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Background: Moral distress is a problem and negative experience among health-care professionals. Various instruments have been developed to measure the level and underlying reasons for experienced moral distress. The moral distress thermometer (MDT) is a single-tool instrument to capture the level of moral distress experienced in real-time. Aim: The aim of this study was to translate the MDT and adapt it to the Swedish cultural context. Research design: The first part of this study concerns the translation of MDT to the Swedish context, and the second part the psychometric testing of the Swedish version. Participants and research context: 89 healthcare professionals working at a hospital in northern Sweden participated. Convergent validity was tested between MDT and Measure of Moral Distress-Healthcare Professionals (MMD-HP), and construct validity was tested by comparing MDT scores among healthcare professionals. MDT was compared with responses to the final questions in MMD-HP. One-way ANOVA, Welch's ANOVA, Games–Howell post-hoc test and Pearson's correlation analysis were done. Ethical considerations: The study was approved by the Swedish Ethics Review Authority (dnr 2020-04120) in accordance with Helsinki Declaration. Results: The translated Swedish version of MDT was described as relevant to capture the experience of moral distress. The mean value for MDT was 2.26, with a median of 2 and a mode value of 0. The result showed moderate correlations between the MDT and MMD-HP total scores. There was a significant difference when comparing MDT and healthcare professionals who had never considered leaving their present position with those who had left and those who had considered leaving but had not done so, with the latter assessing significantly higher moral distress. Conclusion: The MDT is an easily available instrument useful as an extension to MMD-HP to measure the real-time experience of moral distress among healthcare professionals in a Swedish context. [ABSTRACT FROM AUTHOR]

Aims and objectives: To describe healthcare professionals' perceptions of person‐centred care for patients with colorectal cancer, within the standardised care concept of Enhanced Recovery After Surgery. Background: International guidelines for colorectal surgery describe standardised perioperative care. Combining standardised care with person‐centred care could be accomplished using the person‐centred nursing framework for establishing and maintaining relationships with patients. Despite strong evidence for the standardised care concepts' medical benefits, studies concerning the practice of person‐centred care from a nursing point of view are sparse. Design: A qualitative descriptive design was used. Methods: Four focus groups interviews were performed including 22 healthcare professionals with 1–29 years' experience of caring for patients with colorectal cancer. Data were analysed using qualitative conventional content analysis. The COREQ checklist for reporting qualitative research was used. Results: Three themes emerged in the analysis; Framework in the healthcare system, Facing differences in participation and Interacting with the person beyond the illness. Conditions for person‐centred care were related to the interactions between patients and healthcare professionals, the structure of care were also considered relevant. Conclusion: There is a discrepancy between what is considered important to do and what is done in clinical practice to create conditions for patient participation. Interacting with patients and creating an interprofessional environment are important conditions, the structure of care is also a fundamental key to promoting person‐centred care. There is a need for further improvement in care of patients with colorectal cancer to achieve person‐centredness within standardised care. Relevance to clinical practice: The findings provide valuable insights into what healthcare professionals consider to be important for achieving person‐centred care. This knowledge can be useful in clinical practice and education programs. Patient or public contribution: At the outset of the study, three patients were interviewed aimed at improving the conditions for the healthcare professionals' focus groups. [ABSTRACT FROM AUTHOR]

To be regularly physically active is of major importance for the health of people with metabolic risk factors. Many of these persons are insufficiently active and in need of support. This study aimed to explore barriers and facilitators perceived by health care professionals' within Swedish primary care in their work to support persons with metabolic risk factors to increase their physical activity. A qualitative design with focus group discussions was used. The data were analysed using qualitative content analysis with a manifest, inductive approach. Primary health care in five Swedish healthcare regions. Nine physiotherapists, ten physicians and five nurses participated in six digital focus group discussions including two to six participants. Barriers and facilitators to supporting persons with metabolic risk factors to increase their physical activity were found within four generic categories, where the barriers and facilitators related to each generic category: 'Patient readiness for change', 'Supporting the process of change', 'The professional role', and 'The organisation of primary care'. The findings suggests that barriers and facilitators for supporting patients with metabolic risk factors can be found at several levels within primary care, from individual patient and the health care professionals to the organisational level. In the primary care setting, this should be highlighted when implementing support to increase physical activity in people with metabolic risk factors. Health care professionals within primary care are in a position to support people with metabolic risk factors to increase their physical activity. Barriers and facilitators to support the patients should be addressed at several levels within primary care. The study highlights factors on multiple levels such as professional responsibility, organisational prioritisation and resources, and the challenge to motivate behaviour change. [ABSTRACT FROM AUTHOR]

Background: In Sweden, antenatal and child health care are offered free of charge to all expectant and new parents. Professionals in antenatal and child health care play an important role in supporting parents. Previous research shows that same‐sex mothers face heteronormative assumptions and insufficient support during their transition to parenthood. Objective: To explore professionals' experiences of supporting two‐mother families in antenatal and child health care. Method: A qualitative method with focus group discussions was used. An interview guide was followed, and the discussions were held online. The data was analysed according to inductive content analysis. Settings and participants: The participants were midwives (n = 8) and nurses (n = 5) in antenatal and child health care from different parts of Sweden. Participants were recruited through the coordinating midwives and child health care nurses in the different regions. Findings: One main category was identified: Striving to be open‐minded in supporting same‐sex mothers. Health care professionals described meeting well‐prepared mothers, with an equal commitment between each other, and mothers on guard against heteronormative views. Professionals provided support through empowerment by creating a safe environment and aiming at providing equal support to all parents or tailored support to same‐sex mothers. Mothers described handling challenges, as a balancing act to acknowledge both mothers. Struggling with documents and communication and a lack of information were other challenges to be handled. Professionals reflected on their own professional competence and expressed that knowledge acquired through education, experience and personal interest all contributed to their competence. Conclusions: Forms and documentation need to be updated to be gender neutral to be including to a variety of family constelleations. Health care professionals need time to reflect on norms and challenges to better support both mothers in a two‐mother family. [ABSTRACT FROM AUTHOR]

Background: There is an increasing trend towards person-centred care (PCC) worldwide, suggesting that PCC should be mastered by future health care professionals. This study aims to explore programme directors' views on facilitators and barriers to implementing PCC in four of the largest national study programmes in Sweden training future health care professionals. Methods: A qualitative design was applied and interviews were conducted with 19 programme directors of Swedish national study programmes in medicine, nursing, occupational therapy and physiotherapy. The interviews were analysed using qualitative content analysis. Themes were sorted according to the Consolidated Framework for Implementation Research (CFIR) in an abductive approach. COREQ guidelines were applied. Results: The overarching theme, as interpreted from the programme directors' experiences, was 'Person-centred care is on the move at different paces.' The theme relates to the domains identified by the CFIR as outer setting, innovation, inner setting and process. PCC was understood as something familiar but yet new, and the higher education institutions were in a state of understanding and adapting PCC to their own contexts. The movement in the outer setting consists of numerous stakeholders advocating for increased patient influence, which has stirred a movement in the inner setting where the higher educational institutions are trying to accommodate these new demands. Different meanings and values are ascribed to PCC, and the concept is thus also 'on the move', being adapted to traditions at each educational setting. Conclusion: Implementation of PCC in Swedish higher education is ongoing but fragmented and driven by individuals with a specific interest. There is uncertainty and ambiguity around the meaning and value of PCC and how to implement it. More knowledge is needed about the core of PCC as a subject for teaching and learning and also didactic strategies suitable to support students in becoming person-centred practitioners. [ABSTRACT FROM AUTHOR]

Objective: This study described the experiences and perceptions of how primary health care professionals (PHCPs) support patients with venous leg ulcers (VLUs) in self-care monitoring., Design: A qualitative approach with reflexive thematic analysis was used, with 24 individual qualitative open interviews., Setting: Primary health care clinics and community health care in four southern regions in Sweden., Subjects: Registered nurses, district nurses and nurse assistants who had experience of caring for patients with VLUs. In total, 24 interviews were conducted with PHCPs in Sweden., Results: PHCPs have a vital role in promoting patient independence and responsibility, identifying needs and adapting care strategies, while also recognising unmet needs in patients with VLUs., Conclusion: PHCPs actively monitor patients' self-care and establish caring relationships. They see a need for a structured primary health care work routine for ulcer management.

This study aimed to explore child health care nurses' clinical experiences from encounters with mothers exposed to intimate partner violence (IPV), as little research has explored this topic. Nine child health care nurses from two Swedish regions were interviewed. The interviews were analysed using thematic analysis. The narratives depicted the nurses' strong commitment to, and professional relationship with, the exposed mothers. The experience of working as a nurse and having encountered IPV in clinical practice made the nurses more confident, which impacted their performance and attitude towards this topic. The ability to uphold the professional relationship was threatened by lack of support and interprofessional collaborations. The professional relationship was central to the encounters, yet could impose an emotional burden on the nurses. While the nurses wanted to improve their knowledge of the process around the mother and child, they were happy to pass the primary responsibility over to other professionals. The findings highlight the challenge in establishing sustainable support for nurses, and building a transparent collaboration process between the health care sector and the social services, serving the well-being and safety of the mother and child. [ABSTRACT FROM AUTHOR]

Purpose: The aim of this study was to describe patient experiences of received primary care for low back pain (LBP) according to the BetterBack Model of Care (MoC) with a focus on illness beliefs and self-management enablement. Methods: Individual interviews were conducted with 15 adults 4–14 months after receiving treatment according to the BetterBack MoC for LBP in primary care in Sweden. Data were analysed using content analysis. Results: When analysing the data, the following theme emerged; "Participant understanding of their treatment for low back pain and self-management strategies—a matter of support systems", comprising the following categories: "Knowledge translation", "Interaction and dialogue", "The health care professional support" and "Form organization". Participants experienced that they had better knowledge about their LBP and received tools to better manage their health condition. The participants expressed good communication with the treating physiotherapist and provided suggestions to further improve the treatment of LBP. Conclusions: Participants experienced that they had gained new knowledge about their health problems and after the treatment they had the tools to handle their back problems. This suggests that the BetterBack MoC may be used as a basis for a support system to provide valuable tools for self-management for patients with low back pain. [ABSTRACT FROM AUTHOR]

Background: As person centred care (PCC) is being implemented globally, higher educational institutions (HEI) have begun to play a crucial part in enabling this transition. In Sweden, however, the delivery of PCC is inconsistently implemented in medicine, nursing, occupational therapy, and physiotherapy study programmes. This inconsistency is partly the result of a lack of a national strategy across HEI. Program directors are responsible for the PCC content of their programs, so their views influence how PCC is taught. Using interviews with programme directors in higher education, we aim to deepen the understanding of the preconditions needed to implement PCC by exploring discourses and identifying subject positions of how PCC is taught and learned., Methods: We performed a discourse analysis based on interviews with program directors in the above-mentioned national study programmes. A discourse can be seen as a struggle over identity. The subject position - i.e., discourses designate positions for persons to occupy as subjects - guided our analysis and identification of the subject positions of the teacher and the student in teaching and learning PCC., Results: This study unfolded in two main antagonistic aspects with respect to teaching and learning PCC, resulting in four subject positions for the teacher and four corresponding subject positions for the students. First, the teacher and student were given a subject position as change agents towards a more egalitarian healthcare and were assigned a subject position to cope with a practical reality they could not change. Second, the teacher and student were assigned a subject position that embodied profession-specific identities, navigating and valuing these boundaries. Simultaneously, both teachers and students assumed a subject position that required interprofessional interaction and co-creation for teaching and learning PCC., Conclusion: This study demonstrates the discursive tension surrounding the implementation of PCC in HEI, and the findings can serve as a basis for creating future relevant and high-quality learning activities. The process of negotiating diverse and co-existing perspectives as well as building interprofessional trust when incorporating PCC into higher education is essential and requires further exploration., (© 2024. The Author(s).)

Background: Dementia is a major global public health challenge, and with the growing elderly population, its prevalence is expected to increase in the coming years. In Sweden, municipalities are responsible for providing special housing for the elderly (SÄBO), which offers services and care for older individuals needing specific support. SÄBO is both the person´s home and a care environment and workplace. Polypharmacy in patients with dementia is common and increases the risk of medication interactions. Involving clinical pharmacists in medication reviews has been shown to enhance medication safety and improve prescribing practices. However, the views of the standard care team involved in medication prescribing, administration, monitoring and documentation on integrating pharmacist services have received less attention. Thus, this study aims to explore how pharmacists' contributions can enhance medication safety, improve patient care efficiency, and potentially alleviate the workload of general practitioners for people with dementia living in special housing., Methods: This study has a descriptive qualitative study design using semi-structured interviews and qualitative content analysis. The study was conducted in a southern Swedish special housing and included nurses, assistant nurses, general practitioners (GPs), and a pharmacist. Due to the COVID-19 pandemic, interviews were conducted over the phone. The Swedish Ethical Review Authority approved the study., Results: The analysis revealed three main categories, and eleven subcategories.: (1) Integrating multidisciplinary approaches for holistic dementia care, (2) Strengthening dementia care through effective medication management and (3) Advancing dementia care through pharmacist integration and role expansion. Nurses focused on non-pharmacological treatments, while GPs emphasized the importance of medication reviews in assessing the benefits and side-effects of prescribed medication. Pharmacists were valued for their reliable medication expertise, appreciated by GPs for saving time and providing recommendations prior to consultations with individuals with dementia and their next-of-kin. Although medication reviews were considered beneficial, there was skepticism about their ability to solve all medication-related problems associated with dementia care., Conclusions: This study highlights the critical role pharmacists play in enhancing medication safety and patient care efficiency in special housing for individuals with dementia. Despite the value of their contributions, communication barriers within healthcare teams pose significant challenges. Recognising potential pharmacist role expansion is essential to alleviate the workload of GPs and ensure effective collaborative practices for better patient outcomes., (© 2024. The Author(s).)

Aim: To explore child health professionals' experiences of the early implementation of the rotavirus vaccination in the two regions that first introduced this vaccination in Sweden. Methods: A descriptive and repeated cross‐sectional study based on a digital study‐specific questionnaire with a baseline in 2014 and with a 2‐year follow‐up in 2016. The study population consisted of nurses and doctors working in child health centres in the health care regions of Stockholm and Jönköping. Results: In Stockholm, a larger proportion of the respondents (n = 355) had concerns in 2014, in comparison with the respondents in Jönköping (n = 101), mostly about the vaccination being a new and time‐consuming task (60% versus 23%). In 2016, the overall attitude to vaccination was more positive in both regions and the levels of concern about increased workload were reduced (Stockholm, n = 519, 39%, versus Jönköping, n = 96, 10%). Challenges before and after the introduction in both regions were particularly related to how to give information about the vaccine's potential increased risk of intussusception. Conclusion: The gap between respondents' knowledge, attitudes and concerns pre‐ and post‐vaccination introduction was larger in Stockholm compared to Jönköping. In both regions, overall, the implementation of the rotavirus vaccination was perceived as being easier than expected. [ABSTRACT FROM AUTHOR]

Background: Breast cancer (BC) and related treatment are associated with the risk of developing a wide range of persistent disabling impairments. Despite extensive research in the field and an enhanced focus on BC rehabilitation, up to 34-43% of these patients are at risk of developing chronic distress. In addition, it is known that these patients repeatedly report unmet needs, which are strongly associated with reduced quality of life. However, despite knowledge that patients' needs for support during BC rehabilitation varies greatly, individualized rehabilitation is often lacking. Therefore, this study aimed to explore health care professionals' (HCPs) experiences of current rehabilitation practice and describe current barriers and facilitators for individualized rehabilitation for patients following BC treatment.Methods: A total of 19 HCPs were included, representing various professions in BC care/rehabilitation within surgical, oncological and specialized cancer rehabilitation units at a university hospital in Sweden. Five semi structured focus group interviews were conducted and inductively analysed using conventional qualitative content analysis.Results: Three categories were captured: (1) varying attitudes towards rehabilitation; (2) incongruence in how to identify and meet rehabilitation needs and (3) suboptimal collaboration during cancer treatment. The results showed a lack of consensus in how to optimize individualized rehabilitation. It also illuminated facilitators for individualized rehabilitation in terms of extensive competence related to long-term experience of working with patients with BC care/rehabilitation. Further, the analysis exposed barriers such as a great complexity in promoting individualized rehabilitation in a medically and treatment-driven health care system, which lacked structure and knowledge, and overarching collaboration for rehabilitation.Conclusion: This study suggests that the cancer trajectory is medically and treatment-driven and that rehabilitation plays a marginal role in today's BC trajectory. It also reveals that structures for systematic screening for needs, evidence-based guidelines for individualized rehabilitation interventions and structures for referring patients for advanced rehabilitation are lacking. To enable optimal and individualized recovery for BC patients', rehabilitation needs to be an integrated part of the cancer trajectory and run in parallel with diagnostics and treatment. [ABSTRACT FROM AUTHOR]

Introduction: Person-centered care (PCC) appears particularly suitable for patients with complex diseases and in multidisciplinary care. However, previous research tends to focus on each profession and condition separately. Purpose: We studied how health care professionals (HCPs) understand PCC, and whether their clinical practice is aligned with their theoretical understanding, when starting clinical practice at a novel multidisciplinary clinic. Methods: In total, 16 semi-structured interviews with HCPs and 31 non-participatory observations of outpatient meetings and other activities at the clinic such as team meetings were conducted at a multidisciplinary, integrated outpatient clinic in Sweden. All patients had simultaneous diabetes mellitus, chronic kidney disease and established cardiovascular disease. The clinic employed a PCC approach. Data were analyzed using an inductive thematic approach. Results: Two key findings emerged. First, PCC requires a holistic view of the patient at all times during care, with everything focused on the patient. This requires that the HCPs know the patient well enough as an individual to be able to tailor the care together with them. Second, working with a PCC philosophy leads to transformed roles for HCPs in patient meetings, with more active involvement by the patient and often also their next of kin. The observations, in comparison with the interviews, showed that not all HCPs applied their views on PCC in patient meetings. Observations showed that some patient meetings were less person-centered than others, potentially due to stress or lack of time. Conclusion: PCC require HCPs to have a holistic view of the patients and a deeper understanding of their situation, as individuals. Working with PCC also leads to a more coaching, supportive role of the HCPs. [ABSTRACT FROM AUTHOR]

In Moral Case Deliberation (MCD), healthcare professionals discuss ethically difficult patient situations in their daily practice. There is a lack of knowledge regarding the content of MCD and there is a need to shed light on this ethical reflection in the midst of clinical practice. Thus, the aim of the study was to describe the content of healthcare professionals' moral reasoning during MCD. The design was qualitative and descriptive, and data consisted of 22 audio-recorded inter-professional MCDs, analysed with content analysis. The moral reasoning centred on how to strike the balance between personal convictions about what constitutes good care, and the perceived dissonant care preferences held by the patient. The healthcare professionals deliberated about good care in relation to demands considered to be unrealistic, justifications for influencing the patient, the incapacitated patient's nebulous interests, and coping with the conflict between using coercion to achieve good while protecting human dignity. Furthermore, as a basis for the reasoning, the healthcare professionals reflected on how to establish a responsible relationship with the vulnerable person. This comprised acknowledging the patient as a susceptible human being, protecting dignity and integrity, defining their own moral responsibility, and having patience to give the patient and family time to come to terms with illness and declining health. The profound struggle to respect the patient's autonomy in clinical practice can be understood through the concept of relational autonomy, to try to secure both patients' influence and at the same time take responsibility for their needs as vulnerable humans. [ABSTRACT FROM AUTHOR]

Aims and objectives With a focus on sexual health and rights, this study describes how transgender people experience meetings with health care professionals. Background Transgender people face prejudice and discrimination worldwide. Little is known of their experiences in sexual health-promoting settings. Method Within a descriptive design, 20 persons aged 18-74 and identifying as transgender and nonbinary were interviewed. The results were analysed with constructivist grounded theory. Results Disrespect among health care professionals is the core category connected to the experiences in the result; transgender people experience estrangement, expectations and eviction in different sexual health-promoting settings. Conclusion Transgender knowledge needs to be increased in general, in both specialised transgender health care and many other health care settings, to prevent transgender peoples' experiences of estrangement. Moreover, an increased knowledge of, and respect for, sexual health and rights is needed to prevent transgender peoples' exposure to gender binary, cis- and heteronormative expectations. In addition, access to sexual health care is essential following gender-confirmatory care as well to avoid transgender peoples' experiences of eviction from the health care system. Relevance to clinical practice Nurses have an important role to play in striving for equity and justice within health care. This study describes how health care professionals appear to be disrespectful and suggestions of how this can be avoided are made. [ABSTRACT FROM AUTHOR]

Purpose:Exploring healthcare professional experiences of Multimodal rehabilitation (MMR) in primary care. Methods:Fourteen healthcare professionals (11 women, 3 men) were individually interviewed about their work with MMR in primary care. Interviews covered experiences of assessing patients and work with patients in the programme. Transcribed interviews were analysed by qualitative content analysis. Results:The analysis resulted in four categories: select patients for success; a multilevel challenge; ethical dilemmas and considering what is a good result. MMR work was experienced as useful and efficient, but also challenging because of patient complexity. Preconceptions about who is a suitable patient for MMR influenced the selection of patients (e.g. gender, different culture). Interviewees were conflicted about not to being able to offer MMR to patients who were not going to return to work. They thought that there were more factors to evaluate MMR than by the proportion that return to work. Conclusions:Healthcare professionals perceive MMR as a helpful method for treating chronic pain patients. At the same time, they thought that only including patients who would return to work conflicted with their ethical views on equal healthcare for all patients. Preconceptions can influence selection for, and work with, MMR.Implications for rehabilitationMultimodal pain rehabilitation in primary healthcare is challenging because of the complexity of the patients.Healthcare professionals must deal with conflicting emotions in regard to different commitments from healthcare legislation and the goals of multimodal rehabilitation.Healthcare professionals should be aware that stereotypes regarding gender and immigrants can lead to bias when selecting patients for multimodal rehabilitation. [ABSTRACT FROM AUTHOR]

The importance of consulting children in health care situations is acknowledged but not always put into action. Health care professionals have difficulties with facilitating children's participation and children are not pleased with their amount of involvement. The aim of this study was to explore health care professionals' reflections on being in care situations with children. A qualitative design with workshops and content analysis was used. The participants (n=29) represented various health care professions. The findings show that health care professionals understand being in care situations with children as an ambiguous challenge since each situation depends on the participants involved: the child, the parents and the professionals. The findings can be used for integrating theory and practice to broaden professionals' awareness of the child's perspective in care situations. This will encourage professionals to question procedures which are taken for granted and facilitate children's participation. [ABSTRACT FROM AUTHOR]

Background: SBAR has been suggested as a means to avoid unclear communication between health care professionals and in turn enhance patient safety in the healthcare sector. Aim: to evaluate hospital-based health care professionals experiences from using the Situation, Background, Assessment and Recommendation (SBAR) communication model. Methodology: A quantitative, descriptive, comparative pre- and post-intervention questionnaire-based pilot study before and after the implementation of SBAR at surgical hospitals wards. Open comments to questionnaire items were analyzed qualitatively. Results: The introduction of SBAR increased the experience of having a well-functioning structure for oral communication among health care professionals regarding patients’ conditions. Qualitative findings revealed the categories: Use of SBAR as a structure, Reporting time, Patient safety, and Personal aspects. Conclusions: SBAR is perceived as effective to get a structure of the content in patient reports, which may facilitate patient safety. [ABSTRACT FROM AUTHOR]

Group interaction is put forward as the principal advantage for focus group research, although rarely reported on. The aim of the article is to contribute to the methodological knowledge regarding focus group research by providing an empirical example of the application of the Lehoux, Poland, and Daudelin template suggested for analysis of the interaction in focus groups. The data source was 18 focus groups' performance in Sweden: 12 with older patients and 6 with general practitioners (GPs). GPs found common ground in belonging to the same profession, whereas the older patients, instead of constituting a group in the word's real sense, started just sharing a common focus. We found the template easy to understand and use, except for identifying participants' explicit and implicit purposes for participating. Furthermore, adding an interaction analysis to the content analysis helped us appreciate and clarify the contexts from which these data were created. [ABSTRACT FROM AUTHOR]

This paper reports on a study of the interplay between nurses and doctors in medical and surgical wards in Sweden. The social order on the wards is seen as a negotiated order, the result of a continuous negotiation between doctors and nurses. The negotiated :order perspective is argued to be a more appropriate means of understanding the interaction on wards than the traditional doctor-nurse game model which has dominated research until now. In particular, the study shows the importance of analysing the structural basis of negotiations and its knowledge context in order to understand the interplay, of doctors' and nurses' opportunities for exerting power on the wards. [ABSTRACT FROM AUTHOR]

Background: Moral distress has been described as an emotionally draining condition caused by being prevented from providing care according to one's convictions. Studies have described the impact of moral distress on healthcare professionals, their situations and experiences. The Measure of Moral Distress for Healthcare Professionals (MMD-HP) is a questionnaire that measures moral distress experienced by healthcare professionals at three levels: patient, system and team. The aim of this project was to translate and make a cultural adaption of the MMD -HP to the Swedish context., Methods: The questionnaire comprises 27 items, rated according to frequency and intensity on a five-point Likert scale (0-4). The procedure for translating MMD-HP followed WHO guidelines (2020). These entailed a forward translation from English to Swedish, a back translation, expert panel validation, pretesting and cognitive face-to-face interviews with 10 healthcare professionals from various professions and healthcare contexts., Results: The Swedish version of MMD-HP corresponds essentially to the concept of the original version. Parts of some items' had to be adjusted or removed in order to make the item relevant and comprehensible in a Swedish context. Overall, the cognitive interviewees recognized the content of the items which generally seemed relevant and comprehensible., Conclusion: The Swedish version of MMD-HP could be a useful tool for measuring moral distress among healthcare professionals in a Swedish healthcare context., (© 2021. The Author(s).)

Purpose: The purpose was to describe health care professionals' experience of using the World Health Organization (WHO) surgical safety checklist., Design: A descriptive cross-sectional mixed-method study, including health care professionals from two clinics at the same university hospital in the western part of Sweden was conducted., Methods: Data were collected from one hundred ninety-six health care professionals using a self-administered questionnaire that contained 12 questions. The Mantel-Haenszel and Pearson χ 2 tests were used for ordered and unordered categorical variables. The text analysis was inspired by Malterud., Findings: The most statistically significant difference between the clinics related to the responsibility for administering the checklist (P = .0010) and always using the checklist in all emergency situations (P = .045). Among the health care professionals who were educated and trained in using checklists, 63% and 65.5% stated that the checklist was adapted to the department. Sixty four percent stated that the assistant nurses were responsible for implementing the checklist. The health care professionals also mentioned a large number of positive and negative aspects of using the WHO checklist., Conclusions: The health care professionals had difficulties using the WHO checklist in the Swedish health care system. More research is needed to determine why specific items are overlooked and whether these items could form the basis of the further elaboration of a modified checklist. An increased understanding of why the checklist is important, as well as updated knowledge on the content could produce greater compliance and thereby increase patient safety., (Copyright © 2019 American Society of PeriAnesthesia Nurses. Published by Elsevier Inc. All rights reserved.)

Background: The New Public Management movement strove for transparency so that policy makers and citizens could gain insight into the work and performance of health care. As the use of the electronic health record (EHR) started to diffuse, a foundation was laid for enhanced transparency within and between health care organizations. Now we appear to be experiencing a new kind of transparency in the health care sector. Many health care providers offer their patients online access to their EHRs (here referred to as Open Notes). The Open Notes system enables and strives for transparency between the health care organization and the patient. Hence, this study investigates health care professional (HCP) perceptions of Open Notes and deepens the understanding of the transparency that Open Notes implies.Objective: Based on two survey studies of HCP perceptions of Open Notes, this paper aims to deepen the academic writing on the type of transparency that is connected to Open Notes.Methods: HCPs in adult psychiatry in Region Skåne, Sweden, were surveyed before and after implementation of Open Notes. The empirical material presented consists of 1554 free-text answers from two Web surveys. A qualitative content analysis was performed.Results: The theoretically informed analysis pivots around the following factors connected to transparency: effectiveness; trust; accountability; autonomy and control; confidentiality, privacy, and anonymity; fairness; and legitimacy. The results show that free-text answers can be sorted under these factors as trade-offs with transparency. According to HCPs, trade-offs affect their work, their relationship with patients, and not least, their work tool, the EHR. However, since many HCPs also state that they have not met many patients, and in some cases none, who have read their EHRs, these effects seem to be more connected to the possibility (or threat) of transparency than to the actual effectuated transparency.Conclusions: The implementation (or reform) of Open Notes is policy driven while demanding real-time transparency on behalf of citizens/patients and not the authorities, which makes this particular form of transparency quite unique and interesting. We have chosen to call it governed individual real-time transparency. The effects of Open Notes may vary between different medical specialties relative to their sensitivity to both total and real-time transparency. When HCPs react by changing their ways of writing notes, Open Notes can affect the efficiency of the work of HCPs and the service itself in a negative manner. HCP reactions are aimed primarily at protecting patients and their relatives as well as their own relationship with the patients and secondly at protecting themselves. Thus, governed individual real-time transparency that provides full transparency of an actual practice in health care may have the intended positive effects but can also result in negative trade-offs between transparency and efficiency of the actual practice. This may imply that full transparency is not always most desirable but that other options can be considered on a scale between none and full transparency. [ABSTRACT FROM AUTHOR]

Purpose: Existential loneliness is part of being human that is little understood in health care, but, to provide good care to their older patients, professionals need to be able to meet their existential concerns. The aim of this study was to explore health care professionals' experiences of their encounters with older people they perceive to experience existential loneliness. Method: We conducted 11 focus groups with 61 health professionals working in home care, nursing home care, palliative care, primary care, hospital care, or pre-hospital care. Our deductive-inductive analytical approach used a theoretical framework based on the work of Emmy van Deurzen in the deductive phase and an interpretative approach in the inductive phase. Results: The results show that professionals perceived existential loneliness to appear in various forms associated with barriers in their encounters, such as the older people's bodily limitations, demands and needs perceived as insatiable, personal shield of privacy, or fear and difficulty in encountering existential issues. Conclusion: Encountering existential loneliness affected the professionals and their feelings in various ways, but they generally found the experience both challenging and meaningful. [ABSTRACT FROM AUTHOR]

We performed a qualitative study to identify facilitators of and barriers to the implementation of national guidelines on thrombolytic therapy for acute ischemic stroke. We interviewed physicians and nurses at nine Swedish hospitals using 16 explorative, semistructured interviews, and selected hospitals based on their implementation rate of new stroke care methods according to data from the Swedish Stroke Register, Riks-Stroke. Through content analysis, we identified facilitators and barriers to implementation, which we classified into three categories: (a) individuals, (b) social interactions and context, and (c) organizational and resource issues. Insights obtained from this study can be used to identify target areas for improving the implementation of thrombolytic therapy and other new methods in stroke care.