Mid Sweden University

Psykisk ohälsa är en av samtidens största folkhälsoutmaningar, och personer med allvarlig psykisk sjukdom lever i genomsnitt 20–30 år kortare än övriga befolkningen, främst på grund av somatiska sjukdomar kopplade till levnadsvanor. Forskning visar tydligt att fysisk aktivitet kan minska symtom på depression och ångest (Carek et al., 2011) och även minska risken för att utveckla depression (Pearce et al., 2022). Trots detta är implementeringen av fysisk aktivitet i psykiatrisk vård otillräcklig. Även inom idrotten finns betydande risker för psykisk ohälsa, där hög belastning, prestationspress och skador bidrar till ökad sårbarhet. Internationella studier visar att över 30 procent av elitidrottare rapporterar symtom på depression och/eller ångest. Detta understryker behovet av att idrottsvetare utvecklar kunskap om bemötande, kommunikation och tidig upptäckt av psykisk ohälsa. Studenter vid specialistsjuksköterskeprogrammet i psykiatrisk vård och distriktsvård samt idrottsvetenskapliga programmet möter båda målgrupper där kropp och själ samspelar. Här finns en tydlig möjlighet att låta professionerna mötas genom interprofessionellt lärande (IPL), en pedagogisk metod som enligt WHO:s ramverk (2019) stärker samarbete och kvalitet i framtida vård och hälsoarbete. Systematiska översikter visar att IPL ökar studenters förmåga till teamarbete och förbättrar lärandeprocesser (Lapkin et al., 2011; Rodrigues da Silva Noll Gonçalves et al., 2021). Syftet med projektet är att utveckla ett interprofessionellt moment där studenter utforskar sambandet mellan fysisk aktivitet, levnadsvanor och psykisk hälsa, med fokus på tvärprofessionellt och personcentrerat hälsofrämjande arbete.

Genomförandet sker i tre steg med de tre olika studentgrupperna tillsammans: 1. Workshop: Introduktion till psykisk hälsa/ohälsa och levnadsvanor, ledd av lärare från respektive program. 2. Case-baserat arbete: Studenter från alla tre utbildningarna arbetar i blandade grupper med ett patientfall (t.ex. person/elitidrottare med depression, låg fysisk aktivitet, social isolering). 3. Presentation & reflektion: Grupperna presenterar sin gemensamma hälsoplan och reflekterar över samarbete, etik och kommunikation.

Upplägget utgår från studentaktiva metoder och ett sociokulturellt lärandeperspektiv där kunskap utvecklas i dialog och samspel (Vygotsky, 1978). I linje med NU-konferensens pedagogiska triad syftar momentet till att skapa intryck genom mötet mellan professionerna, avtryck genom fördjupad förståelse för varandras kompetenser och uttryck genom studenternas gemensamma handlingsförslag och presentationer. Projektet utvärderas genom att studenterna skriver reflektionsloggar efter utbildningsinsatsen och mindre fokusgrupper med frivilliga studenter. Förväntade resultat är ökad förmåga för studenter att integrera kunskap om fysisk och psykisk ohälsa i teori och praktik, samt stärkt interprofessionell förståelse och utveckling av konkreta strategier för hälsofrämjande arbete.

Referenser

Carek, P.J., Laibstain, S.E.,& Carek, S.M. (2011). Exercise for the treatment of depression and anxiety. Int´L J Psychiatry in Medicine, 41(1), pp. 15-28. WHO (2019). https://interprofessional.global/wp-content/uploads/2019/11/WHO-2010- Framework-for-Action-on-Interprofessional-Education-and-Collaborative-Practice.pdf

Lapkin, S., Levett-Jones, T., & Gilligan, C. (2011). The effectiveness of interprofessional education in university-based health professional programs: A systematic review. JBI Libr Syst Rev, 9(46), 1917-1970. doi:10.11124/01938924-201109460-00001

Pearce, M., Garcia, L., Abbas, A., Schuch, F.B., Golubic, R., Kelly, P., Khan, S., Utukuri, M., Laird, Y., Mok, A., Smith, A., Tainio, M., Brage, S.,& Woodcock, J. (2022). Association between physical activity and risk of depression. A systematic review and meta-analysis. JAMA Psychiatry, 79(6), pp 550-559. Doi: 10.1001/jamapsychiatry.2022.0609

Rodrigues da Silva Noll Gonçalves, J., Noll Gonçalves, R., da Rosa, S. V., Schaia Rocha Orsi, J., Moysés, S. J., & Iani Werneck, R. (2021). Impact of interprofessional education on the teaching and learning of higher education students: A systematic review. Nurse Educ Pract, 56, 103212. doi:10.1016/j.nepr.2021.103212

Vygotsky, L. S. (1978). Mind in Society: The Development of Higher Psychological Processes. Cambridge, MA: Harvard University Press.

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.

This study explores the implementation of a lifestyle programme within municipal mental health services from the perspectives of staff working with housing support, focusing on the challenges and facilitators that shaped its delivery over time. Drawing on longitudinal data collected across three time points, the findings highlight the complexity of implementing lifestyle programmes in fragmented service environments. While early stages were marked by staff engagement and contextual adaptation, sustainability was hindered by staff turnover, limited organisational anchoring, and unclear responsibilities. The Consolidated Framework for Implementation Research was used to analyse how organisational context, leadership, and timing influenced outcomes. The study underscores the importance of shared responsibility, embedded support structures, and flexible implementation strategies. It also points to the potential of cross-sector collaboration, particularly with third sector organisations, as a means of sustaining preventive efforts when internal resources are constrained. Overall, the findings contribute to a deeper understanding of how complex interventions can be adapted and maintained in real-world mental health settings.

Individuals living with mental disorders are at heightened risk of lifestyle-related health problems and premature mortality. Lifestyle programmes with both individual support and group interactions with a person-centred focus in outpatient psychiatric care may help mitigate these risks. However, mental health staff's experiences of implementing such programmes remain underexplored. The aim of this study was to explore the experiences of mental health staff in facilitating a person-centred lifestyle programme within psychiatric outpatient care. Using a descriptive qualitative design, 10 mental health staff educated to group leaders were interviewed in semi-structured formats following their delivery of a 12-session lifestyle programme. Data were analysed using qualitative content analysis. Three main categories emerged: Programme planning and implementation, Programme content and structure, and A supportive relationship. Subcategories addressed challenges, such as lack of preparation time, organisational barriers, and the need for programme adaptation. The findings suggest that aligning lifestyle programmes with person-centred care emphasising both empathy and structure can enhance participants' health while fostering professional fulfilment among staff. To ensure long-term sustainability, enhanced organisational support and integration into routine practice are recommended.

Psykisk ohälsa är ett betydande folkhälsoproblem som påverkar livskvalitet, hälsolitteracitet och tillgång till stöd. I högre utbildning innebär detta ett behov av pedagogiska modeller som rustar studenter att arbeta evidensbaserat, personcentrerat och tillsammans över professionsgränser. Detta projekt bygger på en forskningsbaserad grupputbildning som tidigare utvecklats och utvärderats i två doktorsavhandlingar (Björk, 2020; Rönngren, 2018). Teoretiskt förankras projektet i modern forskning om personcentrerad vård (Gyllensten et al., 2025), konstruktiv länkning och studentaktivt lärande (Biggs, 1996), samt tjänstedesign som metod för samskapande och värdeskapande i välfärdstjänster (Yu & Sangiorgi, 2017).

Syftet är att vidareutveckla den befintliga grupputbildningen till en sammanhållen och användarcentrerad tjänst för personer med psykisk ohälsa, samtidigt som projektet prövar ett högskolepedagogiskt upplägg där studenter i omvårdnad och tjänstedesign samarbetar i en verklighetsnära och forskningsanknuten utvecklingsprocess.

Metodologiskt genomfördes projektet med tjänstedesignens faser – förstå, utforska, idéutveckla och testa. Studenterna genomförde intervjuer, användarresor, problemträd och klustring baserat på empiriskt material från kommunal verksamhet och brukarorganisationer. Teoretiska perspektiv från personcentrerad vård (Gyllensten et al., 2025) och design för värdeskapande (Yu & Sangiorgi, 2017) integrerades med forskningsresultaten från avhandlingarna (Björk, 2020; Rönngren, 2018) för att säkerställa vetenskaplig och pedagogisk kvalitet.

Resultaten visar tre huvudsakliga utvecklingsområden: (1) svårigheter att nå målgrupper, särskilt unga, på grund av otydlig och analog kommunikation; (2) ett omfattande och texttungt material som skapar kognitiv och organisatorisk belastning för både deltagare och gruppledare; samt (3) bristande strukturerad uppföljning av avhopp, vilket försvårar kontinuitet och personcentrering. Samtidigt visar användarinsikterna att gruppformatet stödjer gemenskap, trygghet och igenkänning – centrala komponenter i personcentrerad vård (Gyllensten et al., 2025).

Pedagogiskt visar projektet att tjänstedesignstudenter utvecklar fördjupad förståelse för psykisk ohälsa och komplexiteten i välfärdstjänster, medan omvårdnadsstudenter utvecklar praktisk kompetens i behovsanalys, samskapande och iterativ tjänsteutveckling. Kombinationen av forskningsbaserat innehåll, autentiska användardata och tvärprofessionellt lärande skapar en hållbar modell för högre utbildning som stärker både tjänsteutveckling och framtida professionell handlingsberedskap.

Referenser

Biggs, J. (1996). Enhancing teaching through constructive alignment. Higher Education, 32(3), 347– 364.

Björk, A. (2020). Stödjande gemenskap: Utveckling och utvärdering av en intervention för livsstilsförändring bland vuxna med ADHD. Mid Sweden University Doctoral Thesis 315.

Gyllensten, H., Cederberg, M., Alsén, S., Blanck, E., Ali, L., Fors, A., … Ekman, I. (2025). Personcentred care: State-of-the-art and future perspectives. Current Heart Failure Reports, 22(1), 15. https://doi.org/10.1007/s11897-025-00702-3

Rönngren, Y. (2018). Supporting healthy lifestyle habits in persons with mental disorders: The development of a nurse-led lifestyle intervention. Mid Sweden University Doctoral Thesis 279.

Yu, E., & Sangiorgi, D. (2017). Service Design as an Approach to Implement the Value Cocreation Perspective in New Service Development. Journal of Service Research, 21(1), 40–58. https://doi.org/10.1177/1094670517709356

Background: In palliative care, everyday conversations between registered nurses (RNs) and patients often lead to deeper, more confidential discussions about existential concerns and end-of-life matters. These conversations, which are essential but emotionally challenging, are typically initiated by patients. RNs must address various emotional and psychological needs, managing empathy alongside professional responsibility while protecting their own emotional well-being and that of the patient. However, understanding is limited of how RNs develop the skills required to navigate the complex dynamics inherent in confidential conversations within palliative care.

Aim: To to explore and gain a deeper understanding of how RNs in palliative care develop personal and professional approaches in confidential conversations with patients.

Methods: This study employed a qualitative design, using five focus groups. A total of 22 RNs working in specialised palliative care participated. The transcribed interviews were analysed using Thorne’s interpretive description methodology.

Results: RNs in palliative care pursued meaningful and supportive interactions during confidential conversations. Their reflections revealed vulnerabilities and the importance of continuous self-reflection, which fostered growth, resilience and professional development. They sought ways to process emotional challenges, from individual reflection to peer discussions and structured supervision, refining their approaches to care. Four themes emerged: balancing external demands with inner motivation, recognising personal limitations, managing empathy with professional responsibility and gradually building trust. These themes highlight the complex interplay of emotional and professional demands, underscoring the value of reflective practices in supporting RNs’ personal and professional development.

Conclusion: Reflection and continuous professional development are essential for meaningful confidential conversations in palliative care. These practices help nurses manage emotional and professional challenges, balancing empathy with boundaries. Peer support, shared learning, and integration of self-awareness and emotional resilience into nursing education promote resilience, care quality and sustained professional development across healthcare settings.

Keywords: Confidential conversations; Education, Professional; Focus Groups; Nurse-Patient Relations; Palliative Care; Reflective practice; Registered Nurses; Professional development

Projektet baserades på ett personcentrerat livsstilsprogram i grupp för personer med psykisk ohälsa. Syftet med projektet var att studera integreringen och effekterna av livsstilsprogrammet i kommunal verksamhet och att undersöka programmets påverkan på fysisk, psykisk och social hälsa samt hälsokunskap hos deltagarna med psykisk ohälsa.

Managers in psychiatric outpatient care may play a crucial role in motivating staff to adopt new approaches, often navigating challenges such as organisational resistance and the complexities of the care environment. This study describes managers? experiences motivating staff to adopt a new approach by implementing a lifestyle program for individuals with mental illness in an outpatient psychiatric setting. Interviews with seven managers revealed an overarching theme of a ?learning-oriented relationship,? emphasising the importance of mutual engagement and staff development. The findings highlight that building relationships and prioritising staff development enhance engagement and facilitate meaningful change. A learning-focused leadership style?marked by inspiration, support, and trust?emerged as a key driver of sustainable change and the adoption of health-promoting practices. This leadership approach may not only aid the implementation of new initiatives but also foster a workplace culture grounded in collaboration, growth, and shared purpose. The study also underscores the importance of training managers in frameworks like Self-Determination Theory, focusing on inspirational motivation and personalised support. Embodying genuine care managers can create an empowering environment that enables staff to embrace and sustain new practices. Future research should explore perspectives to refine strategies for implementation in complex healthcare settings.