patients 6 months after the operation. Significant differences in patients' total, physical and psychosocial quality of life 6 months postoperatively compared to the situation prior to the operation were found, but not between the situation before and 6 weeks after the total hip replacement surgery. The majority of patients were of the opinion that it was more important that the pain had disappeared or decreased, than any overall increase in the quality of life. Postoperative complications occurred within 6 weeks, and even after 6 months some patients still suffered from these.

An illness or injury sustained by a family member affects all family members. It is consequently important that a child’s need to be involved in a family member’s care is clearly recognized by healthcare professionals. The aim of this study was to describe healthcare professionals’ approaches to children as relatives of a parent being cared for in a clinical setting. A web-based study-specific questionnaire was sent and responded to by 1052 healthcare professionals in Sweden. Data were analysed using descriptive statistics and qualitative analysis. The results show that guidelines and routines are often lacking regarding involving children in the care of a parent. Compared to other areas, psychiatric units seem to have enacted routines and guidelines to a greater extent than other units. The results indicate that structured approaches based on an awareness of the children’s needs as well as a child-friendly environment are vital in family-focused care. These aspects need to be prioritized by managers in order to support children’s needs and promote health and wellbeing for the whole family.

BACKGROUND:

Despite a cultural change in visitation policies for children (0-17 years) in the intensive care unit (ICU) to a more open approach, children are still restricted from visiting for various reasons. To overcome these obstacles, it is vital to determine what is needed while encountering a child.

AIM:

To elucidate nurses' experiences of what constitutes the encounter with children visiting a sick parent in an adult ICU.

METHOD:

An explorative inductive qualitative design was used, entailing focus group interviews with 23 nurses working at a general ICU. The interviews were analysed according to inductive content analysis.

RESULTS:

The findings show components that constitute the encounter with children as relatives at the ICU, as experienced by ICU nurses: nurses need to be engaged and motivated; parents need to be motivated; the child needs individual guidance; and a structured follow-up is needed. This reflects a child-focused encounter.

CONCLUSIONS:

Nurses need to adopt a holistic view, learn to see and care for the child individually, and be able to engage parents in supporting their children. To accomplish this the nurses need engagement and motivation, and must have knowledge about what constitutes a caring encounter, in order to achieve a caring child-focused encounter.

Purpose

Children's visits to the ICU are still restricted, and more focus on the child's own needs and experiences are needed. The aim of this study is to illustrate the meaning of being a visiting child of a seriously ill parent receiving care at the ICU.

Method

A qualitative descriptive design was used, with open-ended interviews with seven children (6-18 years) performed and analysed using a phenomenological research approach.

Findings

Being a visiting child of a seriously ill parent receiving care at the ICU is described as a life situation taking place in an unfamiliar environment, characterized by a heartfelt, genuine desire to be there, in an interdependence entailing offering a loved one the help they need while at the same time being seen in a compassionate way and being able to share, revealing a sudden awakening of an inner truth of reality and a sense of a healing wisdom of understanding.

Conclusions

The children felt good when they visited their ill parent, but at the same time not fully involved, and desired a more compassionate, caring approach by the nurses. Improvements are needed in how to approach visiting children in a more individual and caring way.

This qualitative study aims to describe nursing students’ experiences of learning caring science by using reflection seminars as a didactic model. A reflective lifeworld research approach according to Husserl’s phenomenological philosophy was used. Findings suggest that reflective seminars increased understanding of caring science, other people and one’s self. Moreover, substance-oriented reflection and lifeworld perspectives provided a good learning environment. Learning prerequisites were found to be openness, honesty, respect, trust, security, justice, parity and shared responsibilities along with having a common platform and a clear framework. These findings highlight conditions for a culture conducive to learning and for gaining embodied knowledge, but also present concerns regarding the difficulty and importance of establishing a good learning environment. A need to create meaningfulness, establish caring as conscious, reflective acts and show the value in personal differences were also found. These findings offer an important perspective necessary for preparing nurses to perform good quality care.

Few studies focus on how reflection seminars can support the learning of knowledge in caring science when inserted throughout the curriculum. The aim of this study was to describe students’ experiences of participating in reflection seminars, using lifeworld theory and focusing on caring science. A qualitative descriptive study based on interviews was carried out, and ten students between 21 and 33 years of age volunteered to participate. A reflective lifeworld research approach was used. Reflection seminars contribute to developing students’ ability to relate to caring and life. A deeper understanding is obtained when reflection sessions are spread over a longer period and when reflection becomes a process. The process helps caring science to become more natural and useful. Reflective seminaries based on a theoretical foundation contribute to facilitate learning more readily. A good atmosphere pervaded by a lifeworld perspective characterized by openness and thoughtfulness contributes to learning.

Little is known about the frequency of children visiting their nearest relatives in adult ICUs or if there are any policies/guidelines or recommendations regarding these. The aims of this multi-centre descriptive study were to survey Swedish ICUs policies/guidelines or recommendations, and examine the reasons given both for and against restricting child visits; if parents/guardians sought advice in connection with such visits, and if any differences in demographic data could be ascertained. Fifty-six Lead Nurse Managers (LNM), representing as many general adult ICUs, participated by answering a questionnaire. Only one ICU had written policy/guidelines concerning child visits; most ICUs (70%) had no policies/guidelines at all. All LNMs reported that their ICU was positive to child visits, but only two actively encouraged these. Nineteen (34%) of the ICUs restricted child visits. More than 50% of the LNMs reported that only about half of their patients ever had visits from children. Seventy percent of the ICUs had no restrictions on visiting hours, but 30% imposed some form of restriction. Twenty LNMs reported that 75% of the parents/guardians of children 0-6 years old asked for advice about child visits. However, those responsible for children >12 years of age seldom asked for any advice at all.

The Model for Improvements in Learning Outcomes (MILO) is theoretically grounded and designed to intertwine didactics, pathophysiology and medicine with specific concepts important for learning. The aim was to describe supervisors' experiences of undergraduate nursing students' learning during clinical practice when using MILO. A qualitative and explorative design was used. Seventeen supervisors, thirteen women and four men from different departments at three hospitals in southern Sweden participated. After using the model, data were collected through four focus group interviews with open unstructured interview questions and analysed using inductive latent content analysis. Twelve subcategories, four generic subcategories and one main category emerged. The students developed a questioning approach and were more reflective, open and compliant. Twosomes enhanced learning. Specific documents generated structure and feelings of participation. The supervisors felt that taking the students' pre-understanding into account and a caring approach in the learning environment were valuable for enhanced learning. The students established a caring relationship with the patients and the patients’ perspective became emphasized. Using MILO, intertwining between the natural and the professional became possible; enhanced learning in nursing skills together with a more caritative caring approach towards the patient was revealed. The need of compassion is discussed.

Aim: To describe undergraduate nursing students' attitudes to learning during clinical practice in different semesters when using the conceptual learning model, Model for Improvements in Learning Outcomes (MILO) grounded in a caritative caring perspective.

Background: With the intention to support interlinking between theory and praxis and offer understanding and structure to facilitate learning, MILO, theoretically grounded in hermeneutics and a caritative caring perspective based on ethical values, was implemented. MILO consists of four contextual concepts (peer learning, co-clinical teachers, student-centred and student-active supervision) and four intrapersonal concepts (nursing, a reflective approach, a critical approach, quality and safety).

Methods: A descriptive comparative quantitative study design was applied at a Swedish university, 3 hospitals and 13 municipalities in one county. Cross-sectional data collected via a questionnaire developed to assess attitudes to learning related to MILO's contextual and intrapersonal concepts and their applications were used.

Results: 209 students in semester 3, 4 and 6 participated in 6 different clinical practice courses. In comparison, intrapersonal concepts, that is, the student's own characteristics and abilities were viewed to be of greater value for learning than contextual, that is, organisational-related concepts in all semesters. Understanding the needs of others and reflective learning were rated to be of major importance. Students in semester 3 valued the use of the applications the highest. To be supervised in pairs was rated the lowest in semester 6. Some of the concepts and their applications were to great extent not applied.

Conclusions: In all semesters, fundamentals in caritative caring and characteristics and abilities related to the individual student were rated to be of greater importance for learning than environmental support. Providing students opportunities to develop independency seems essential. Use of a learning model such as MILO is dependent on a bearing of a caritative caring culture and a shared understanding between all involved in student learning during clinical practice.

Background

Creative strategies are needed in nurse education to integrate theory, practice and lived experiences. Towards that end, reflective seminars, conducted in congruence with reflective lifeworld theory and caring science, were implemented during a three-year nursing programme. The reflection seminars took place during the theoretical parts of education and the clinical placements. Each reflection group consisted of six to nine students, and the seminars were led by a lecturer from the university.

Objectives

This article aims to describe the experiences of learning about caring science by participating in reflective seminars that were integrated into courses during a three-year nursing education programme.

Design

A phenomenological approach was used, and qualitative group interviews were conducted.

Setting

The study was conducted at a university in southern Sweden.

Participants

Twenty three students, 19 women and four men, volunteered to participate. All participants were at the end of a three-year nurse education programme. Data were collected through four group interviews with five to seven participants in each group.

Methods

This study used a reflective lifeworld research approach based on phenomenological philosophy.

Results

The findings reveal that nursing students experience reflective seminars as being valuable for their professional development. The result is described in more detail via four meaning units: An obtained awareness of the value of reflection in clinical practice; Reflection contributes to an approach of thoughtfulness; Caring science has become second nature, and Reflection as a strength and a challenge at the threshold of a profession.

Conclusions

This study contributes to the understanding of reflective seminars grounded in lifeworld theory as a didactic strategy that enables students to increase their knowledge of caring science and develop their reflective skills.

The aim: To conduct a follow up study to measure registered nurses’ time of direct patientcare after implementation of patientfocused care(PFC).

Background: PFC is an organizational model with the objective to increase both patient participation and health care effectiveness. After areconstruction of wards to single bedrooms in a hospital south of Sweden. PFC was implemented to increase time for direct patientcare inorder to better meet patients’ needs.

Method: Time measured observations were conducted. 20 registered nurses were observed in four different wards at a 525-bed hospital insouth of Sweden after implementation of PFC.

Findings: In a workday of 8,5 hrs, registered nurses spend 6,8 hrs (79,8 %) with work related to patients. Time for directcare was 2 hrs(23,8 %) and time for indirect care was 4,8 hrs (56 %). Indirect care consists of categories such as documentation, report and medical round.

Conclusion: In comparison before implementation of PFC, time for patientrelated care increased by 10,8 %. However, time is spent mainlyat patient indirectcare activities. It is important to also focus on a change of culture in the organization to succeed with an implementationof PFC.

When a person with vague symptoms calls 112, the dispatchers often have difficulty prioritising the severity of the call. Their only alternative has been to send an ambulance. In Gothenburg, Sweden, a nurse-manned single responder (SR) was initiated to assess this patient group. The study aims to describe patient characteristics and assessment level made by the SR nurse among patients assessed by the dispatcher as low priority and/or vague symptoms. A consecutive journal review was conducted. During six months, 529 patients were assessed; 329 (62%) attended the emergency department (ED) or inpatient care (IC). Of these, 85 patients (26%) were assessed as high priority. Only 108 were assessed as being in need of ambulance transport. ED/IC patients were significantly older. Two hundred (38%) stayed at the scene (SS) (n = 142) or were referred to primary care (PC) (n  = 58). Of the 200 SS/PC patients, 38 (19%) attended the ED within 72 hrs with residual symptoms, 20 of whom were admitted to a ward. Nine patients (4% of 200 SS/PC patients) required inpatient treatment and 11 patients stayed overnight for observation. These results suggest a relatively high level of patient safety and the usefulness of an SR among patients assessed by the dispatcher as low priority.

Rationale: To maintain patients’ dignity and well-being and alleviate suffering, it is essential that healthcare providers engage in caring behaviours. Yet, every year patient boards receive an increasing number of complaints from patients and significant others regarding healthcare providers’ non-caring behaviours. Defining and measuring both verbal and nonverbal caring and non-caring behaviour in healthcare delivery is vital to address such complaints. However, no studies were found that incorporated a comprehensive theory of caring to code encounters between healthcare providers and patients.

Aim: The aim was to develop and test a Caring Behavior Coding Scheme based on Swanson’s Theory of Caring.

Method: An instrument development process was used for behavioural coding including observational data from thirty-eight video recordings collected in an undergraduate nursing course at a Swedish University. The observational data involved interactions between undergraduate nursing students and a standardised patient.

Result: The Caring Behavior Coding Scheme (the CBCS), contains seventeen verbal and eight nonverbal behavioural codes, categorised as caring and non-caring in accordance with Swanson’s Theory of Caring. Content and face validity were assessed. Timed-event sequential continuous coding was performed in INTERACT software. The coder achieved excellent agreement with the developed gold standard (k = 0.87) and excellent mean inter-rater reliability (k = 0.82). All domains in Swanson’s Theory of Caring were observed and coded in the interaction.

Discussion/Conclusion: The CBCS is a theory-based instrument that contributes to research on healthcare providers’ behavioural encounters. It uses verbal and nonverbal caring and non-caring behavioural codes to assess the alignment of both the theory and practice of caring. The CBCS can contribute to both development and measurement of interventions focused on improving healthcare providers’ caring behaviour with the intended outcome of patient well-being.

BACKGROUND: In today's complex healthcare organisations there is an increasing recognition of the need to enhance care quality and patient safety. Nurses' competence in demonstrating caring behaviour during patient encounters affects how patients experience and participate in their care. Nurse educators are faced with the challenge of balancing the demand for increasingly complex knowledge and skills with facilitating students' abilities essential to becoming compassionate and caring nurses.

AIM: The aim was to describe undergraduate nursing students' development of caring behaviour while participating in a caring behaviour course.

METHOD: This pilot study used a quantitative observational design. At a university in Sweden, video-recorded observational data from twenty-five students were collected in the first and last weeks of a full-time five-week Caring Behaviour Course (the CBC). In total, 56-min video-recorded simulation interactions between a student and a standardised patient were coded by a credentialed coder using a timed-event sequential continuous coding method based on the Caring Behaviour Coding Scheme (the CBCS). The CBCS maps the five conceptual domains described in Swanson's Theory of Caring with related sub-domains that align with Swanson's qualities of the Compassionate Healer and the Competent Practitioner. The CBCS contains seventeen verbal and eight non-verbal behavioural codes, categorised as caring or non-caring.

RESULTS: Between the two simulations, most verbal caring behaviours increased, and most non-verbal caring behaviours decreased. Statistically significant differences between the simulations occurred in the sub-domains Avoiding assumptions and Performing competently/skilfully in the quality of the Competent Practitioner. Most observed caring behaviours aligned with the Compassionate Healer.

CONCLUSION: Generally, the students' development of caring behaviours increased while participating in the CBC. Using a structured observational behavioural coding scheme can assist educators in assessing caring behaviour both in education and in practice, supporting caring as the universal foundation of nursing and a key to patient safety.

This study examines undergraduate nursing students' experiences of participating in a Caring Behavior Course using various learning didactics. Twenty-five students participated in one of five focus group interviews with data analyzed according to qualitative content analysis. The main theme to emerge, an insightful and sudden awakening that caring is not only theoretical words, was further explained with three themes and nine subthemes. The Caring Behavior Course demonstrates effective learning didactics to develop awareness of values that influence caring behaviors and can contribute to patient well-being, particularly relevant for the care challenges in the time of COVID-19 and beyond.

BACKGROUND: Prospective nurses need specific and sufficient knowledge to be able to provide quality care. The Swedish Society of Nursing has emphasized the importance of the six quality and safety competencies (QSEN), originated in the US, in Swedish nursing education.

PURPOSE: To investigate the visibility of the QSEN competencies in the assessment tools used in clinical practice

METHOD: A quantitative descriptive method was used to analyze assessment tools from 23 universities.

RESULTS AND CONCLUSION: Teamwork and collaboration was the most visible competency. Patient-centered care was visible to a large degree but was not referred to by name. Informatics was the least visible, a notable concern since all nurses should be competent in informatics to provide quality and safety in care. These results provide guidance as academic and clinical programs around the world implement assessment of how well nurses have developed these essential quality and safety competencies.