Mid Sweden University

Aim: To explore and gain a deeper understanding of how registered nurses in palliative care develop personal and professional approaches in confidential conversations with patients. Design: A qualitative study using focus groups. Method: Between March and May 2024, 22 registered nurses working in specialised palliative care in the northern region of Sweden participated in five focus groups. The discussions were recorded, transcribed verbatim and analysed using interpretive description. Findings: Registered nurses pursued meaningful, supportive interactions during confidential conversations. Their reflections revealed vulnerabilities and the importance of continuous self-reflection, fostering growth, resilience and professional development. They sought ways to process emotional challenges, from individual reflection to peer discussions and structured supervision, refining their approaches. Four themes emerged: balancing external demands with inner motivation, recognising personal limitations, managing compassion with professional responsibility and gradually building trust. Conclusion: Reflection and continuous professional development are essential for navigating confidential conversations in palliative care. These practices help registered nurses balance empathy with boundaries whilst managing emotional and professional challenges. Peer support and shared learning, as well as fostering self-awareness and emotional resilience can enhance care quality and promote sustained professional growth across healthcare settings. Implications for the Profession and/or Patient CareThis study highlights the emotional challenges registered nurses face in confidential conversations with patients at the end of life. Reflection and support help them handle these challenges and promote person-centred care by enabling patients to express their inner thoughts and wishes. The findings apply to palliative care and other settings caring for patients at the end of life. Reporting Method: Findings were reported following the Consolidated Criteria for Reporting Qualitative Research guidelines. Patient or Public Contribution: This study did not include patient or public involvement in its design, conduct or reporting.

Aim To explore aspects of interpersonal relationships in palliative care nursing, focusing on confidential conversations between patients and registered nurses (RN).Design A qualitative study employing focused ethnography.Methods Data were collected through unstructured participant observations, field notes and interviews with patients and RN in specialist palliative care. Data were analysed using reflective thematic analysis.Findings Confidential conversations in palliative care are founded on trust that is fragile and develops dynamically through consistent interactions. Small talk, presence and silence are essential for initiating and maintaining trust and the interpersonal relationship. The environment, patient condition and RN emotional presence and competence shape these conversations. As the relationship evolves, conversations adapt to the patient's changing needs. Missed signals or interruptions can disrupt flow, but the potential for repair remains, allowing for restoration and strengthening of trust and connection.Conclusion Confidential conversations in palliative care are grounded in fragile, dynamic trust, necessitating ongoing presence, sensitivity and adaptability from RN. To support these interactions, healthcare environments must prioritise privacy, relational continuity and communication training. Future research should investigate how organisational structures and clinical settings influence confidential conversations.Implications for the Profession and/or Patient Care Healthcare environments should facilitate confidential conversations by ensuring relational continuity and minimising distractions. Communication training that emphasises presence and management of silence can strengthen nurse-patient relationships, enhancing patient care and emotional support.Impact This study explores key aspects of confidential conversations in palliative care, emphasising trust and emotional sensitivity. It addresses a research gap in palliative care using rare observational methods to deepen understanding of nursing relational aspects. The findings offer practical guidance for enhancing communication and relational skills, informing training and policy development and ultimately, improving emotional support and care.Reporting Method Findings are reported in accordance with the Consolidated Criteria for Reporting Qualitative Research guidelines.Patient or Public Contribution This study did not involve patient or public participation in its design, conduct or reporting.

Abstract

Purpose: To explore the concept of teamwork between professionals perceived by staff at nursing homes and interpreted through the lens of the Magnet model. 

Methodology: Two workshops with assistant nurses from two departments and one workshop with registered nurses (RNs), occupational therapists and physiotherapists at a nursing home were performed to explore teamwork between professionals. The workshops were held between November 2024 and January 2025. Data were deductively analyzed using the Magnet model’s core component, Exemplary Professional Practice and its five Magnet forces as an analytical framework. 

Findings: Findings from the analysis were that all Magnet forces for Exemplary Professional Practice were embraced by the data. However, the Magnet forces for Autonomy and Nurses as Teachers only included a few reflections from the healthcare professionals. The Magnet model can function as a structural model for describing and improving teamwork in nursing homes. However, other data collection methods and the voices of relatives could complement the present research.

Research limitations/implications: This study was limited to one nursing home. Further research will be conducted at several nursing homes in different municipalities and with other stakeholders to more broadly explore the concept of teamwork between professionals.

Originality/value: The originality with this research is the use of the Magnet model to analyse and improve teamwork in nursing homes within a municipality context.

Background: Leadership is vital for well-coordinated healthcare and affects the quality of care and patient safety. Nursing leaders are crucial in creating appropriate structures and processes to enhance patient outcomes during care transitions in a rural context. Despite their importance to care transitions, there is limited research on nursing leaders’ perspectives in rural settings. This study explored nursing leaders’ concerns regarding the provision of quality care during transitions from hospital care to home healthcare in rural areas and their experiences in improving these processes.

Methods: A qualitative study using constructivist grounded theory methodology was conducted. Twenty nursing leaders in hospital and rural municipal care in Sweden were interviewed. All were educated in social care or healthcare, most in nursing, and most had a master’s degree. Data were analyzed using constant comparative analysis.

Results: Nursing leaders’ main concern about creating quality care in transitions was a lack of clearly defined, shared goals for a high-quality care transition. The core category explaining their approach was minding one’s unit by working within organizational unit borders. Three categories further explained this: (I) promoting nursing competence by recruiting and training nurses, emphasizing patient involvement, (II) ensuring continuous care flow by collaborating within one’s organization and clarifying rights and obligations, and (III) evaluating collaboration within each unit.

Conclusions: Seamless care transitions are challenging when nursing leaders lack clear, mutually shared quality goals for care transitions. Implications for nursing management include improving collaborative routines, establishing common platforms, and integrating patient input throughout the process, as these measures are essential for enhancing interorganizational collaboration in rural care transitions.

Background: Bereavement groups offering support to people after a loss can be adapted and conducted in alternative ways due to societal crises.This study aimed to explore the experiences of bereaved people participating in in-person bereavement groups during the pandemic, as an illustration of how offering bereavement support can be adapted in response to societal crises. Method: Semi-structured interviews were conducted and analysed using content analysis. Findings: The main category identified was 'the need to tell my story in times of isolation' emphasising the need to meet others in in-person meetings. Five sub-categories emerged: 'supportive storytelling for myself and for others','impact of the pandemic','role of the counsellors','homogeneity and design of the groups' and 'life after bereavement groups'. Conclusion: Participants were clear that they preferred in-person bereavement groups. Meetings outdoors were made possible through the counsellors' prudence and imagination. Increased support from healthcare providers can reduce prolonged grief.

Aim: To explore the meaning of ‘safety’ as it applies to critical care nurses during daily care practice in the intensive care setting.

Design: A qualitative study design was employed.

Methods: The study enlisted 18 critical care nurses and nurse leaders from three hospitals in Sweden. Interview data were collected in 2017 and in 2024. The data were examined using reflexive thematic content analysis.

Results: The meaning of safety within critical care settings was illustrated by the themes ‘Sustaining a safety mindset’, ‘Fostering commitment to patient safety’, ‘Showing individual accountability and continuous learning’ and ‘Managing complexity while prioritising safety standards’. Safe care practice in daily practice also involved adaptability and resilience in response to changing circumstances or unexpected events, ensuring thoroughness and allowing for a return to regular routines when conditions permitted, thereby preventing incomplete care. Core competencies in safety encompassed both technical and non-technical skills, such as the ability to assess and use technology, remain vigilant and thorough, plan ahead, prioritise and identify, and follow through on nursing interventions, all while working in a team and allocating sufficient time for patients.

Conclusion: Sustaining a safe mindset over time is both challenging and essential. Further research should focus on how tofoster a sustained safety mindset. A more proactive approach to learning may be achieved by reflecting on and discussing things that have worked well even in challenging circumstances.

Implications for the Profession and/or Patient Care: This study enriches our understanding of practising safe care in intensive care. It furnishes the nursing profession with a deeper theoretical grasp of proactive safety efforts, encompassing various factors that can mitigate risks in a technologically advanced environment.

Patient safety culture is a critical component of health care quality in nursing homes. Surveys on patient safety culture can be helpful tools to evaluate care. The aims of the study were to translate a survey on patient safety culture, namely, the Nursing Home Survey on Patient Safety Culture (NHSOPS 1.0) from English into Swedish and to adapt it to Swedish conditions and to validate the translation. The survey was translated into Swedish following the TRAPD translation process —translate, review, adjudicate, pre-test, and document, as suggested by the provider of the original survey. The validity of the items was measured by Cronbach's alpha. Some changes in wording were made according to Swedish conditions. A pre-test with staff working in nursing homes showed adequate results for the translation. In this pilot study, all items and questions were considered valuable for measuring patient safety and were therefore retained in the Swedish version. The translated survey may be a helpful tool for measuring patient safety in nursing homes and prompting staff to reflect on their workplaces.

Background: A mayority of individuals suffering from life-threatening diseases prefer a home death. Registered nurses (RNs) in home healthcare (HHC) play a crucial role in providing this care, as they are responsible for the caregiving process by leading home care workers (HCWs) who provide bedside care, constituting a complex collaboration. However, the research available on this topic, with a focus on nurse leadership, is rather limited.Objective: This study aimed to explore RNs' experiences of leading HCWs who were caring for dying individuals in the last days of life.Design: A qualitative, descriptive, and inductive design was utilized with the help of focus group interviews (FGIs), which involved interviewing 20 RNs employed in HHC in northern Sweden. The FGIs were then analyzed using qualitative content analysis.Results: The RNs found that a solid working relationship between themselves and HCWs is important to ensure high-quality care in the last days of a patient's life. They aimed to be available to HCWs and guide them on how to anticipate the dying process and felt responsible for supporting them, often putting their own needs last. The RNs longed for support and guidance themselves while developing their teams. They led HCWs in their development, emphasizing that care in the last days of life was specifically multifaceted, complex, and demanding. Language barriers, organizational challenges, and unclear delineations of leadership responsibilities complicated RNs' leadership in relation to HCWs.Conclusion: The RNs favored relational leadership styles, but they faced numerous challenges that varied between urban and rural areas. Moreover, the RNs led by example in dealing with existential feelings, providing care, ensuring symptom management, and fostering communication and teamwork. Through their leadership, marked by compassion and empowerment, they aimed to enhance the quality of care and nurture a supportive network essential for navigating care in patients' last days of life.

Background: Transitional care encompasses to ensure high-quality healthcare from illness onset through hospitalization to returning home. Relatives of intensive care patients are notably vulnerable to adverse emotional and psychological effects due to the sudden, life-threatening nature of their next of kins' conditions. Unfortunately, limited research explores the experiences of relatives in transitional care contexts. Therefore, the aim of this study was to explore the experiences of relatives as they navigate the process of transitional care, encompassing the journey from home to hospital, from intensive care to general ward settings, and the eventual return to their homes. 

Method: A qualitative research design was used, semi-structured individual interviews with 14 participants who had experience with transitional care, spanning from intensive care to general care, and their return home. Data were analyzed using reflexive thematic analysis as described by Braun and Clarke. 

Preliminary Findings: In the context of transitional care, relatives perceive themselves as frequently becoming invisible and subsequently abandoned by the healthcare system. Relatives perceived that they went in and out of being a part of the care- sometimes invited, other times, they were not, which led to fluctuations in their involvement and confusion regarding how the healthcare system operated.

Background: Being a family member to someone who suffers from a serious illness can change one's perspectives about life. A sudden and severe illness can result in a demanding journey that involves acute admission to hospital, intensive care, post-care, and finally, returning home. Aim: To describe the experience of staying beside a next of kin throughout the healthcare journey, from the onset of illness at home, to the intensive care unit, post-care, and returning home. Methods: The study employed a qualitative design, with data collected via semi-structured interviews and analysed using reflexive thematic analysis. A purposive sampling was used to recruit participants (n = 14), who had experiences of staying beside a next of kin throughout the healthcare journey from the onset of illness to discharge from the hospital. Findings: Family members’ experiences were captured under the overarching theme Journey through an emotional turmoil and the themes Entering a new world, Continuing the journey towards something unknown, and Striving for the new normal at home. They described going through a non-linear process, characterised by transitions or changes in several aspects. The transitions included shifts in the roles that the family members played, in the various environments they found themselves in, and in the progression of the patient's illness or injury. Conclusion: The study suggested that family members with a next of kin who experienced life-threatening situations undergo challenging transitions. The informal caregiver role placed on family members of intensive care unit-survivors significantly impacts their lives and the healthcare systems should prioritise providing high-quality support to family members throughout the entire healthcare journey. Elevating the importance of nursing care within the healthcare system can contribute to delivering holistic care and facilitating transitions. Further research should focus on understanding the support that family members perceive as necessary to facilitate their transition and enhance their well-being.