Background: Person-centred care (PCC) is when the person seeking care get’s involved in their care and are seen as more then their illness or ailment. PCC as a concept began in dementia care, but is now the approach that most healthcare institutions strive after. To achieve the improved care that PCC can bring, there is need for a well- planned and clear implementation plan from the management.

Aim: To describe the nursing staffs experience of implementing person-centred care as a work procedure in inpatient care.

Method: An inductive qualitative study where eleven interviews was completed. Eight interviews were strategically chosen and a content analysis was carried out.

Result: There is hope among the participants that implementation will bring a better and safer care, but also concerns about fear of change among the healthcare staff and increased workloads. Participants experience that PCC will place higher demans on the healthcare staff, especially nurses, regarding time, knowledge and communication skills.

Conclusion: To provide the best care, there has to be dedicated and competent staff who also have the support and understanding from the management. Despite the obstacles that seem to exist, there is a positive spirit among the nurses in relation to the implementation of person-centred care.  There is hope that person-centred care, among other things, will increase participation that could lead to shorter hospital stays and risk of needing to seek care again short after being discharged from the hospital. Ultimately it provides a better care in the whole for the individual person seeking care.

Studiens syfte är att ur professionellas perspektiv undersöka hur personer med kognitiva funktionshinder är delaktiga i beslut gällande flytt till egen bostad samt hur professionellas handlingsutrymme påverkar besluten. Studien genomfördes som en kvalitativ intervjustudie med hermeneutisk ansats och kvalitativ innehållsanalys som bearbetningsmetod. Intervjuer gjordes med fem anställda, de flesta av dem socionomer inom en offentlig organisation som producerar tjänster för personer med kognitiva funktionshinder. Resultatet visar att personer med kognitivt funktionshinder har begränsad delaktighet och få valmöjligheter i beslut gällande flytt till egen bostad. Delaktigheten påverkas av klientens och socialarbetarens förmåga att kommunicera med varandra men trots det användes inga kommunikationshjälpmedel i utredningen. Anhöriga antar ofta rollen som klientens tolkningsföreträdare och när det gäller beslut om flytt till egen bostad är det anhöriga som tar beslutet oberoende klientens grad av funktionshinder. Socialarbetarna upplever sig styrda av överordnade men det hindrar dem inte från att ibland överskrida det formella handlingsutrymmet för att göra det som de anser vara det bästa för klienten.

Ultraljudsundersökningar av arteria carotis communis (CCA) utförs med ultraljud vid bedömning av kärlförändringar och flödeshastigheter (FH) samt utredning av sjukdomar i CCA. Lumendiameter (LD) i CCA är en markör för riskfaktorer som leder till stroke, hjärtinfarkt och ateroskleros. Syftet med den aktuella studien är att studera om det sker någon vasoaktiv förändring i CCA vid konsumtion av koffein hos unga vuxna. Det var 33 försökspersoner som delades upp i grupper beroende på deras koffeinkonsumtionsvanor och undersöktes med ultraljud. Försökspersonerna hade innan undersökning inte konsumerat koffein på 12 timmar. Undersökningen utfördes innan konsumtion av koffeindryck och 45 minuter efter koffeinkonsumtion. En signifikant skillnad efter konsumtion av koffein påvisades i lågkonsument gruppen (grupp 1) (p.0,06) och högkonsument gruppen (grupp 3) (p=0,05). En positiv korrelation mellan LD innan och efter konsumtion (r=0,955; p <0,01) samt FH innan och efter konsumtion (r=0,393; p <0,01) av koffein kunde påvisas.

Nyckelord: Carotisduplex, Kaffe, Vasoaktiv, CCA.

Background: Lung cancer and malignant melanoma are diseases investigated by the dual-modality positron emission tomography/computed tomography (PET/CT). There are radiation risks with the examination that can appear as stochastic effects such as cancer. The aim of this study was to compare the radiation doses between the lung cancer group (suspected or verified) and the malignant melanoma group by calculating the total effective radiation dose and to declare the risk with the PET/CT examination. Material and method: The material contained parameters regarding the examination and the sample contained 20 patients from the two groups. The method was retrospective with a quantitative approach. Results: There was a significant difference (p <0,001) between these two groups, were the lung cancer group received 11,95 milliSievert (mSv) and the malignant melanoma group 6,03 mSv and the percentage risk for lethal cancer increased by 0,06% and 0,03%, respectively. Conclusions: The lung cancer group received twice as much effective dose than the malignant melanoma group. However, the effective dose is so low that the risk increase of the lethal cancer is marginal, and the benefit of the examination outweighs the risks.

The overall aim was to investigate municipal guidelines for paid dependent care which were available online, i.e. documents regarding situations where a relative is hired to care for a next-to-kin. The overall aim has been built on the following three research questions regarding how municipalities describe: 1) which situations qualify for paid dependent care, 2) how the elderly person’s needs are met in case of paid dependent care and 3) how the dependent caregivers’ rights and well-being are ensured?

There is no legal basis for demanding cash-for-care setting, and the local self-government determines whether the municipality offers this form of care. Recently, paid dependent care has been restricted and banned in several Swedish municipalities, and according to some statistics paid dependent care is allowed in 55–65 % of the Swedish municipalities. It is mostly women of foreign origin who are dependent caregivers nowadays, and feminist care research and the media lift up cash-for-care settings as a trap for women and for migrant integration.

The study included guidelines from a total of 21 municipalities, which were analyzed using qualitative content analysis according to Elo & Kyngäs (2007). The guidelines analysed were found from the websites of Sweden's 121 medium and large municipalities (more than 20 000 inhabitants). The results were processed using feminist theory (Hirdman 2012).

The results show that overall there are few guidelines available in Sweden's municipalities and that the regulations differ in the different municipalities’ guidelines. The guidelines that are available often contain general or vague descriptions. One conclusion is therefore that many municipalities ensure their own discretion and prevail through vague and general rules in their guidelines. From a feminist perspective, these different municipal policies create unfair structures and differences in conditions and terms for the elderly and their family caregivers regarding cash-for-care settings. Finally, the result shows that the few detailed descriptions prioritize elder people's rights over their caregivers'. Ensuring the paid dependent caregivers’ rights is mainly described to be done by checking and controlling them. In other words, the paid dependent caregivers are often invisible in the guidelines, are often regarded as pseudo-employees and therefore fall between the cracks in terms of their need for support (Sand 2010).

Serious games (SGs), are gaining prominence as a tool for early education at home as well as in school settings. Given the mixed effects of gamification on various aspects of users' lives, it is pertinent to study its broader effects on a child's pre-school and school years. Given the lack of consensus on a comprehensive measure that encapsulates these effects on an individual's routine functioning, the present study examined whether various engagement states in SGs use influence a relatively broader measure of users' functioning across significant life domains such as Quality of Life (QoL). It is argued that it would serve scholars, teachers, and parents better to understand the broader implications of SGs on children's overall QoL rather than isolated physiological and behavioral effects. Consequently, utilizing structural equation modeling, results from 335 parents of 2-10-year-olds in a developing country showed that cognitive and behavioral engagement in gamified applications appear to influence the child's QoL, but not affective engagement. Results are discussed in terms of the consequences of using game-based technology for a child's development, with far-reaching academic, personal, physical, and social implications not only for the school-going ages, but also for early teenage years. The results are promising in relation to QoL. The findings indicate the role modern technology plays in improving individuals' lives. The findings provide scholars, parents, and creators of SGs important information for their plan of action regarding children's exposure to SGs and making SGs a frequent aspect of the learning experience early in life.

When society is viewed in a social constructive manner, the social worker is as affected as the general population by the media and the image it portrays. A prejudice or bias social worker will not be as effective in his work as his intentions are.

The purpose of this thesis was to discover if there are any visible cultural differences in the usage and description of the concept of psychopathy or a psychopath himself in the media, more specifically, daily newspapers. There are three American newspapers and three Swedish newspapers examined in this study.

The study is based on a quantiative content analysis of articles published between 1st of January 2008 and 1st of July 2012. The collected data is categorized where the articles can fall under one or more of five available categories. Even though no clear results occurred, some interesting indications are visible between American newspapers and Swedish newspapers, but more so between different American newspapers. Psychopaths, people with an Antisocial Personality Disorder, are most frequently mentioned as criminals or maniacs/madmen in both countries with a modestly higher percentage for the United States of America.

Det finns ett starkt samband mellan cigarrettrökning och förekomst av parodontit. Parodontit är dosberoende och minskning av cigarrettrökning eller tobaksstopp har potential att förhindra utveckling av parodontit samt fortsatt progression av redan existerande parodontit.  

Background: Cosmesis has been found to have an impact on prosthesis users' body image. Therefore the satisfaction of the cosmesis plays an essential role in a prosthesis user perception of themselves. Most cosmeses on the market are natural-looking, although more futuristic options are coming to the market. Most of the previous evidence has been conducted using quantitative methods. There is a lack of research investigating the experiences of cosmesis in transtibial prosthesis users through qualitative methods. This is expected to elucidate potentially undiscovered areas and factors surrounding patient satisfaction. 

Purpose: The aim of this thesis is to explore transtibial prosthesis user's satisfaction with the appearance of their cosmesis and gain a deeper understanding of their experiences regarding cosmeses. 

Methods: The method in this thesis is a qualitative phenomenology approach with an interpretivist view. The experiences of 5 male transtibial users regarding their cosmesis and satisfaction towards it were explored. This was done by having in-depth semi-structured interviews that were analyzed with thematic analysis. 

Results: The results five main themes arrived: Satisfaction, Natural-looking cosmesis, Function, Difficulties with the material, and Awareness. The results of these themes showed that the participants have different experiences regarding cosmesis. 

Conclusion: This thesis found a variation regarding satisfaction of the appearance among unilateral transtibial prosthesis users. Similarities in satisfaction and experience were found in the respective age groups of the participants. However, due to saturation not being fully reached, there should be further investigations. 

Background: In connection with increased globalization, multicultural societieslead to more transcultural care encounters. The multicultural world makes itnecessary for nurses to plan a care based on transcultural nursing. Previous researchshows that nurses lack cultural competence. By acquiring cultural competence,nurses can provide better care for the care recipient that has a different culturalbackground.Aim: To describe nurses' experiences of caring for patients with different culturalbackgrounds.Method: Qualitative method with inductive approach. Article searches wereconducted in CINAHL, MEDLINE and PsycInfo. After quality review, 13 articlesremained which were compiled in a matrix. The articles were analyzed using Friberg'sanalysis model.Results: Three main categories emerged in the results. The first main category ischallenges in communication with subcategories language barriers and nursesexperiences of interpreters use. The second main category is challenges in nursingwork with subcategories cultural differences, prejudices and uncertainty and lowerquality nursing. Third main category is organizational aspects with subcategoriesneed for knowledge and resources and the importance of routines. The results shownurses' challenges in transcultural care meetings. Nurses express a need to getresources such as an interpreter and knowledge in transcultural nursing.Conclusions: Transcultural care encounters are characterized by difficulties due tolanguage barriers and cultural differences. The lack of cultural competency affects the quality of care when meeting patients with different cultural backgrounds.

Aim: The aim of this literature study was to investigate oral health in children and adolescents with Down syndrome.

Method: The study is a general literature study where the searches were carried out in the databases CINAHL, MEDLINE and Dentistry & oral sciences source (DOSS). Scientific articles that responded to the purpose of the study were selected based on inclusion and exclusion criteria and relevant keywords. Results: A total of 22 quantitative studies were reviewed which showed that children and adolescents with Down syndrome had poorer oral hygiene, more oral diseases and malocclusions compared to children and adolescents without Down syndrome. The reported oral diseases/conditions were caries, gingivitis, periodontitis, oral candidosis, malocclusions, attrition, agenesis and dental erosion. Risk factors that can influence the development of oral diseases and malocclusions, for example, oral hygiene habits and oral motor factors. Conclusion: Children and young people with Down syndrome have an increased risk of suffering from oral diseases and malocclusions. Through increased knowledge about the oral health of children and young people with Down syndrome, dental hygienists can work preventively and motivate support and care for this risk group.

We used national surveys to study how older persons’ changing household patterns influence the gender balance of caregiving in two countries with distinct household structures and cultures, Spain and Sweden. In both countries, men and women provide care equally often for their partner in couple-only households. This has become the most common household type among older persons in Spain and prevails altogether in Sweden. This challenges the traditional dominance of young or middle-aged women as primary caregivers in Spain. In Sweden, many caregivers are old themselves. We focus attention to partners as caregivers and the consequences of changing household structures for caregiving, which may be on the way to gender equality in both countries, with implications for families and for the public services.

Usually it is women who take care of family members in the home, but with age, gender differences become less pronounced and, from 80 years onwards, there are more men caring for a family member – generally their partner – than women. Social and demographic changes are presenting new challenges for public services. In particular, in two-person households with elderly inhabitants, one of whom is dependent, it is necessary to tackle not only the needs of the dependent partner but also those of the carer partner. For this reason, carer support programmes are needed.

During the simulation, participants experience different degrees of stress and anxiety. It could be described as “Anxiety is like perpetually hearing the enemy music but never seeing the threat”. This study aimed to describe the Emergency Medical Services personnel's feelings of anxiety during simulation. The study had a qualitative design with interviews of 28 participants. The data were analyzed using content analysis. The result shows how the simulation could be perceived as a stage performance in the form of a theatre. The perceived acting was unpleasant and embarrassing due to unfamiliarity to perform. To be scrutinized meant having spectators reviewing ones' performance. It was considered more natural to care for actors than manikins. The interaction and connection with a human, even unconscious, were more natural. To care for a human did not require the imagination to empathize in the simulation.

A common feature of prehospital emergency care are short and fragmentary patient encounters with in­creased demands for efficient and rapid treatment. Crucial decisions are often made, based on the premise of the ambulance staff`s ability to capture the situation instantaneously. The assessment is, therefore, a pre-requisite for decisions about appropriate actions. However, a low exposure to severe trauma cases leads to vulnerability for the ambulance staff, which makes the assessment more difficult. Assessment of severe trauma patients at the scene of accident is difficult and complicated. No trauma scenarios are alike and practical skills, training, and feedback are therefore necessary.

Purpose – The purpose of this paper was to describe firefighters’ experiences of First Response Emergency Care.

Design/methodology/approach – An explorative descriptive design with a qualitative approach. Data was collected through group interviews of 35 firefighters and subjected to qualitative content analysis.

Findings – The results showed that the firefighters’ professional role and their uniform serve as protection against mentally strenuous situations. It is important to protect the dignity of the injured or dead, as well as to protect and safeguard colleagues from the experience of the tragedy of an accident. Having a solid and sterling medical education gives a sense of security when providing emergency care, as well as when caring for the relatives. Debriefing brings thoughts and feelings to the surface for processing and closure. The sense of sadness lingers for those they were unable to save, or the ones that had been dead on arrival or were forgotten.

Originality/value – A firefighter’s work situation is exposed and stressful. The firefighter’s uniform as a mental barrier, colleagues, time to mentally prepare and being allowed to show feelings are factors all needed to cope. It is therefore important to encourage, promote and strengthen the protective role of camaraderie for the firefighter, which can likely be emphasized for other uniform-wearing professions such as police, military and ambulance personell. Being acknowledged for their contribution to other peoples’ lives and wellbeing can confirm the firefighters’ importance.

Takotsubo can be detected as a kindred disease, predominantly affecting post-menopausal women. By correctly identifying these patients as having an acute heart failure syndrome, the outcome can be favorable.

Purpose - The purpose was to investigate what effect an intervention of low-dose, highfrequencycardiopulmonary resuscitation (CPR) training with feedback for one month wouldhave on professionals’ subjective self-assessment skill of CPR.

Design/methodology/approach - This study had a quantitative approach. In total, 38firefighters performed CPR for two minutes on a Resusci Anne QCPR. They then self-assessedtheir CPR through four multiple-choice questions regarding compression rate, depth, recoil, andventilation volume. After one month of low-dose, high-frequency training with visual feedback,the firefighters once more performed CPR and self-assessed their CPR.

Findings - With one month of low-dose, high-frequency training with visual feedback, the levelof self-assessment was; 87% (n=33) correct self-assessment of compression rate, 95% (n=36)correct self-assessment of compression depth, 68% (n=26) correct self-assessment of recoil and87% (n=33) correct self-assessment of ventilations volume. The result shows a reduced numberof firefighters who overestimate their ability to perform CPR.

Originality/value - With low-dose, high-frequency CPR training with visual feedback for amonth, the firefighters develop a good ability to self-assess their CPR to be performed withinthe guidelines. By improving their ability to self-assess their CPR quality, firefighters can selfregulatetheir compression and ventilation quality.

Purpose

The purpose of this paper is to investigate the effects of the intervention of low-dose, high-frequency cardiopulmonary resuscitation (CPR) training with feedback for firefighters for one month.

Design/methodology/approach

The study had a quantitative approach. Data were collected through an intervention by means of simulation. The data collection consisted of a pre- and post-assessment of 38 firefighter’s CPR performance.

Findings

There was a statistically significant improvement from pre- to post-assessment regarding participants’ compression rates. Compression depth increased statistically significantly to average 2 mm too deep in the group. Recoil decreased in the group with an average of 1 mm for the better. There was a statistically significant improvement in participants’ ventilation volume from pre- to post-assessment.

Originality/value

Prehospital staff such as firefighters, police, and ambulance perform CPR under less than optimal circumstances. It is therefore of the utmost importance that these professionals are trained in the best possible way. The result of this study shows that low-dose, high-frequency CPR training with an average of six training sessions per month improves ventilation volume, compression depth, rate, and recoil. This study concludes that objective feedback during training enhances the firefighters’ CPR skills which in turn also could be applied to police and ambulance CPR training.

Aim: To describe how the nurse anaesthetist empowers the patient in the perioperative dialogue. Design: A qualitative descriptive design with interviews with 12 nurse anaesthetist (NA). Method: A hermeneutic text interpretation with a foundation in Gibson's empowerment model. Result: The results highlight Gibson's nursing domain: Helper, Supporter, Counsellor, Educator, Resource Consultant, Resource Mobilizer, Facilitator, Enabler and Advocate. The overall understanding is revealed as a relationship can be built through closeness between the patient and the NA. The NA helps the patient master the situation by talking to and touching the patient. The patient is helped to find their own strengths and to cope with their fears. The patients decide over their own bodies. When the patients do not want to or cope with protecting themselves, the NA protects and represents the patient.

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.

Background

A patient’s survival from cardiac arrest is improved if they receive good quality chest compressions as soon as possible. During cardiopulmonary resuscitation (CPR) training subjective assessments of chest compression quality is still common. Recently manikins allowing objective assessment have demonstrated a degree of variance with Instructor assessment. The aim of this study was to compare peer-led subjective assessment of chest compressions in three groups of participants with objective data from a manikin.

Method

This was a quantitative multi-center study using data from simulated CPR scenarios. Seventy-eight Instructors were recruited, from different backgrounds; lay persons, hospital staff and emergency services personnel. Each group consisted of 13 pairs and all performed 2 ​min of chest compressions contemporaneously by peers and manikin (Brayden PRO®). The primary hypothesis was subjective and objective assessment methods would produce different test outcomes.

Results

13,227 chest compressions were assessed. The overall median score given by the manikin was 88.5% (interquartile range 71.75–95), versus 92% (interquartile range 86.75–98) by observers. There was poor correlation in scores between assessment methods (Kappa −0.051 – +0.07). Individual assessment of components within the manikin scores demonstrated good internal consistency (alpha ​= ​0.789) compared to observer scores (alpha ​= ​0.011).

Conclusion

Observers from all backgrounds were consistently more generous in their assessment when compared to the manikin. Chest compressions quality influences outcome following cardiac arrest, the findings of this study support increased use of objective assessment at the earliest opportunity, irrespective of background.

The aim of this study was to describe specialist ambulance nurse students’ experiences of ethical conflicts and dilemmas in prehospital emergency care. In the autumn of 2015, after participating in a mandatory lecture on ethics, 24 specialist ambulance nurse (SAN) students reported experiences and interpretations concerning conflicts and ethical dilemmas from prehospital emergency care. The text consisted of 24 written critical incidents which were interpreted using hermeneutic text interpretation. The text revealed three themes: Not safeguarding a patient’s body and identity; Not agreeing on the care actions; and Not treating the patient with dignity. The SANs experiences ethical dilemmas and conflict of values when they witness how others violate a patient’s dignity. Discussion and reflection is based on ethical conflicts and dilemmas experienced when students see how caregivers do not safeguard the patient’s body or identity. When caregivers have a conflicting will, it results in patients not being treated in an ethical manner. Also, seeing how caregivers put themselves in a power position over patients is described as an ethical dilemma that students experience when they choose not to intervene.

Introduction. We focus on trauma care conducted in the context of a simulated traumatic event. This is in this study defined as a four-meter fall onto a hard surface, resulting in severe injuries to extremities in the form of bilateral open femur fractures, an open tibia fracture, and a closed pelvic fracture, all fractures bleeding extensively. 

Methods. The simulated trauma care competence of 63 ambulance nurses in prehospital emergency care was quantitatively evaluated along with their perception of their sufficiency. Data was collected by means of simulated trauma care and a questionnaire. 

Results. Life-saving interventions were not consistently performed. Time to perform interventions could be considered long due to the life-threatening situation. In comparison, the ambulance nurses’ perception of the sufficiency of their theoretical and practical knowledge and skills for trauma care scored high. In contrast, the perception of having sufficient ethical training for trauma care scored low. 

Discussion. This study suggests there is no guarantee that the ambulance nurses’ perception of theoretical and practical knowledge and skill level corresponds with their performed knowledge and skill. The ambulance nurses rated themselves having sufficient theoretical and practical knowledge and skills while the score of trauma care can be considered quite low.

Introduction. As a part of the emergency medical services, the Swedish fire brigade can increase the survival rate in out-of-hospital cardiac arrests.

Aim. To compare the quality of cardiopulmonary resuscitation (CPR) performed by firefighters at a routine CPR practice versus when involved in a simulated life-saving event.

Methods. In this study, 80 firefighters divided into two groups performed CPR according to guidelines: one group indoors during a routine training session; the other group outdoors during a smoke diving exercise wearing personal protective clothing and self-contained breathing apparatus. Descriptive and inferential statistics were used to analyze the data.

Results. The results showed a tendency for the outdoor group to perform CPR with better ventilation and compression quality, as compared to the indoor group. The ventilation of the manikin was not hampered by the firefighters wearing personal protective clothes and self-contained breathing apparatus, as the Swedish firefighters remove their facial mask and ventilate the patient with their mouth using a pocket mask.

Conclusions. Overall, the results in both groups showed a high quality of CPR which can be related to the fire brigade training and education traditions. CPR training is regularly performed, which in turn helps to maintain CPR skills.

Introduction

During military missions medical care is provided to military personnel as well as civilians. Although cardiopulmonary resuscitation (CPR) may not be a common task in a military field hospital, all personnel need to be trained to deal with cardiac arrest.

Methods

This study was a comparative simulation study. Participants (n=36) from the Swedish armed forces performed CPR for 2 minutes at one of three different locations: at ground level, a military bed, or a transportable military stretcher. Compression depth and rate after 2 minutes of CPR and at the time of the participants’ own request to be relieved were measured. Descriptive and inferential analysis was conducted.

Results

There is a direct correlation between compression depth and working level, concluding that the higher working level, the lower the compression depth. There is in total an overall low percentage of participants within limits for correctly conducted CPR regarding both compression depth and rate. Time to fatigue is related to working level, where increased level results in early fatigue.

Conclusion

The quality of CPR is affected by the level at which it is performed. The quality of CPR was satisfactory when working at ground level, but suboptimal when working at hospital bed level or military stretcher level. When working at raised levels, participants appeared to misjudge their own compression depth and rate. This may indicate that changes are needed when CPR is practised in the military hospital setting. Future studies regarding the use footstools are required due to the height of military beds and transportable stretchers.

Purpose: To evaluate military personnel’s self-rated perceptions of their knowledge, experience and training after high-fidelity battle injury simulation.

Design: 26 military medical personnel participated in this quantitative study. Data was collected using a questionnaire after a six-day exercise where participants self-rated 10 statements regarding having sufficient medical, practical and ethical knowledge, experience and training. Descriptive and inferential analyses were conducted to obtain the results.

Results: Nurses rated themselves statistically significantly higher than medics in having sufficient medical knowledge and experience, practical knowledge, experience and training, as well as ethical knowledge and experience. The nurses also rated themselves statistically significantly higher than physicians in having practical knowledge, experience and training. Physicians’ self-rated perception was low regarding sufficient knowledge, experience and training in practical skills. Physicians, nurses and medics all reported low ratings for sufficient training in ethical issues.

Discussion: Military medical personnel are required to have the knowledge and skills to work autonomously in challenging and threatening environments. For personnel that seldom see battlefield-like injuries, a clinical placement in a country with a high frequency of battlefield-like injuries would be advisable. A comparison between subjective and objective assessments may identify deficiencies in competence, which can negatively impact quality of care.

INTRODUCTION: Swedish firefighters are a part of the emergency medical services. Therefore, they perform prehospital cardiopulmonary resuscitation (CPR) on a regular basis. Training becomes crucial for maintaining the CPR skills and increasing the patients’ chances of survival. Training with visual feedback is for Swedish firefighters a new way of training CPR. The aim of this study was to evaluate firefighters’ perception of a CPR manikin with visual feedback.

METHOD: This study had a qualitative approach. Data were collected by interviews with 16 firefighters after performing CPR on a manikin with visual feedback. The data were analyzed with a manifest content analysis.

RESULTS: Visual feedback makes it easy to identify and maintain correct compression rate. There is a need for identifying too deep compressions. Uncertainty regarding the closeness to the stomach arises when using the whole hand during compressions instead of just the wrist. To accomplish an open airway requires a bit of adjustment of the manikins’ head.

DISCUSSION: To train and learn CPR is feasible with visual feedback. The firefighters can maintaing a correct compression rate and correct compression depth during the sessions. Ventilating a patient with bag-valvemask or pocket mask may require training with visual feedback to guarantee the firefighters being able to secure an open airway of the patient. All these skills are essential and improve the chance of survival for the patients.

OBJECTIVE: The aim of this study was to evaluate the simulated emergency care performed by firefighters and their perception of simulation as an educational method.

METHODS: This study had a mixed method with both a quantitative and a qualitative approach. Data were collected by simulation assessment, a questionnaire, and written comments. Descriptive analysis was conducted on the quantitative data whereas a qualitative content analysis was conducted on the qualitative data. Finally, a contingent analysis was used where a synthesis configured both the quantitative and the qualitative results into a narrative result.

RESULTS: The cognitive workload that firefighters face during simulated emergency care is crucial for learning. In this study, the severity and complexity of the scenarios provided were higher than expected by the firefighters. Clearly stated conditions for the simulation and constructive feedback were considered positive for learning. Patient actors induced realism in the scenario, increasing the experience of stress, in comparison to a manikin.

CONCLUSION: To simulate in a realistic on-scene environment increases firefighters' cognitive ability to critically analyze problems and manage emergency care. Simulation of emergency care developed the firefighters as professionals.

Background In the perioperative dialogue, pre-, intra- and postoperatively, the patient shares their history. In the dialogue, the nurse anesthetist (NA) gets to witness the patient's experiences and can alleviate the patients' suffering while waiting for, or undergoing surgery. The aim of this study was to describe the nurse anesthetist's experiences of the perioperative dialogue. Methods The study had a qualitative design. Interviews were conducted with 12 NA and analyzed with interpretive content analysis. The methods were conducted in accordance with the COREQ guidelines. Results In the result, three categories emerge: A mutual meeting (the preoperative dialogue) where the patient and the NA through contact create a relationship. The NA is present and listens to the patient, to give the patient confidence in the NA. In the category, On the basis of the patient's needs and wishes (the intraoperative dialogue), the body language of the NA, as well as the ability to read the body language of the patient, is described as important. In the category, To create a safe situation (the postoperative dialogue) the NA ensures that the patient has knowledge of what has happened and of future care in order to restore the control to the patient. Conclusion The patient is met as a person with their own needs and wishes. It includes both a physical and a mental meeting. In a genuine relationship, the NA can confirm and unreservedly talk with the patient. When the patients leave their body and life in the hands of the NA, they can help the patients to find their inherent powers, which allows for participation in their care. Understanding the patient is possible when entering in a genuine relationship with the patient and confirm the patient. The perioperative dialogue forms a safety for the patients in the operating environment.

By educating laymen, survival after cardiac arrest can increase in society. It is difficult to reach the entire population with cardiopulmonary resuscitation (CPR) training. However, if 15% of the population knows how to perform CPR, an increase in short- and long-term survival in patients suffering a cardiac arrest could be seen. To educate youth is a way to reach parts of the population. This study aimed to investigate the effect of a 2-h CPR intervention for youth.

BACKGROUND:

A rapid emergency care intervention can prevent the cardiac arrest from resulting in death. In order for Cardio Pulmonary Resuscitation (CPR) to have any real significance for the survival of the patient, it requires an educational effort educating the large masses of people of whom the youth is an important part. The aim of this study was to investigate the effect of a two-hour education intervention for youth regarding their self-confidence in performing Adult Basic Life Support (BLS).

METHODS:

A quantitative approach where data consist of a pre- and post-rating of seven statements by 50 participants during an intervention by means of BLS theoretical and practical education.

RESULTS:

The two-hour training resulted in a significant improvement in the participants' self-confidence in identifying a cardiac arrest (pre 51, post 90), to perform compressions (pre 65, post 91) and ventilations (pre 64, post 86) and use a defibrillator (pre 61, post 81). In addition, to have the self-confidence to be able to perform, and to actually perform, first aid to a person suffering from a traumatic event was significantly improved (pre 54, post 89).

CONCLUSION:

By providing youth with short education sessions in CPR, their self-confidence can be improved. This can lead to an increased will and ability to identify a cardiac arrest and to begin compressions and ventilations. This also includes having the confidence using a defibrillator. Short education sessions in first aid can also lead to increased self-confidence, resulting in young people considering themselves able to perform first aid to a person suffering from a traumatic event. This, in turn, results in young people perceiveing themselves as willing to commence an intervention during a traumatic event. In summary, when the youth believe in their own knowledge, they will dare to intervene.

Simulation provides the opportunity to learn how to care for patients in complex situations, such as when patients are exposed to high-energy trauma such as motor vehicle accidents. The aim of the study was to describe nurses' perceptions of high-energy trauma care through simulation in prehospital emergency care. The study had a qualitative design. Interviews were conducted with 20 nurses after performing a simulated training series. Data were analyzed using a phenomenographic method. The result indicates that simulation establishes, corrects, and confirms knowledge and skills related to trauma care in prehosp ital emergency settings. Trauma knowledge is readily available in memory and can be quickly retrieved in a future trauma situation. 

Background: Caring for patients in the end-of-life is an emotionally and physically challenging task. Therefore, undergraduate nursing students (UNS) need opportunities to learn to care for the dying patient. This study aimed to describe UNS' experiences of caring for patients at end-of-life.

Methods: Interviews with 16 UNS in their last semester of nursing education were conducted. Data were analyzed with a phenomenological approach.

Results: The UNS created a professional relationship with the dying patient. It meant that when the patient was unable to speak for themselves, the UNS could still meet his/her wishes and needs. The UNS believed they could take responsibility for the patient who was no longer able to take responsibility for themselves. Meeting with the patient's family could be experienced with anxiousness but was dependent on the personal chemistry between the patient's family and the UNS.

Conclusion: The UNS creates a relationship with the patient and their family. To be knowledgeable about the patient's physical and psychosocial needs means that the UNS can support the patient in the end-of-life phase. Being close to the patient and the family results in an intensity of emotions in the care situation. The UNS can receive support from their colleagues during processing their emotions and creating an experience from their encounters with patients in end-of-life care. 

The medical nature of esthetic treatments is confusing, as the boundaries between medicine and beauty are unclear. A person's autonomous decision is an indicator for esthetic treatments that will improve their self-image, self-esteem and appearance to others. Robust ethical consideration is therefore necessary for the medical esthetician in each meeting with the client. This study aimed to describe medical estheticians' perceptions of ethics and esthetics in injection treatments with Botox and Filler. The results are described in Understanding what different clients desire, Reaching a mutual understanding of expectations and possibilities and Taking responsibility for beauty.

Well-educated ambulance staff is a prerequisite for high-quality prehospital trauma care. The aim of this study was to examine how nurses in the ambulance service experienced participation in trauma simulation. Sixty-one nurses, working in an emergency ambulance service, performed simulated trauma care on four different occasions and afterward rated three statements on a 5-point Likert scale. A descriptive and inferential analysis was conducted. There are statistically significant increases between the pre- and posttests regarding all three statements: I think simulation of severe trauma with manikins is realistic (0.23 or 6% increase), Simulation is a suitable method for learning severe trauma care (1.3 or 38% increase), and I am comfortable in the situation learning severe trauma care through simulation (0.74 or 19% increase). With the experience of realism in simulation, participants become more motivated to learn and prepare for future events. If the participants instead feel uncomfortable during simulation training, they focus on their own feelings instead of learning. In a realistic simulated environment, participants are prepared to understand and manage the emergency care situation in clinical work. Participants learn during simulation when they are outside their comfort zone but without being uncomfortable or experiencing anxiety.

Introduction: Microscopy is gold standard for urine sediment analysis, although the method is often insufficiently standardized. Several automated instruments, such as UF-5000, are commercially available on the market. Urine sediment analysis is crucial for diagnosis of kidney and urinary tract diseases where elements such as erythrocytes, leukocytes, epithelial cells, casts and crystals can be identified. Aim: The aim was to evaluate the performance of UF-5000 and compare the method with manual microscopic analysis of urine sediment. Method: Analysis with UF-5000 and microscopy was conducted on 69 samples. Data were processed with Passing Bablok-regression, Bland-Altman bias plot and Spearman's rank order correlation. Result: Comparison showed statistical significance between the two methods. Performance evaluation showed high accuracy apart from the coefficient of variation for low concentration of leukocytes and systematic error for linearity. Discussion: Since microscopy of urine sediment is an insufficiently standardized method, differences were acknowledged caused by discrepancies in the reference method. Further studies where UF-5000 is compared to a more standardized manual microscopy with a larger amount of pathological urine samples is of great importance. Reduction for cut-off may also be relevant. For further analysis of linearity, an additional instrument should be used as a complement.

Fenomenet hemmasittare ökar i omfattning och utgör en aktuell problematik för forskning och de som arbetar inom skolans värld.  Skolkuratorer är en yrkesgrupp som arbetar aktivt med elever som är hemmasittare. Syftet med denna studie är att öka förståelsen för skolkuratorers arbete med hemmasittande högstadieelever. För att undersöka detta har författaren genomfört semi-strukturerade intervjuer med fyra skolkuratorer i en medelstor stad i Sverige. Studiens resultat baseras på en tematisk analys och behandlades följande två teman och tillhörande underteman: Elev-fokuserat arbetssätt och Varierande arbetsroller. Resultatet av den tematiska analysen visar att de intervjuande skolkuratorerna arbetar i nära kontakt med hemmasittande elever samtidigt som de förhåller sig till de krav och normer som skolan har och för att förstå detta analyseras resultatet med hjälp av Lipskys teori om gräsrotsbyråkrati.

Background: Leg and foot ulcers are expected to increase in the world as people live longer. Ulcer pain is common in patients who have difficult-to-heal leg and foot ulcers and can be treated in different ways. District nurses in home care service have a complex responsibility for these patients.

Aim: The aim of the study was to describe district nurses' experiences of pain management for patients with difficult-to-heal leg and foot ulcers in home care service.

Method: Three home care service units with a total of 14 participants were interviewed. The interviews were conducted in a municipality in southern Sweden and analyzed according to Graneheim and Lundman's content analysis with a manifest approach.

Results: The results are presented in three categories: Competence affect the possibility of pain assessment at home, The importance of applying different strategies for pain management at home and Organizational needs in home care service. It was found that the competence of district nurses influenced the assessment of wound pain in patients' homes. The district nurses used different strategies for pain management of leg and foot ulcers. They also emphasized the importance of having the right organizational conditions to be able to provide safe care in patients' homes.

Conclusion: When assessing pain, the use of pain assessment instruments is required, among other things. District nurses need to have the knowledge and ability to use different treatment strategies for pain relief. There is also a need of clear routines and common guidelines in the work with pain in difficult-to-heal leg and foot ulcers in home care service.

Sammanfattning

Bakgrund: Antalet personer med diabetes Mellitus typ 2 växer snabbt i världen. Egenvård krävs för att bromsa progressionen av DMT2 och förhindra eller fördröja komplikationer. Många personer med DMT2 sköter emellertid inte sin egenvård enligt rekommendationer.

Syftet: Att beskriva erfarenheter av egenvård hos personer med DMT2.

Metod: Med hjälp av Fribergs femstegsmodell gjordes en litteraturöversikt av elva kvalitativa studier om erfarenheter av egenvård hos personer med DMT2.

Resultat: Att integrera egenvården i vardagen är en utmaning. Familjen och vårdpersonalen har en nyckelroll och kan utgöra såväl ett hinder som ett stöd för egenvården. Andra personer med diabetes upplevs som ett entydigt positivt stöd. Att acceptera sjukdomen är en förutsättning för att kunna bedriva egenvården. Brist på förståelse och okunskap kring DMT2 utgör ett hinder mot egenvård. Personliga mål och feedback är avgörande för motivationen.

Slutsatser: Socialt stöd, acceptans av sjukdomen, positiv feedback och individualiserad information upplevs underlätta egenvård.

Background. Samis are indigenous people in north Europe. In the territory called Sa´pmi (Lapland), reindeer herding is the traditional base for the Sami economy. The relation between living conditions and positive health of the Swedish Samis has been sparsely studied. As health is closely linked to sense of coherence (SOC), an understanding of the background factors to SOC may contribute knowledge that might be useful in promoting living conditions and health.

Methods. The study examines relations between the level of SOC and background factors from surveys in a Sami population (n=613) in comparison to a non-Sami population (n=525) in Sweden, and in comparison between 2 subsamples of Samis, that is, herders and non-herders.

Results. There are more similarities than differences between the Sami and non-Sami populations. However, dividing the Sami population, reindeer herders had significantly lower SOC, and in specific the subcomponent manageability, that is, less ability to use available resources to meet different demands in life, compared to non-herders.

Conclusions. In addition to age and health, predictors of SOC are related to the life form of reindeer husbandry and the belonging to the herding community

The aim was to evaluate and test the psychometric properties of the Dental Hygienist Beliefs Survey (DHBS) in a Swedish sample of different patient groups and students. It was hypothesized that negative dental hygienist beliefs would discriminate between fearful and non-fearful study groups. The DHBS was distributed together with the revised Dental Beliefs Survey (DBS-R) and the Dental Anxiety Scale (DAS). The study sample included 394 subjects (130 students, 144 general dental patients, 90 periodontal patients and 30 patients on a waiting list for dental fear treatment). The results verified that the DHBS discriminates well between dentally fearful and non-fearful study groups. The DHBS had high internal consistency (Cronbach's alpha = 0.96-0.98) in all the groups. The correlation between the DHBS and the DBS-R was high (rho = 0.82, P < 0.001). Furthermore, the DHBS correlated significantly with the DAS, as well as with a low but significant correlation to age (more negative attitudes in younger age groups) and gender (more negative attitudes amongst women). Regression analysis showed that gender and the DHBS items: 23, 16 and 28, i.e. items related to feeling helpless, worries/fears not being taken seriously and fear about 'bad news' possibly preventing treatment, were the most important predictors of dental fear. The results suggest that the DHBS may be a valid and reliable scale to use in order to assess patient's specific attitudes to dental hygienists. However, the psychometric properties including test-retest analysis and the underlying factor structure of the DHBS need to be further explored.

The aim of this study was to evaluate and to test the psychometric properties of a Swedish version of the revised Dental Beliefs Survey (DBS-R) in different patient groups and in a non-clinical sample of students. It was hypothesized that negative dental beliefs, assessed using the DBS-R, would discriminate between fearful and non-fearful study groups. The questionnaire was distributed together with the Dental Anxiety Scale (DAS). The sample included 550 adults who responded to the questionnaires (206 students, 177 general dental patients, 105 periodontal patients and 62 patients at a waiting list for dental-fear treatment). The internal drop-out rate was low. The results confirmed that the DBS-R discriminates well between fearful patients and the other study groups. The DBS-R had a high internal consistency in all the study groups. Furthermore, the DBS-R correlated significantly with age (higher values in younger age groups) and the DAS. Regression analyses showed that the DBS-R subdimensions of 'communication' and 'control'/or 'trust', respectively, were significant predictors for dental fear. The results suggest that the DBS-R is a reliable and valid instrument for use in different Swedish patient- and non-clinical population groups in order to assess attitudes to dentists. However, the underlying factor structure of the DBS-R needs to be further explored and established.

Background: Children with intellectual disabilities living in developing countries are vulnerable to participation restrictions. Few studies have been made regarding their own perspectives. Aim: To describe how children in a low income country aged 13-17 with an intellectual disability perceive their participation in everyday life activities. Method: This bachelor thesis was conducted as a descriptive study and had a quantitative approach. Participants were collected through a non-probability, goal-oriented consecutive sampling. Data were collected by using “Picture my Participation”, an instrument designed as a structured interview with quantitative questions. The data were analyzed with IBM SPSS Statistics 21. Tables and diagrams were made in Microsoft Excel 2013. Result: The activity that the children participated in most frequently was “Daily routines at home for personal care (dressing, choosing clothing, hair care, brushing teeth)”. The activity that most children prioritized as most important, and they were most involved in was “Organised leisure activities”. “Services and policies” and “Social environment” were the factors seen as “Facilitators” to participation, whereas “Family attitudes” was seen as a “Barrier” to participation. Conclusion: The children perceived their participation in the prioritized activities as high and experienced few barriers in the context of participation.