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Communication in healthcare extends beyond patient care, impacting the work environment and job satisfaction. Interprofessional communication is essential for fostering collaboration, but challenges arise from differences in training, roles, and hierarchies. The study aimed to explore psychiatric outpatient clinicians' experiences of interprofessional communication and their perceptions of how the communication intersects the organizational and social work environment of healthcare. Qualitative research involved focus group interviews with clinicians from five psychiatric outpatient units in Central Sweden, representing diverse professions. The authors analyzed semi-structured interview data thematically to uncover clinicians' perspectives on interprofessional communication. An overarching theme, "Adjustment of communication," with subthemes "Synchronized communication" and "Dislocated communication," emerged. Clinicians adapted communication strategies based on situations and needs, with synchronized communication promoting collaboration and dislocated communication hindering it. Communicating with each other was highly valued, as it contributed to a positive work environment. The study underscores the importance of an open, supportive environment that fosters trust, and respect among healthcare clinicians. Consistent with prior research, collaboration gaps underscore the urgent need to improve interprofessional communication. [ABSTRACT FROM AUTHOR]

Background: Communication in healthcare has been extensively studied, but most research has focused on miscommunication and the importance of communication for patient safety. Previous research on interprofessional communication has mainly focused on relationships between physicians and nurses in non-psychiatric settings. Since communication is one of the core competencies in psychiatric care, more research on interprofessional communication between other clinicians is needed, and should be explored from a broader perspective. This study aimed to explore and describe interprofessional communication in a psychiatric outpatient unit. Method: During spring 2022, data consisting of over 100 h of fieldwork were collected from observations, formal semi-structured interviews and informal conversations inspired by the focused ethnography method. Data was collected at an outpatient unit in central Sweden, and various clinicians participated in the study. The data analysis was a back-and-forth process between initial codes and emerging themes, but also cyclical as the data analysis process was ongoing and repeated and took place simultaneously with the data collection. Results: We found that a workplace's history, clinicians´ workload, responsibilities and hierarchies influence interprofessional communication. The results showed that the prerequisites for interprofessional communication were created through the unit's code of conduct, clear and engaging leadership, and trust in the ability of the various clinicians to perform new tasks. Conclusion: Our results indicate that leadership, an involving working style, and an environment where speaking up is encouraged and valued can foster interprofessional communication and respect for each other´s professional roles is key to achieving this. Interprofessional communication between different clinicians is an important part of psychiatric outpatient work, where efficiency, insufficient staffing and long patient queues are commonplace. Research can help shed light on these parts by highlighting aspects influencing communication. [ABSTRACT FROM AUTHOR]

People use the Web to seek health-related information and to discuss health issues with peers. Netnography, a qualitative research methodology, has gained the attention of researchers interested in people's health and health issues. However, no previous reviews have accounted for how netnography is used in nursing research. The purpose of this mapping review was to generate a map of netnographic research in nursing. The search was conducted in PubMed, Academic Search Elite, the Cumulative Index to Nursing and Allied Health Literature, Medline, PsycINFO, Scopus, and Web of Science. Data were extracted from 53 original articles. The results show an increasing trend in published netnographies over time; 34% of the total sample was published in 2021. Of the total, 28% originated from Sweden, and 81% had used a covert approach. In studies in which the researchers used more participatory designs, the time spent on online forums ranged between 4 weeks and 20 months. Informed consent is found to be an issue in netnographic studies. We discuss the fact that nursing researchers have used netnography to address a wide range of research topics of concern and interest, from self-care support in an online forum for older adults to nursing students' perspectives on effective pedagogy. In line with the digital transformation in society in general, we discuss the fact that netnography as a research methodology offers great opportunities for nurse researchers to monitor new spaces and places that presuppose online methodological knowledge. [ABSTRACT FROM AUTHOR]

Aim: To describe intensive care nurses' reflections on being part of interdisciplinary emergency teams involved in in‐hospital cardiopulmonary resuscitation. Design: A qualitative descriptive design. Methods: Eighteen intensive care nurses from two regions and three hospitals in Sweden were interviewed. The data were analysed with General Inductive Analysis. Results: The work for intensive care nurses in the emergency team was reflected in three phases: prevention, intervention and mitigation—referred as before, during and after the CPR situation. Conclusions: The findings describe the complexity of being an intensive care nurse in an interdisciplinary emergency team, which entails managing advanced care with limited and unknown resources in a non‐familiar environment. The present findings have important clinical implications concerning the value of having debriefing sessions to reflect on and to talk about obstacles to and prerequisites for performing successful resuscitation. [ABSTRACT FROM AUTHOR]

Burnout syndrome limits work capacity and the ability to manage a social and family life. Such limitations may lead to alienation from oneself and can result in frustration and anger. The recovery process may include a search for quick fixes from professionals but responsibility is in the hands of the ill with support from professionals, family, and work. Learning about limitations, the need to rest and accepting illness, are vital in the recovery process, but they are also associated with feelings of shame and blaming oneself for causing one’s own burnout by neglecting bodily signals. Objective: Burnout syndrome affects the individual as a whole because it involves emotional exhaustion, depersonalization, and a low sense of personal accomplishment. Research into burnout syndrome has predominantly focused on treatment outcomes measured using quantitative methods. The existing qualitative research has deepened theoretical insights from a lifeworld perspective, although, methodologically speaking, previous qualitative studies have been restricted to interviews. The qualitative interview method is somewhat limited. Hence, the objective of the present study was to analyze how autobiographers narrate their experiences of burnout syndrome and to describe their recovery process. Design: An inductive qualitative approach with a descriptive design was used to gain insights into the authors’ experience of burnout and recovery process, as expressed in writing. Setting/Subjects: The data comprised six autobiographies written by authors from Sweden. Results: The results are presented in three categories: 1) descriptions of estrangement from one’s own body, 2) descriptions of how the phenomenon is manifested in everyday life, and 3) descriptions of recovery processes. Conclusion: Burnout syndrome intersects both work life and family life and reveals the individual as a whole, integrated being. It is vital for healthcare professionals to adopt a person-centered approach that sees the individual as an integrated whole, consisting of body, mind, and soul. [ABSTRACT FROM AUTHOR]

Purpose: Our aim was to describe Swedish Healthcare Direct (SHD) and its features as a complex system. Methods: Qualitative interviews were conducted with 20 SHD telenurses, covering their experiences and skills when encountering and advising callers with mental illness. Complexity science was used as an a priori theoretical framework to enhance understanding of the complex nature of telenursing. Results: SHD was described as a complex system as nurses were constantly interacting with other agents and agencies. During these interactions, dynamic processes were found between the agents in which the nurses adapted to every new situation. They were constantly aware of their impact on the care-seekers, and perceived their encounters with callers with psychiatric illness as "balancing on a thin line". SHD was also described as both an authority and a dumping ground. The openness of the system did not give the nurses possibility to control the number of incoming calls and the callers' intentions. Conclusions: These new insights into SHD have important implications for organization developers and nursing management in terms of overcoming linear thinking. [ABSTRACT FROM AUTHOR]

Healthcare professionals working on inpatient wards face the externalizing or challenging behaviour of the patients who are admitted. Ethical values and principles in psychiatric nursing have been reported to be important when approaching patients during the most acute phase of deterioration in their mental health. Hence, the aim of this study was to discover and describe staff members' ethical and moral concerns about their work as healthcare professionals in a psychiatric intensive care unit. The study has a qualitative descriptive design and makes use of Framework Analysis. Registered nurses and psychiatric aides in a psychiatric intensive care unit in Sweden were observed during ethical reflection meetings. Four to six staff attended the 90-min meetings. The data comprise observations from six meetings, which provided 94 pages of text. The results demonstrate that the work was described as being both motivating and exhausting. The staff faced ethical concerns in their daily work, as patients often demonstrated challenging behaviours. Three themes were identified as follows: (i) concerns about the staff impacting on patients' experience of care, (ii) concerns about establishing a safe working environment, and (iii) concerns about becoming unprofessional due to expectations and a high workload. Ethical concerns included simultaneously taking into account both the patients' dignity and safety aspects, while also being exposed to high workloads. These elements of work are theorized as influencing complex psychiatric nursing. If we are to bring these influential factors to light in the workplace, advanced nursing practice must be grounded in moral mindfulness. [ABSTRACT FROM AUTHOR]

Aims and objectives: To explore and describe the cultural routine of shift reports among nursing staff in a psychiatric intensive care unit and further to develop a taxonomic, thematic and theoretical understanding of the process. Background: Lack of communication among healthcare staff is associated with risks for medical errors. Thus, handovers and shift reports are an essential and integral routine among nurses to pass on information about the patients’ health status. Previous studies within the field have highlighted the benefits of structured reporting tools. However, shift reports as a cultural activity within the nursing tradition have been given less attention, not the least in psychiatric care. Methods: Focused ethnography was used. The data comprised 20 observational sessions. The observations ranged over a time span of 5 months and were conducted in a psychiatric intensive care unit in Sweden. Results: The process of shift reports encompassed the following three phases: (a) getting settled, (b) giving the report and (c) engaging in the aftermath. The results demonstrate that the phases entail different cultural activities, which take place in different areas of the ward and that the level of formality varied. Conclusions: Shift reports are not an isolated event with clear boundaries. The study enriches the understanding of shift reports as a “fuzzy process”. The individual phases were found to be tied to cultural connotations, such as activities, places and roles with certain meanings for staff members. Relevance to clinical practice: The new insights are useful for nurses in overcoming an uncritical adoption of the biomedical tradition regarding pace and tone during shift reports. The reporting nurse has the potential to transform shift reports from a monologue with a foreclosed style to a more dialogical interaction with colleagues that focuses on the patients’ needs rather than the needs of staff. [ABSTRACT FROM AUTHOR]

The aim of this study was to describe individuals' experiences of being hospitalized in psychiatric intensive care units (PICUs). Four participants who had previously been admitted in a PICU were interviewed using open-ended questions. The data were analyzed using thematic analysis. Analysis resulted in a synthesis of the various ways patients experienced limitations: (1) Descriptions of Being Limited in the Environment, (2) Descriptions of being Limited in Interactions with Staff, (3) Descriptions of Being Limited in terms of Access to Information, and (4) Descriptions of Having Limited Freedom and Autonomy. Hospitalization is experienced as a life-changing event that shows akaleidoscopic viewof limitation. We stress that the conceptualization of limitation must be considered due to its historical origins, sociopolitical aspirations, and philosophy of care. Thus, nurse practitioners and nursing leaders are advised to put the patient's experience at the center of care, and to involve and integrate patients throughout the recovery process. [ABSTRACT FROM AUTHOR]

Purpose This study aimed not only to describe the development and implementation of the module but also to evaluate the nursing students' perceptions. Design and Methods A cross-sectional design including 101 students who were asked to participate and answer a survey. We describe the development of the pedagogic module Students Active Learning via Internet Observations based on situated learning. Findings The findings show that learning about service users' own lived experiences via web-based platforms was instructive according to the students: 81% agreed to a high or very high degree. Another important finding was that 96% of students responded that the module had clinical relevance for nursing work. Practice Implications We argue that learning that engages students with data that are contextually and culturally situated is important for developing competence in caregiving. [ABSTRACT FROM AUTHOR]

The article focuses on several unexpected outcomes that are caused by sensitive dependence on initial conditions. Topics include considered that complexity science is based on the view that systems inherently strive toward non-static states systems wobble, change, and evolve and in contrast to pure systemic thinking, the complexity perspective draws attention to the processes in a system that drive the system toward a non-equilibrium relationship.

Patients in the hospital environment are suffering from disrupted sleep, which adversely affects their recovery process, health and well-being. The aim of this study was to explore nurses' experiences and their strategies to promote inpatients' sleep. An empirical qualitative design was applied. Eight nurses at a hospital in Sweden were purposefully selected to be included in semi-structured interviews. Burnard's method for inductively analysing interview transcripts was applied. The findings are presented in four categories: (i) prevention and planning as a sleep-promoting nursing strategy; (ii) adaptation of the environment as a sleep-promoting nursing strategy; (iii) use of drugs as a sleep-promoting nursing strategy; and (iv) caring conversation as a sleep-promoting nursing strategy. Using strategies to promote sleep is important as it affects the recovery of the patients. We argue for the use of simple strategies of sensory reduction as cost-effective sleep-promoting measures that also reduce the use of sedative drugs. [ABSTRACT FROM AUTHOR]

Aims and objectives To describe what nurses want to accomplish in relationships with patients who are hospitalised in forensic psychiatric settings. Background Relationships between staff and patients in forensic psychiatric settings should be grounded in trust and confidence, and the patients need opportunities for emotional reconciliation. However, relationships can be challenging for nurses, who sometimes distance themselves from patients' expressions of suffering. The role of forensic mental health nurses is nebulous, as are the prescriptives and the implementation of nursing practices. Design Qualitative descriptive design. Methods In-depth interviews with five nurses who all work in forensic psychiatric settings. Results We present a descriptive analysis of what nurses want to accomplish in relationships with patients who are hospitalised in forensic psychiatric settings. The results are presented in two main categories: (1) getting to know the person behind the illness and (2) making a difference. Conclusion Care in forensic psychiatry needs to shift towards a more long-term view of the role of nursing, focusing less on the traditional and stereotypical identity of the productive nurse and more on the care given when nurses slow down and take the time to see the patients as individuals. Establishing trusting relationships with patients in forensic psychiatric settings is viewed as a less oppressive way to control patients and guide them in directions that are preferable for the nurses and for the society. Relevance to clinical practice Nurses may use simple strategies in their daily practice such as sitting on the sofa with patients to establish trust. We stress that nurses should abandon policing roles and custodial activities in favour of guiding principles that promote individual recovery, treatment and health-promoting care. [ABSTRACT FROM AUTHOR]

Aims and objectives To describe the nurses' experiences of performing cardiopulmonary resuscitation in intensive care units. Background Research in the area of resuscitation is primarily concentrated on medical and biophysical aspects. The subjective experiences of those who perform cardiopulmonary resuscitation and their emotions are more seldom addressed. Design Qualitative descriptive design. Methods Qualitative semi-structured interviews were used ( n = 8). Data were analysed with content analysis. Results Three categories describe the experiences of nurses: training and precardiopulmonary resuscitation; chaos and order during cardiopulmonary resuscitation; and debriefing postcardiopulmonary resuscitation. The study results indicate that the health care staff find it necessary to practice cardiopulmonary resuscitation, as it provides them with a basic feeling of security when applying it in actual situations. Conclusion We argue that postcardiopulmonary resuscitation debriefing must be viewed in the light of its eigenvalue with a specific focus on the staff's experiences and emotions, and not only on the intention of identifying errors. Relevance to clinical practice Debriefing is of the utmost importance for the nurses. Clinical leaders may make use of the findings of this study to introduce debriefing forums as a possible standard clinical procedure. [ABSTRACT FROM AUTHOR]

Becoming a father is a life changing event and this transition is associated with various emotions. Educational activities aimed at new parents are important in healthcare parental support ( HCPS). HCPS has been critiqued for its predominant focus on mothers, while the needs of fathers seem to have been downplayed. As a result, fathers often turn to Internet-based forums for support. As virtual discussions and mutual support among fathers take place in cyberspace, it is important to monitor these forums to observe the ways in which the fathers discuss HCPS. The aim of this study is to explore the ways in which new fathers visiting an Internet-based forum for fathers communicated their experiences of HCPS. A netnographic method consisting of six steps was used to gather and analyse the data. The findings show that fathers shared with one another their experiences of the attitudes expressed by HCPS workers as well as their own attitudes towards HCPS. The attitudes of HCPS workers that were directed towards the fathers were perceived as highly personal and individual, while fathers described their attitudes towards the HCPS in general terms, towards HCPS as a system. Overall, the fathers described HCPS as a valuable confirmatory support that eased their worries concerning sudden infant death syndrome (SIDS), colic, weight gain, fever and teething. Although the fathers expressed gratitude towards HCPS, they also shared their negative experiences, such as feeling invisible, disregarded and insulted. In fact, the twofold attitudes that exist in the relationship between the fathers and HCPS can act as a barrier rather than being a confirmatory support. We recommend that HCPS adopts a broader approach using more targeted and strategic didactic methods for supporting fathers in the growth of their own personal awareness, as such an approach would offer a competitive and professional alternative to the support offered in informal experience-based Internet forums. [ABSTRACT FROM AUTHOR]

This article presents intensive psychiatric nurses' work and nursing care. The aim of the study was to describe expressions of cultural knowing in nursing care in psychiatric intensive care units (PICU). Spradley's ethnographic methodology was applied. Six themes emerged as frames for nursing care in psychiatric intensive care: providing surveillance, soothing, being present, trading information, maintaining security and reducing. These themes are used to strike a balance between turbulence and stability and to achieve equilibrium. As the nursing care intervenes when turbulence emerges, the PICU becomes a sanctuary that offers tranquility, peace and rest. [ABSTRACT FROM AUTHOR]

The objective was to describe registered nurse anesthetists' reflections and strategies in relation to supervision of specialist nursing students in anesthetic care. In anesthesiology care, registered nurse anesthetists work with advanced care in a high-technology environment. The complexity of working with production requirements, time pressure and patient safety creates great challenges. Registered nurse anesthetists have a unique position and are responsible for the patient's life during surgery. At the same time, they must supervise students without risking patient safety. Little research to date has focused on the clinical supervisory role in this context. A qualitative design was used. The data were collected in 2018 from qualitative interviews with a purposive sample of twelve student registered nurse anesthetists from a large hospital in Sweden. The data were analyzed using content analysis. The results demonstrated that the dual role of registered nurse anesthetist and supervisor was experienced as satisfying, important and promoting development, although it also involved several challenges. Creating opportunities for supervision and learning in perioperative care improved supervisors' prerequisites for supporting students and helping them develop. Being a supervisor was also rewarding, and given the interplay with students, supervision was viewed as a process of mutual growth. By focusing on students and their learning, we can help produce well-qualified registered nurse anesthetists who have positive experiences of the workplace and who want to stay in their profession. • Supervising students is a non-straightforward process. • Being a supervisor is both exhausting and stimulating. • Student profiles are useful for supervisors to plan supervision. • Students and supervisors benefit from reflecting. • Reflecting is a way to grow and develop. [ABSTRACT FROM AUTHOR]

Background: Conflicts with patients and relatives occur frequently in intensive care units (ICUs), driven by factors that are intensified by critical illness and its treatments. A majority of ICU healthcare professionals have experienced verbal and/or physical violence. There is a need to understand how healthcare professionals in ICUs experience and manage this workplace violence., Methods: A qualitative descriptive analysis of four hospitals in Sweden was conducted using semi-structured focus-group interviews with ICU healthcare professionals., Results: A total of 34 participants (14 nurses, 6 physicians and 14 other staff) were interviewed across the four hospitals. The overarching theme: "The paradox of violence in healthcare" illustrated a normalisation of violence in ICU care and indicated a complex association between healthcare professionals regarding violence as an integral aspect of caregiving, while simultaneously identifying themselves as victims of this violence. The healthcare professionals described being poorly prepared and lacking appropriate tools to manage violent situations. The management of violence was therefore mostly based on self-taught skills., Conclusions: This study contributes to understanding the normalisation of violence in ICU care and gives a possible explanation for its origins. The paradox involves a multifaceted approach that acknowledges and confronts the structural and cultural dimensions of violence in healthcare. Such an approach will lay the foundations for a more sustainable healthcare system., (© 2024. The Author(s).)

Patients with mental illness generally make their initial healthcare contact via a registered nurse. Although studies show that encountering and providing care to care-seekers with mental illness might be a challenge, little research exists regarding Primary Care Nurses' (PCN) view of the challenges they face. The aim of this study was to qualitatively explore PCNs' reflections on encountering care-seekers with mental illness in primary healthcare settings. The results consist of three themes: constantly experiencing patients falling through the cracks, being restricted by lack of knowledge and resources, and establishing a trustful relationship to overcome taboo, shame, and guilt.

Internationally, research on psychiatric intensive care units (PICUs) commonly reports results from demographic studies such as criteria for admission, need for involuntary treatment, and the occurrence of violent behaviour. A few international studies describe the caring aspect of the PICUs based specifically on caregivers' experiences. The concept of PICU in Sweden is not clearly defined. The aim of this study is to describe the core characteristics of a PICU in Sweden and to describe the care activities provided for patients admitted to the PICUs. Critical incident technique was used as the research method. Eighteen caregivers at a PICU participated in the study by completing a semistructured questionnaire. In-depth interviews with three nurses and two assistant nurses also constitute the data. An analysis of the content identified four categories that characterize the core of PICU: the dramatic admission, protests and refusal of treatment, escalating behaviours, and temporarily coercive measure. Care activities for PICUs were also analysed and identified as controlling - establishing boundaries, protecting - warding off, supporting - giving intensive assistance, and structuring the environment. Finally, the discussion put focus on determining the intensive aspect of psychiatric care which has not been done in a Swedish perspective before. PICUs were interpreted as a level of care as it is composed by limited structures and closeness in care.