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Background: Patient safety is a global health priority. Errors of omission, such as missed nursing care in hospitals, are frequent and may lead to adverse events. Emergency departments (ED) are especially vulnerable to patient safety errors, and the significance missed nursing care has in this context is not as well known as in other contexts. Aim: The aim of this scoping review was to summarize and disseminate research about missed nursing care in the context of EDs. Method: A scoping review following the framework suggested by Arksey and O’Malley was used to (1) identify the research question; (2) identify relevant studies; (3) select studies; (4) chart the data; (5) collate, summarize, and report the results; and (6) consultation. Results: In total, 20 themes were derived from the 55 included studies. Missed or delayed assessments or other fundamental care were examples of missed nursing care characteristics. EDs not staffed or dimensioned in relation to the patient load were identified as a cause of missed nursing care in most included studies. Clinical deteriorations and medication errors were described in the included studies in relation to patient safety and quality of care deficiencies. Registered nurses also expressed that missed nursing care was undignified and unsafe. Conclusion: The findings from this scoping review indicate that patients’ fundamental needs are not met in the ED, mainly because of the patient load and how the ED is designed. According to registered nurses, missed nursing care is perceived as undignified and unsafe.

Aim To explore newly graduated registered nurses' perceptions of their work situation and management of nursing care in complex patient situations after 18 months of work experience. Background Newly graduated registered nurses working in acute care hospital settings play a critical role in providing safe nursing care. Methods An explorative qualitative design, with four focus group interviews with 14 newly graduated registered nurses working in acute care hospital settings. Results One theme emerged: 'Clarity and security in one's own nursing role despite facing challenges that hinder professional development' and three categories: 'Independency due to one's own efforts and experience', 'Well-functioning teamwork' and 'Challenges in the work situation'. Conclusion After 18 months in the profession, the nurses were considered to be advanced beginners; at the same time, the most experienced nurses on their respective wards. They found it challenging and need to further develop competences concerning managing and organizing the nursing care of several complex patient situations or new patient groups, as well as supervising novice registered nurses and nursing students. Implication for Nursing Management Powerful and urgent action is needed to be taken by national healthcare policymakers as well a hospital and nurse managers to develop long-term strategies to improve working conditions for newly registered graduated nurses.

Objective: The objective with the project is to find a valid and culturally appropriate instrument for measuring the professionals' knowledge, skills and information needs on older residents’ hearing loss and hearing aids. Such an instrument could optimally be used in clinical praxis, as well as in research, for cross-sectional studies and for measuring change related to educational interventions. Materials: The Norwegian instrument Knowledge, skills and information needs on residents’ hearing loss and hearing aids was identified in the literature. Its content was, by the research group regarded as relevant in a Swedish setting, although some cultural adaptations seemed to be necessary. Methods: The translation and cultural adaptations were performed in line with the International Society For Pharmacoeconomics and Outcomes Research (ISPOR) Task Force For Translation and Cultural Adapation, as outlined below: 1. We first asked one of the original authors for permission to translate the instrument. 2. Two of the authors (KB and MB) individually translated the content of the instrument. Their first language is Swedish, but both are familiar with the Norwegian language. 3. The other authors individually and together checked the translations and judged whether the statements were comprehensible in Swedish, and made necessary cultural adaptations. For example, the nursing home settings, and job types within this sector are not identical in the two countries. 4. An independent person, with knowledge of both Swedish and Norwegian (Norwegian being the first language), but with no previous knowledge of the instrument made a back-translation. This person had good knowledge of the setting, being a professor in geriatrics. 5. The authors compared the original version of the instrument with the back-translated version and discussed some inconsistences with the first author of the original instrument, before we all agreed on a first preliminary Swedish version. 6. 12 professionals

Background: Since 2011, patients in Swedish cancer care have been offered a contact nurse (CN). The CN role is to improve patient participation, care continuity, and provide information and manage patients’ symptoms and needs across the whole continuum of the cancer pathway. A competence profile for the CN role is yet to be developed, and it is important to assess CNs’ self-reported competence to assure that they are well equipped for the role. Objectives: To assess self-reported professional competence among contact nurses working in Swedish cancer care and relate the findings to education level and clinical experience. Methods: The Nurse Professional Competence scale short form (35 items) was used to assess the nurses’ professional competence. Data were collected through a web-based survey in 2017 in 2 regional cancer centers in Sweden. Results: One hundred eight CNs participated in the study and reported highest scores in “value-based nursing care” and lowest scores in “development, leadership, and organization of nursing care.” Higher age, extended clinical work experience, and academic degree were significantly associated with higher competence. Conclusions: CNs with extensive work experience and CNs with an academic degree reported higher scores concerning their generic competence. There is a need in future studies to assess CNs’ specific competence in cancer care. Implications for Practice: There is room for improvement in the competence development of CNs, primarily in the areas of leadership and organization of nursing care. What is Foundational: CNs’ competence regarding leadership and organization should be improved, preferably as part of academic education.

In this grounded theory study the aim was to explore professionals' experiences of promotion of adolescents' sexual health, and views on inter-professional collaboration in relation to this subject. Data collection was by five focus group interviews and two pair interviews with professionals working with sexual health promotion in health care and schools. The results showed that professionals were reaching out to young people through competence and trusting relationships along with working on a broader front. In conclusion, professionals need to be knowledgeable about the world of young people, accessible and able to offer adequate support, and improve their inter-professional collaborations.

Aims and objectives: To explore newly graduated registered nurses' experiences and how they manage complex patient situations.Background: Newly graduated registered nurses' working in acute care hospital settings are challenged by managing complex patient situations in rapidly changing clinical contexts involving increased patient acuity, comorbidities and staffing shortages.Design: Qualitative study design.Methods: Data were collected using focus groups interviews of a total of 16 newly graduated registered nurses with clinical work experience of 6 months of direct patient care in an acute care hospital setting. Analyses were conducted using qualitative content analysis. COREQ reporting guidelines were used.Results: The analysis resulted in the overarching theme "Not being sufficiently prepared and supported to meet responsibilities and demands." The theme included three categories: "Responsibility is not in proportion to competence," "Lack of medical competence and experience complicates patient safety" and "Strives for control to manage and organise nursing care."Conclusion: The results show that newly graduated registered nurses' are not sufficiently supported for the level of responsibility and the demands placed on them when providing nursing in complex patient situations in acute care hospital settings. If they are given sole responsibility for multiple complex patient situations, patient safety may be compromised.Relevance to practice: Special attention need to be paid to NGRNs support to medical competence in the areas of assessing, planning, prioritizing, leading, and distributing nursing care in daily clinical settings for at least their first year of professional work.

AIM: To assess self-reported clinical competence and the need for further training among newly graduated registered nurses (NGRNs) working in Swedish acute care hospital settings. BACKGROUND: NGRNs are expected to take full responsibility for patients' nursing care in an increasingly complex clinical context and professional nurses' clinical competence is critical in providing high quality and safe nursing care. DESIGN: A cross-sectional design. METHODS: Data were collected using the 50-item ProffNurse SAS II. A total of 85 NGRNs who had recently commenced working with direct patient care at three hospitals in central Sweden participated in the study. The response rate was 69%. The STROBE cross-sectional reporting guidelines was used. RESULTS: The NGRNs assessed their clinical competence as being highest in areas relating to team collaboration and ethics and lowest in areas relating to professional development and direct clinical practice. The need for further training was greatest in areas such as direct clinical practice and patient safety and lowest in areas such as team collaborating and ethics. CONCLUSION: The use of instruments to identify NGRNs' self-assessed clinical competence is of value when designing and evaluating introductory programs for NGRNs taking on positions in acute care hospital settings. The availability of experienced nurses from whom NGRNs can gain clinical competence and learn from is of importance, both from the perspective of the NGRNs themselves as well as patient safety. RELEVANCE TO CLINICAL PRACTICE: An understanding of NGRNs' clinical competence and their need for further training may assist in both planning and organizing nursing programs and in making clinical policy decisions when designing introduction programs in acute care settings.

Aim To explore and describe changes in self-assessed clinical competence and the need for further training among newly graduated Registered Nurses during their first 15 months of professional work in acute care hospital settings. Design Quantitative longitudinal design. Methods The 50-item Professional Nurse Self-Assessment Scale of clinical core competencies II was used. A total of 45 newly graduated Registered Nurses answered the questionnaire at four different occasions. Data were collected after 2, 5, 9 and 15 months of working experience. Result The components "ethical decision-making," "cooperation and consultation" and "clinical leadership" were rated highest in clinical competence and lowest in need for further training. The components "professional development" and "critical thinking" were rated lowest in clinical competence and "direct clinical practice" rated highest in need for further training. The clinical competence increased significant between 9-15 months, with the exception of "critical thinking" and need for further training decreased significantly between 9-15 months, with the exception of "critical thinking."

Background: Sexuality in relation to Health- Related Quality of Life (HRQoL) is mostly studied with younger patients as participants who have undergone bone marrow transplantation and concerns fertility and/or sexual function. However, patients with hematologic malignancies such as DLBCL, CLL or AML most often are above their fifties and are treated with chemo- or chemoimmunotherapy. Objective: The aim was to examine how sexuality and HRQoL was affected in patients with hematologic malignancies, at baseline compared to one month after chemo- or chemoimmunotherapy. Methods: Data were collected twice with a longitudinal design, using The Sexual Adjustment Questionnaire - S and EORTC QLQ C30. Results: Thirty-two patients responded. The importance of sexuality, sexual desire and sexual ability decreased one month after treatment and distressing symptoms such as feelings of tiredness occurred more frequently, compared to baseline. At the same time improvement in Global health status/QoL as well as affected functions in HRQoL was reported. Conclusion: The findings are of significance for nurses in cancer care as it highlights that sexuality and HRQoL needs to be considered also in older patients with hematologic malignancies when fertility issues are of less importance. Implication for practice: In order to meet these patients’ needs regarding sexuality and HRQoL the care must provide greater consistency and continuity. One way is to organize the care in a patient-centered way where patients continuously meet a nurse guided by the idea of holistic individual nursing care throughout the care trajectory.

Bakgrund Longitudinella studier som undersöker sexualitet, kroppsuppfattning och hälsorelaterad livskvalitet saknas för medelålders och äldre patienter som behandlats med kemoterapi eller kemoimmunoterapi för maligna blodsjukdomar. Syfte Syftet var att beskriva och undersöka förändringar i sexualitet, kroppsuppfattning och hälsorelaterad livskvalitet hos patienter behandlade för maligna blodsjukdomar, från baseline till sex månader efter behandlingen. Metod Tjugo patienter 45 år och äldre som behandlats för DLBCL, KLL eller AML deltog. Data samlades in vid baseline, en - och sex månader efter behandling med hjälp av tre instrument; SAQ-S, BIS och EORTC QLQ-C30. Deskriptiv- och icke-parametrisk statistik. Resultat En månad efter behandlingen var patienternas sexualitet påverkad avseende intresse (P=.005), funktion (P=.031), tillfredsställese (P=.016, P=.004) och relation. Samtidigt rapporterade patienterna förbättrad hälsorelaterade livskvalitet jämfört med baseline och att kroppsuppfattningen var påverkad i liten grad. Efter sex månader rapporterade patienterna förbättringar inom samtliga områden, med undantag för sexuell relation. Kroppsuppfattning var i liten grad påverkad efter en månad och efter sex månader rapporterade 50 % av patienterna att kroppsuppfattning inte alls var påverkad. Beträffande HRQoL, rapporterade patienterna successivt förbättrade värden under studieperioden (statistiskt signifikant). Slutsats och implikation för omvårdnad Patienter 45 år och äldre som behandlats för maligna blodsjukdomar rapporterade problem avseende sexualitet, kroppsuppfattning och hälsorelaterad livskvalitet under och efter behandling, med rapporterade förbättringar inom samtliga områden sex månader efter behandling. Eftersom intresse för sexualitet visade sig vara lågt för flertalet av patienterna bör stödet anpassas individuellt till patients behov. Patientcentrerad vård föreslås där patienterna kontinuerligt träffar en sjuksköterska som ger holistisk omvårdnad.

Background: Longitudinal studies examining sexuality, body image and health-related quality of life (HRQoL) in middle-aged and elderly patients treated with chemotherapy or chemoimmunotherapy for hematologic malignancies are lacking. The aim of this study was to describe and explore changes in sexuality, body image and HRQoL in patients treated for hematologic malignancies, from baseline until twelve months after treatment. Material and Methods: Patients above 45 years treated for Diffuse large B-cell Lymphoma (DLBCL), Chronic Lymphocytic Leukemia (CLL) or Acute Myeloid Leukemia (AML). Data were collected at baseline (n = 32), one (n = 25), six (n = 20) and 12 months (n = 19) after treatment by means of three instruments: The Sexual Adjustment Questionnaire (SAQ), The Body Image Scale (BIS) and The European Organization for Research and Treatment of Cancer Quality of Life questionnaires (EORTC QLQ-C30, version 3). Descriptive- and non-parametric statistics were used. Results: One month after treatment scores were lowered regarding sexual interest (P = 0.005), sexual function (P = 0.031), sexual satisfaction (P = 0.016, P = 0.004) and sexual relationship. After six months the patient reported scores had returned almost entirely to baseline scores, except for sexual relationship. At 12 months, sexual relationship was still negatively affected. Body image was reported to be affected in a low extent during the study period. After six and 12 months, body image was reported to not be affected at all by 50% and 53%, respectively. However, women reported body-image to be more affected than men at one (P = 0.01) and 12 months (p = 0.021). Regarding HRQoL, patients reported gradually statistically significant improved scores during the study period. Conclusion: In this study, sexuality, body image and HRQoL became negatively affected in patients with hematologic malignancies 45 years and older during treatment. Improvements were gradually seen after treatment, but the scores

The aim of the study was to examine patients’ perceptions of side effects, health-related quality of life (HRQL), generalhealth, and nutritional care among patients receiving home enteral tube feeding (HETF) at two occasions after dischargefrom hospital. Three questionnaires, one study-specific, the Short Form 12 (SF-12) and the Health Index (HI), were sent topatients with HETF (n=62) twice, two weeks after discharge from hospital and two months later. Forty patients respondedtwo weeks after discharge and out of these 29 patients also responded after two months. Data were collected in centralSweden from March 2006 to January 2010. Side effects were common at both points of data collection (70% of thepatients after two weeks and 72% after two month). Patients using bolus feeding reported significantly fewer side effectsthan patients using intermittent feeding. HRQL and HI scores for the total group were low at both points of data collection.The bolus feeding group reported significantly higher physical HRQL and emotional HI than the intermittent feedinggroup did. Most patients were satisfied with the information and support they received from the health care team. Thisstudy has revealed that patients treated with HETF experienced side effects limiting their daily life to a great extent.Differences in HRQL related to feeding methods were found. Individualized support and regular controls are needed inorder to meet patient needs. Bolus feeding may be a suitable feeding method to improve well-being., This article was published as manuscript at the time of the PhD defense.