Impact of the pandemic on leisure physical activity and alcohol consumption.

BACKGROUND: The COVID-19 pandemic precipitated heightened morbidity and elevated mortality attributed to the SARS-CoV-2 infection. The pandemic also influenced health behaviors such as physical activity (PA) and alcohol consumption. The aim of this study was to examine changes in leisure PA and alcohol consumption in Sweden during the pandemic, and elucidate potential discrepancies in changes across demographic strata and socioeconomic status (SES). METHODS: Data were retrieved from two waves of the longitudinal cohort study Life conditions, Stress and Health (LSH) (n = 2,523). Two measures of change were used; longitudinal change relative to baseline (2012-2015) and reported change compared to before the pandemic. For these two change measures, differences between sex, age group and SES were analyzed using multinomial logistic regression. RESULTS: Regardless of the change measure, the proportion of individuals with diminished PA was notably higher among females compared to males. Furthermore, relative to baseline, females were less likely to have increased their PA, however according to the reported change they were more likely to have increased PA. Longitudinal change in PA compared to baseline followed a reversed age gradient, while, according to reported change, a decrease in PA during the pandemic was most prevalent in respondents 45 years of age at baseline (OR = 1.8, CI: 1.2-2.5) and respondents 50 years of age at baseline (OR = 1.7, CI: 1.2-2.4). High SES was associated with a greater variability in PA. Alcohol consumption was generally reduced during the pandemic. However, individuals aged 40 or 45 years at baseline were more likely than others to have initiated risky alcohol consumption. CONCLUSIONS: Females exhibited a greater propensity to alter their PA levels during the pandemic, with the most profound decreases observed among individuals of working ages. Despite a general downturn in alcohol consumption, individuals aged 40 and 45 had a heightened likelihood of having initiated risky alcohol consumption compared to individuals in other age cohorts. In conclusion, societal restrictions during a pandemic render a dual impact on PA levels. While posing a risk for decreased PA among individuals in working ages, the restrictions also present a potential window of opportunity to increase PA, particularly among females.

Workplace bullying among healthcare professionals in Sweden: a descriptive study.

Workplace bullying is a taboo event which occurs worldwide, although the prevalence varies significantly between and within countries. Nurses have been regarded an occupational risk group for bullying at the work place. Bullying in health and social care contexts is sometimes reported as frequent and, other times, as not occurring, which sparked our interest in mapping the occurrence of bullying in the health and social care system in Sweden. Thus, the purpose of the study was to examine the prevalence of bullying, and to discuss cultural traditions and environmental factors that affect bullying in workplaces. The sample (n = 2810) consisted of employees at inpatient wards at four hospitals, and employees at municipal eldercare wards in Sweden. A questionnaire including NAQ-22 R was distributed and subsequently analysed with descriptive statistics using SPSS. The youngest group of respondents scored higher than the older groups. Using contrasting estimates of bullying, the prevalence varied between 4.1 and 18.5%, with the lowest prevalence in regards to self-reported exposure. According to the cut-off scores, NAQ-22 R, 8.6% of the respondents were occasionally exposed to bullying while 2.3% were considered to be victims of severe bullying. Work-related negative acts were more common than personal negative acts. The variations in prevalence of bullying as a result of contrasting estimation strategies are discussed from perspective of the 'law of Jante', the 'tall poppy syndrome' and shame. Bullying deteriorates the working conditions which may have an impact on quality of patient care.

Managing bullying in Swedish workplace settings: A concealed and only partially acknowledged problem.

AIM: The purpose of this article was to explore workplace routines and strategies for preventing and managing bullying in the context of health and elderly care. BACKGROUND: Bullying is a serious problem in workplaces with consequences for the individual, the organisation and the quality of care. METHOD: Open-ended interviews were conducted with 12 participants, including managers and specialists within one hospital and three municipalities. The interviews were analysed with qualitative content analysis. RESULTS: Bullying was often concealed, due to avoidance, unclear definition and lack of direct strategies against bullying. No preventative work focusing on bullying existed. Psychosocial issues were not prioritized at workplace meetings. The supervisor had the formal responsibility to identify, manage and solve the bullying problem. The most common decision to solve the problem was to split the group. CONCLUSIONS: The findings showed that bullying was a concealed problem and was first acknowledged when the problem was acute. IMPLICATIONS FOR NURSING MANAGEMENT: Crucial strategies to prevent and combat bullying consist of acknowledgement of the problem, transformational leadership, prioritization of psycho-social issues, support of a humanistic value system and work through bullying problems to achieve long-term changes.

The relationships between the combination of person- and organization-related conditions and patients' perceptions of palliative care quality.

BACKGROUND: Little is known about the combination of person- and organization- related conditions and the relationships with patients' perspectives of care quality. Such a combination could contribute knowledge reflecting the complexity of clinical practice, and enhance individualized care. The aim was to investigate the relationships between the combination of person- and organization-related conditions and patients' perceptions of palliative care quality. METHODS: A cross-sectional study, including 191 patients in the late palliative phase (73% response rate) admitted to hospice inpatient care (n = 72), hospice day care (n = 51), palliative units in nursing homes (n = 30) and home care (n = 38), was conducted between November 2013 and December 2014, using the instrument Quality from the Patients' Perspective specific to palliative care (QPP-PC). Data were analysed, using analysis of covariance, to explore the amount of the variance in the dependent variables (QPP-PC) that could be explained by combination of the independent variables - Person- and organization-related conditions, - while controlling for differences in covariates. RESULTS: Patients scored the care received and the subjective importance as moderate to high. The combination of person- and organization - related conditions revealed that patients with a high sense of coherence, lower age (person - related conditions) and being in a ward with access to and availability of physicians (organization-related condition) might be associated with significantly higher scores for the quality of care received. Gender (women), daily contact with family and friends, and low health-related quality of life (person-related conditions) might be associated with higher scores for subjective importance of the aspects of care quality. CONCLUSION: Healthcare personnel, leaders and policy makers need to pay attention to person- and organization-related conditions in order to provide person-centered palliative care of high quality. Further studies from palliative care contexts are needed to confirm the findings and to investigate additional organizational factors that might influence patients' perceptions of care quality.

Preventive Strategies and Processes to Counteract Bullying in Health Care Settings: Focus Group Discussions.

The aim of the present study was to explore preventive strategies and processes to counteract bullying in workplaces. Data were collected by individual interviews and focus group discussions at one hospital and two nursing home wards for elderly, a total of 29 participants. In the analysis of the interviews we were inspired by constructivist grounded theory. Persistent work with a humanistic value system by supervisor and coworkers, raising awareness about the bullying problem, strong group collaboration, and conflict management, along with an open atmosphere at the workplace, appears to be imperative for accomplishing a policy of zero tolerance for bullying.

Patients' perceptions of palliative care quality in hospice inpatient care, hospice day care, palliative units in nursing homes, and home care: a cross-sectional study.

BACKGROUND: Patients' perceptions of care quality within and across settings are important for the further development of palliative care. The aim was to investigate patients' perceptions of palliative care quality within settings, including perceptions of care received and their subjective importance, and contrast palliative care quality across settings. METHOD: A cross-sectional study including 191 patients in late palliative phase (73 % response rate) admitted to hospice inpatient care, hospice day care, palliative units in nursing homes, and home care was conducted, using the Quality from the Patients' Perspective instrument-palliative care (QPP-PC). QPP-PC comprises four dimensions and 12 factors; "medical-technical competence" (MT) (2 factors), "physical-technical conditions" (PT) (one factor), "identity-orientation approach" (ID) (4 factors), "sociocultural atmosphere" (SC) (5 factors), and three single items (S); medical care, personal hygiene and atmosphere. Data were analysed using paired-samples t-test and analysis of covariance while controlling for differences in patient characteristics. RESULTS: Patients' perceptions of care received within settings showed high scores for the factors and single items "honesty" (ID) and "atmosphere" (S) in all settings and low scores for "exhaustion" (MT) in three out of four settings. Patients' perceptions of importance scored high for "medical care" (S), "honesty" (ID), "respect and empathy" (ID) and "atmosphere" (S) in all settings. No aspects of care scored low in all settings. Importance scored higher than perceptions of care received, in particular for receiving information. Patients' perceptions of care across settings differed, with highest scores in hospice inpatient care for the dimensions; ID, SC, and "medical care" (S), the SC and "atmosphere" (S) for hospice day care, and "medical care" (S) for palliative units in nursing homes. There were no differences in subjective importance across settings. CONCLUSION: Strengths of services related to identity-orientation approach and a pleasant and safe atmosphere. Key areas for improvement related to receiving information. Perceptions of subjective importance did not differ across settings, but perceptions of care received scored higher in more care areas for hospice inpatient care, than in other settings. Further studies are needed to support these findings, to investigate why perceptions of care differ across settings and to highlight what can be learned from settings receiving high scores.

Learning by simulation in prehospital emergency care - an integrative literature review.

BACKGROUND: Acquiring knowledge and experience on high-energy trauma is often difficult due to infrequent exposure. This creates a need for training which is specifically tailored for complex prehospital conditions. Simulation provides an opportunity for ambulance nurses to focus on the actual problems in clinical practice and to develop knowledge regarding trauma care. The aim of this study was to describe what ambulance nurses and paramedics in prehospital emergency care perceive as important for learning when participating in simulation exercises. METHODS: An integrative literature review was carried out. Criteria for inclusion were primary qualitative and quantitative studies, where research participants were ambulance nurses or paramedics, working within prehospital care settings, and where the research interventions involved simulation. RESULTS: It was perceived important for the ambulance nurses' learning that scenarios were advanced and possible to simulate repeatedly. The repetitions contributed to increase the level of experience, which in turn improved the patients care. Moreover, realism in the simulation and being able to interact and communicate with the patient were perceived as important aspects, as was debriefing, which enabled the enhancement of knowledge and skills. The result is presented in the following categories: To gain experience, To gain practice and To be strengthened by others. CONCLUSION: Learning through simulation does not require years of exposure to accident scenes. The simulated learning is enhanced by realistic, stressful scenarios where ambulance nurses interact with the patients. In this study, being able to communicate with the patient was highlighted as a positive contribution to learning. However, this has seldom been mentioned in a previous research on simulation. Debriefing is important for learning as it enables scrutiny of one's actions and thereby the possibility to improve and adjust one's caring. The effect of simulation exercises is important on patient outcome.

Quality of life and sense of coherence in young people and adults with uncomplicated epilepsy: A longitudinal study.

OBJECTIVES: The aim of the study was, in a ten-year follow-up, to describe and explore potential changes in quality of life and sense of coherence in relation to gender differences among persons with epilepsy in the transition from adolescence to adulthood. MATERIALS AND METHODS: A longitudinal study of sense of coherence (SOC) and quality of life with repeated measurement design (1999, 2004, and 2009) was conducted in a population of persons (n = 69) who were aged 13-22 years in 1999 and 23-33 years in 2009. The Quality-of-Life Index (QLI) and the Sense of Coherence (SOC) scale were used. RESULTS: There was a significant decrease (p ≤ 0.001) in seizures compared with the 2004 results, mainly among the women (p = 0.003). When comparing the total QLI scores, no significant differences were found between the three data collections and there were no differences in total scores between men and women. There was a decrease in the SOC total score over the 10-year period study. Total SOC was significantly higher among those being 30-33 years old compared to those being 23-29 years old (p = 0.014) and among those having a driving license (p = 0.029) compared to those not having a driving license. CONCLUSIONS: Both quality of life and sense of coherence are important for maintaining health and well-being. Promoting health and well-being requires effective high-quality multidisciplinary person-centered care.

Patients' preferences in palliative care: A systematic mixed studies review.

BACKGROUND: It is necessary to develop palliative care to meet existing and future needs of patients and their families. It is important to include knowledge of patient preferences when developing high-quality palliative care services. Previous reviews have focused on patient preferences with regard to specific components of palliative care. There is a need to review research on patient's combined preferences for all elements that constitute palliative care. AIM: The aim of this study is to identify preferences for palliative care among patients in the palliative phase of their illness, by synthesizing existing research. DATA SOURCES: Studies were retrieved by searching databases - the Cochrane Library, Medline, CINAHL, PsycINFO, Scopus and Sociological Abstracts - from 1946 to 2014, and by hand searching references in the studies included. DESIGN: A systematic mixed studies review was conducted. Two reviewers independently selected studies for inclusion and extracted data according to the eligibility criteria. Data were synthesized using integrative thematic analysis. RESULTS: The 13 qualitative and 10 quantitative studies identified included participants with different illnesses in various settings. Four themes emerged representing patient preferences for care. The theme 'Living a meaningful life' illustrated what patients strived for. The opportunity to focus on living required the presence of 'Responsive healthcare personnel', a 'Responsive care environment' and 'Responsiveness in the organization of palliative care'. CONCLUSION: The four themes may be useful for guiding clinical practice and measurements of quality, with the overall goal of meeting future needs and improving quality in palliative care services to suit patients' preferences.

Patients' perceptions of palliative care: adaptation of the Quality from the Patient's Perspective instrument for use in palliative care, and description of patients' perceptions of care received.

BACKGROUND: Instruments specific to palliative care tend to measure care quality from relative perspectives or have insufficient theoretical foundation. The instrument Quality from the Patient's Perspective (QPP) is based on a model for care quality derived from patients' perceptions of care, although it has not been psychometrically evaluated for use in palliative care. The aim of this study was to adapt the QPP for use in palliative care contexts, and to describe patients' perceptions of the care quality in terms of the subjective importance of the care aspects and the perceptions of the care received. METHOD: A cross-sectional study was conducted between November 2013 and December 2014 which included 191 patients (73% response rate) in late palliative phase at hospice inpatient units, hospice day-care units, wards in nursing homes that specialized in palliative care and homecare districts, all in Norway. An explorative factor analysis using principal component analysis, including data from 184 patients, was performed for psychometric evaluation. Internal consistency was assessed by Cronbach's alpha and paired t-tests were used to describe patients' perceptions of their care. RESULTS: The QPP instrument was adapted for palliative care in four steps: (1) selecting items from the QPP, (2) modifying items and (3) constructing new items to the palliative care setting, and (4) a pilot evaluation. QPP instrument specific to palliative care (QPP-PC) consists of 51 items and 12 factors with an eigenvalue ≥1.0, and showed a stable factor solution that explained 68.25% of the total variance. The reliability coefficients were acceptable for most factors (0.79-0.96). Patients scored most aspects of care related to both subjective importance and actual care received as high. Areas for improvement were symptom relief, participation, continuity, and planning and cooperation. CONCLUSION: The QPP-PC is based on a theoretical model of quality of care, and has its roots in patients' perspectives. The instrument was developed and psychometrically evaluated in a sample of Norwegian patients with various diagnoses receiving palliative care in different care contexts. The evaluation of the QPP-PC shows promising results, although it needs to be further validated and tested in other contexts and countries.

Implementation of patient-focused care: before-after effects.

PURPOSE: The purpose of this paper is to evaluate an organizationally oriented, patient-focused care (PFC) model's effects on care quality and work climate. DESIGN/METHODOLOGY/APPROACH: The study has a before-after (PFC implementation) design. The sample included 1,474 patients and 458 healthcare providers in six participating wards before and after PFC implementation, plus five additional randomly chosen wards, which only featured in the post-assessment. FINDINGS: No pre-post differences were found regarding care perceptions or provider work climate evaluations. Statistically significant improvements were noted among provider care evaluations. Using aggregate-level ward data, multiple regression analyses showed that high adherence to PFC principles and a positive work climate contributed significantly to variance among care quality ratings. RESEARCH LIMITATIONS/IMPLICATIONS: Among healthcare providers, questions related to specific PFC aspects during evenings, nights and weekends had to be dropped owing to a low response rate. PRACTICAL IMPLICATIONS: An important requirement for both practice and research is to tailor PFC to various health and social care contexts. ORIGINALITY/VALUE: The study is large-scale before-after PFC model review, where patient and provider data were collected using well-established measurements.

Ambulance Nurses' Competence and Perception of Competence in Prehospital Trauma Care.

INTRODUCTION: We focus on trauma care conducted in the context of a simulated traumatic event. This is in this study defined as a four-meter fall onto a hard surface, resulting in severe injuries to extremities in the form of bilateral open femur fractures, an open tibia fracture, and a closed pelvic fracture, all fractures bleeding extensively. METHODS: The simulated trauma care competence of 63 ambulance nurses in prehospital emergency care was quantitatively evaluated along with their perception of their sufficiency. Data was collected by means of simulated trauma care and a questionnaire. RESULTS: Life-saving interventions were not consistently performed. Time to perform interventions could be considered long due to the life-threatening situation. In comparison, the ambulance nurses' perception of the sufficiency of their theoretical and practical knowledge and skills for trauma care scored high. In contrast, the perception of having sufficient ethical training for trauma care scored low. DISCUSSION: This study suggests there is no guarantee that the ambulance nurses' perception of theoretical and practical knowledge and skill level corresponds with their performed knowledge and skill. The ambulance nurses rated themselves having sufficient theoretical and practical knowledge and skills while the score of trauma care can be considered quite low.

A Healthy Person: The Perceptions of Indonesian and Scandinavian Nursing Students.

The purpose of this exploratory study was to investigate how nursing students in Indonesia and Scandinavia characterize a healthy person. Two hundred thirty-two nursing students from Indonesia, 50 students from Sweden, and 119 students from Norway participated by answering an open-ended question. Qualitative content analysis was used to identify patterns of health in a cultural and national context. The characteristics of a healthy person were summarized in the theme "external and inner balance," which are intertwined because of the wholeness of self-image and appearance. The subcategories were having a strong and positive body image, feeling well and having inner harmony, following the rules of life, coping with challenges, and acting in unison with the environment. There were more similarities than differences between the Indonesian and Scandinavian nursing students' understanding of being a healthy person. The difference is that the Scandinavian students mentioned individuality, whereas the Indonesian students referred to collective values.

Mapping the use of simulation in prehospital care - a literature review.

BACKGROUND: High energy trauma is rare and, as a result, training of prehospital care providers often takes place during the real situation, with the patient as the object for the learning process. Such training could instead be carried out in the context of simulation, out of danger for both patients and personnel. The aim of this study was to provide an overview of the development and foci of research on simulation in prehospital care practice. METHODS: An integrative literature review were used. Articles based on quantitative as well as qualitative research methods were included, resulting in a comprehensive overview of existing published research. For published articles to be included in the review, the focus of the article had to be prehospital care providers, in prehospital settings. Furthermore, included articles must target interventions that were carried out in a simulation context. RESULTS: The volume of published research is distributed between 1984- 2012 and across the regions North America, Europe, Oceania, Asia and Middle East. The simulation methods used were manikins, films, images or paper, live actors, animals and virtual reality. The staff categories focused upon were paramedics, emergency medical technicians (EMTs), medical doctors (MDs), nurse and fire fighters. The main topics of published research on simulation with prehospital care providers included: Intubation, Trauma care, Cardiac Pulmonary Resuscitation (CPR), Ventilation and Triage. CONCLUSION: Simulation were described as a positive training and education method for prehospital medical staff. It provides opportunities to train assessment, treatment and implementation of procedures and devices under realistic conditions. It is crucial that the staff are familiar with and trained on the identified topics, i.e., intubation, trauma care, CPR, ventilation and triage, which all, to a very large degree, constitute prehospital care. Simulation plays an integral role in this. The current state of prehospital care, which this review reveals, includes inadequate skills of prehospital staff regarding ventilation and CPR, on both children and adults, the lack of skills in paediatric resuscitation and the lack of knowledge in assessing and managing burns victims. These circumstances suggest critical areas for further training and research, at both local and global levels.

Building competence through cross-cultural collaboration in the aftermath of a tsunami: experiences of Indonesian teachers.

The aim of this study was to describe the reported experiences of Indonesian nursing teachers who participated in a two-year cross-cultural project designed to build pedagogical and professional competence after the tsunami in Aceh province in 2004. Eleven Indonesian teachers who had participated in the competence project answered an open-ended questionnaire in November 2007. The data were analyzed by qualitative content analysis, and the main theme "an empowered nursing teacher" emerged. The teachers expressed positive experiences, as having more self confidence, feeling inspired to develop one's potentiality and feeling strength and happiness in one's work. The theme constituted four categories: "encouraged by collaboration and teamwork", "more independent as a teacher", "encouraged by more active students" and, "inspired to develop further competence". The overall result showed that the teachers in the competence developing project reported mostly positive experiences by participating in the project. However, two years is a short time to develop both pedagogical and professional competence. They expressed a desire to continue building their competence, especially in direct clinical practice.