The impact of severe perinatal events on maternity care providers: a scoping review.

BACKGROUND: Severe events during the perinatal period can be experienced as traumatic by pregnant women, their partners or others who are closely involved. This includes maternity care providers who can be affected by being involved in or observing these events. This may have an impact on their personal well-being and professional practice, influencing quality of care. The aim of this study is to map research investigating the impact of severe events during the perinatal period on maternity care providers, and how these experiences affect their well-being and professional practice. METHOD: A scoping review following the manual of the Joanna Briggs Institute was undertaken. The electronic bibliographic databases included PubMed/MEDLINE, CINAHL, PsycINFO, PsycARTICLES, SocINDEX, Cochrane, Scopus, Web of Science and databases for grey literature. Records passing the two-stage screening process were assessed, and their reference lists hand searched. We included primary research papers that presented data from maternity care professionals on the impact of severe perinatal traumatic events. A descriptive content analysis and synthesis was undertaken. RESULTS: Following a detailed systematic search and screening of 1,611 records, 57 papers were included in the scoping review. Results of the analysis identified four categories, which highlighted the impact of traumatic perinatal events on maternity care providers, mainly midwives, obstetricians and nurses: Traumatic events, Impact of traumatic events on care providers, Changes in care providers' practice and Support for care providers; each including several subcategories. CONCLUSION: The impact of traumatic perinatal events on maternity care providers ranged from severe negative responses where care providers moved position or resigned from their employment in maternity care, to responses where they felt they became a better clinician. However, a substantial number appeared to be negatively affected by traumatic events without getting adequate support. Given the shortage of maternity staff and the importance of a sustainable workforce for effective maternity care, the impact of traumatic perinatal events requires serious consideration in maintaining their wellbeing and positive engagement when conducting their profession. Future research should explore which maternity care providers are mostly at risk for the impact of traumatic events and which interventions can contribute to prevention.

Maternal and newborn plasma oxytocin levels in response to maternal synthetic oxytocin administration during labour, birth and postpartum - a systematic review with implications for the function of the oxytocinergic system.

BACKGROUND: The reproductive hormone oxytocin facilitates labour, birth and postpartum adaptations for women and newborns. Synthetic oxytocin is commonly given to induce or augment labour and to decrease postpartum bleeding. AIM: To systematically review studies measuring plasma oxytocin levels in women and newborns following maternal administration of synthetic oxytocin during labour, birth and/or postpartum and to consider possible impacts on endogenous oxytocin and related systems. METHODS: Systematic searches of PubMed, CINAHL, PsycInfo and Scopus databases followed PRISMA guidelines, including all peer-reviewed studies in languages understood by the authors. Thirty-five publications met inclusion criteria, including 1373 women and 148 newborns. Studies varied substantially in design and methodology, so classical meta-analysis was not possible. Therefore, results were categorized, analysed and summarised in text and tables. RESULTS: Infusions of synthetic oxytocin increased maternal plasma oxytocin levels dose-dependently; doubling the infusion rate approximately doubled oxytocin levels. Infusions below 10 milliunits per minute (mU/min) did not raise maternal oxytocin above the range observed in physiological labour. At high intrapartum infusion rates (up to 32 mU/min) maternal plasma oxytocin reached 2-3 times physiological levels. Postpartum synthetic oxytocin regimens used comparatively higher doses with shorter duration compared to labour, giving greater but transient maternal oxytocin elevations. Total postpartum dose was comparable to total intrapartum dose following vaginal birth, but post-caesarean dosages were higher. Newborn oxytocin levels were higher in the umbilical artery vs. umbilical vein, and both were higher than maternal plasma levels, implying substantial fetal oxytocin production in labour. Newborn oxytocin levels were not further elevated following maternal intrapartum synthetic oxytocin, suggesting that synthetic oxytocin at clinical doses does not cross from mother to fetus. CONCLUSIONS: Synthetic oxytocin infusion during labour increased maternal plasma oxytocin levels 2-3-fold at the highest doses and was not associated with neonatal plasma oxytocin elevations. Therefore, direct effects from synthetic oxytocin transfer to maternal brain or fetus are unlikely. However, infusions of synthetic oxytocin in labour change uterine contraction patterns. This may influence uterine blood flow and maternal autonomic nervous system activity, potentially harming the fetus and increasing maternal pain and stress.

The importance of a good therapeutic alliance in promoting exercise motivation in a group of older Norwegians in the subacute phase of hip fracture; a qualitative study.

BACKGROUND: Hip fractures represent a global public health issue that demands high cost both from the patient and from the society. Functional exercise in the subacute phase of a hip fracture is essential in reducing these costs. To the best of our knowledge, no qualitative study has explored the patients' experiences in participating in an exercise program during the first month after surgery. Thus, this study aims to explore how older people who had participated in an evidence-based exercise intervention describe their relationship with their therapists and how this relationship might contribute to their motivation for exercise. METHODS: Thirteen women and six men, who all had experienced a hip fracture and were staying in the same short-term rehabilitation unit, were interviewed by the last author. The interviews lasted from 30 to 70 min. The participants' mean age was 86 years and they had all participated in a High Intensity Functional Exercise (HIFE) program in one-on-one sessions for 2 weeks, a total of 10 sessions. The recruitment was done by therapists involved in an RCT evaluating the HIFE-program with the attempt to obtain maximum variation. Data were analyzed through systematic text condensation in collaboration between all authors. RESULTS: The analysis yielded three main themes integrated in the core theme "Therapeutic alliance is an interpretative filter for the participants' experiences." The three themes were "The feeling of mutuality and respect in the alliance"; "A trusting and motivating relationship" and "Tailoring of the instruction and program to make the task understandable". These themes concerned basic needs in the relationship between the participants and the therapists which brought forward a feeling of mutual respect. The most prominent finding was the experience of trust in the therapists' abilities, and how this contributed to the participants' motivation to fulfil the program and achieve meaningful changes. CONCLUSION: Our findings suggest that therapeutic alliance is an indispensable aspect of a therapy, and relational knowledge and competence are prerequisites in the transfer of professional knowledge in a therapy. Our findings can be useful to therapists involved in clinical practice, especially to those working with vulnerable groups.

Maternal plasma levels of oxytocin during physiological childbirth - a systematic review with implications for uterine contractions and central actions of oxytocin.

BACKGROUND: Oxytocin is a key hormone in childbirth, and synthetic oxytocin is widely administered to induce or speed labour. Due to lack of synthetized knowledge, we conducted a systematic review of maternal plasma levels of oxytocin during physiological childbirth, and in response to infusions of synthetic oxytocin, if reported in the included studies. METHODS: An a priori protocol was designed and a systematic search was conducted in PubMed, CINAHL, and PsycINFO in October 2015. Search hits were screened on title and abstract after duplicates were removed (n = 4039), 69 articles were examined in full-text and 20 papers met inclusion criteria. As the articles differed in design and methodology used for analysis of oxytocin levels, a narrative synthesis was created and the material was categorised according to effects. RESULTS: Basal levels of oxytocin increased 3-4-fold during pregnancy. Pulses of oxytocin occurred with increasing frequency, duration, and amplitude, from late pregnancy through labour, reaching a maximum of 3 pulses/10 min towards the end of labour. There was a maximal 3- to 4-fold rise in oxytocin at birth. Oxytocin pulses also occurred in the third stage of labour associated with placental expulsion. Oxytocin peaks during labour did not correlate in time with individual uterine contractions, suggesting additional mechanisms in the control of contractions. Oxytocin levels were also raised in the cerebrospinal fluid during labour, indicating that oxytocin is released into the brain, as well as into the circulation. Oxytocin released into the brain induces beneficial adaptive effects during birth and postpartum. Oxytocin levels following infusion of synthetic oxytocin up to 10 mU/min were similar to oxytocin levels in physiological labour. Oxytocin levels doubled in response to doubling of the rate of infusion of synthetic oxytocin. CONCLUSIONS: Plasma oxytocin levels increase gradually during pregnancy, and during the first and second stages of labour, with increasing size and frequency of pulses of oxytocin. A large pulse of oxytocin occurs with birth. Oxytocin in the circulation stimulates uterine contractions and oxytocin released within the brain influences maternal physiology and behaviour during birth. Oxytocin given as an infusion does not cross into the mother's brain because of the blood brain barrier and does not influence brain function in the same way as oxytocin during normal labour does.

Home living older adults' subjective perceptions, evaluation, and interpretations of various welfare technology: A systematic review of qualitative studies.

Objectives: This paper aims to map home-living older adults' subjective perceptions, evaluations, and interpretations of various welfare technologies. Study design: Systematic literature review. Methods: The study was designed as a systematic literature review of qualitative studies. This systematic literature review was carried out according to the PRISMA statement and was prospectively registered in PROSPERO registration number CRD42020190206. The international electronic bibliographic databases included AMED, Academic, CINAHL, Cochrane Reviews, EMBASE, Google Scholar, MEDLINE via PubMed, Scopus, and Web of Science. The scientific evidence was synthesized using qualitative analysis. All aspects of the study method followed COREQ guidelines. Results: Following a detailed systematic search and screening of 1405 studies, 10 were included in the systematic review. The study shows that implementing Welfare Technology seems to prolong older adults' independent living in their own homes and was perceived as a complement to face-to-face contact with health care providers. Conclusions: This study indicated that older adults consider accepting Welfare Technology as it contributes to a sense of security and empowerment in their everyday lives.

Key dimensions of women's and their partners' experiences of childbirth: A systematic review of reviews of qualitative studies.

BACKGROUND: The World Health Organization 2018 intrapartum guideline for a positive birth experience emphasized the importance of maternal emotional and psychological well-being during pregnancy and the need for safe childbirth. Today, in many countries birth is safe, yet many women report negative and traumatic birth experiences, with adverse effects on their and their families' well-being. Many reviews have attempted to understand the complexity of women's and their partners' birth experience; however, it remains unclear what the key dimensions of the birth experience are. OBJECTIVE: To synthesize the information from reviews of qualitative studies on the experience of childbirth in order to identify key dimensions of women's and their partners' childbirth experience. METHODS: Systematic database searches yielded 40 reviews, focusing either on general samples or on specific modes of birth or populations, altogether covering primary studies from over 35,000 women (and >1000 partners) in 81 countries. We appraised the reviews' quality, extracted data and analysed it using thematic analysis. FINDINGS: Four key dimensions of women's and partners' birth experience (covering ten subthemes), were identified: 1) Perceptions, including attitudes and beliefs; 2) Physical aspects, including birth environment and pain; 3) Emotional challenges; and 4) Relationships, with birth companions and interactions with healthcare professionals. In contrast with the comprehensive picture that arises from our synthesis, most reviews attended to only one or two of these dimensions. CONCLUSIONS: The identified key dimensions bring to light the complexity and multidimensionality of the birth experience. Within each dimension, pathways leading towards negative and traumatic birth experiences as well as pathways leading to positive experiences become tangible. Identifying key dimensions of the birth experience may help inform education and research in the field of birth experiences and gives guidance to practitioners and policy makers on how to promote positive birth experiences for women and their partners.

Home Care Nurses' Experiences of the Use and Introduction of the Subacute Functional Decline in the Elderly Instrument.

Introduction: Registered nurses are crucial in home care nursing for elderly patients, as detecting geriatric conditions can be difficult due to age-related changes or communication barriers. Disability is often overlooked in elderly care, requiring different assessment tools to determine patient status and necessary nursing interventions. During the COVID-19 pandemic, the subacute functional decline in the elderly (SAFE) instrument was implemented in some Oslo districts to detect early signs of sub acute functional decline in hospital and home care settings. However, the nurses' perception of this new assessment tool and its effectiveness has not been evaluated. Objectives: This study aims to explore home care nurses' experiences and perceptions regarding the introduction and use of the new assessment tool, SAFE. Objectives were to conduct focus group interviews and perform qualitative analysis. Method: The study followed Consolidated Criteria for Reporting Qualitative Research guidelines, had a qualitative design, and included 15 out of 60 permanently employed RNs at Oslo municipality's home care service in Frogner district. Data was collected via three focus group interviews and analyzed thematically. Results: The study identified three themes: (1) Nurses learned to use SAFE through direct experience due to a lack of standard introduction or training. (2) SAFE supported patient-centred care by enabling communication, preventive work, and identifying patients' needs. (3) Integrating SAFE into electronic databases and daily clinical work could improve nursing efficiency. Conclusion: Overall, using SAFE can improve patient outcomes and care quality in home care, but clear guidelines, ongoing support, and standardized procedures are crucial for its effectiveness. Regular updates and complete management support are also necessary. The study's findings align with previous research and can guide the development and implementation of tools in home care to enhance patient outcomes and the quality of care delivered.

Experiences and challenges of the use Subacute and Acute Dysfunction in the Elderly-SAFE Work team coordinators experiences and challenges in the introduction and use of SAFE of in home-based nursing: A qualitative study from the Norwegian context.

Old age is the leading cause of impaired bodily function, which gradually increases healthcare service needs. To offer the best possible care in the home and to be able to detect health-related functional impairment at an early stage, it is necessary to carry out systematic and structured observations. The assessment tool Subacute and Acute Dysfunction in the Elderly (SAFE) has been developed explicitly for these structured observations. This study aims to explore the experiences and challenges of home-based care work team coordinators (WTCs) regarding the introduction and use of SAFE. METHOD: The present qualitative study was performed following Consolidated Criteria for Reporting Qualitative Research (COREQ) guidelines. The data were collected through individual interviews (n = 3) and focus group (FG) interviews (n = 7). The interview transcripts were analysed using the Gioia method. RESULTS: Five aggregated dimensions were identified: Varying acceptance of SAFE, Structuring and quality-assurance of home-based nursing practice, Obstacles for the integration of SAFE in daily practice, Acceptance and use of SAFE require continuous supervision and SAFE contributes to increased quality of nursing care. CONCLUSION: The introduction of SAFE contributes to a structured follow-up of functional status in patients receiving home care. In order to incorporate the tool into home care practice, it is essential to set aside time to introduce the tool and to support nurses' use of it by offering continuous supervision.

Welfare technology interventions among older people living at home-A systematic review of RCT studies.

The main goal of health services is for the elderly to maintain their mental and physical health and live at home independently for as long as possible. Various technical welfare solutions have been introduced and tested to support an independent life. The aim of this systematic review was to examine different types of interventions and assess the effectiveness of welfare technology (WT) interventions for older people living at home. This study was prospectively registered in PROSPERO (CRD42020190316) and followed the PRISMA statement. Primary randomized control trial (RCT) studies published between 2015 and 2020 were identified through the following databases: Academic, AMED, Cochrane Reviews, EBSCOhost, EMBASE, Google Scholar, Ovid MEDLINE via PubMed, Scopus, and Web of Science. Twelve out of 687 papers met the criteria for eligibility. We used risk-of-bias assessment (RoB 2) for the included studies. Based on the RoB 2 outcomes that showed a high risk of bias (>50%) and high heterogeneity of quantitative data, we decided to narratively summarize the study characteristics, outcome measures, and implications for practice. The included studies were conducted in six countries, namely the USA, Sweden, Korea, Italy, Singapore, and the UK. One was conducted in three European countries (the Netherlands, Sweden, and Switzerland). A total of 8437 participants were sampled, and individual study sample sizes ranged from 12 to 6742. Most of the studies were two-armed RCTs, except for two that were three-armed. The duration of the welfare technology tested in the studies ranged from four weeks to six months. The employed technologies were commercial solutions, including telephones, smartphones, computers, telemonitors, and robots. The type of interventions were balance training, physical exercise and function, cognitive training, monitoring of symptoms, activation of emergency medical systems, self-care, reduction of death risk, and medical alert protection systems. The latter studies were the first of their kind and suggested that physician-led telemonitoring could reduce length of hospital stay. In summary, welfare technology seems to offer solutions to supporting elderly people at home. The results showed a wide range of uses for technologies for improving mental and physical health. All studies showed encouraging results for improving the participants' health status.

Digital solutions to follow up on discharged new parents-A systematic literature review.

New parents and their newborns are followed up after discharge either through home visits from midwives/nurses or using information and communication technology. This follow-up focuses on individual needs related to breastfeeding and infant feeding, practical advice on caring for babies, supporting and strengthening the new mother's knowledge and self-confidence concerning child development and parenting skills, and supporting the relationship between parents and baby. This systematic review aims to integrate available research results that describe new parents' experiences when health and care providers used telemedicine as a platform for follow-up after discharge from the childbirth department. This literature review was conducted following the PRISMA statement and was prospectively registered in PROSPERO CRD42021236912. The studies were identified through the following databases: AMED, Academic, EMBASE, Google Scholar, Ovid MEDLINE via PubMed, Cochrane database, and CINAHL. Results from these studies were compiled using thematic analysis. A total of 886 studies were identified. Screening resulted in eight studies that met the inclusion criteria. Thematic analysis produced the following themes: a) Flexibility and convenience of digital support, b) Digital literacy, c) Parents feeling safe with digital support, and d) Adequate substitute for physical meetings. New parents who live in a home environment with a relaxed atmosphere and around-the-clock digital support experience a sense of control, security, full attention, and encouragement. Digital follow up at home has proven effective because it can meet the support needs of new parents when necessary.

Maternal plasma levels of oxytocin during breastfeeding-A systematic review.

INTRODUCTION: Oxytocin is a key hormone in breastfeeding. No recent review on plasma levels of oxytocin in response to breastfeeding is available. MATERIALS AND METHODS: Systematic literature searches on breastfeeding induced oxytocin levels were conducted 2017 and 2019 in PubMed, Scopus, CINAHL, and PsycINFO. Data on oxytocin linked effects and effects of medical interventions were included if available. RESULTS: We found 29 articles that met the inclusion criteria. All studies had an exploratory design and included 601 women. Data were extracted from the articles and summarised in tables. Breastfeeding induced an immediate and short lasting (20 minutes) release of oxytocin. The release was pulsatile early postpartum (5 pulses/10 minutes) and coalesced into a more protracted rise as lactation proceeded. Oxytocin levels were higher in multiparous versus primiparous women. The number of oxytocin pulses during early breastfeeding was associated with greater milk yield and longer duration of lactation and was reduced by stress. Breastfeeding-induced oxytocin release was associated with elevated prolactin levels; lowered ACTH and cortisol (stress hormones) and somatostatin (a gastrointestinal hormone) levels; enhanced sociability; and reduced anxiety, suggesting that oxytocin induces physiological and psychological adaptations in the mother. Mechanical breast pumping, but not bottle-feeding was associated with oxytocin and prolactin release and decreased stress levels. Emergency caesarean section reduced oxytocin and prolactin release in response to breastfeeding and also maternal mental adaptations. Epidural analgesia reduced prolactin and mental adaptation, whereas infusions of synthetic oxytocin increased prolactin and mental adaptation. Oxytocin infusion also restored negative effects induced by caesarean section and epidural analgesia. CONCLUSIONS: Oxytocin is released in response to breastfeeding to cause milk ejection, and to induce physiological changes to promote milk production and psychological adaptations to facilitate motherhood. Stress and medical interventions during birth may influence these effects and thereby adversely affect the initiation of breastfeeding.

The experience of motivation and adherence to group-based exercise of Norwegians aged 80 and more: a qualitative study.

BACKGROUND: Physical activity is crucial for public health; worldwide, across all age groups, exercise has been recognised as a factor that leads to improved health. However, many people do not engage in regular physical activity and hence miss the opportunity to achieve these significant physical and mental health benefits. With the benefits of exercise in mind, the aim of the present study is to describe the experiences of older people's motivation for participating in and adhering to a group-based exercise intervention in a local community setting. METHODS: A qualitative design was used in which semistructured interviews of three men and four women of an advanced age (81-92) were conducted; the participants described their experiences with their participation in and adherence to a long-term group exercise intervention programme in a community setting. Data were analysed using systematic text condensation and discussed in light of the salutogenetic theory. RESULTS: Four main themes emerged from the data collection: (1) Experience of health challenges: A meaningful starting point; (2) Adherence motivated by increased life-manageability; (3) Comprehensibility through skilled instruction and (4) Social and professional support enhancing motivation. The participants; who had experienced negative changes to their health and function, as well as to their life situation, chose to sign up for the exercise groups and continued to participate throughout the entire intervention. Attending group exercise sessions meant positive changes to physical, mental and social functions enhancing the participants' motivation to sustain their attendance and leading to positive behavioural changes that were important to their everyday lives. CONCLUSION: Essential factors for these participants' decision to sign up for the exercise groups were the following: having important life areas connected to physical activity in their history and having belief in exercise as an effective way to restore function and coping; as well as having current experience of health challenges. Adherence to the group exercise was associated with better coping and the ability to fulfil roles and keep up with important life areas. Support from family, friends and professionals also contributed, both to the process of signing up, and adhering to this long-term intervention. The professionals' skills and the way the instructor tailored group instruction were emphasized as very important to the participants' adherence. Understanding of motivational factors for participation in and adherence to, exercise programmes is of great importance to older people, health professionals and society.

Feedback from Digital Systems Used in Higher Education: An Inquiry into Triggered Emotions - Two Universal Design Oriented Solutions for a Better User Experience.

We illustrate in this paper some of the negative emotions experienced by students when interacting with digital systems in learning situations, where there is a lack of feedback, or the interaction with digital systems is faulty. The emotions are classified here as feelings of: neglection, frustration, uncertainty, need for confirmation, and discomfort. We proposed thereafter two solutions. The first solution focuses on the design of digital feedback from a system which should arouse positive emotions. We discuss this in relation to universal design principle 5, tolerance for error. The second solution we propose is to provide feedback mechanisms for user feedback (user input). This may be considered when the first solution is not possible.

Suboptimal Iodine Status among Pregnant Women in the Oslo Area, Norway.

Norway has been considered iodine replete for decades; however, recent studies indicate reemergence of inadequate iodine status in different population groups. We assessed iodine status in pregnant women based on urinary iodine concentration (UIC), urinary iodine excretion (UIE), and iodine intake from food and supplements. In 804 pregnant women, 24-h iodine intakes from iodine-rich foods and iodine-containing supplements were calculated. In 777 women, iodine concentration was measured in spot urine samples by inductively coupled plasma/mass spectrometry (ICP-MS). In addition, 49 of the women collected a 24-h urine sample for assessment of UIE and iodine intake from food frequency questionnaire (FFQ). Median UIC was 92 µg/L. Fifty-five percent had a calculated iodine intake below estimated average requirement (EAR) (160 µg/day). Iodine intake from food alone did not provide the amount of iodine required to meet maternal and fetal needs during pregnancy. In multiple regression models, hypothyroidism, supplemental iodine and maternal age were positively associated with UIC, while gestational age and smoking were negatively associated, explaining 11% of the variance. This study clearly shows that pregnant women in the Oslo area are mild to moderate iodine deficient and public health strategies are needed to improve and secure adequate iodine status.

Norwegian midwives' perceptions of empowerment.

INTRODUCTION: Midwives are educated to care for women during pregnancy, birth and the postnatal period. For midwives to be able to fulfill their professional role they need to be empowered to do so. AIM OF THE STUDY: To investigate Norwegian midwives' perception of empowerment in practice. METHOD: A cross-sectional study. In September 2014, a random sample of 1500 midwives was sent a questionnaire, which included the Perception of Empowerment in Midwifery Practice Scale (PEMS). Of 1458 eligible midwives, 595 (41%) completed the PEMS. Exploratory factor analyses and comparative analyses were done. RESULTS: Exploratory factor analyses identified three factors (subscales): Supportive management, Autonomous professional role, and Equipped for practice. Midwives working in a hospital setting scored significantly lower on the factors Supportive management and Autonomous professional role compared to midwives not working in a hospital setting (p < 0.001). Midwives with extra/special responsibilities scored higher than those without (p < 0.001) on the same two factors. Midwives working at units with <2500 births scored significantly higher on all three factors compared to midwives working at units with ≥2500 births (p < 0.001). CONCLUSION: The PEMS showed that Norwegian midwives' perception of empowerment at work differed according to midwives' education, role at work, duration of work experience, working situation and environment. This study supports the psychometric qualities of the PEMS.

Nursing students' views on promoting successful breastfeeding in Sweden.

Promoting breastfeeding is important work for health-care personnel in the Swedish context. This promotion is multifaceted and demands the ongoing development of knowledge and competence among both health-care personnel and patients. The aim of the present study was to describe the nursing students' perspectives on breastfeeding in Sweden. Data were obtained in the form of written reflections from nursing students (n=65) and examined using manifest content analysis. The results show that the factors of importance in promoting successful breastfeeding are information about breastfeeding's benefits, traditions and cultural acceptance of the practice, and by government prohibition of infant formula. We conclude that knowledge about the benefits of breastfeeding needs to be prioritized continuously during education.

A researcher's self-reflection of the facilitation and evaluation of an action research project within the Swedish social and care context.

The AR's (Lewin, 1946) assumption was that human beings exist in life spaces through interaction, and communication, and that knowledge development is the result of changes in cognitive structures through communication and involvement in research processes. And further, from the construction of new knowledge gained by learning from each other, comes the presumption to change. The participation is described as "citizen power" (Arnstein, 1969), which means being included in the development process. The degree of citizen power is based on partnership, delegated power and citizen control. All these steps are positioned at the highest level when ranking participation. Partnership means engaging and negotiating with the high level decision makers. The result of delegated power is apparent when the negotiations result in achieving leading decisions that influence a particular plan or programme.

How school nurses experience their work with schoolchildren who have mental illness - a qualitative study in a Swedish context.

BACKGROUND: Reports from research have shown that mental illness has increased dramatically in recent years and is currently one of the biggest problems among Swedish children and adolescents. AIM: The aim of this study was to describe how Swedish school nurses experience their work with schoolchildren who have mental illness. METHOD: Data were gained by individual interviews with school nurses (n = 10) and were analyzed by using manifest qualitative content analysis. RESULTS: The results of the study showed that school nurses used various tools when working with schoolchildren who have mental illness. The working tools were regular health talks, motivational interviewing, individual counseling, family counseling, creating trust, and affirming the child's confidence. CONCLUSION: Results of the study demonstrate the need for further research on schoolchildren's experience of getting help and support from the school nurse.

An evaluation by elderly people living at home of the prepared meals distributed by their municipality - a study with focus on the Swedish context.

Prepared meals distributed by municipalities is a service to elderly people, or persons with health related impairments, who live in their own home, have difficulties preparing their own food and cannot meet their food requirements in any other way. This study aimed to provide a brief picture of how elderly people living at home perceive the food they receive through their municipal food service and what is important to them. The data was collected using questionnaires. 274 out of 276 participants answered the questionnaire (n=173 women 62% and n=101 man 37%). The data was analyzed using Principal Component Analysis (PCA). The results showed that the elderly persons receiving meals through the service were often satisfied, especially with the size of the portions and the delivery time. Those who had been using the food delivery service for a longer time were not satisfied with the alternative dishes they were been offered. There was no significant difference between the views of either gender. Further, those who were receiving special food were, in general, unsatisfied with the meals delivered. Development of the food distribution service by systematic quality insurance and interactive knowledge exchange between the producers and consumers seems to be a way to promote a more holistic and individual adjusted service. Evaluation of the municipal FD service is a powerful tool that can contribute to the development of this service. The food service can be improved and consequently even the quality of life and health of its receivers. The present survey should be revisited and developed in order to detect differences between genders.

How public home care officers reason when making a needs assessment for food distribution to homebound elderly persons in Sweden.

Food distribution (FD) is a part of the public social and care service in Sweden aiming to prevent improper food intake for persons that they are unable to do their own shopping, and prepare their own meals, and in that way ensure reasonable standard of living. Before a person can be granted the FD service, from any municipality, an assessment of their individual requirements has to be made by a public home care officer. The aim of this study was to explore how public home care officers reason when they make a needs assessment for homebound elderly people. The data was collected through individual interviews (n=18). The transcribed interview material was analysed by means of the grounded theory method. The findings showed that the public home care officers were confronted with many challenges when making an assessment of a person's individual needs. They are influenced by their subjective feelings related to their personal views as to what should be the right solution for the individual. However, they remained aware that they needed to be guided by the legal requirements.  Further, they described that the level of an individual's living standard is a leading concept in the governing laws that they need to interpret. Interpretation of this concept is very subjective with the possible consequence that an assessment result may lead to inefficient support. In conclusion, the concept of a reasonable standard of living needs to be clearly defined, decision regarding FD should not take long time, need assessment and decision should be based on the whole picture behind each individual case and there are needs to develop general guidelines for making needs assessment. The findings in this study have implications for public administration, nursing and gerontology.