Parents' perceptions of care quality at child health centres: A cross-sectional study from Sweden.

AIM: To examine parents' perceptions of care quality at child health centres. Specific objectives were to examine parents' perceptions of the care received and the subjective importance of such care. Furthermore, to examine the relationship between parents' sociodemographic characteristics and the perceptions of care quality. DESIGN: A cross-sectional study. METHODS: A random sample of parents of children born in Sweden in 2021 participated. Data were collected by the QPP-CHC questionnaire and analysed using descriptive and analytical statistics. RESULTS: The response rate was 19.4%. The targeted sample size of 210 participants was reached as 584 parents responded to the questionnaire. Parents' overall ratings of care quality at child health centres indicated optimal quality with mean values >3. However, various potential improvements areas were identified as needing additional information. These included dental care (m = 2.82), allergy prevention (m = 2.25), breastfeeding (m = 2.97), sleep (m = 2.83), the child's behaviour (m = 2.47) and the child's crying (m = 2.47). Also, parents rated suboptimal quality regarding that the care was based on healthcare routines rather than parental preferences and needs (m = 2.86). Parents born outside of the Nordic countries rated higher care quality than those born in the Nordic countries, as well as parents with a non-academic education. CONCLUSION: Parents want information based on their preferences and needs. Parent's perceptions of areas for improvement are new and important knowledge for registered nurses at child health centres. IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE: The findings indicate that parents feel that insufficient attention is given to areas of care that they perceive as important. Parents' perspectives on the care quality at child health centres is an important component of quality work and might lead to improvements in the care quality at child health centres. REPORTING METHOD: The Strengthening the Reporting of Observational Studies (STROBE) checklist for cross-sectional studies was used to guide reporting. IMPLICATIONS FOR POLICY AND PRACTICE: The findings of this study suggests that parents feel that insufficient attention is given to areas of care that they perceive as important. Parents' perspectives on the care quality at child health centres provides important knowledge which can guide further development of care quality at child health centres. The findings indicate that a family-centred approach that integrates relational and routine-oriented nursing can be a way to ensure that the care is based on parents' preferences and needs. No patient or public contribution.

Perioperative Staff's Experiences of Premedication for Children.

PURPOSE: Providing perioperative care for children who express anxiety or react with negative anxiety-associated consequences can be a challenge. The use of premedication is established as an important intervention for young children before surgery, yet research into care providers' experiences of premedication is limited. The aim of this study was to explore perioperative staff's experiences of premedication for preschool-age children. DESIGN: A descriptive inductive qualitative study was performed based on focus group discussions. METHODS: A purposive sample of a team from the operating department with experience in anesthetizing and caring for children in the perioperative period was interviewed in small focus groups: five preoperative and postoperative care nurses, five nurse anesthetists, and five anesthesiologists. The transcribed text was categorized using qualitative content analysis. FINDINGS: The content analysis revealed three themes: a matter of time, do not wake the sleeping bear, and on responsive tiptoes. CONCLUSIONS: Care providers must adapt their work to the child's emotional state of mind and needs, allowing time for the child to trust and accept the premedication and for the premedication to reach its peak effect. Premedication provides light sleep preoperatively, which requires careful treatment of the child to avoid emotional reactions, and the postoperative path is most peaceful when the premedication supports a long duration of sedation. Our findings highlight the need for safety precautions and a permissive and flexible organization with the goal of achieving a smooth and safe journey for the child in the perioperative path.

Postoperative recovery in preschool-aged children: A secondary analysis of a randomized controlled trial comparing premedication with midazolam, clonidine, and dexmedetomidine.

BACKGROUND: Preoperative anxiety in pediatric patients can worsen postoperative outcomes and delay discharge. Drugs aimed at reducing preoperative anxiety and facilitating postoperative recovery are available; however, their effects on postoperative recovery from propofol-remifentanil anesthesia have not been studied in preschool-aged children. Thus, we aimed to investigate the effects of three sedative premedications on postoperative recovery from total intravenous anesthesia in children aged 2-6 years. METHODS: In this prespecified secondary analysis of a double-blinded randomized trial, 90 children scheduled for ear, nose, and throat surgery were randomized (1:1:1) to receive sedative premedication: oral midazolam 0.5 mg/kg, oral clonidine 4 µg/kg, or intranasal dexmedetomidine 2 µg/kg. Using validated instruments, outcome measures including time for readiness to discharge from the postoperative care unit, postoperative sedation, emergence delirium, anxiety, pain, and nausea/vomiting were measured. RESULTS: After excluding eight children due to drug refusal or deviation from the protocol, 82 children were included in this study. No differences were found between the groups in terms of median time [interquartile range] to readiness for discharge (midazolam, 90 min [48]; clonidine, 80 min [46]; dexmedetomidine 100.5 min [42]). Compared to the midazolam group, logistic regression with a mixed model and repeated measures approach found no differences in sedation, less emergence delirium, and less pain in the dexmedetomidine group, and less anxiety in both clonidine and dexmedetomidine groups. CONCLUSIONS: No statistical difference was observed in the postoperative recovery times between the premedication regimens. Compared with midazolam, dexmedetomidine was favorable in reducing both emergence delirium and pain in the postoperative care unit, and both clonidine and dexmedetomidine reduced anxiety in the postoperative care unit. Our results indicated that premedication with α2 -agonists had a better recovery profile than short-acting benzodiazepines; although the overall recovery time in the postoperative care unit was not affected.

The Meaning of Critical Illness for People Suffering From COVID-19: When a Frightening Unreality Becomes Reality.

The aim of this study was to elucidate the meaning of critical illness for people with COVID-19. This study used a qualitative design. Thirteen people who were critically ill with COVID-19 during 2020 and admitted to a COVID-19 intensive care unit in northern Sweden participated in the study. Data collection was conducted as individual interviews with a narrative approach, and data were analyzed with phenomenological hermeneutic interpretation. The participants did not think they would get critically ill with this unexpected illness. They experienced terrible nightmares where their relatives had been killed, and they missed their relatives both in their dreams and in reality, as they had not been allowed to be with them due to the virus. Gratefulness was described for surviving. Participants described thoughts of not being able to imagine going through this again. They felt fear and loneliness, as a terrifying unreality had become a reality.

Parents' strategies and advice for creating a positive sleep situation in the family.

AIM: The aim of this study was to describe the experience-based knowledge of parents of children aged 0-3 years for creating a positive sleep situation in the family. DESIGN: This study has a qualitative design. Data were collected using an online survey and analysed using the critical incident technique. METHODS: The study participants were recruited through an announcement posted in parenting groups on a social media platform in September 2018. A total of 93 parents answered the questionnaire; 76 of the parents matched the study's selection criteria, and their responses were included in the analysis. RESULTS: The results are presented from the two main questions in the survey: "Strategies for creating a positive sleep situation" and "Advice to new parents regarding sleep". Having routines and reading the child's signals were important strategies, as were creating good conditions for sleep and making sure the child was well-fed and content at bedtime. Winding down and giving the child closeness and touch was described as important, and some parents would co-sleep to soothe the child quickly and create a sense of security and belonging. Parents' most frequent advice to other parents was to accept the situation and to let go of the idea that the child should sleep without waking up in a separate bed or room. CONCLUSION: Personal preferences and needs are likely to vary among individuals, and it is important that nurses tailor sleep advice in accordance with families' preferences and needs, taking individual variations and views into account.

Nature-based interventions to promote health for people with stress-related illness: An integrative review.

BACKGROUND: Stress-related illness is increasing and is a common cause of sick leave. Spending time in nature have a positive effect on health and well-being for instance by reducing stress. Specific programmes with nature-based interventions (NBI) with the intention to involve people in activities in a supportive natural environment have been developed for people with stress-related illness. AIM: To identify and summarise scientific studies of NBIs to promote health for people with stress-related illness. METHOD: The design used in this study is integrative literature review. Scientific studies focusing on any type of NBI for people with stress-related illness were sought in Cinahl, PubMed, PsycInfo, AMED and Scopus. In total, 25 studies using both qualitative and quantitative designs were included in the review. RESULT: The reviewed studies focused on garden or forest interventions. In the majority of the studies, NBIs were performed in groups, including individual activities, and the length of programmes varied. Interventions in natural environments have unique qualities for individualised, meaningful activities and interactions with others in a non-demanding atmosphere. NBIs offer restoration that reduces stress, improves health and well-being and strengthen self-efficacy and work ability. Connectedness with nature support existential reflections and people with stress-related illness can achieve balance in everyday life. CONCLUSION: In conclusion, NBIs may have advantages to promote health for people with stress-related illness and should therefore be considered as an alternative to those affected. Further research from different perspectives, including nursing, is needed to understand the possibilities of NBIs and how they can be integrated into practice.

Postoperative Recovery: Experiences of Patients Who Have Undergone Orthopedic Day Surgery.

PURPOSE: Day surgery is a common phenomenon and is associated with several benefits including cost-effectiveness. However, patients are required to manage their postoperative recovery at home. Patients undergoing orthopedic surgery are a particularly vulnerable group, and their postoperative recovery requires further investigation. This study aimed to describe the experiences of postoperative recovery of patients who had undergone orthopedic day surgery. DESIGN: A qualitative and descriptive study design was used METHODS: Participants were selected purposefully and included 18 orthopedic day-surgery patients who underwent surgery in October and November 2020. Semi-structured interviews were conducted from December 2020 to February 2021. All interviews were recorded and transcribed verbatim. The transcribed data were analyzed using qualitative content analysis with an inductive approach. The process of analysis was done in several steps and resulted in four categories FINDINGS: Four categories that described the postoperative recovery experiences of patients who underwent orthopedic day surgery were developed: (1) Questions arose when I got home; (2) I wanted confirmation that I was on the right path; (3) I felt lonely and dependent on others; and (4) I strove to find a balance between activity and rest CONCLUSIONS: For most patients, there was no follow-up after day surgery. However, patients expressed a desire for confirmation that their recovery process was within the normal trajectory. Most of the recovery takes place at home, leading to feelings of loneliness and highlighting the need for support from healthcare providers and close relatives. A phone call from a nurse after surgery might offer support, reduce feelings of loneliness, and promote a sense of safety. This study highlights the importance of systematic follow-up following orthopedic day surgery.

Preoperative anxiety in preschool children: A randomized clinical trial comparing midazolam, clonidine, and dexmedetomidine.

INTRODUCTION: Anxiety in pediatric patients may challenge perioperative anesthesiology management and worsen postoperative outcomes. Sedative drugs aimed to reducing anxiety are available with different pharmacologic profiles, and there is no consensus on their effect or the best option for preschool children. In this study, we aimed to compare the effect of three different premedications on anxiety before anesthesia induction in preschool children aged 2-6 years scheduled for elective surgery. The secondary outcomes comprised distress during peripheral catheter (PVC) insertion, compliance at anesthesia induction, and level of sedation. PATIENTS AND METHODS: In this double-blinded randomized clinical trial, we enrolled 90 participants aged 2-6 years, who were scheduled for elective ear-, nose-and-throat surgery. The participants were randomly assigned to three groups: those who were administered 0.5 mg/kg oral midazolam, 4 µg/kg oral clonidine, or 2 µg/kg intranasal dexmedetomidine. Anxiety, distress during PVC insertion, compliance with mask during preoxygenation, and sedation were measured using the modified Yale Preoperative Anxiety Scale, Behavioral Distress Scale, Induction Compliance Checklist, and Ramsay Sedation Scale, respectively. RESULTS: Six children who refused premedication were excluded, leaving 84 enrolled patients. At baseline, all groups had similar levels of preoperative anxiety and distress. During anesthesia preparation, anxiety was increased in the children who received clonidine and dexmedetomidine; however, it remained unaltered in the midazolam group. There were no differences in distress during PVC insertion or compliance at induction between the groups. The children in the clonidine and dexmedetomidine groups developed higher levels of sedation than those in the midazolam group. CONCLUSIONS: In preschool children, midazolam resulted in a more effective anxiolysis and less sedation compared to clonidine and dexmedetomidine.

Lone and lonely in a double ambivalence situation as experienced by callers while waiting for the ambulance in a rural environment.

BACKGROUND: In a rural environment where distances and access to ambulance resources in people's immediate area are limited, other responders like firefighters dispatched to perform a first aid before ambulance arrives in areas where a longer response time exists; an assignment called 'While Waiting for the Ambulance' (WWFA). Knowledge is limited about the experience from a caller's perspective when a person has a life-threatening condition needing emergency help and both firefighters in a WWFA assignment and ambulance staff are involved. AIM: The aim of the study is to describe the emergency situation involving a WWFA assignment in a rural environment from the caller's perspective. METHOD: A descriptive design using qualitative methodology with a reflective lifeworld research (RLR) approach was used for this study, including in-depth interviews with eight callers. RESULTS: An emergency situation involving WWFA assignment in a rural environment mean a sense of being lone and lonely with a vulnerability in while waiting to hand over responsibility for the affected person. Ambivalence in several dimensions arises with simultaneous and conflicting emotions. A tension between powerlessness and power of action where the throw between doubt and hope are abrupt with a simultaneous pendulum between being in a chaos and in a calm. CONCLUSION: A double ambivalence emerges between, on one hand feeling alone in the situation and having full control, on the other hand, with trust handing over the responsibility, thereby losing control. Contact with the emergency medical dispatcher becomes a saving lifeline to hold onto, and access to emergency help in the immediate area of WWFA is valuable and important. Trust and confidence are experienced when callers are met with empathy, regardless of personal acquaintance with arriving responders.

Strategies to Relieve Patients' Preoperative Anxiety Before Anesthesia: Experiences of Nurse Anesthetists.

PURPOSE: To investigate nurse anesthetists' experiences of strategies that alleviate adult patients' preoperative anxiety before anesthesia administration. DESIGN: The study has a qualitative approach wherein the data were collected through semistructured interviews. The study included interviews with six active nurse anesthetists with at least 5 years of experience who worked in a hospital in southern Sweden. METHODS: Critical incident technology was used to analyze the data. FINDINGS: Four different categories emerged: behavior of nurse anesthetist, preoperatively providing information, diverting attention to create security, and medicine as an alternative. CONCLUSIONS: Awareness can increase the use of different strategies by both new and experienced nurse anesthetists, as well as by nurses in preoperative units, which in turn alleviates patient anxiety about anesthesia. This may result in a better perioperative experience for the patient.

The Impact of Preoperative Patient Anxiety on Postoperative Anxiety and Quality of Recovery After Orthopaedic Surgery.

PURPOSE: To study how preoperative anxiety affects postoperative recovery in orthopaedic surgery based on two specific issues: does preoperative anxiety affect postoperative anxiety, pain, and nausea in the postanesthesia care unit (PACU) and does preoperative anxiety affect the quality of recovery. DESIGN: This was a nonexperimental quantitative observational study. METHODS: Patients (N = 37) were included through consecutive selection. Anxiety, pain, and nausea were measured preoperatively, 30 minutes after arrival at PACU and before discharge from PACU. Three days after discharge, participants completed the Quality of Recovery Questionnaire by telephone. FINDINGS: There was a significant correlation between preoperative anxiety and anxiety in PACU as well as anxiety, sadness, and depression 3 days after discharge from PACU. CONCLUSIONS: Patients who experience preoperative anxiety also experience anxiety in PACU. The quality of recovery 3 days after surgery is also affected by preoperative anxiety. Patients experience continued anxiety as well as sadness and depression.

Factors Influencing Early Postoperative Recovery After Laparoscopic Cholecystectomy.

PURPOSE: To study the factors influencing early postoperative recovery after laparoscopic cholecystectomy. DESIGN: A nonexperimental retrospective study. METHODS: The study was performed using records from all patients who had undergone laparoscopic cholecystectomy at a hospital in Northern Sweden in 2017 (219 patients in total). Nonparametric data were analyzed using Spearman's rho, Mann-Whitney U test, and logistic regression. Parametric data were analyzed using Pearson's correlation, an independent t test, and analysis of variance. FINDINGS: The length of stay in the postanesthesia care unit was not predicted by factors such as age, gender, body mass index, American Society of Anesthesiologists classification, postoperative nausea and vomiting, premedication, or type of surgery. Younger age and high classification level were significant predictors of pain during rest and pain when in motion. No significant predictors of postoperative nausea were found. The majority of study participants experienced little or no pain or nausea. The documentation of pain, nausea, and premedication was inadequate in many cases. CONCLUSIONS: Nurses in postanesthesia care units should work to preventively identify and address patients' medical and emotional needs so that optimal conditions for postoperative recovery can be provided.

Peripheral intravenous catheter difficulty - A clinical survey of registered nurse and critical care nurse performance.

OBJECTIVES: To describe the characteristics, problems and interventions associated with performing peripheral intravenous catheterisation in difficult situations when registered nurses need support from critical care nurses. BACKGROUND: Only a few studies have focused on peripheral intravenous catheterisation problems or interventions to promote success. There is limited research on the education, knowledge, confidence and skills of registered nurses associated with successful peripheral intravenous catheterisations. DESIGN: A descriptive cross-sectional survey design was used. RESULTS: A total of 101 questionnaires were completed by critical care nurses (n = 32) and 92 by registered nurses (n = 83); the total number of participants was 115. The same critical care nurses and registered nurses could participate several times on different occasions. Statistical analyses were performed using descriptive statistics. The patterns differed in part between the registered nurses who needed support and the critical care nurses who provided the support. Both registered nurses and critical care nurses used ultrasound to a very low extent (2.2% vs. 1.0%). The registered nurses indicated to a significantly higher extent (p = 0.02) that the veins were invisible and that they had performed the optional interventions. The success rate for critical care nurses was considerably high (86.1%). The most common place for successful insertion was the wrist. Critical care nurses performed fewer interventions, and they informed the patients and assessed that the veins were fragile to a higher extent. CONCLUSIONS: Superior nursing skills are required in order to adapt and assess specific situations related to peripheral intravenous catheterisation difficulties and to choose the adequate interventions. Young and newly graduated registered nurses should be offered individualised training during the post-educational period on how to assess problems and perform peripheral intravenous catheterisations in specific difficult situations. RELEVANCE TO CLINICAL PRACTICE: Simulation is suggested for practical training in order to increase patient safety related to the performance of technical skills such as peripheral intravenous catheterisation.

Difficult Airways: Key Factors for Successful Management.

PURPOSE: To describe anesthetic nurses' experiences of key factors for the successful management of difficult airways in adult patients. DESIGN: This study had a qualitative observational and descriptive design following the critical incident technique. METHODS: Twelve experienced anesthetic nurses were interviewed. FINDINGS: We identified five key factors for the successful management of difficult airways: identification of the difficult airway, creating a plan of action, remaining calm and focusing on the task, technical skills, and using the equipment. Identification of the difficult airway implies preassessment with standardized methods and actively observing for signs indicative of a difficult airway. Having all equipment available at bedside during induction and creating a backup plan increases the action force in unexpected situations. A calm and methodical work procedure facilitates the management of the difficult airway as well as selecting techniques and equipment according to the patient and situation. CONCLUSIONS: Reflective practice can aid the anesthetic nurse in drawing on experience and remaining calm in acute situations.

Key Factors for Successful General Anesthesia of Obese Adult Patients.

PURPOSE: To study nurse anesthetists' experiences of key factors for successful airway management in general anesthesia of adult obese patients. DESIGN: The study was a qualitative observational study with a descriptive approach. METHODS: Eight semistructured interviews were conducted. Data were analyzed using the critical incident technique. FINDINGS: Five key factors for successful general anesthesia of adult obese patients were identified. These factors were preparing and planning the anesthesia, optimizing patient position, optimizing ventilation through proper preoxygenation and increasing positive end-expiratory pressure, quickly securing the airway, and working in teams. CONCLUSIONS: Knowledge of key factors that facilitate and improve the anesthesia care of obese patients is important to provide safe and quality anesthesia to this patient group as obese patients often have small margins and urgent situations can quickly arise. This knowledge enables the nurse anesthetist to be one step ahead and to be ready to take action if complications occur.

Patients' Perceptions of Short-Term Recovery After a Gastric Bypass.

PURPOSE: To explore gastric bypass patients' perceptions of their postoperative recovery over 1 month. DESIGN: A standardized questionnaire, the postoperative recovery profile, was used. METHODS: Postoperative recovery profile is a multi-item questionnaire for self-assessment of general postoperative recovery. Participants were patients who had undergone gastric bypass surgery (n = 39). The changes in recovery between 1 day and 1 month postsurgery were evaluated by a statistical method developed specifically for analyzing changes in paired ordered data over time. FINDINGS: Most of the symptoms and/or functions were significantly improved on a group level. The most marked improvement was to pain and sleeping difficulties followed by mobilization. In terms of the psychological items, the proportion of patients who indicated no problems was high at both endpoints. The items that deviated from the improvement pattern were appetite changes and gastrointestinal function which demonstrated a relatively high proportion of deterioration, and the individual variability was prominent. CONCLUSIONS: There is a need for interventions to improve recovery on a group as well as an individual level.

Patterns of Changes in Patients' Postoperative Recovery From a Short-Term Perspective.

PURPOSE: To explore patterns of changes in patients' postoperative recovery over 1 month within different surgery groups. DESIGN: A quantitative longitudinal survey design was used. METHODS: A standardized questionnaire was used (N = 167 patients); the postoperative recovery profile for self-assessment of recovery. The postoperative recovery profile developed for hospitalized patients contains 17 items distributed over five dimensions: physical symptoms, physical function, psychological function, social function, and activity. FINDINGS: Overall, orthopaedic patients perceived a lower recovery than general surgery patients. All major surgery groups and subgroups except for joint replacement patients indicated significant systematic changes toward lower levels of problems. The orthopaedic patients assessed their psychological functioning as impaired, and the gastric bypass group was the most recovered. CONCLUSIONS: The patients' expectations should be charted initially, and patients should be given realistic information to achieve a realistic hope for a good life in the future. A patient's recovery trajectory may not start after the surgery is completed. Rather, it has already commenced before surgery.

Patients' Perceptions of Perioperative Quality of Care in Relation to Self-rated Health.

PURPOSE: To explore (1) associations between patient and perioperative factors and dimensions of quality of care and (2) perioperative patients' self-rated physical health in relation to information, encouragement, and participation. DESIGN: A nonexperimental descriptive exploratory design (n = 170 participants). METHODS: Analyses were performed using quantitative techniques; collected data were quantitative in nature. Multiple logistic regression and Mann-Whitney U tests were used to analyze the data. FINDINGS: The factor associated with patients' satisfaction within the dimension of "identity-oriented approach of the caregivers," including the quality of information, encouragement, and participation, was self-estimated physical health. Those who estimated their physical health as being good were generally more satisfied. Patients who rated their physical health as being less than good were significantly less satisfied with the information provided before surgery about their stay in the postanesthesia care unit (PACU). CONCLUSIONS: Nurses should chart patients' estimations of their physical health initially in care to provide reinforced support for patients who estimate their physical health is less than good. Before surgery, patients who have estimated their physical health as being less than good should be given realistic information about their stay in the PACU-that they will be in a PACU after surgery, what that stay means, and why it is necessary.

Follow-up visit in an ICU: receiving a sense of coherence.

AIM: To describe patients' experiences of a follow-up visit to an intensive care unit (ICU) after being critically ill and nursed there. BACKGROUND: Knowledge about the follow-up visit needs to be developed, with the previously critically ill patient in focus. DESIGN: Qualitative descriptive. METHOD: Semi-structured interviews were conducted with nine patients and analysed using qualitative content analysis. The data collection occurred during spring 2014. FINDINGS: During the follow-up visits in ICU, the relatives, the patient diary, and those who took part in the care contribute to fill memory gaps to create a picture and an explanation of the care period. CONCLUSION: The follow-up visit is an important tool in the patients' struggle to create a context and coherence from a missing or unreal time. The patient diary is essential to subsequently be able to relate to the period of care. RELEVANCE TO CLINICAL PRACTICE: The follow-up visit, together with a personal diary, after an ICU stay could be seen as significant for strengthening the patients' feeling of coherence and better health.

Nursing Students' Reflections After Meetings With Patients and Their Relatives Enacted by Professional Actors: Being Touched and Feeling Empathy.

When professional actors have been used in mental health simulations with nursing students, the experience has been regarded as a meaningful contribution to their education and described as a safe way of experiencing challenging situations that can occur in clinical settings. The aim was to study nursing students' reflections after meetings with nursing patients and their relatives, as enacted by professional actors, in psychiatric/elderly care. The design was a qualitative descriptive research approach. Gibbs's ( 1988 ) reflective cycle was the basis for the questions that were asked. Written reflections with 60 nursing students were analysed using qualitative thematic content analysis. The analysis produced the theme "being touched and feeling empathy," with four categories: "becoming aware of what knowledge and skills are needed," "wanting to do well and to have the right answer," "daring to get close and being present," and "knowledge comes alive." Simulation with real people who act as patients or relatives in vulnerable situations creates feelings of empathy. To talk with them, experience eye contact, and see how they react on touch makes nursing students feel they have experienced closeness and their knowledge has become alive.