Oral health-related side effects are common in patients with both untreated and PAP-treated OSA and can hinder adherence to PAP treatment. Despite extensive research on OSA and PAP, oral health experiences of PAP professionals remain unexplored. The aim was to describe PAP professionals' experiences and management of symptoms and treatment effects on oral health in patients with OSA before and during PAP treatment. The study has a qualitative design with an inductive approach, where 17 strategically selected PAP professionals (physicians, nurses, and biomedical scientists) at nine Swedish PAP clinics participated in semi-structured in-depth interviews. The data was analysed with content analysis. Four categories described PAP professionals' experiences before and during PAP treatment. The categories Acknowledging oral health aspects when exploring the clinical data and Exploring the patients' oral health-related experiences described the OSA diagnosis, intra-oral visual features, and shared signs between OSA and oral health. The categories Adjusting the PAP device related to oral health and Managing oral health-related situations during PAP treatment described the oral health-related challenges in patient collaboration and individualised PAP treatment. In conclusion, oral dryness was an oral health-related symptom of OSA and a side effect of PAP treatment, noted by PAP professionals. Management of oral health-related situations and treatment effects was difficult as there was a lack of knowledge and no established remedial routine.

Background: Restless legs syndrome (RLS) is a long-term sensory-motor illness impacting individuals and their family members, yet little is known about the family members' everyday experiences.

Aim: To explore and describe the everyday life experiences of family members of individuals with RLS.

Methods: An inductive, qualitative exploratory design was used. Telephone interviews were conducted with 25 family members (e.g. partner, child) and analysed using qualitative content analysis.

Results: Family members described adjusting their routines and social activities to accommodate the individual with RLS, often balancing these changes with their own needs. This adaptation affected their everyday lives, as conflicting desires required balancing personal needs with sleep disruptions, resulting in tiredness. Despite these challenges, they employed strategies such as shared activities and self-care to manage the impact on the individuals with RLS.

Conclusions and contribution to nursing: This study highlights the importance of family involvement in RLS care and the need for a family nursing approach in guidelines. Healthcare professionals could invite both family members and individuals with RLS in shared decision-making. Policies and practices could provide resources to support flexible coping strategies and reduce isolation. Future research could explore social support to better understand family members' experiences.

Background: Restless legs syndrome (RLS) is a prevalent neurological condition affecting daily life. Symptoms can vary and worsen during the evening and night, with sleep problems as a common consequence. Few, if any, qualitative studies have explored how patients with RLS experience their sleep problems.

Aim: The aim was to explore and describe how patients with RLS experience their sleep problems, the subsequent daytime consequences, and self-care activities used to improve sleep.

Methods: An inductive, descriptive, qualitative design was used, including semi-structured interviews with 28 strategically selected patients from a national RLS organisation. Data were analysed with manifest qualitative content analysis and reported according to the COREQ checklist.

Results: RLS-related ailments affecting sleep were: noticing initial symptoms in the evening, enduring stressful RLS symptoms at night, and being concerned about not having symptom-relieving treatment. Struggles with daytime consequences of poor sleep were: feeling excessive fatigue and managing social interactions. Self-care actions to improve sleep included trust in daily routines, benefiting from the use of various distractions, and actively seeking effective medical treatment.

Conclusions and contribution to nursing: Knowledge about various RLS-related ailments affecting sleep can be used by nurses to provide adequate education about the disease and potential nursing interventions to improve sleep.

Introduction: Restless legs syndrome (RLS) is a prevalent disorder that disrupts sleep and impairs quality of life. Establishing effective treatment is complex, and shared decision-making (SDM) might reduce decisional conflicts. No previous study has examined SDM or factors linked to decisional conflicts in RLS. Therefore, this study aimed to explore and compare sociodemographic and clinical factors associated with SDM in general and decisional conflicts in particular among patients with RLS. Methods: A cross-sectional design using a postal survey (June-September 2022), inviting all similar to 1500 members of the national RLS patient organization. Comparative statistical analyses and logistic regression models examined associations with sociodemographic and clinical factors, using the instruments: Restless Legs Syndrome-6 scale (RLS symptoms), Pittsburgh Sleep Quality Index (sleep), Patient Health Questionnaire-9 (depressive symptoms), eHEALS (e-health literacy), CollaboRATE (SDM), and SURE (decisional conflicts). Ad hoc items regarding treatment satisfaction and informational needs were also used. Results: In total, 788 patients, 65% women, mean age 70.8 (standard deviation = 11.3) were included. Fifty-eight percent reported a low SDM experience, and 78% experienced decisional conflicts. Multiple logistic regression analysis showed that RLS symptoms at nighttime (odds ratio [OR] = 1.073, P = 0.020), RLS treatment dissatisfaction (OR = 2.077, P < 0.001), low e-health literacy (OR = 0.964, P = 0.007), and a low SDM experience (OR = 0.800, P < 0.001) were associated with decisional conflicts. Conclusion: Most patients experienced low levels of SDM and decisional conflicts, with several factors associated with their experiences. Awareness among healthcare professionals can support a collaborative approach, using SDM to prevent treatment-related decisional conflicts in RLS care.

Aims Insomnia is an independent risk factor for coronary artery disease (CAD). Persistent sleep difficulties after percutaneous coronary intervention (PCI) may hinder recovery, however, studies investigating factors contributing to insomnia in a longitudinal perspective are scarce. Therefore, we aimed to describe and determine: (i) the prevalence of insomnia symptoms in women and men with CAD after PCI; (ii) changes in insomnia symptoms scores over time and (iii) the association between insomnia symptoms, self-reported health status and individual factors 2-, 6- and 12 months post-PCI. Methods and results Large-scale, prospective, multicentre cohort study on patients after PCI (N = 3,417). Patient-reported outcomes for all included patients were collected during index hospitalization after PCI prior to hospital discharge and 2-, 6-, and 12-months post-PCI (T0-T3 respectively). Insomnia symptoms were assessed with the Minimal Insomnia Symptom Scale, and self-reported health status with RAND-12 and the Seattle Angina Questionnaire. Clinical characteristics were collected from The Norwegian Registry of Invasive Cardiology and patients' medical records. The prevalence of insomnia symptoms was high (women 47% vs. men 28%) at T0 (p < 0.001) and remained at similar levels (T1-T3). Reduced mental health in men (p < 0.001, T1, T2 and T3) and women (p = 0.002 (T1), p = 0.005 (T2) and p = 0.040 (T3)) and physical health in women (p = 0.032 (T2) and p = 0.016 (T3)) were significantly associated with more severe insomnia symptoms. Moreover, insomnia symptoms at previous timepoints were associated with insomnia symptoms at later timepoints for both sexes (p < 0.001 for all comparisons). Conclusion Insomnia symptoms are highly prevalent following PCI, particularly among women, persisting over time, and related to poorer mental health in men and women. Greater attention should be directed toward early screening and targeted sleep interventions in both sexes.

Background: Surgical aortic valve replacement (SAVR) and transcatheter aortic valve implantation (TAVI) improve survival and quality of life in older patients with severe aortic stenosis (AS). However, in the scientific literature, characteristics of the 10-year survivors in the oldest group of patients undergoing surgery are sparsely described. Purpose: To describe the clinical and demographic baseline characteristics of the nonagenarian survivors 10 years after aortic valve replacement. Methods: A longitudinal prospective cohort study of patients with severe AS receiving SAVR or TAVI was performed in a tertiary Norwegian university hospital. Inclusion criteria: ≥ 80 years, previously accepted for SAVR or TAVI, able to speak and understand Norwegian, and provide written consent to participate. Clinical and demographic data were identified from medical records. Comorbidity burden was assessed using the Charlson Comorbidity Index (CCI), and surgical cardiac risk with the Logistic EuroSCORE I. Self-reports from the Study of Osteoporotic Fractures (SOF) frailty index. The Barthel Index (ADL), the Nottingham scale (IADL), and hospital anxiety and depression scale (HADS). Hospital information registries provided information regarding vital status. Results: A total of 143 patients were included. Mean age of the total cohort at the time of surgery (baseline) was 83.5+ 2.7 years, (57% women, 55% SAVR and45%TAVI), and 34% were robust, 27% prefrail, and 39% frail. At 10-year follow- up, 38 (27%), now nonagenarians, were still alive (mean age 92.7 years, range 90-99 years, 68% women, 74% SAVR and 26% TAVI). Baseline socio-demographic characteristics of the 10-year survivors were as follows; 50% were widow/widowers and lived alone, 74% had basic education,18% high school, and 8% bachelor or higher education. Baseline clinical characteristics were as follows; 47% were in NYHA class III. Logistic EuroSCORE I was 11.8+ 6.2, and CCI was 1.7, 95% had LVEF >50, mean aortic valve area 0.4 cm2, while mean aortic valve gradient was 52 mmHg. As for baseline self-report, 53% were robust, 32% were prefrail, and 16% were frail. Mean Barthel index 19.4+1.1, HADS anxiety score was 4.5 +1.1, HADS depression score was 2.9 +2.1. Mean IADL was 57.9+ 8.3. Number of readmissions at 10-year post-surgery was mean 7.2 (range 1-37). Conclusion: As expected, the survivors had reduced physical functioning before treatment, including reduced independence in activities of daily living. The number of readmissions varied greatly during the 10-year follow-up time. However, typical for the survivors- now reached the age of 90+- was good mental health at baseline. They were also considered robust or prefrail with a low CCI score before treatment. Further work on post-treatment status at6 months is currently being conducted.

Background: Surgical care increasingly shifts pre- and postoperative care responsibility to patient self-care at home. By using the capability, opportunity, motivation-behaviour (COM-B) framework, patient determinants influencing self-care can be explained.Aim: The aim was to describe patients' experienced facilitators of and barriers to self-care in surgical fast-track programmes related to capability, opportunity and motivation.Methods: A qualitative design study with semi-structured interviews was conducted among 27 general and orthopaedic surgery patients at three Swedish hospitals. Data were analysed deductively using the COM-B framework.Results: The patients' self-care experiences were explained by capability, opportunity and motivation and the dynamic interaction between these factors. A key analytical finding was the pivotal role of family and friends, whose emotional and practical support strengthened patients' capability and motivation. Facilitators for behaviour change included prior surgical experience, clear information, physical ability, social and professional support, optimism and realistic goals. Barriers included cognitive and physical limitations, pain, fatigue and emotional distress.Conclusions: Findings highlight family involvement as an underused resource and support policy development of person centred pre- and postoperative self-care strategies. This study advances nursing theory by applying the COM-B model to illuminate interdependent behavioural processes in surgical self-care; themes could occasionally overlap.

Background Neonatal cardiopulmonary resuscitation (CPR) requires a skilled team including pediatric registered nurses (pRNs) who must manage complex, high-stress situations. This study aimed to describe pRNs' experiences of neonatal CPR and to interpret these in relation to two levels of clinical expertise, novice and expert, using Benner's framework. Design and methods A qualitative secondary analysis included two strategically selected novices and two experts from three level III and IV NICUs in Sweden. Data were analyzed using abductive content analysis framed by the Swedish competence description for pRNs and Benner's nursing theory. Results Novices relied on guidelines and familiar team members to manage stress and ensure patient safety. Experts demonstrated confidence in team dynamics, anticipatory decision-making, and mentoring behaviors. Conclusion The findings highlight differences in how novice and expert pRNs experience neonatal resuscitation and emphasize the importance of mentorship and structured support for professional development.

OBJECTIVES: Adequate sleep and a schedule aligned with circadian rhythms are essential for healthy development in adolescents. One strategy to improve sleep, mental health, and academic performance is to delay school start times. A few Swedish schools have implemented later school start times, but these changes or the perceptions of these changes have not been formally studied. The present study aimed to illuminate adolescents' concerns and positive expectations regarding later school start times.

METHODS: The study included 314 adolescents aged 13-15 years (52% self-identified as girls) at 2 secondary schools in Sweden. Adolescents were to start their school days an hour later, from 8:00-9:00 am, beginning in August 2024. Data were collected from June 2024-August 2024 through 28 individual interviews and one open-ended survey question answered by 286 adolescents. These data were analyzed using inductive qualitative content analysis.

RESULTS: Adolescents' concerns and positive expectations were summarized into 4 categories. They expected the change to result in altered morning routines, as well as improved well-being and performance during the school day. They also anticipated changes in leisure time, with more energy but less free time, and both improvements (longer sleep duration and easier sleep onset) and potential drawbacks (later bedtimes) regarding sleep. Their views reflected both enthusiasm and apprehension, thereby highlighting ambivalence toward the upcoming change.

CONCLUSION: The impending shift to later school start times was largely viewed positively, offering hopes of better sleep and well-being, including longer sleep duration and an easier time falling asleep due to reduced pressure to go to bed early. However, the impending shift also raised concerns regarding longer school days and less leisure time. These findings indicate a predominantly positive perspective, although some ambivalence remains about both opportunities and challenges. Follow-up research should further clarify adolescents' experiences.