Mid Sweden University

Bakgrund: Barns rätt att delta i vården är fastslagen i lagstiftning och professionell etik. I den prehospitala vården utmanas denna rätt av tidspress, osäkerhet i att vårda barn och en miljö utformad för vuxna. Dessa faktorer kan skapa svårigheter i vården av barn, och tidigare forskning har visat att vårdinsatser ibland uteblir när patienten är ett barn. I flera regioner i Sverige finns särskilda barnombud inom ambulanssjukvården med uppdrag att främja barns rättigheter. Deras perspektiv ger viktig kunskap om hur barns delaktighet kan möjliggöras i akuta vårdmöten.

Syfte: Att utforska barnombuds uppfattningar om barns möjligheter till delaktighet i prehospital akutsjukvård.

Metod: En kvalitativ design med fenomenografisk ansats användes. Tio barnombud verksamma inom svensk ambulanssjukvård intervjuades under våren 2024. Intervjuerna analyserades induktivt för att identifiera variationer i hur barns delaktighet uppfattas och förstås.

Resultat: Barnombuden beskrev barns delaktighet som möjlig även under akuta förhållanden, men beroende av ambulanspersonalens attityd, erfarenhet och förmåga att skapa relation. Erfarenhet och trygghet i att vårda barn främjade kommunikation och empatiska möten, medan osäkerhet ofta ledde till ett mer uppgiftsfokuserat arbetssätt. Barns ålder, situationens allvar och föräldrars känslomässiga tillstånd påverkade hur mycket barnet kunde involveras, men även små handlingar, som att låta barnet välja färg på ett bandage, använda lek eller att väcka nyfikenhet, kunde minska rädsla och stärka delaktighet. Ambulansmiljön upplevdes som vuxencentrerad,men barnombuden betonade att kreativitet och vilja kunde omvandla även begränsade förutsättningar till delaktiga möten.

Slutsats:Barns delaktighet i prehospital vård formas i första hand av professionell vilja, snarare än av yttre begränsningar. För att barn ska kunna göras delaktiga krävs utbildning i barncentrerad kommunikation, strukturellt stöd och barnanpassade resurser. Delaktighet i ambulanssjukvård bör betraktas som en etisk och professionell kompetens, möjlig även i akutasituationer när vårdpersonal aktivt bekräftar barnet som del av vårdmötet.

Background: While experiencing grief following the death of a close relative is a universal experience, the grieving process and the perceived value of bereavement support vary between individuals. While research suggests that most grief reactions are considered normal and diminish over time, some individuals experience prolonged or complicated grief. Knowledge regarding which factors are associated with grief and how bereavement support is perceived by bereaved individuals is limited.

Aim: This study aimed to explore factors associated with grief reactions after the death of a close relative and to describe how bereavement support was perceived by bereaved individuals.

Methods: A quantitative cross-sectional design, including qualitative analysis of written comments was employed. The study’s population was made up of 75 bereaved relatives of patients cared for by a palliative care team based in rural Northern Sweden (response rate 60%). Participants completed the Traumatic Grief Inventory Self-Report Plus (TGI-SR+, Swedish version). Statistical analyses included independent t-tests and analysis of variance (ANOVA). The qualitative component consisted of 51 written comments analysed using inductive manifest content analysis.

Results: Participants whose loss had occurred within the previous 12 months had significantly higher grief scores than those who had been bereaved for up to 2 years earlier. Overall, grief diminished over time, and only one item – longing and yearning for the deceased – reached pathological levels among those bereaved for less than 12 months. The qualitative findings revealed an overarching theme: the art of surviving. Participants described organised bereavement groups, professional listeners, family, friends, and even financial backing as meaningful forms of support. Some reported having no need for formal support, while a few found that talking about the loss increased their distress.

Conclusion: Grief generally decreases over time, and no demographic factors are identified as reducing grief. Bereavement support does not necessarily need to be professional; informal and individual coping strategies may be equally important. Health care professionals should be educated to identify individuals in need of support and to provide person-centred bereavement care. 

Background

The transition from hospital to home represents a pivotal and potentially high-risk phase for older adults, especially within rural contexts where geographical remoteness, limited resources, and decentralized healthcare infrastructure amplify vulnerabilities. Existing literature offers limited insight into the experiences of rural older adults during this transitional process. Therefore, this study aimed to explore older adults’ experiences of transitioning from hospital to home in rural settings and to describe how they felt during the process.

Methods

This qualitative study used open, unstructured interviews to explore older adults’ experiences of hospital-to-home transitions in a rural region of northern Sweden. Nine older adults (aged 69–85) who had recently been discharged from somatic inpatient wards of a county hospital participated. In one interview, the spouse of one of them also participated. Data were analyzed using a six-phase Reflexive Thematic Analysis.

Results

Older adults’ hospital-to-home transitions were experienced as twofold, involving both a physical transition from hospital to home and an inner transition of self-image. Their experiences related to three interconnected dimensions: organizational, psychological, and social. The themes identified were “Knowing one’s way through the healthcare system,” “Understanding and managing one’s thoughts and emotions,” and “Feeling socially connected.”

Conclusions

Care transitions for older adults in a rural context are complex and highly personal; therefore, healthcare professionals must thoroughly assess each individual’s specific circumstances, including their psychological resources and social networks, during care planning.

Children have the right to express their views and to have those views considered respectfully in matters affecting them, as articulated in Article 12 of the United Nations Convention on the Rights of the Child. In emergency care, this right must be balanced with the child's best interests, particularly when illness, distress or developmental or cognitive factors limit a child's ability to participate directly (Article 3). Little is known about how this is implemented in prehospital emergency care. This study explores how children's participation occurs during ambulance care, as perceived by their parents, using Shier's ‘Pathways to Participation’ model. A qualitative study involving semi-structured interviews with 12 parents (nine mothers and three fathers) of 12 children (five females and seven males, aged 0–14) who received ambulance care in Sweden was conducted. A deductive content analysis was performed, guided by Shier's five-level participation model. Ethical approval was obtained. Participation was described at the first levels of Shier's model: children being listened to, supported in expressing their views and having their views considered. Parents described how emergency medical services clinicians used age-appropriate language, adjusted tone and body language and made meaningful adaptations. Preverbal children were included through non-verbal interaction and emotional presence. However, higher levels of participation were absent. Participation appeared relational and dependent on individual clinicians’ communication style. Participation was more likely when time allowed and less likely during urgent interventions. Children's participation in prehospital emergency care is not only feasible but already realised through relational and responsive clinical behaviours. However, participation is inconsistent and dependent on individual clinicians rather than embedded structures. To align practice with Article 12, clinicians should consider implementing training and clinical routines that facilitate child participation. These findings contribute to evidence that child-centred care is possible in fast-paced emergency contexts.

This article explores the role of end-of-life conversations between palliative home-care patients and their relatives in shaping the bereavement process. Through interviews with 17 bereaved relatives, four distinct modes of contingency were identified: denial, acknowledgment, accepting, and receiving. While some individuals remained in a single mode, others transitioned through all four, suggesting a deeply personal process independent of external influences. The findings underscore the importance of healthcare providers facilitating these conversations, as they can help relatives process emotions and support their grieving. By addressing these modes, caregivers can aid relatives in becoming compassionate advocates for patients nearing death. The study highlights the need for further research into strategies for supporting relatives in navigating these modes, potentially enhancing bereavement care practices.

Purpose: To explore the concept of nursing homes as attractive workplaces perceived by staff and interpreted through the lens of the Magnet Model®.

Methodology: Two workshops with staff from two departments at a nursing home and one workshop with registered nurses, occupational therapists and physiotherapists were held to explore attractive workplaces. Additionally, interviews were conducted with 12 registered nurses, occupational therapists and physiotherapists in another municipality. For the analysis, the authors combined all of the text from the workshops and the interviews and analysed it versus the five core components from the Magnet Model®: 1) transformational leadership, 2) structural empowerment, 3) exemplary professional practice, 4) new knowledge, innovation, and improvements, and 5) empirical quality results as a deductive frame of analysis.

Findings: The analysis revealed how the staff perceived nursing homes as attractive workplaces through the lens of the Magnet Model®. When sorting the material versus the five core components, all the components contributed attractive workplace examples even though innovation and improvements had the fewest examples and empirical quality results the second least.

Research limitations/implications: This study was limited to staff from one nursing home and all registered nurses, occupational therapists and physiotherapists in another municipality. Further research can be conducted at several nursing homes to explore their view of attractive workplaces. 

Originality/Value: The originality of this research is the use of the Magnet model to analyse an attractive workplace in nursing homes within a municipality context.

Aim To explore how chief nursing officers perceive and enact their leadership within bureaucratic healthcare systems, with a particular focus on patient safety, strategic responsibilities and the advancement of nursing care quality.Methods A qualitative study design was used. Semistructured interviews were conducted between October 2023 and May 2024 with nine female Chief Nursing Officers, representing diverse regional healthcare settings across Sweden. The interviews were analysed using reflexive thematic analysis, which was informed by the theory of bureaucratic caring to support interpretation.Findings Chief nursing officers described navigating hierarchical and bureaucratic systems while promoting person-centred care and professional governance. Their work involved balancing strategic mandates with ethical imperatives, advocating for workforce development and fostering a culture of proactive safety. The analysis generated four interrelated themes: (1) grappling with complexity and power structures; (2) guided by ethics, compassion and purpose; (3) empowering the nursing workforce to provide improved care; and (4) shaping quality care through innovation, evidence and technology.Conclusion Chief Nursing Officers can act as key agents of transformation at the intersection of structure and care. Their leadership extends beyond administrative functions to encompass strategic influence, ethical advocacy and system-level improvement. The findings underscore the need to further formalise and institutionalise the role, ensuring it is equipped with the mandate and structures required to lead across organisational levels. Strengthening such roles calls for leadership models that foster collaboration, support shared governance and enable flatter organisational hierarchies-structures designed to enhance participation, distribute decision-making and promote professional autonomy.Reporting Method This study followed reporting standards for qualitative research by adhering to the EQUATOR Network guidelines and using the COREQ checklist.Patient or Public Contribution Only health care staff participated in this study.Implications for the Profession and/or Patient Care This study highlights the strategic, ethical and relational dimensions of chief nursing officers' leadership and its impact on patient safety, quality improvement and workforce development. The findings demonstrate that they can play a pivotal role in embedding ethical perspectives into healthcare leadership-bridging professional nursing values with structural and strategic priorities. This underscores the importance of enabling nurses to shape care systems in ways that promote safety, professional governance and person-centredness.

Purpose: Employee participation in quality improvement is essential for fostering engagement and job satisfaction and delivering high-quality care, as highlighted in the total quality management literature. However, how employee participation is facilitated during quality improvement processes within healthcare organizations remains largely unexplored. Previous studies have identified a research gap, highlighting the importance of examining this phenomenon from the perspective of health professionals. The purpose of this study was to gain a deeper understanding of how health professionals in nursing homes experience their participation in quality improvement. The underlying aim was to describe their involvement and how it can be strengthened, ultimately improving the quality of care. Design/methodology/approach: This study is based on interviews with 17 health professionals from 2 nursing homes in a medium-sized Swedish municipality. Data were analysed with Reflexive Thematic Analysis. Findings: The themes identified through the analysis are “experiences of barriers at the organizational level that limit participation in quality improvement” and “experiences of barriers in daily care that limit participation in quality improvement”. Originality/value: The themes address barriers to participation in quality improvement, reflecting an organizational structure that hinders participation and quality improvement. A quality culture, along with structured approaches to improve quality and foster employee participation is lacking. Implementing total quality management could help address the challenges faced by health professionals in these settings. 

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.