Unscheduled home consultations by registered nurses may reduce acute clinic visits.

BACKGROUND: To effectively utilize available healthcare resources, integrated care models are recommended. According to such model's, registered nurses have the potential to increase patient access to health care services and alleviate organizational workload. Studies on acute home consultation assessments by registered nurses are sparse. The aim was to describe the reasons and actions for unscheduled same-day face-to-face registered nurse consultation at home offered to patients calling the national telephone helpline for healthcare in Sweden (SHD 1177), according to the integrated Collaborative Health Care model. METHODS: A descriptive cross-sectional study was designed. Data from registered nurses (n = 259) working within the Collaborative Health Care model, who performed unscheduled consultations at home (n = 615) using a data collection tool from 2017 to 2018 were collected. RESULTS: Among the 615 unscheduled home consultations performed by registered nurses, > 50% of the patients were managed at home as their health problems were not deemed as requiring a same-day referral to a clinic when assessed by the registered nurses. The most frequent health problems and reasons for contact were urinary tract problems, followed by medical and surgical conditions. Social factors, including living alone, impacted referral. Those living with a partner received care at home to a greater extent than those who lived alone. CONCLUSION: An integrated model for healthcare involving registered nurses direct assessment, action and accountability seems to be an efficient option for providing integrated care at home and reducing acute clinic visits.

Exploring experiences of ageing in older adults living with HIV in Sweden: a qualitative study.

PURPOSE: The number of people living and ageing with HIV is increasing. Insight into their well-being is lacking. The present study was conducted to explore needs, psychosocial issues and experiences of ageing in older adults living with human immunodeficiency virus (HIV) in Sweden. METHODS: A qualitative approach was employed. Semi-structured interviews were conducted with a convenience sample of 22 participants aged 65 years or older living with HIV in Sweden. Thematic analysis based on descriptive phenomenology was used. RESULTS: Being an older adult living with HIV emerged as a multifaceted experience. The meaning and impact of HIV varied from minimal to substantial, and ageing could overshadow the significance of HIV in everyday life. Three themes emerged: 1) increasing age in the foreground, 2) internalizing HIV in everyday life, and 3) socioemotional impact on everyday life. CONCLUSIONS: The findings suggest a need for a more holistic approach to care of older adults living with HIV, recognizing the broader context of healthy ageing. While participants experienced good health, challenges related to ageing persist, and experiencing HIV-related stigma. The findings highlight the importance of empowering older adults living with HIV.

Occupational balance and associated factors among students during higher education within healthcare and social work in Sweden: a multicentre repeated cross-sectional study.

OBJECTIVE: The aim was to explore whether occupational balance is associated with health, health-promoting resources, healthy lifestyle and social study factors among students during higher education within healthcare and social work. DESIGN: The study has a multicentre repeated cross-sectional design. Data were collected via a self-reported, web-based questionnaire based on the validated instruments: the 11-item Occupational Balance Questionnaire (OBQ11), the Sense of Coherence (SOC) Scale, the Salutogenic Health Indicator Scale (SHIS) and five questions from the General Nordic Questionnaire (QPS Nordic) together with questions about general health and lifestyle factors. SETTING: Students at six universities in western Sweden at one of the following healthcare or social work programmes: biomedical scientists, dental hygienists, nurses, occupational therapists, physiotherapists, radiology nurses and social workers. PARTICIPANTS: Of 2283 students, 851 (37.3%) participated. RESULTS: The students experienced that occupational balance increased during education. The total OBQ11 score was higher among students in semesters 4 and 6/7, compared with semester 1 students. Students with higher OBQ11 also reported higher SOC throughout their education, while health seemed to decrease. Students who reported higher levels of OBQ11 reported lower levels of health and well-being in semesters 4 and 6/7, compared with semester 1. There was an opposite pattern for students reporting lower levels of OBQ11. CONCLUSIONS: The association between higher levels of OBQ11 and lower levels of health and well-being is remarkable. There is a need for more research on this contradiction and what it means for students' health and well-being in the long run.

A qualitative analysis of child and family complaints related to child mental health services.

PROBLEM: Little is known about issues of patient-reported problems, in particular within psychiatric services for children with mental ill health. Child and family complaints related to child mental health services can be analyzed and discussed in light of the universal human right to health and healthcare. Therefore, the aim of this study was to analyze child and family complaints related to child mental health services. METHODS: A retrospective, descriptive design was used. Child and family complaints were analyzed with a qualitative thematic analysis. FINDINGS: The findings were described in three themes describing lack of access to care, inadequate communication between services and children with mental ill health and their families, and lack of clarity of who is responsible for care, leading to neglect of children's needs. These issues place a huge responsibility on parents or relatives. CONCLUSION: Better communication within mental health services, and better collaboration with other services such as school and social services, could limit children's suffering. Healthcare services with named professionals who specialize in child mental health and provide continuity in care, are required. General human rights principles should guide planning and care of children.

The patient's first point of contact (PINPOINT) - protocol of a prospective multicenter study of communication and decision-making during patient assessments by primary care registered nurses.

BACKGROUND: A major challenge for primary care is to set priorities and balance demands with available resources. The registered nurses in this study are practice nurses working in primary care offices, playing a large role in initial assessments. The overall objective of this research is to investigate practices of communication and decision-making during nurses' initial assessment of patients' health problems in primary care, examine working mechanisms in good practices and develop feasible solutions. METHODS: Project PINPOINT aims for a prospective multicenter study using various methods for data collection and analysis. A purposive sample of 150 patient‒nurse consultations, including 30 nurses and 150 patients, will be recruited at primary care centers in three different geographic areas of southwest Sweden. The study will report on outcomes of communication practices in relation to patient-reported expectations and experiences, communication processes and patient involvement, assessment and decision-making, related priorities and value conflicts with data from patient questionnaires, audio-recorded real-time communication, and reflective interviews with nurses. DISCUSSION: This research will contribute to the knowledge needed for the guidance of first-line decision-making processes to best meet patient and public health needs. This knowledge is necessary for the development of assessments and decisions to be better aligned to patients and to set priorities. Insights from this research can empower patients and service providers and help understand and enhance feasible person-centered communication strategies tailored to patients' level of health literacy. More specifically, this research will contribute to knowledge that can strengthen nurses' communication, assessments, and clinical decision-making in primary care. In the long term, this will contribute to how the competencies of practice nurses and other professionals are organized and carried out to make the best use of the resources within primary care. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT06067672.

Adolescents' and young people's experiences of social relationships and health concerns during COVID-19.

PURPOSE: To illuminate the meaning of social relationships and health concerns as experienced by adolescents and young people during the COVID-19 pandemic. METHODS: A longitudinal qualitative study was conducted. Data reported from 172 adolescents and young people aged 12-24 years in five countries; Chile, South Africa, Sweden, the United Kingdom and the United States collected from May 2020 to June 2021 were analysed via thematic analysis. RESULTS: Adolescents and young peoples' experiences of social relationships and health concerns were described in seven themes: Family proximity, conflicts and frustration; difficulties and challenges related to limited living space; peer relations and maintaining friendship in times of social distancing; the importance of school as a place for interaction; vulnerability, emotional distress and uncertainty about the future; health concerns and sense of caring for others; and worries and concerns related to financial hardship. These reports show that the changes to everyday life that were introduced by public responses to the pandemic generated feelings of loneliness, vulnerability, and emotional distress, as well as increased sense of togetherness with family. CONCLUSIONS: The everyday lives of adolescents and young people were restricted and affected more by the consequences of the pandemic than by the COVID-19 virus. These experiences had various impacts on well-being and mental health, where some individuals felt more exposed and vulnerable to emotional distress and loneliness than others. Family and peer relationships could be protective and support a sense of togetherness and belonging. Hence, social relationships are important to provide emotional support. Support for adolescents and young people should be tailored accordingly around social and emotional concerns, to encourage health and well-being.

The onset of sepsis as experienced by patients and family members: A qualitative interview study.

AIMS AND OBJECTIVES: To explore the onset of sepsis based on patients' and family members' experiences. BACKGROUND: Knowledge about the onset of sepsis is limited among patients and their families, which makes early recognition of sepsis difficult. Previous studies argue that their stories are important to recognising sepsis and reduced suffering and mortality. DESIGN: A descriptive design with a qualitative approach was used. METHODS: In total, 29 patients and family members participated in 24 interviews with open-ended questions, including five dyadic and 19 individual interviews. The interviews were conducted during 2021, and participants were recruited from a sepsis group on social media. A thematic analysis based on descriptive phenomenology was performed. The study followed the COREQ checklist. FINDINGS: Two themes emerged from the experiences: (1) When health changes into something unknown, including the two subthemes; Bodily symptoms and signs being vague but still tangible and Feelings of uncertainty, and (2) Turning points when warnings signs are deemed as serious, including the two subthemes Passing borders when feeling out of control and Difficulties understanding the seriousness. CONCLUSIONS: Patients' and family members' stories of the onset of sepsis indicate that symptoms and signs appeared insidiously and then noticeably worsen. The symptoms and signs seemed not be attributed to sepsis; instead, there was uncertainty about what the symptoms and signs meant. It was mainly family members who possibly understood the seriousness of the disease. IMPLICATIONS FOR THE PROFESSION AND PATIENT CARE: Patients' experiences of their symptoms and signs and family members' unique knowledge of the patient, indicate that healthcare professionals should listen and try to understand what the patient and family members are telling and take their concerns seriously. How the condition appears, and family members' concerns are important pieces of the assessment to recognise patients with sepsis. PATIENT OR PUBLIC CONTRIBUTION: Patients and family members contributed to the data collected.

Positive effects of a child-centered intervention on children's fear and pain during needle procedures.

To examine whether children experience less fear or pain using a child-centered intervention and if there were differences between the intervention group and the control group regarding heart rate, time required for the procedure, success rate for the cannula insertion, and patient satisfaction. A controlled single-center case study of observational design, with one control and one intervention group. Child self-reported fear or pain levels did not reveal any differences for those receiving the intervention compared with controls. However, according to a behavioral observation measure with the Procedure Behavior Check List, effects of the intervention were lower distress in relation to fear and pain during the cannula insertion. The time it took to perform the cannula insertion also decreased significantly in the intervention group. More children in the intervention group reported that they were satisfied with the needle procedure compared with the children in the control group. The child-centered intervention provides reduced observed distress related to fear and pain in children undergoing a cannula insertion and reduced total time by more than 50%. This study found that child involvement in care strengthen their ability to manage a needle procedure.

'Sometimes you need an eye-opener': A qualitative study on nursing assistants' experiences of developing communication skills through an educational intervention on person-centred communication.

AIM: To explore nursing assistants' (NAs') experiences of developing communication skills while participating in an educational intervention on person-centred communication. DESIGN: A descriptive qualitative study was conducted. METHODS: Data were collected from interviews and written assignments before, during and after an educational intervention on person-centred communication targeting NAs in home care services. The data were analysed using a phenomenological approach. A total of 25 NAs participated in the study. RESULTS: The findings describe NAs' experiences concerning the communication skills needed for building relationships with older persons and handling emotionally challenging situations. The educational intervention increased their knowledge and awareness of the importance of communication skills and how such skills are developed and refined.

Prediction of the Risk of Sepsis by Using Analysis of Plasma Glucose and Serum Lactate in Ambulance Services: A Prospective Study.

INTRODUCTION: The early recognition of patients with sepsis is difficult and the initial assessment outside of hospitals is challenging for ambulance clinicians (ACs). Indicators that ACs can use to recognize sepsis early are beneficial for patient outcomes. Research suggests that elevated point-of-care (POC) plasma glucose and serum lactate levels may help to predict sepsis in the ambulance service (AS) setting. STUDY OBJECTIVE: The aim of this study was to test the hypothesis that the elevation of POC plasma glucose and serum lactate levels may help to predict Sepsis-3 in the AS. METHODS: A prospective observational study was performed in the AS setting of Gothenburg in Sweden from the beginning of March 2018 through the end of September 2019. The criteria for sampling POC plasma glucose and serum lactate levels in the AS setting were high or intermediate risk according to the Rapid Emergency Triage and Treatment System (RETTS), as red, orange, yellow, and green if the respiratory rate was >22 breaths/minutes. Sepsis-3 were identified retrospectively. A primary and secondary analyses were carried out. The primary analysis included patients cared for in the AS and emergency department (ED) and were hospitalized. In the secondary analysis, patients who were only cared for in the AS and ED without being hospitalized were also included. To evaluate the predictive ability of these biomarkers, the area under the curve (AUC), sensitivity, specificity, and predictive values were used. RESULTS: A total of 1,057 patients were included in the primary analysis and 1,841 patients were included in the secondary analysis. In total, 253 patients met the Sepsis-3 criteria (in both analyses). The AUC for POC plasma glucose and serum lactate levels showed low accuracy in predicting Sepsis-3 in both the primary and secondary analyses. Among all hospitalized patients, regardless of Sepsis-3, more than two-thirds had elevated plasma glucose and nearly one-half had elevated serum lactate when measured in the AS. CONCLUSIONS: As individual biomarkers, an elevated POC plasma glucose and serum lactate were not associated with an increased likelihood of Sepsis-3 when measured in the AS in this study. However, the high rate of elevation of these biomarkers before arrival in hospital highlights that their role in clinical decision making at this early stage needs further evaluation, including other endpoints than Sepsis-3.

Implementing A person-centred CommunicaTION (ACTION) educational intervention for in-home nursing assistants - a study protocol.

BACKGROUND: In this study, the focus is on how to support the competence development needed for nursing assistants in home care. Home care services for older persons can be challenging concerning the nature of the interpersonal interaction and communication needed to care for and respond to the diverse needs of older people who seek to live well in our communities. This implies a need to offer more person-centred care (PCC) to older persons. However, there is a lack of knowledge on how to develop such competence. We, therefore, developed A Person-centred CommunicaTION (ACTION) programme, which is a web-based educational intervention aimed at supporting competence development for nursing assistants. The research objective is to evaluate the ACTION programme with respect to participants' responses to and the effect of the intervention. METHODS: A multicentre case-control study with pre- and post-assessments was designed. The ACTION programme will be implemented at home care units, in two different geographic areas in Sweden. A total of 300 nursing assistants will be recruited: 150 for the intervention group and 150 for the control group. We will evaluate the impact measures and the process. Pre- and post-assessments will be performed with data collected via a) audio recordings of communication, b) a questionnaire on self-efficacy communication skills, PCC, empathy and job satisfaction, c) user data, evaluation forms, field notes and observations, and d) interviews. The data will be analysed with descriptive and analytic statistics and/or qualitative methods for meanings. DISCUSSION: This study has the potential to contribute to the evidence supporting competence development required to offer person-centred and quality home care to older persons and to meet upcoming needs for flexible and easily accessible competence development. TRIAL REGISTRATION: ISRCTN64890826. Registered 10 January 2022, https://www.isrctn.com/ISRCTN64890826.

Registered nurse-patient communication research: An integrative review for future directions in nursing research.

AIM: To explore communication research in nursing by investigating the theoretical approaches, methods, content and perspectives in research on real-time registered nurse (RN)-patient communication. DESIGN: An integrative review of real-time communication between RNs and patients. DATA SOURCES: Empirical research papers were searched in PubMed, CINAHL Plus and Medline. The results from the database searches were supplemented with results from manual searches in reference lists. REVIEW METHODS: A total of 1369 articles published between January 1996 and December 2021 were screened, which resulted in the inclusion of 52 articles. RESULTS: The integration of various theories, such as nursing or communication theories, is weak in most of the included studies. RN-patient communication appears to influence relationship building. Even when nurses strive to meet patients' needs, they often focus primarily on nursing routines and physical care. The topic of the communication varies depending on the situation and different communication styles are used. When a patient-centred approach is adopted, the interpersonal communication becomes quite symmetrical, with complementary roles of nurses and patients. Within a more asymmetric communication context, nurses dominate communication, choose topics and function as instructors. How the nurses communicated subsequently influenced the patients' communication styles and strategies. CONCLUSION: Communication is multifaceted, contains different strategies and is important for building trust and facilitating patient-centred care. The importance of RNs' communication for interaction and relationship-building seems to be well established within research, but few studies focused on patients' communication with RNs. IMPACT: This integrative review gives an overview of the width and depth of observational studies on RN-patient communication research. The variety of studies indicates that this area is a less well-grounded field of research. Future research is warranted to support nurses in their communication, especially regarding the exploration of patients' communication and desired communication skills in nurse-patient interactions. PATIENT OR PUBLIC CONTRIBUTION: No patient or public contribution was included in this integrative review.

The clinical learning environment during clinical practice in postgraduate district nursing students' education: A cross-sectional study.

AIM: To describe and compare the clinical learning environment in community-based home care and primary health care in postgraduate district nursing students' education. DESIGN: Cross-sectional study design. METHODS: A convenience sample of postgraduate district nursing students was derived from five Swedish universities in 2016 and 2017. RESULTS: The postgraduate district nursing students were generally satisfied with the clinical learning environment in their clinical placement. In clinical placement, several factors affected the students' opportunities to learn, such as sufficiently meaningful learning situations with multidimensional content. A working environment that imposed psychosocial strain and high levels of stress among the staff negatively affected the students' learning. To further improve their learning from clinical practices, the students need preceptors who have the skills and competence required to support more advanced reflections and critical thinking on caring situations.

Communication in home care-A feasibility study of an educational intervention in self-efficacy and job satisfaction.

AIM: To explore the feasibility of evaluating a novel educational intervention on person-centered communication for nursing assistants (NAs) in home care. DESIGN: A feasibility study with pre- and post-assessments. METHODS: Feasibility was assessed pre- and post-intervention, including evaluation of data collection procedures, completion rates and missing data in two questionnaires: Self-efficacy Questionnaire measuring communication skills and Measure of Job Satisfaction, analysed descriptively and statistically. RESULTS: The questionnaires were feasible and acceptable for the NAs to complete and understand. The pre- and post-assessments showed 83% and 61% completion rates, respectively, and a low proportion of missing data. Barriers for not participating in data collection were stress caused by staff shortages and high workload. Preliminary analysis of the questionnaires showed no significant difference pre- and post-intervention, even though an overall tendency of increased communication self-efficacy was observed. The NAs' self-efficacy ratings also revealed a ceiling effect.

Health-promoting factors among students in higher education within health care and social work: a cross-sectional analysis of baseline data in a multicentre longitudinal study.

BACKGROUND: Educational environments are considered important in strengthening students' health status and knowledge, which are associated with good educational outcomes. It has been suggested to establish healthy universities based on a salutogenic approach - namely, health promotion. The aim of this study was to describe health-promoting resources and factors among first-semester students in higher education in healthcare and social work. METHODS: This cross-sectional study is based on a survey distributed among all students in seven healthcare and social work programmes at six universities in southern Sweden. The survey was carried out in 2018 using a self-reported, web-based questionnaire focussing on general health and well-being, lifestyle factors together with three validated instruments measuring health-promoting factors and processes: the Sense of Coherence (SOC) scale, Salutogenic Health Indicator Scale (SHIS) and Occupational Balance Questionnaire (OBQ). RESULTS: Of 2283 students, 851 (37.3%) completed the survey, of whom 742 (87.1%) were women; 722 (84.8%) were enrolled on healthcare programmes, and 129 (15.2%) were enrolled on social work programmes. Most reported good general health and well-being (88.1% and 83.7%, respectively). The total mean scores for the SOC scale, SHIS and OBQ were, respectively, 59.09 (SD = 11.78), 44.04 (SD = 9.38) and 26.40 (SD = 7.07). Well-being and several healthy lifestyles were related to better general health and higher SOC, SHIS and OBQ scores. Multiple linear and logistic regressions showed that perceived well-being and no sleeping problems significantly predicted higher general health and higher SOC, SHIS and OBQ scores. Being less sedentary and non-smoking habits were significant predictors of higher SOC. CONCLUSIONS: Swedish students in higher education within the healthcare and social work sector report good general health and well-being in the first semester, as well as health-promoting resources (i.e. SOC, SHIS and OBQ), and in some aspects, a healthy lifestyle. High-intensity exercise, no sleeping problems and non-smoking seem to be of importance to both general health and health-promotive resources. This study contributes to knowledge about the health promotive characteristics of students in the healthcare and social work fields, which is of importance for planning universities with a salutogenic approach.

'Are they really allowed to treat me like that?' - A qualitative study to explore the nature of formal patient complaints about mental healthcare services in Sweden.

The improvement of mental healthcare services requires patients' experiences to identify problems and possible deficits in care. In this study, we explored the nature and meaning of formal patient complaints about mental healthcare services in one region of Sweden using a descriptive design with a qualitative approach. A systematic random sample of 106 formal patient complaints about mental healthcare services in 1 Swedish county was selected and analysed thematically, based on descriptive phenomenology. Themes identified were: lack of access to mental healthcare services and specialist treatment, problems related to unmet needs and difficulties with healthcare staff, insufficient care and treatment and lack of continuity in care, and experiences of not been taken seriously or feeling abused by staff. The vulnerability of patients already in the system is a greater issue than realized. The human right to health and the healthcare of patients with mental ill health can be strengthened by increased access to care, listening to patients properly, and delivering continuity in care.

Children's communication of emotional cues and concerns during a preoperative needle procedure.

OBJECTIVE: This study explores children's expressions of emotional cues and concerns during needle procedures, nurses' responses and findings in relation to children's age and sex. METHODS: Twenty-six children aged 6-12 years were video recorded during a preoperative needle procedure. Emotional communication was analyzed using Verona Coding Definitions of Emotional Sequences. RESULTS: A total of 111 cues or concerns were identified in the observed needle procedures, with a distribution of 77 cues and 34 concerns. A majority of children (85%) expressed emotional cues through non-verbal communication. No differences between child age or sex related to expressed emotion were found. The child elicited the communicated emotion in 98% of sequences. Nurses' responses were coded as not providing space for communication in 75% of sequences. CONCLUSION: Children are capable of expressing their emotional distress, primarily non-verbally, during needle procedures. A child showing less overt expressions during a needle procedure does not necessarily experience less fear or pain. The nurses' communication focused on practical information during the needle procedure, with less attention to the child's distress. PRACTICE IMPLICATIONS: Nurses need to develop strategies to be aware of emotions the child communicates before, during and after a needle procedure.

Assessment of patients with suspected sepsis in ambulance services: a qualitative interview study.

BACKGROUND: The initial care of patients with sepsis is commonly performed by ambulance clinicians (ACs). Early identification, care and treatment are vital for patients with sepsis to avoid adverse outcomes. However, knowledge about how patients with sepsis are assessed in ambulance services (AS) by AC is limited. Therefore, the aim of this study was to explore the meaning of ACs' lived experiences in assessing patients suspected of having sepsis. METHODS: A descriptive design with a qualitative approach was used. Fourteen ACs from three Swedish ambulance organizations participated in dyadic and individual semistructured interviews. A thematic analysis based on descriptive phenomenology was performed. RESULTS: AC experiences were grouped into four themes: (1) being influenced by previous experience; (2) searching for clues to the severity of the patient's condition; (3) feeling confident when signs and symptoms were obvious; and (4) needing health-care professionals for support and consultation. CONCLUSIONS: This study indicates that several factors are important to assessments. ACs needed to engage in an ongoing search for information, discuss the cases with colleagues and reconsider the assessment throughout the entire ambulance mission. A reflective and open stance based on professional knowledge could contribute to recognizing patients with sepsis.

Process evaluation of the ACTION programme: a strategy for implementing person-centred communication in home care.

BACKGROUND: There is currently a strong emphasis on person-centred care (PCC) and communication; however, little research has been conducted on how to implement person-centred communication in home care settings. Therefore, the ACTION (A person-centred CommunicaTION) programme, which is a web-based education programme focusing on person-centred communication developed for nurse assistants (NAs) providing home care for older persons, was implemented. This paper reports on the process evaluation conducted with the aim to describe and evaluate the implementation of the ACTION programme. METHODS: A descriptive design with a mixed method approach was used. Twenty-seven NAs from two units in Sweden were recruited, and 23 of them were offered the educational intervention. Quantitative and qualitative data were collected from multiple sources before, during and after the implementation. Quantitative data were used to analyse demographics, attendance and participation, while qualitative data were used to evaluate experiences of the implementation and contextual factors influencing the implementation. RESULTS: The evaluation showed a high degree of NA participation in the first five education modules, and a decrease in the three remaining modules. Overall, the NAs perceived the web format to be easy to use and appreciated the flexibility and accessibility. The content was described as important. Challenges included time constraints; the heavy workload; and a lack of interaction, space and equipment to complete the programme. CONCLUSIONS: The results suggest that web-based education seems to be an appropriate strategy in home care settings; however, areas for improvement were identified. Our findings show that participants appreciated the web-based learning format in terms of accessibility and flexibility, as well as the face-to-face group discussions. The critical importance of organizational support and available resources are highlighted, such as management involvement and local facilitation. In addition, the findings report on the implementation challenges specific to the dynamic home care context. TRIAL REGISTRATION: This intervention was implemented with nursing assistants, and the evaluation only involved nursing staff. Patients were not part of this study. According to the ICMJE, registration was not necessary ().

Swedish School Nurses' Experiences of Child Abuse.

Child abuse recognition and the protection of children is a global concern. In Sweden, the role of the school nurse (SN) is to promote schoolchildren's health and development and to identify and prevent harm. The aim of this study was to describe Swedish SN experiences of suspecting, identifying, and reporting child abuse and to compare them with respect to (a) years of experience as SN, (b) age of SN, and (c) pupil population size. A descriptive design was used. Two-hundred and thirty-three SNs completed a survey detailing their experiences. Most SNs (96%) reported having suspected a child suffering from physical or psychological abuse. Approximately half of them reported occurrences of honor-related violence (54%) and of child sexual abuse (57%). SNs with less nursing experience reported significantly less recognition and reporting of child abuse. The findings indicate that experiences of child abuse are common. Thus, it is vital that SNs have the necessary competency and support to identify and report suspected child abuse.