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Introduction: Encounters with children of foreign origin call for school nurses’ cultural competence during the health visits. This study aimed to investigate the statistical associations between the cultural constructs described by the Process of Cultural Competence in the Delivery of Healthcare Services (PCCDHS) model and whether school nurses’ cultural encounters, cultural knowledge, and cultural skill could statistically predict their cultural awareness. Methodology: Spearman correlation and hierarchical regression analyses were conducted using cross-sectional secondary data from 816 Swedish school nurses. The cultural constructs in the theoretical description of the PCCDHS model guided the selection and sorting of the items on cultural competence. Results: The constructs of cultural knowledge, cultural skill, cultural encounters, and cultural awareness were positively correlated with each other. However, becoming culturally aware was not statistically predicted by included cultural constructs ( R2 = 13.4, p = .06). Discussion: Despite the interrelations between the investigated cultural constructs of the PCCDHS model, understanding cultural awareness development requires further empirical testing.

Nurses in the Swedish child healthcare system can make a difference by offering support to parents of children who are overweight or at risk of becoming so. Still, research concerning these nurses’ clinical practice when encountering parents whose child is overweight is inadequate. The aim of this study was to describe nurses’ clinical practice when encountering parents of an overweight child. Data were collected through interviews with 10 nurses, and a content analysis approach was used. The nurses’ clinical practice is described in relation to Olander’s theory: Individualising actions, Creating a dialogue, Documenting, and Focusing on normality. This study adds knowledge about nurses’ clinical practice in encounters with parents whose child is overweight. Also, it adds information on how an issue in a specific care situation may contribute to further understanding and use of an existing theory in caring science.

BackgroundSchool nurses in the school health services are assigned to promote health and participation among children when conducting health visits. Still, for children of foreign origin this promotion of participation might be hampered by challenges related to cultural diversity and language barriers. Therefore, knowledge needs to be developed regarding how these children’s participation can be promoted, to support them in sharing and describing matters important for their health. The aim was to investigate school nurses’ descriptions of promoting participation for children of foreign origin in health visits.MethodsA content analysis of 673 Swedish school nurses’ answers to eight open-ended questions regarding promotion of participation for children of foreign origin was conducted. The open-ended questions were part of a larger web-based cross-sectional survey distributed to school nurses in Sweden.ResultsThe results show that school nurses use three main approaches during the health visit: adjusting according to the child’s proficiency in Swedish and/or cultural or national background, adjusting according to the child’s individual needs, and doing the same for all children regardless of their origin. Yet, adjustments according to the child’s proficiency in Swedish and/or cultural or national background were the most common.ConclusionsBy combining the approaches of adjusting, a child-centered care that contributes to children’s participation in health visits and equity in health could be provided.

Background All children in Sweden are invited to health visits to the school nurse to talk about their health. However, health visits with children of foreign origin might involve challenges when the child and school nurse do not share language and or culture. Such challenges might hinder the child's participation as e.g. sharing needs and experiences important for their health. Hence, school nurses' promotion of participation for these children need to be clarified to develop knowledge on how to promote health. The aim was to investigate school nurses' descriptions of promoting participation for children of foreign origin in health visits. Methods A cross-sectional study was conducted, using a web-based questionnaire distributed to all school nurses in Sweden. It contained eight open-ended questions regarding promotion of participation for children of foreign origin. Answers were provided by 673 Swedish school nurses and analyzed using qualitative content analysis. Results The preliminary result shows that school nurses use three approaches to promote participation: 1) adjusting according to the child's proficiency in Swedish and/or cultural or national background, 2) adjusting according to the child's individual needs, and 3) doing the same for all children regardless of their origin. These approaches are used throughout the health visit, although the most commonly was number 1. Such adjustments included the school nurse considering cultural aspects, simplifying their way of talking, or asking the child about their culture or background. Conclusions Adjustment according to the child's proficiency in Swedish and/or cultural or national background are warranted to promote participation in health visits with children of foreign origin. These will strengthen the opportunities for children to share their experiences as well as the encounter between school nurses and children. Key messages School nurses adjust promotion of participation when encountering children of foreign origin. Adjusting promotion of participation in health visits will enable children to share their health needs.

The purpose of this study was to investigate associations between school nurses' self-assessed cultural competence in health visits with children of foreign origin and demographic variables, by using a cross-sectional design. A Web-based questionnaire assessing cultural competence and demographic variables was distributed to a nationally representative sample (n = 816) of school nurses in Sweden. Data were analyzed using regression analysis. School nurses assessed themselves as culturally aware and moderately culturally competent, but not as culturally knowledgeable, culturally skilled, or comfortable in cultural encounters. Cultural competence was related to education in cultural diversity, how often nurses encounter children of foreign origin, and nurses' country of origin. In total, these variables explained 23.6% of the variation in school nurses' cultural competence. Because school nurses regard themselves as moderately culturally competent, a foundation for promoting children's health on equal terms in school health care exists. However, education in cultural diversity combined with other additional strategies is needed to further strengthen school nurses' cultural knowledge, skills, and comfort level in encounters with children of foreign origin.

Nurses in Swedish child and school healthcare need to balance their assignment of promoting children’s health and development based on the national health-monitoring programme with their responsibility to consider each child’s needs. In this balancing act, they encounter children through directed and pliable strategies to fulfil their professional obligations. The aim of this study was to analyse the extent to which nurses use different strategies when encountering children during their recurrent health visits throughout childhood. A quantitative descriptive content analysis was used to code 30 video recordings displaying nurses’ encounters with children (3–16 years of age). A constructed observation protocol was used to identify the codes. The results show that nurses use pliable strategies (58%) and directed strategies (42%) in encounters with children. The action they use the most within the pliable strategy is encouraging (51%), while in the directed strategy, the action they use most is instructing (56%). That they primarily use these opposing actions can be understood as trying to synthesize their twofold assignment. However, they seem to act pliably to be able to fulfil their public function as dictated by the national health-monitoring programme, rather than to meet each child’s needs.

Purpose: Encounters between health care professionals, parents and children in health care services for children are complex as these encounters involve the various perspective and understanding of each person involved. The aim of the study is to describe health care professionals’ understanding of significant encounters with children and parents to uncover the meaning of participation. Method: A qualitative descriptive design was applied. The health care professionals’ narratives (n = 35) of their significant encounters with children were interpreted from the perspective of participation. A phenomenological-hermeneutical approach was used in the analysis. Results: The findings show children’s participation as a dynamic movement in mutuality and alienation which can vary within a situation or between different situations involving the same persons. The movement can occur in mutuality and or in alienation depending on what or towards whom the persons direct themselves. Understanding participation as a movement in health care situations is useful in supporting children’s opportunities to participate from their own perspective and deal with health care examinations. Conclusion: The outcome of a situation can never be predicted. Still, professionals can be aware of their actions in encounters with children.

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.

Throughout childhood, children take part in health visits according to a health-monitoring programme. The visits are aimed to promote the children's development and health and to strengthen them to take own responsibility for their health. Nurses' actions when encountering children at these visits are not explored to any great extent. Exploring nurses' actions can facilitate their reflections on their actions towards children and thereby promote children's involvement in such visits.The aim of this study was to explore nurses' actions when encountering children at health visits.A qualitative explorative design, based on 30 video recordings of health visits in child and school health care, was used in this study. These visits were ordinary real-life health visits. The data were subjected to qualitative content analysis. The right to conduct video recordings during health visits was approved by appropriate research ethics committees.The findings show that nurses, in order to carry out the health visits, encounter children through negotiated guidance. This guidance is understood as the process through which the nurses reach agreement with the children, and is comprised of directed and pliable strategies. At one moment, the nurse can use a directed strategy to inform the child and at the next moment a pliable strategy to provide the child space within the given frame, the health-monitoring programme. By using these strategies intertwined, the nurse can provide the child space within the given frame and, at the same time, fulfil his/her responsibility to promote children's health and development.The results highlight nurses' challenging and complex assignment of guiding children to promote their engagement in the health visits, thereby enabling the nurses to promote the children's health and development according to the national health-monitoring programme.

The UN Convention on the Rights of the Child (1989) asserts the right of every child to self-determination, dignity, respect, non-interference, and the right to make informed decisions. The provision of quality care in health services tailored to children’s preferences means that health professionals have a responsibility to ensure children’s rights, and that the child is encouraged and enabled to make his or her view known on issues that affect them. This paper will help illuminate and differentiate between a child perspective and the child’s perspective in health care settings. The issues are supported with research which illustrates the different perspectives. Both perspectives are required to perceive and encounter children as equal human beings in child-centred health care settings.

In Sweden, children’s health and development are promoted through Primary Child Health Care (PCHC) visits. The children participate in these visits from their own perspective through bodily and ver ...

In this article, we have explored 5-year-old children’s expressions when they as actors took part in an immunization situation in the Primary Child Health Care (PCHC) service in Sweden. Although children’s health and development are the main concern in the PCHC service, their perspectives in such a setting have not been explored fully. To capture children’s perspectives we used a hermeneutic design and video observations. The findings revealed children as competent and active participants, contributing to the construction of the PCHC situation in mutuality with the nurse and the parent. The conceptualization of children’s expressions and actions revealed how they influenced and dealt with a PCHC situation by using strategies of tuning-in, affirmative negotiation, and delaying negotiation. Understanding children’s actions will assist nurses to act with sensitivity when they encounter and support children.

In the Swedish Primary Child Health Care (PCHC) children participate in regular health visits. In these visits children as actors demonstrate their subjective maturity through bodily and verbal expressions. The aim of this study was to explore three-year-old children’s expressions when they take part as actors in a PCHC situation. An explorative design with a hermeneutic approach and video observations was used. Twenty-nine children participated. The findings exhibit a variation of expressions in the situation conceptualized as actions in a progression of states: from a state of getting ready to a state of being ready and further to a state where the child strengthens their own self. This progression is dynamic and coloured with the states of not being ready or of being adverse. The conceptualization of children’s expressions can contribute towards encouraging nurses’ sensitivity when inviting and guiding children in PCHC situations.

Newly graduate public health nurses’ experiences of telephone advice nursing: An interview study

Children's participation in decision-making in the health care setting is complex because parents and health professionals tend to take a protective stance towards children to act in their best interest. Children prefer to be protected in some situations and to share decision-making in others. Adults in the health care setting need to consider children as individuals, rather than as a homogenous group, and take into account that a child's competence and preferences will depend on the circumstances in every situation. This article argues for a situational perspective of children's participation to act in the child's best interest and to balance protection with shared decision-making, according to children's rights and desires.