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Background Limited language fluency can impede healthcare system navigation. In Sweden, the national telehealth line (Healthcare Guide 1177) offers interpretation in Arabic and Somali. We compared calls by language to identify differences in healthcare use for immigrant populations, focusing on three contact causes: pregnancy; vomiting or nausea in children; and worry/anxiety. Methods We conducted a cross-sectional analysis of 3.9 million (n  = 18 351 Arabic, n  = 7199 Somali) telehealth calls (2014–18). Using multivariable logistic regression, we investigated associations between language of the call (Arabic, Somali, non-interpreted) and each contact cause. Potential confounders (age, region, year, and additionally for vomiting or nausea, month) and an interaction between age and language were considered. Results Compared with non-interpreted calls, interpreted calls were associated with increased odds of being for pregnancy, especially for 19 to 29-year-olds [adjusted odds ratio (aOR) (95% CI) = 4.04 (3.66–4.46) and 4.60 (4.05–5.23), for Arabic and Somali calls, respectively]. Vomiting or nausea showed similar results, with aOR increasing with age: from 0.90 (0.75–1.07) (Arabic, <1 year) to 3.79 (2.86–5.01) (Somali, 5–9 years). In contrast, in unadjusted analyses, Arabic and Somali calls were associated with decreased odds of being for worry/anxiety [OR = 0.47 (0.38–0.58) and 0.34 (0.21–0.50)], respectively, compared with non-interpreted calls. Conclusion Our results suggest callers to the interpreted lines may need additional assistance navigating the healthcare system for pregnancy and for vomiting or nausea among children. These findings can inform healthcare services planning for immigrants to Sweden and highlight a novel use of telehealth data as a way to uncover disparities in healthcare use within a multi-linguistic population. [ABSTRACT FROM AUTHOR]

Background: The ongoing global migration has led to multicultural societies, with many migrants who do not speak the official language in the host country. This could contribute to communication problems with staff in healthcare and a risk to patient safety. Research on patient safety in medication use in migrants is an under-researched area. The aim was to explore diverse foreign-born people's experiences and perceptions of self-management of medication and determine if home-based practice patterns have implications on medication safety, and what factors may support safe medication use. Methods: A qualitative explorative study, with individual semi-structured interviews and participant observations in the patients' home. Qualitative content analysis was applied. Results: A purposeful sample of 15 foreign-born persons identified by healthcare staff as having language difficulties in Swedish that may pose a safety risk in connection with medication use at home, was selected. Three categories were identified. The first category showed respondents being dependent on another person, having experiences of not receiving information about their medications due to language barriers, having difficulties getting access to the healthcare centre and feeling distrusted/misunderstood. The second category showed respondents being independent and self-motivated Although they struggled, they managed to get access/contact with the healthcare centre themselves and felt understood/listened to by the staff. The last category concerned factors that facilitating medication use; such as having a medication list in the respondents' own language and offering a choice of language on the answering machine at the healthcare centre. Although they knew it was impossible to get an interpreter at the pharmacy, they felt safe knowing there was always a solution for receiving understandable information. Conclusion: The findings highlighted that language barriers can complicate the communication between migrants and the healthcare, which can affect the medication safety. Understanding of this group is essential to improve the cooperation between patients and staff, leading to culturally congruent care. This knowledge should be used in healthcare to understand the gap in communication to increase patient safety. Further research from other angles, e.g. pharmacy/healthcare staff and relatives is needed to identify and evaluate facilitation to improve the outcome of the intended medication treatment. [ABSTRACT FROM AUTHOR]

Purpose: Postpartum Depression (PPD) --a common health problem for mothers' postpartum increases the risk of negative interaction between mothers and infants as it reduces the former's ability to respond to the latter's needs appropriately. Migrant mothers exhibit a higher prevalence of risk factors for PPD. Hence, this study aimed to investigate migrant mothers' life experiences pertaining to motherhood and PPD. Methods: Qualitative interviews were conducted with 10 immigrant mothers in the south of Sweden during 2021. Results: The qualitative content analysis revealed the following main themes: 1) PPD (two sub themes--psychosomatic symptoms and burden of responsibility due to feelings of loneliness); 2) mistrust of social services (one sub-theme--afraid of losing their children and Swedish social services' lack of understanding); 3) inadequate healthcare (two subthemes-- limited healthcare literacy for migrant mothers and language barrier; 4) women's coping strategy for well-being (two sub-themes--better awareness and understanding of the Swedish system and society, and freedom and independence in the new country). Conclusions: PPD, mistrust of social services, and inadequate healthcare lacking personal continuity were common among immigrant women, thus precipitating discrimination-- including lack of access to services because of limited health literacy, cultural differences, language barriers, and insufficient support. [ABSTRACT FROM AUTHOR]

Aim. The aim of the research is to identify intergenerational communication problems in tourism and hospitality enterprises and define teaching/learning initiatives and methodologies required to develop employees' competencies to solve intergenerational communication problems. Methods. 12 semi-structured expert interviews with tourism and hospitality business owners and/or top-level management in three countries (Lithuania, Latvia, and Sweden) were conducted to collect information on generational differences in communication and intergenerational communication problems in the company. Qualitative content analysis was applied for data analysis. Results. Nine main groups of intergenerational communication problems have been detected and corresponding teaching/learning initiatives and methodologies that take into account the specific characteristics of each generation are recommended to eliminate each of the problems identified. Conclusion. Generational differences and differences in communication lead to intergenerational communication conflicts in tourism and hospitality enterprises. The suggestions on organising adult learners' teaching/learning process based on generational differences may be applicable in workplace learning and also in educational institutions providing adult education. Cognitive value. The paper focusses on analysing intergenerational aspects in communication processes in tourism and hospitality enterprises and offers the means of solving communication conflicts by employing certain adult teaching/learning initiatives and methodologies suitable to non-formal and formal adult learning. [ABSTRACT FROM AUTHOR]

Families arriving in Sweden after being forced to flee their home need health care. Communication is a key component to establishing good care relations and becomes difficult when there are language barriers between families and healthcare professionals. In the context of neonatal care, communication is carried out with parents. The aim of the study was to describe parents' experiences of communication with neonatal healthcare professionals and using pictorial support when language barriers exist. The study takes a qualitative approach based on seventeen interviews with parents who had experienced neonatal ward. Qualitative content analysis was used. The parents needed to communicate through supports, which caused distress and misunderstanding. The relationship between parents and the healthcare professionals affected the communication. Pictorial support was used to different degrees. Four categories were identified from the data analysis: Communicating through supports, Facing barriers in communication, Facing external influences and The need for a good healthcare relationship. The present study is the first to describe parents' experience with using the pictorial support developed in the project KomHIT Refugee and therefore fulfils the function of being a first evaluation of the pictures from parents' perspective. [ABSTRACT FROM AUTHOR]

COVID-19 has highlighted the importance of health information for prevention of communicable disease. Knowledge about groups that have high risk is important to prevent disease transmission. In Sweden, immigrants have been identified as one such group. Yet, little is known about where they have sourced information about COVID-19 and their opinions toward it. The aim of this study was to describe the COVID-19 information sources used by immigrants with limited proficiency in Swedish as well as their opinions on how comprehensive the information has been, the importance of the recommendations and their possibility to follow them. A cross-sectional survey was conducted via introductory Swedish language classes in Region Uppsala (n = 855). The results showed the immigrants were using different information sources, with the majority using school, media and social media. The immigrants' opinions about COVID-19 information differed. Most reported they knew where to find information; however, over two-fifths reported the recommendations from the authorities should be more extensive. The majority reported it is important to follow the recommendations, whereas the possibility to follow the recommendations was more mixed. Age differences in opinions toward COVID-19 information were detected. Although the results were largely positive, there still appears to be a need for improvement in how immigrant groups with limited ability in the host country´s language are reached. Effective health communication that engages the whole nation is an important factor authorities should commit to as we face the current pandemic. This research suggests that an approach tailored by age could be helpful. [ABSTRACT FROM AUTHOR]

Background: Difficulty in communicating can lead to stressful situations both for foreign‐born female patients suffering from common mental disorders (CMDs) and for the health care professionals. Aim: The aim of the study was to explore how foreign‐born female patients with CMDs experienced their health care encounters and how they perceived a care manager could be a support during their illness, as well as to explore the care managers' perceptions and experiences concerning this group. Methods: A qualitative method with semi‐structured interview was chosen. The data were analysed with systematic text condensation. The study was conducted in primary care in western Sweden. Eight Persian‐speaking female patients were recruited by the snowball method and participated in the study. Furthermore, nine care managers participated. Results: Foreign‐born female patients felt shame and anxiety because of language difficulties, interpreter presence, mental illness, and feelings of dependency. The care managers and the patients felt that physical meetings, access to translated assessment scales and female telephone interpreters, and early and continuous contact and access to health care personnel with a similar cultural background could facilitate communication. Conclusion: In order to facilitate mutual understanding and knowledge, accessibility and continuity of health care are needed to enable foreign‐born female patients with CMD to support their own health development. Female interpreters, telephone interpreting, translated scales, and telephone contacts combined with face‐to‐face visits could facilitate communication. [ABSTRACT FROM AUTHOR]

Young unaccompanied refugees come in contact with acute psychiatric care due to pre‐existing mental health conditions as well as stressful and traumatic experiences before, during, and after migration. Previous research on nurses' experiences of caring for refugees has primarily reported on difficulties related to cultural differences and communication and how nurses might distrust refugees. This study aimed to describe registered nurses' experiences of caring for young unaccompanied refugees in acute psychiatric care. Semi‐structured interviews with ten nurses were analysed using a method for qualitative content analysis. Data were collected in Sweden during 2019 and 2020. Results describe nurses' experiences of caring for young unaccompanied refugees in acute psychiatric care in one theme: learning your limits and three sub‐themes: feeling powerless but doing what you can; taking a stance in a politicized environment; and being frustrated and in need of support. Findings highlight the potential and limitations of mental health nursing, the importance of reflection and peer support, and the importance of viewing the roles and responsibilities of mental health nurses and nursing in a societal context. These findings suggest that nurses can make a difference for young unaccompanied refugees in acute psychiatric care. However, in doing so, nurses need support in realizing what they can and cannot achieve. The study is reported in accordance with the COREQ guidelines. [ABSTRACT FROM AUTHOR]

Objective: The aim of the study was to explore the communication tools that child healthcare nurses can use during home visits to families when language barriers exist. Design: Qualitative study using data collected from focus group sessions. Sample: Six semi‐structured focus group interviews with twenty nurses in child healthcare services. Measurements: The results were analyzed with a thematic content analysis. Results: The analysis resulted in two themes: Using pictures as support in the conversation, with subthemes Not using pictures as support, Wanting to know how to use pictures as support, Pictures as support for invitations, Different types of pictures as support, and Alternative means of communication with the subthemes Possibilities of using an interpreter, Obstacles to using an interpreter, Mixed communication. Conclusion: If language barriers are present during home visits, decision‐making nurses in Child Health Care (CHC) put families in an unequal position when communicating with them. These results point to a need for more education, guidelines and support regarding alternative and augmentative communication (AAC) tools and structures to assist in overcoming language barriers. [ABSTRACT FROM AUTHOR]

Background: Telephone triage at emergency medical dispatch centres is often challenging for registered nurses due to lack of visual cues, lack of knowledge about the patient, and time pressure – and making the right decision can be a matter of life and death. Some calls may be more difficult to handle, and more knowledge is needed about these calls to develop education and coping strategies. Therefore, the aim of this study was to describe the perspectives of registered nurses' views about managing difficult calls to emergency medical dispatch centres. Methods: A descriptive design with a qualitative inductive approach was used. Three dispatch centers in mid-Sweden were investigated, covering about 950,000 inhabitants and handling around 114,000 calls per year. Individual interviews were carried out with a purposeful sample of 24 registered nurses. Systematic text condensation was conducted. Results: Seven themes were generated: calls with communication barriers, calls from agitated or rude callers, calls about psychiatric illness, calls from third parties, calls about rare or unclear situations, calls with unknown addresses and calls regarding immediate life-threatening conditions. There was a strong consensus among the registered nurses about which calls were experienced as difficult, with the exception of calls about immediate life-threatening conditions. Some registered nurses thought calls about immediate life-threatening conditions were easy to handle as they simply adhered to protocol, while others described these calls as difficult and were emotionally affected. Conclusion: The registered nurses' descriptions of difficult calls focused on the callers, while their own role, the organisational framework, and leadership were not mentioned. Many types of calls included difficulties, which could be related to the caller, their symptoms, or different circumstances. The registered nurses pointed to language barriers and rude, agitated callers as increasing problems. An investigation of actual emergency calls is warranted to examine the extent and nature of such calls. [ABSTRACT FROM AUTHOR]

Objective: To investigate the reasons for not using interpreters to secure patient-safe communication.Methods: Healthcare personnel at six paediatric oncology centres in Sweden responded to the Communication over Language Barriers questionnaire. Descriptive and comparative analyses were performed.Results: The participants (n = 267) often cared for patients with limited Swedish proficiency, although they were not trained in using interpreters. A lack of time was perceived as a barrier in emergency care situations, but also in planned care situations. Another barrier was the interpreter's ability to correctly interpret medical/care terminology. There were significant differences in evaluating the interpreters' abilities between those with/without education in using interpreters, and between Medical Doctors and Nursing Assistants. Participants were unsure whether the patient had received the correct information and thought that it was difficult to control the family/patient's understanding of the given information. The vast majority did not perceive financial constraints as a barrier for using interpreters.Conclusions: Economic resources and legislation are not enough to increase the use of interpreters. Reasons for not using interpreters are found in limitations of time, training, and interpreters' skills and knowledge.Practice Implications: There is a need for a greater focus on training, interpreters' skills, and booking procedures in paediatric healthcare. [ABSTRACT FROM AUTHOR]

Background: Child forensic interviewers have expressed concerns regarding the quality of interpreter-mediated child forensic interviews. However, research on interpreters' perspectives on these interviews is scarce and specialized education for interpreters limited., Objective: This mixed-methods study aimed to explore interpreters' experiences and knowledge of interpreting child forensic interviews., Participants and Setting: A total of 130 Swedish interpreters with different authorization statuses responded to a digital survey about interpreting child forensic interviews., Methods: Qualitative data were analyzed with reflexive thematic analysis and content analysis, and quantitative data with descriptive and inferential statistics., Results: Interpreters reported challenges concerning children's limited language skills, the emotional effects of interpreting child forensic interviews, the limited access to information before interviews, and the complex balance between following interpreters' ethical guidelines and adjusting for situational demands. Regarding practical conditions, interpreters preferred interpreting in person instead of via telephone. Interpreters' general knowledge of child forensic interviewing did not differ between interpreters with different authorization statuses (F(2,108) = 0.80, ω 2  = -0.002, p = .45), except from views on using leading questions (H(2) = 17.34, η 2  = 0.14, p < .001) and whether interpreters may clarify terms to child interviewees (H(2) = 8.02, η 2  = 0.06, p = .02)., Conclusions: It is crucial to consider interpreters' perspectives when striving to improve the quality of interpreter-mediated child forensic interviews. Interpreters should be provided sufficient information to prepare and assess their suitability. Interpreters should also be offered education in interpreting child forensic interviews and given appropriate service structures to support their wellbeing., Competing Interests: Declaration of competing interest None., (Copyright © 2023 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Based on a study of prevention politics in Sweden, this article probes the turn to resilience in its institutionalized form: cross-sectorial partnerships. It interrogates how resilience proponents strategically deploy the semantics of the shift in policymaking, arguing that they perform the 'shift' (in mind-set) to criticize a long-established welfare-state governmentality, associated with professional 'silos', to create new possibilities for partnership-organized intervention. Part I draws attention to how resilience policy mobilizes partnerships around the indeterminate problem of 'problem setting'. Based on the idea of limited knowledge and governance in an indeterminate world, failure is considered inevitable and potentially productive, if handled appropriately – which is an issue of problem design or framing. It is considered particularly important to handle problems of coordination and communication internal to partnerships, since failures here risk jeopardizing collaboration and hence the whole enterprise. Part II demonstrates how partnership-organized resilience initiatives bracket-off risky failure by strategically reframing problems and bringing new visions of the future into being – through the semantics of the shift. In characteristically epochal terms, the 'shift' casts partnership formation as an improvement of the future, although the strategists' belief in future visions is apparently shot through with cynicism. [ABSTRACT FROM AUTHOR]

Purpose: In general, newly resettled refugees have poorer physical and mental health than native-born Swedes. This indicates that the society must make special efforts to enable refugees to attain health that is on a par with the rest of the population. The challenges rest primarily with employees in the public sector. But what resources do professionals need to meet the refugees' health needs? This paper is about the need to develop strategies for professionals working with diversity and health, with a focus on the establishment of newly resettled refugees in Sweden. Thus, the purpose of this paper is to identify the needs and obstacles in working with diversity and health for the newly resettled. Design/methodology/approach: The paper is based on focus group interviews with 40 professionals working in three large municipalities and one County Administrative Board, all of whom work with challenges related to migration and health on a daily basis. Findings: The needs expressed by the interviewees are primarily about developing and improving communications. Three important areas of communication were expressed: how information can be transferred from sender to receiver, institutionalization and interactions at different levels. Originality/value: This paper identifies important needs and obstacles when working with diversity and health in Sweden, with a focus on the establishment of newly resettled refugees. It is an important contribution because refugees in general have poorer physical and mental health than native-born Swedes and strategies to improve their health, therefore, need to be further developed. [ABSTRACT FROM AUTHOR]

Background: Healthcare personnel are responsible for providing patient-centered care regardless of their patients' language skills, but language barriers is identified as the main hindrances providing effective, equitable and safe care to patients with limited proficiency in a country's majority language. This study is a national multisite cross-sectional survey aiming to investigate communication over language barriers in pediatric oncology care. Material and Methods: A survey using the Communication over Language Barriers questionnaire (CoLB-q) distributed to medical doctors, registered nurses and nursing assistants at six pediatric oncology centers in Sweden (response rate 90%) using descriptive statistical analyses. Results: Professional interpreters on site were the most common solution when using an interpreter, although relatives or even children were used. The use of professional interpreters on site differed among the professions and in different clinical situations, such as medical encounter, education or procedure preparation. All professions reported that the use of professional interpreters greatly increased care relationships, patient safety and patient involvement in care. Conclusions: Healthcare personnel seem to believe that professional interpreters are crucial when caring for patients and family members who do not speak the majority language, but there is an obvious discrepancy between this belief and their use of professional interpreters. [ABSTRACT FROM AUTHOR]

Aims and objectives: To explore the strategies of nurses working in the ambulance service while caring for patients with limited Swedish–English proficiency. Background: Communication difficulties due to lack of mutual language is a challenge in healthcare systems around the world. Little is known about nurses’ strategies while caring for patients with whom they do not share a mutual language in an unstructured, unplanned prehospital emergency environment, the ambulance service. Design and Method: A qualitative study design based on interviews was used, and a purposeful sample and snowball technique were used to identify nurses with prehospital emergency experience of caring for patients with limited Swedish–English proficiency. Results: Eleven nurses were interviewed, and the main strategy they used was adapting to the patients’ need and the caring situation. The nurses used their own body, and tone of voice for creating a sense of trust and security. The nurses also used structured assessment in accordance with medical guidelines. Translation devices and relatives/bystanders were used as interpreters when possible. Another strategy was to transport the patient directly to the emergency department as they had not found a secure way of assessing and caring for the patients in the ambulance. Conclusion: The nurses used a palette of strategies while assessing and caring for patients when there was no mutual language between the caregiver and care seeker. Relevance to clinical practice: The nurses need to be prepared for how to assess and care for patients when there is a lack of mutual language; otherwise, there is a risk of increased unequal care in the ambulance service. To further explore and learn about this field of research, studies exploring the patients’ perspective are needed. [ABSTRACT FROM AUTHOR]

Purpose: The aim of the present study was to identify problems with communication with persons with aphasia and persons with dementia in a collaborative interview setting with their significant others. In particular, to compare interactional practices used in order to resolve problems caused by specific symptoms. Method: Five persons with aphasia and five persons with dementia and their spouses participated in the study. Interviews were carried out couple by couple, and the interviews had a task-oriented character. The interviews were video and audio recorded. All interviews were transcribed. From the transcriptions categorisations according to previous literature were made. Result: The results demonstrated that repair sequences were frequent in interaction involving people with aphasia (PWA), and even more so in interaction involving persons with dementia (PWD). In general, it was the PWA/PWD that initiated the repair sequence more often than the spouse, thus keeping the general rule of a preference for self-initiated repair compared to other-initiated repair. Conclusion: The active involvement of the conversational partners in trouble solving sequences in interaction with PWA/PWD demonstrated in the present study indicates that the interactional style of the conversational partner to PWA/PWD important. This implies that conversation partner training programmes would be useful both for PWA and for PWD. [ABSTRACT FROM AUTHOR]

Background:Despite the negative impacts of several cancer treatments on fertility, many patients do not recall having fertility-related discussions with their physicians. This study was conducted to identify those factors related to physicians’ discussing the treatment impacts on fertility with cancer patients of reproductive age. Material and methods:In this nationwide survey of cancer care physicians (n = 329, response rate 55%), oncologists and hematologists (mainly) completed a questionnaire on practice behavior, barriers, attitudes and confidence in knowledge regarding treatment-related fertility risks. Logistic regression analyses were conducted to identify factors associated with not routinely discussing fertility issues with patients. Results:Most of the physicians agreed that they were responsible for discussing fertility issues with patients of reproductive age (91%), but approximately 30% did not do so regularly. Those factors decreasing the likelihood of discussion were: patient already had children (female/male OR 3.0/6.9), high workload (OR 3.3/4.8), seeing <5 female/male patients of reproductive age weekly (OR 3.2/3.4) and access to a reproduction clinic (OR 5.2/4.2). Conclusions:Most Swedish oncologists and hematologists regularly discuss impact of treatment on fertility with their patients. Those factors having a negative impact on fertility discussions may guide targeted organizational and educational efforts to further improve fertility-related communication in cancer care. [ABSTRACT FROM AUTHOR]

Background Because of worldwide migration, the healthcare staff in general as well as in paedi"atric care specifically is challenged increasingly by people from various ethnic backgrounds. The challenge is related to providing culturally competent care and effectively communicating with people from diverse cultural and ethnic backgrounds who have different health beliefs, practices, values and languages. This also applies to the Swedish society and to Swedish paediatric care. Aim The purpose of this study was to describe the expectations and experiences of cross-cultural care encounters among minority ethnic parents in Swedish paediatric care. Method A qualitative design was used in the study. Data were collected using semi-structured interviews between October 2011 and March 2012. The sample consisted of 12 parents of minority ethnic backgrounds who had their child in a ward at a children's hospital in the Stockholm County Council. The interviews were analysed using manifest content analysis. Ethical considerations The Regional Ethical Review Committee approved the study (Ref: Nr: 2011/927-31/5). Results The analysis of the interviews led to three categories: fundamentals in nursing, cultural sensitivity and understanding, and influencing conditions. Conclusions Generic knowledge and skills of nurses outweighed the need for the nurses to have culture-specific knowledge of their patients or relatives in cross-cultural care encounters. Language skills and the availability of bilingual nurses in a multi-ethnic society can facilitate communication and increase parents' satisfaction in cross-cultural care encounters. [ABSTRACT FROM AUTHOR]

Introduction: Workplace violence within the ambulance services is a serious problem. A prevalence of up to 8.5% of all ambulance missions has previously been reported. Prior research used a retrospective design and the knowledge of risk factors for workplace violence is weak. Therefore, the aim of the current study was to measure the prevalence of workplace violence within the ambulance service in a Swedish region. Method: This was a prospective cohort study using data from all ambulance missions in a region in Sweden during one year. The data was analyzed with descriptive and analytic statistics using SPSS. Results: Data was collected from 28,648 ambulance missions. A total of 209 unique workplace violence incidents were reported, corresponding to a prevalence of 0.7%. Seventy-three of all incidents reported physical violence and 161 verbal threats, where some of the incidents included both physical and verbal violence. The most common risk factors for workplace violence were: the perpetrator was under the influence of alcohol or drugs (70.5%), mental illness (60.5%) and communication problems (15.3%). The perpetrator was most often a man (n=68%) between 18 and 29 years of age. Co-variation between the risk factors was high. No significant differences in the occurrence of workplace violence could be seen in relation to time of the year, weekday, or time of day. Conclusion: The prevalence of workplace violence was one of the lowest reported. An understanding of risk factors could be used within the ambulance service and dispatch centers to identify situations with an increased risk of workplace violence and mitigate the risk of such incidents. [ABSTRACT FROM AUTHOR]

Background Pain is a common postoperative symptom, and length of hospital stay after surgery is short which highlights the importance of pain assessments. Experiences of assessing pain are mainly described from the perspective of nurses. In postoperative care, enrolled nurses and physicians also assess pain. It is therefore important to take note of their experiences to improve postoperative pain assessments. Objectives The aim of this study was, through considering critical incidents, to describe care experiences and actions taken by healthcare professionals when assessing postoperative pain. Methods An explorative design employing critical incidents technique analysis was used. A total of 24 strategically selected enrolled nurses, nurses and physicians employed at orthopaedic or general surgery wards in four Swedish hospitals were interviewed. The intention was to reach variation in age, sex, profession and professional experience. Findings In pain assessments, patient-related facilitators were patients' verbal and emotional expressions including pain ratings, while lack of consistency with observed behaviours was a barrier. Clinical competence, continuity in care and time were healthcare-related facilitators. The actions healthcare professionals took were gathering facts about patients' pain manifestations and adapting to patients' communication abilities. Patient observations, either passive or active were used to confirm or detect pain. Collaboration between healthcare professionals, including consultations with pain experts, social workers and relatives, strengthened understanding of pain. Conclusions Communication skills and working conditions have an impact on performance of pain assessment. Patient comfort without compromising safety is reached by including healthcare professionals' dissimilar responsibilities when collecting patients' and relatives' perspectives on current pain. [ABSTRACT FROM AUTHOR]

The total number of persons living with dementia is estimated to double every 20 years and ageing migrant populations are growing in several countries. There are gaps in the health and social care of people from other countries, regardless of the efforts made when someone has a dementia diagnosis; similarly, receiving care in sheltered accommodation is less common. The aim of this study was to explore and describe the nursing staff's experiences of caring for non-Swedish speaking persons living with dementia in a Finnish speaking group home in relation to a Swedish speaking group home in Sweden. 27 qualitative semi-structured interviews were analysed using qualitative content analyses. The first main category, "communication", concentrated on language abilities and deficiencies, non-verbal language, highlighting the consequences of not understanding and the benefits of a common language. The second main category, "culturally oriented activities", focused on being served traditional food, celebrating holidays at the group home, the importance of traditions and the importance of familiar music as cultural elements. The Swedish speaking nursing staff could provide qualitative and equitable care, but the challenge was greater for them than for the bilingual nursing staff who spoke the same language as the residents. [ABSTRACT FROM AUTHOR]

Using the methodology of conversation analysis to examine audio-recorded multi-party conversations between a Swedish-/Farsi-speaking resident and multilingual staff in a Swedish residential home, this article describes a practice for establishing shared understanding by one caregiver enacting the role of language broker. The focus is on caregiving settings where caregivers assist an elderly person with her personal hygiene. We demonstrate how brokering is used to (1) maintain the conversational flow in a small talk sequence and (2) address the contents in the resident's complaints. The article thus advances our understanding of language brokering as an activity that multilingual staff in a linguistically asymmetrical workplace setting take on to assist a colleague in performing client-oriented activities. [ABSTRACT FROM AUTHOR]

Background: Immigrants experience significant challenges when in contact with healthcare and report less satisfaction with maternity care compared to native Swedes. Research that gives voice to pregnant immigrant women and their partners following a prenatal diagnosis of a fetal anomaly is scarce. Thus, the aim of this study was to explore experiences and preferences of care following a prenatal diagnosis of congenital heart defect among Swedish immigrants.Methods: Pregnant immigrants and their partners were consecutively recruited following a prenatal diagnosis of a congenital heart defect in the fetus. Nine respondents were interviewed in five interviews, four with the aid of a professional interpreter. The material was analyzed using manifest qualitative content analysis.Results: The analysis resulted in five categories: 1) "Trustworthy information", 2) "Language barriers", 3) "Psychosocial situation", 4) "Peer support", and 5) "Religious positions".Conclusion: The potential need for interpreter services, visual information, psychosocial support, coordination with welfare officers, and respect for religious positions about termination of pregnancy are all important aspects for health professionals to consider when consulting immigrants faced with a prenatal diagnosis of fetal anomaly in the fetus. Peer support within this context needs to be further explored in future studies. [ABSTRACT FROM AUTHOR]

Aims and objectives To study a group of immigrants' experiences regarding interactions with primary health care through an interpreter. Background Approximately, 230 million people are resettled outside of their own home country. Thus, more than 3% of the world's population are migrants. It is a major challenge for health care providers to satisfy immigrants' needs for individualised health care services. Design Qualitative study. Methods Focus group interviews were conducted with four groups of immigrants ( n = 24) from Bosnia and Herzegovina, Croatia, Kosovo and Somalia. The group interviews were audio recorded, transcribed and analysed, and the text was categorised using the content analysis method. Results Participants′ expectations of the interpreter-mediated consultations were high, but not always fulfilled. Interpreters being late, lacking professionalism or lacking knowledge in medical terminology and the use of health care professionals or relatives as interpreters were some of the problems raised. Conclusion A well-organised, disciplined interpreter service with professional and competent interpreters is needed to overcome problems regarding clinical consultations involving interpreters. A satisfactory language bridge has a significant impact on the quality of communications. Clinical implication Interpreter services should be well organised, and interpreters should be linguistically, culturally and socially competent, as these factors may have a significant impact on consultation outcomes. Using relatives or staff as interpreters can sometimes be a solution but often results in an unsatisfactory clinical consultation. [ABSTRACT FROM AUTHOR]

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Background and objectives Managing communicative disability is a pervasive issue in long-term care facilities. The aim of this study was to explore how enrolled nurses experience their everyday interactions with residents in nursing homes, particularly focusing on interactions with residents with communicative disability. Design A qualitative exploratory design including content analysis was used. Participants and setting Eight individuals working at six nursing homes in western Sweden were interviewed. Method The interviews were semi-structured with questions about the participants’ experiences in communicating with residents, feelings associated with interactions involving residents with communicative disability, meaning ascribed to interactions, and factors influencing interactions. The interviews were analysed using content analysis. Results A dynamic interplay between interpersonal relations, daily interactions and the managing of communicative disability was revealed. The enrolled nurses had good knowledge of supportive strategies and an awareness of the importance of the development of personal relationships with residents in order to facilitate interaction. However, factors in the environment presented barriers to communication. Conclusions/implications The organisation and physical environment of nursing homes prevent the enrolled nurses from taking full advantage of the communicative resources they have in interaction with residents with communicative disability, hence affecting staff–resident relationships and the delivery of person-centred care. [ABSTRACT FROM AUTHOR]

Background: Worldwide, there is a growing population of older people who develop dementia in a country other than that of their origin. When their dementia has reached an advanced stage, residential care is most often needed. People with dementia in Sweden are often cared for in group homes. For immigrants, this may mean a linguistically challenging care environment for both healthcare staff and the patients' family members. The aim of this study was to explore and describe the experiences of family members and professional caregivers regarding the care provided to immigrants with dementia in group homes in Sweden.Methods: An exploratory, descriptive study with a qualitative approach was chosen. In-depth semi-structured interviews were conducted with nine professional caregivers and five family members of people with dementia with Finnish, Estonian, Hungarian and Ingrian backgrounds; all were chosen purposefully. All people with dementia had lost their Swedish language skills as their second language. The data was analysed using qualitative content analysis.Results: Three main categories and seven subcategories were identified. The first main category: A new living situation comprised the subcategories: adjusting to new living arrangements and expectations regarding activities and traditional food at the group home, the second main category: Challenges in communication with the subcategories: limited communication between the immigrant with dementia and the Swedish-speaking nursing staff and the consequences of linguistic misunderstandings and nuanced communication in a common language and the third main category: The role of the family member at the group home with the subcategories: a link to the healthy life story of the family member with dementia and an expert and interpreter for the nursing staff.Conclusions: The family member played a crucial role in the lives of immigrants with dementia living in a group home by facilitating communication between the nursing staff and the PWD and also by making it possible for PWD to access the cultural activities they wanted and which professional caregivers were either not able to recognise as needed or could not deliver. [ABSTRACT FROM AUTHOR]

Background: In Sweden, migrants from countries considered to have a high burden of certain infectious diseases are offered health screening to prevent the spread of these diseases, but also identify their health needs. However, very little is known about their experiences and perceptions about the screening process. This study aimed at exploring these perceptions and experiences in order to inform policy and clinical practice.Method: Using an interpretive description framework, 26 new migrants were interviewed between April and June 2013 in four Swedish counties. Thematic analysis was used to analyze data.Results: The three themes developed include: new country, new practices; new requirements in the new country; and unmet needs and expectations. Participants described what it meant for them to come to a new country with a foreign language, new ways of communicating with caregivers/authorities and being offered health screening without clarification. Participants perceived health screening as a requirement from the authorities to be fulfilled by all newcomers but conceded that it benefits equally the host society and themselves. However, they also expressed concern over the involvement of the Migration Board staff and feared possible collaboration with health service to their detriment. They further stated that the screening program fell short of their expectations as it mainly focused on identifying infectious diseases and overlooked their actual health needs. Finally, they expressed frustration over delay in screening, poor living conditions in reception centers and the restrictive entitlement to care.Conclusions: Migrants are aware of their vulnerability and the need to undergo health screening though they view it as an official requirement. Thus, those who underwent the screening were more concerned about residency rather than the actual benefits of screening. The issues highlighted in this study may limit access to and uptake of the screening service, and compromise its effectiveness. To maximize the uptake: (1) linguistically and culturally adapted information is needed, (2) other screening approaches should be tried, (3) trained medical interpreters should be used, (4) a holistic and human right approach should be applied, (5) the involvement of migration staff should be reconsidered to avoid confusion and worries. Finally, to improve the effectiveness, (6) all migrants from targeted countries should be offered screening and efforts should be taken to improve the health literacy of migrants and the living conditions in reception centers. [ABSTRACT FROM AUTHOR]

Background: National statistics have shown that only about 40% of asylum seekers actually attend the optional health assessment offered upon their arrival in Sweden, but the reasons for this have not been fully explored. Health assessments for newly arrived asylum seekers have become a regular practice in most EU countries, but what is performed, how it is organized and whether it is mandatory or not varies between countries. Aim: The aim of the study was to explore and improve our understanding of how former asylum seekers from Eritrea perceived and experienced the health assessment during their asylum-seeking process. Methods: We used a qualitative research approach guided by grounded theory. Semi-structured interviews were conducted with 11 former asylum seekers from Eritrea. Data were analysed based on constant comparative analysis. Findings: The asylum seekers expressed feelings of ambiguity and mistrust and felt that they were seen only as objects by the Swedish healthcare system during their asylum-seeking process. Poor communication and inability to overcome language and cultural barriers seemed to be the most important findings in the narratives. The core category was defined as ‘A state of limbo – in transition between two contexts’. Conclusions: There are reasons to believe that these issues with communication negatively affected both the quality of the health assessment and the number of asylum seekers attending the health assessment. Improved communication by the authorities towards the asylum seekers is, therefore, of vital importance. [ABSTRACT FROM AUTHOR]

Background Many Western countries have cervical cancer screening programmes and have implemented nation-wide human papillomavirus ( HPV) vaccination programmes for preventing cervical cancer. Objective To explore immigrant women's experiences and views on the prevention of cervical cancer, screening, HPV vaccination and condom use. Design An exploratory qualitative study. The Health Belief Model ( HBM) was used as a theoretical framework. Setting and participants Eight focus group interviews, 5-8 women in each group (average number 6,5), were conducted with 50 women aged 18-54, who studied Swedish for immigrants. Data were analysed by latent content analysis. Results Four themes emerged: (i) deprioritization of women's health in home countries, (ii) positive attitude towards the availability of women's health care in Sweden, (iii) positive and negative attitudes towards HPV vaccination, and (iv) communication barriers limit health care access. Even though the women were positive to the prevention of cervical cancer, several barriers were identified: difficulties in contacting health care due to language problems, limited knowledge regarding the relation between sexual transmission of HPV and cervical cancer, culturally determined gender roles and the fact that many of the women were not used to regular health check-ups. Conclusion The women wanted to participate in cervical cancer prevention programmes and would accept HPV vaccination for their daughters, but expressed difficulties in understanding information from health-care providers. Therefore, information needs to be in different languages and provided through different sources. Health-care professionals should also consider immigrant women's difficulties concerning cultural norms and pay attention to their experiences. [ABSTRACT FROM AUTHOR]

Introduction The prevailing inequities in healthcare have been well addressed in previous research, especially screening program participation, but less attention has been paid to how to overcome these inequities. This paper explores a key factor of a successful improvement project: collaboration with local doulas to raise cervical cancer screening participation by more than 40 percent in an area with a large number of foreign-born residents. Methods Data was collected through two focus group discussions with the doulas in order to design interventions and debrief after interventions had been carried out in the community. Various tools were used to analyze the verbal data and monitor the progress of the project. Results Three major themes emerged from the focus group discussions: barriers that prevent women from participating in the cervical cancer screening program, interventions to increase participation, and the role of the doulas in the interventions. Conclusions This paper suggests that several barriers make participation in cervical cancer screening program more difficult for foreign-born women in Sweden. Specifically, these barriers include lack of knowledge concerning cancer and the importance of preventive healthcare services and practical obstacles such as unavailable child care and language skills. The overarching approach to surmount these barriers was to engage persons with a shared cultural background and mother tongue as the target audience to verbally communicate information. The doulas who helped to identify barriers and plan and execute interventions gained increased confidence and a sense of pride in assisting to bridge the gap between healthcare providers and users. [ABSTRACT FROM AUTHOR]

AimThe aim was to explore adults’ experiences of their family members’ use of interpreters in health-care encounters.BackgroundLanguage barriers are a major hindrance for migrants to receive appropriate healthcare. In a foreign country, family members often need support in care of migrant patients. No previous studies focusing on adult family members’ experiences of the use of interpreters in healthcare have been found.MethodA purposive sample of 10 adult family members with experiences of the use of interpreters in health-care encounters. Data were collected between May and September 2009 by focus-group interviews and analysed with qualitative analysis according to a method described for focus groups.FindingsThree categories emerged from the analysis: (1) Experiences of the use of professional interpreters, (2) Experiences of being used as an interpreter and (3) Experiences of what needs to be improved when using interpreters. The main findings showed no agreement in family members’ experiences; interpretation should be individually and situationally adapted. However, when family members acted as interpreters, their role was to give both practical and emotional support, and this led to both positive and negative emotions. Use of simple language, better collaboration in the health-care organization and developing the interpreters’ professional attitude could improve the use of professional interpreters. The type of interpreter, mode of interpretation and patient's preferences should be considered in the interpretation situation. In order to achieve high-quality healthcare, health-care professionals need to organize a good interpretation situation case-by-case, choose the appropriate interpreters with the patient in focus and cooperate with members of the patient's social network. [ABSTRACT FROM AUTHOR]

The article describes an investigation into dialogues between native Swedish psychotherapists and refugee families. Dialogue is needed to establish the therapeutic alliance, which is ultimately important for healing, whether of individual sickness or family crisis. However the development of dialogue is hindered by cross-cultural and language barriers. We concentrate on one aspect of research originally presented in a Doctoral Thesis by the first author, asking how culture and power differences, together with their resettlement in a strange country, affected meetings with refugee families, and how these problems were overcome; language and the presence of an interpreter are not discussed. A multi-perspective methodology was used in the original research, combining text analysis, review of video-recordings by the participating therapists, and interviews with the families. All these forms of investigation are drawn on here, but particularly text analysis. Significant hindrances to dialogue turn out to be differences in cultural values between refugee and therapist, their different power positions, and the refugee's weariness and distrust of meetings. Strategies to minimise power differences are an essential aspect of the Finnish open dialogue approach, which turns out to be particularly relevant to such refugee meetings. [ABSTRACT FROM AUTHOR]

The present case study demonstrates how the multilingual practices of a linguistically diverse workforce contribute to the functioning of a modern workplace. Based on ethnographic fieldwork and recordings in a residential home for elderly people with dementia in Sweden, the article explores how multilingual immigrant care workers creatively use their language skills to overcome linguistic boundaries and communicate with an elderly Kurdish resident. It is shown that despite the fact that the participants do not, or only to a limited extent, share a common language, the care workers manage to create multilingual encounters that allow them to perform care tasks in an activity context where empathy and efficiency are of great importance. Although the data in this study manifest the struggle of multilingual care workers to bridge language barriers, the study also highlights the complexity of providing adequate and well-functioning care in today's diverse society, where linguistic and cultural matching of clients and caregivers cannot always be obtained. These results are discussed in the light of new demands on Swedish (and more broadly Western) care systems to adapt to the increasing number of multilingual older people, who will become residents in care facilities. [ABSTRACT FROM AUTHOR]

Objective Identify differences in the early treatment of acute chest pain patients with regard to the language proficiency of patients and thus identify opportunities for improving equity in cardiac care. Design Retrospective cross-sectional study comparing care delivered to Swedish-speaking (SS) and non-Swedish-speaking (NSS) patients. Setting A Swedish university hospital that provides highly specialized care to 1.6 million inhabitants. Participants All patients with acute chest pain or symptoms suggestive of acute coronary syndrome who sought care between mid-September and mid-December 2008 (2588 visits). Missing data on the patient group to which study subjects belonged were 2% (45 visits). NSS represented 8% of the 2543 visits (NSS = 2334; NNSS = 209). Main Outcome Measure(s) Delay times from arrival in hospital to admission to catheterization laboratory or ward (ΔTHOSP-PCI), first physical contact to first electrocardiogram (ΔTCONTACT-ECG), first physical contact to first aspirin (ΔTCONTACT-ASA) and arrival in hospital to coronary angiography (ΔTHOSP-ANGIO). Also included baseline characteristics of patients, diagnosis and findings in hospital and secondary preventive activities. Results The median ΔTHOSP-PCI was longer for NSS by 43 min [254 versus 211, 95% confidence interval (CI), odds ratio (OR) = (1.3; 2.8)]. The median ΔTCONTACT-ECG and ΔTHOSP-ANGIO were longer for NSS by 4 min [17 versus 13, 95% CI, OR = (0.8; 1.8)] and 14 h [44 versus 30, 95% CI, OR = (0.6; 3.6)], respectively. Conversely, the median ΔTCONTACT-ASA was longer for SS by 20 min [81 versus 61, 95% CI, OR = (0.3; 1.6)]. Conclusions Poorer language proficiency was associated with longer delay time from arrival in hospital to admission to catheterization laboratory or ward. No other delay times were found to be statistically significantly different with respect to the language proficiency of patients. [ABSTRACT FROM PUBLISHER]

Aims and objectives To describe the experiences of home care providers and social workers in communication, via in-person interpreters, with patients who do not share a common language, and to offer suggestions for practice based on this description. Background The use of interpreters is essential for successful communication to provide equal access to health care for patients not sharing a common language with care providers. Successful bilingual communication is probably even more complex within the home care services with its focus on medical treatment, care and daily support in relation to the more exclusive focus on medical treatment within hospital care. Design An explorative, qualitative, descriptive study. Methods Data were collected in seven focus group interviews. A total of 27 persons, working as registered nurses, assistant nurses and social workers in municipal home care, participated. The analysis was inspired by inductive content analysis. Results The results express a traditional view on interpretation where the in-person interpreter is supposed to act to a greater or lesser extent as an objective and neutral conduit or communicator of what is said. The interpreter is also expected to observe when medical terms and other concepts need to be explained, which thus exceeds the basic role as a communicator of what was said. Conclusions This study emphasises the need to view the interpreter as an active and explicit party in a three-way communication. Relevance to clinical practice Viewing the interpreter as an active and explicit party in a three-way communication and as an essential part of the care team might reduce the possible threat to patient confidentiality, and could contribute to solve the problem of interpreting the patient's non-verbal signs. [ABSTRACT FROM AUTHOR]

In this study our aim was to explore the experiences of doula support among foreign-born women in Sweden in the context of a “Community-Based Doula” (CBD) intervention project. We conducted interviews with 10 women and analyzed the data using content analysis. Participating women reported that, in addition to support during labor, doulas provided important information and continuity of care, which apparently increased their satisfaction with and trust in maternity health care. Training of CBDs, therefore, has implications for the delivery of equitable maternity care, which applies not only to Sweden and other European countries but wherever there are increasingly diverse populations. [ABSTRACT FROM PUBLISHER]

Rapid globalization and the integration of national economies have contributed to the sharp rise in enrollment in international schools. How does this global nomadism affect international school children and their individual health needs? This study attempts to find an answer by interviewing 10 school nurses, with varying degrees of experience in international schools in Sweden, Germany, and Switzerland. Through qualitative semistructured interviews, the school nurses described that the international school children expressed common health needs similar to the ones faced by children in other school settings. However, children in the international schools expressed additional context-specific health needs related to their transient lifestyle, such as language and cultural difficulties, emotional distress, vulnerability, homesickness, alienation, and increased physical health needs related to their expatriate lifestyle. These factors often present a challenge for the school nurse whose profession is to interpret the child’s health needs, which may be obscured by cultural diversity. [ABSTRACT FROM PUBLISHER]

Background: To enhance communicative ability and thereby the possibility of increased participation of persons with aphasia, the use of communication strategies has been proposed. However, little is known about how persons with aphasia experience having conversations and how they perceive their own and their conversation partner's use of communication strategies. Aims: To explore how people with aphasia experience having conversations, how they handle communication difficulties, and how they perceive their own and their communication partners' use of communication strategies. Methods & Procedures: Semi-structured interviews were conducted with four women and seven men with chronic aphasia ( n = 11). Interviews were video-recorded, transcribed verbatim and analysed by qualitative content analysis. Outcomes & Results: Informants appreciated having conversations despite the fact that they perceived their aphasia as a serious hindrance. Different factors related to the informants, the conversation partners, the conversation itself and the physical environment were perceived to impact on conversations. The importance of the communication partners' knowledge and understanding of aphasia and their use of supporting conversation strategies were acknowledged by the informants. The informants' views on using communication aid devices or strategies varied considerably. Four themes that characterized the informants' narratives were: loss and frustration, fear and uncertainty, shared responsibility based on knowledge, and longing for the past or moving forward. Conclusions & Implications: The informants longed to regain their former language ability and role as an active participant in society. To enhance participation of persons with aphasia, it is suggested that communication partner training should be an important and integral part of aphasia rehabilitation. Important elements of such training are reflecting on communication behaviours, training in real-life situations, and acknowledging each individual's special needs and preferences. To deal with the consequences of aphasia, counselling and psychological support may be needed. [ABSTRACT FROM AUTHOR]

Introduction: Ethnic and socioeconomic inequalities in the Swedish health care system have increased. Most indicators suggest that immigrants have significantly poorer health than native Swedes. The purpose of this study was to explore the views of midwives on the factors that contribute to health care inequality among immigrants. Methods: Data were collected via semi-structured interviews with ten midwives. These were transcribed and related categories identified through content analysis. Results: The interview data were divided into three main categories and seven subcategories. The category "Communication" was divided into subcategories "The meeting", "Cultural diversity and language barriers" and "Trust and confidence". The category "Potential barriers to the use of health care services" contained two subcategories, "Seeking health care" and "Receiving equal treatment". Finally, the category "Transcultural health care" had subcategories "Education on transcultural health care" and "The concept". Conclusions: This study suggests that midwives believe that health care inequality among immigrants can be the result of miscommunication which may arise due to a shortage of meeting time, language barriers, different systems of cultural beliefs and practices and limited patient-caregiver trust. Midwives emphasized that education level, country of origin and length of stay in Sweden play a role when an immigrant seeks health care. Immigrants face more difficulties when seeking health care and in receiving adequate levels of care. However, different views among the midwives were also observed. Some midwives were sensitive to individual and intra-group differences, while some others viewed immigrants as a group of "others". Midwives' beliefs about subgroup-specific health services vs. integrating immigrants' health care into mainstream health care services should be investigated further Patients' perspective should also be considered. [ABSTRACT FROM AUTHOR]

engström m., skytt b. & nilsson a. (2011) Journal of Nursing Management 19, 732-741 Working life and stress symptoms among caregivers in elderly care with formal and no formal competence Aim The aim of the present study was to describe and compare caregivers with formal and no formal competence on job satisfaction, psychosomatic health, structural and psychological empowerment and perceptions of care quality. A further aim was to study relationships among study variables. Methods A convenience sample of 572 caregivers in elderly care participated. Results Caregivers with no formal competence perceived higher workload, more communication obstacles, less competence, poorer sleep and more stress symptoms than did their colleagues. Linear regression analyses revealed that the factor self-determination was an explanatory variable of stress levels among caregivers with no formal competence, and self-determination and impact among caregivers with formal competence. Linear regression analysis revealed that different dimensions in structural and psychological empowerment explained the variance in staff job satisfaction, perceived stress symptoms and quality of care. Conclusions No formal competence seems to be a risk factor for psychosomatic health problems. Implications for nursing management Managers need to have a strategic plan for how to create a working environment for caregivers with no formal competence. Caregivers' self-determination seems to be important for stress symptoms. Meaning, self-determination, impact and opportunities appear to be important for job satisfaction and competence, opportunities, resources and formal power for quality of care. [ABSTRACT FROM AUTHOR]

HADZIABDIC E, HEIKKILÄ K, ALBIN B and HJELM K. Nursing Inquiry 2011; 18: 253-261 Problems and consequences in the use of professional interpreters: qualitative analysis of incidents from primary healthcare The aim of this study was to explore what problems are reported by healthcare professionals in primary healthcare concerning the use of interpreters and what the problems lead to. The study involved a single case in a real-life situation with qualitative content analysis of 60 incident reports written by different healthcare professionals. The main problems documented were related to language, such as lack of the interpreters with proficiency in a particular language, and to organisational routines, with difficulties in the availability of interpreters and access to the interpreter agency. The problems reported led to incorrect use of time and resources, which increased the workload and thus delayed treatment. Other consequences were limited possibilities to communicate and thus consultation was carried out without a professional interpreter, using family members instead. The results highlight the importance of developing good co-operation between the interpreter agency and the primary healthcare centre in order to fulfil the existing policy of using professional interpreters to provide the right interpreter at the right time and guarantee high-quality care. [ABSTRACT FROM AUTHOR]

Sweden's cultural diversity generates considerable challenges for occupational therapists. The aim of this study was to explore experiences and perceptions of occupational therapists working with immigrant psychiatric clients from the Middle East region. The study included interviews with eight occupational therapists employed in mental health care and working in a variety of settings. The data collection and analysis were carried out in accordance with the grounded theory approach. One core category, “the challenges of the multicultural therapeutic journey—a journey on a winding road” was identified. The core category included three categories: dilemmas in clinical practice, feelings and thoughts, and building cultural bridges, in turn comprising sub-categories and components. The results showed that the many dilemmas influencing effective multicultural occupational therapy were cultural, societal, and professional in nature. The dilemmas influenced feelings and thoughts, in turn influencing both motivation for seeking cultural knowledge and choice of adequate strategies in which the multicultural therapeutic relationship could develop. The results imply that culturally congruent occupational therapy practice needs to be further developed and more research is needed on how cultural issues can be met in occupational therapy practice. [ABSTRACT FROM AUTHOR]

Sweden has a long history of conducting questionnaire-based Public Health Surveys (PHS) to monitor health determinants. As Sweden has become a multi-ethnic society a linguistically adapted instrument to collect data was first used in Stockholm PHS 2006 to overcome the barrier of lack of Swedish language proficiency, but more importantly to overcome the psychological barrier of being excluded. The questionnaire was translated into the six most spoken languages among Swedish immigrants, namely Arabic, English, Farsi, Finnish, Spanish, and Turkish. In spite of a decrease in participation rate (—2.9%, p < 0.0001) among native Swedes in PHS 2006 compared with PHS 2002, there was a substantial increase in participation rate among immigrants in PHS 2006 who received a translated questionnaire or were interviewed in their mother tongue. The increase in response rate varied from 2.1% among Finnish-speaking immigrants up to 12.4% among Turkish-speaking immigrants and was significant for Arabic-speaking (p < 0.0001), Farsi-speaking (p = 0.003), Spanish-speaking (p < 0.0001) and Turkish-speaking (p < 0.0001) immigrants. Various attempts to increase participation rate will be of importance to policy makers involved in the integration of the immigrant population, to healthcare professionals, and obviously to the public. [ABSTRACT FROM PUBLISHER]

Scand J Caring Sci; 2010; 24; 678-683 'It should be an ordinary thing'- a qualitative study about young people's experiences of taking the HIV-test and receiving the test result Increased HIV-testing has public health benefits, but for youth there is a multitude of barriers against the test. The aim of this study is to explore how young women and men in Sweden experience HIV-testing within primary healthcare. Six focus-group interviews were tape recorded, transcribed verbatim and analysed according to qualitative content analysis. Three themes emerged, describing how the informants were met before, during and after testing; ' Obstacles accessing the clinic'- describes their perceptions on how to overcome different barriers and enter into primary health care. ' Quick and easy testing'- describes perceptions of the testing procedure and ' Conflicting and unclear information about test results'- describes inconsistencies concerning communication of the test result and a concern about 'what would happen' in the event of an HIV-positive finding. Most of these youth preferred the HIV-test 'quick and easy' and preferred a telephone referral of the test result. A minority of them worried about HIV, and they thought that the staff seemed to be unprepared for an HIV-positive test result. According to these youth, a quick and easy testing procedure together with a short pretest discussion may be sufficient and may also help normalising the testing practice. In a Swedish context, it may be common to see heterosexual youth as a risk-free population, and this perception may act as a barrier for HIV-testing and increase missed opportunities for early diagnose of HIV within primary care. [ABSTRACT FROM AUTHOR]

Scand J Caring Sci; 2010; 24; 436–444 Student nurses’ experiences of communication in cross-cultural care encounters Background: Communication is a fundamental component of cross-cultural care encounters. Nurses experience communication difficulties in situations where they do not speak the same language as their patients. Communication difficulties are a major obstacle for immigrant patients and can lead to insufficient information and poor quality nursing care in contrast to the majority population. Aim: To explore student nurses’ experiences of communication in cross-cultural care encounters. Methods: Semi-structured interviews were undertaken a purposive sample of 10 final year students from one university in Sweden: five participants were from a Swedish background and five from an immigrant background. Interviews explored participant’s experiences of communication in cross-cultural care encounters. Interviews were tape recorded, transcribed and analysed using ‘framework’ approach. Results: Four themes were identified: conceptualizing cross-cultural care encounters, difficulties in communication, communication strategies and factors influencing communication. ‘Culture’ was equated with country of origin. Cross-cultural care encounters involved patients from a different immigrant background to the nurse. Student nurses experienced particular difficulties communicating with patients with whom they did not share a common language. This led to care becoming mechanistic and impersonal. They were fearful of making mistakes and lacked skills and confidence in questioning patients. Various strategies were used to overcome communication barriers including the use of relatives to interpret, nonverbal communication, gestures and artefacts. Other factors which influenced communication included the student’s attitude, cultural knowledge acquired through education and life experience. Conclusion: Although student nurses seek creative ways to communicate with patients from different cultural backgrounds they lack skills and confidence in cross-cultural communication. Nursing programmes need to address this deficit to ensure that nurses are equipped with the knowledge and skills to provide quality care to patients from different cultural backgrounds. [ABSTRACT FROM AUTHOR]

Aim. To identify self-reported perceptions of the barriers to research utilisation by Turkish staff nurses working in a university hospital and to ascertain whether involvement in research-related activities influenced their perception of the barriers. Background. Research utilisation in nursing has been a prominent concern for the last 30 years. While investigators in several countries have identified nurses’ perception of barriers to research utilisation, this is the first study to investigate such barriers in Turkey. Design. This is a descriptive, cross sectional study with a sample of 329 staff nurses working in a university hospital. Two instruments were used; a demographics questionnaire that investigated research activities and the Barriers Scale to measure perceptions. An additional item, ‘studies are published in English’ was added to the scale. Results. The lack of time to implement new ideas was the most frequently, 84·5%, perceived barrier. The second most frequently perceived barrier was difficulty in reading English. The top six barriers were all related to the setting. Additionally, research-active nurses found insufficient time less of a barrier but unawareness of research findings and being isolated from knowledgeable colleagues as greater barriers to research utilisation. Conclusions. Turkish nurses’ perception of barriers is similar to the findings in other countries, i.e., that the top six barriers were related to setting. Language barrier compares similarly with studies in other countries that investigated this variable. Relevance to clinical practice. The gap between theory and practice in nursing can be minimised by identifying strategies to increase research utilisation in clinical settings. Such strategies can also improve patient care outcomes. [ABSTRACT FROM AUTHOR]

Aim. This paper is a report of a study exploring nurse radiographers’ experiences of examining patients who do not speak the native language. Background. The increased number of immigrant patients in Western countries poses a challenge to healthcare staff, as mutual understanding is needed in encounters with patients who do not speak the language of the host country. In particular, little is known about the quality of communication in the setting of radiological examinations, i.e. short encounters with demanding technical and caring components. Methods. Three focus group interviews with experienced nurse radiographers ( n = 11) were carried out in 2007. The interviews were audiotaped and transcribed. A qualitative content analysis method was applied to analyse the interview texts. Findings. Four main categories emerged in the analysis: modes, needs, quality and improvements of interpreting. The need for an interpreter is strongly associated with the type of examination. For interventional procedures and contrast-enhanced examinations, a professional interpreter is required to inform the patient and to identify and handle side effects and complications. Friends, relatives, particularly children, and staff as interpreters were not considered ideal as an alternative. Shortage of time and lack of specific knowledge about radiological procedures were identified as problems with professional interpreters. Interpreter training and checklists specific for radiology department routines were suggested, as well as improved nurse radiographers’ education on intercultural communication. Conclusion. The need for an interpreter, and the native tongue of the patient, should be clearly stated on the radiology request form, to allow timely scheduling of an interpreter. Intercultural communication in nurse radiographers′ education should be enhanced. [ABSTRACT FROM AUTHOR]

Despite claims that prior learning assessment and recognition (PLAR) can act as a transformative social mechanism and a means of social inclusion, this study reports that PLAR has become a serious barrier to adult learning rather than a facilitator. Drawing from Foucault's concept of governmentality, the study examines the difficulties that immigrant professionals have experienced in having their foreign credentials and work experience recognized in the contexts of Canada and Sweden. Using document analysis and interviews, the study analyses how PLAR has created a system of governing through technologies of power and technologies of the self which work as dividing practices in discounting and devaluating immigrants' prior learning and work experience. The study concludes that PLAR has become a technical exercise and a governing tool rather than a form of social transformation. [ABSTRACT FROM AUTHOR]