They are my worries, so it's me the doctor should listen to-adolescent males' experiences of consultations with general practitioners.

BACKGROUND: Many adolescent males visit a general practitioner regularly, yet many report unmet health needs and negative experiences. This indicates a gap between provided healthcare and the needs of adolescent males. In order to improve adolescent males' possibilities to discuss their health concerns with general practitioners, the study's aim was to explore and describe how adolescent males understand and assign meaning to their experiences of consultations with general practitioners. METHODS: This qualitative study was conducted at two healthcare centres in mid-Sweden in 2022. Nine males 15 to 19 years old described their experiences in semi-structured interviews immediately after consulting a general practitioner, regardless of reason for the consultation and whether or not accompanied by a parent. The analysis was guided by thematic analysis according to Braun & Clarke and reflective lifeworld theory's concepts of openness and sensitivity. RESULTS: One overarching theme, To be listened to, and three themes were developed: To handle insecurity and uneasiness, To be understood and cared for, and To get parental support on his terms. In a good appointment, the general practitioner cares about him, listens attentively, and takes him seriously. More importantly, the general practitioner's understanding permeates the consultation, so that all aspects of it is adapted to him. The adolescent males doubted their ability to express themselves and to understand what would happen in the consultation, and therefore feared being dismissed without receiving any help. Such difficulties may be due to unfinished neurocognitive development and inexperience. They struggled with embarrassment, partly due to notions of masculinity, and strived to balance their needs of parental support, privacy, and being the one that the doctor listens to. CONCLUSIONS: We argue that adolescent males are particularly vulnerable due to on-going neurocognitive and emotional development, inexperience, and notions of masculinity. However, good experiences can be generated through rather simple means. Adolescent males need individual adaptations demonstrating that they are cared for, understood and taken seriously. Furthermore, they need an unhurried pace to facilitate understanding, verbal affirmations to mitigate embarrassment, and help in navigating parental involvement.

Nutrition intervention goals from the perspectives of patients at risk of malnutrition: A qualitative study.

BACKGROUND: Nutrition counselling is characterised by a collaborative approach where the patient and the dietitian establish goals that promote health and self-management. Little is known about goal-setting in nutrition interventions of patients at risk of malnutrition. The present study aims to describe the perspectives and needs of patients at risk of malnutrition regarding goals of nutrition interventions. METHODS: Semi-structured interviews were conducted with 15 patients from three primary care centres and one hospital in mid-Sweden selected through purposive sampling. Interview transcripts were analysed using reflexive thematic analysis following the six-phase guidelines of Braun and Clarke to identify patterns of shared meaning and themes in the data. RESULTS: The findings highlight that the participants rarely reflected on their personal goals of the nutrition intervention. Instead, they strived to maintain strength and energy, with the nutrition counselling being seen as supportive in managing nutrition impact symptoms. They described discrepancies between their perspectives and the dietitian's regarding weight goals and the diet prescribed to gain weight. CONCLUSIONS: The study findings suggest that elucidating patients' goals is key to counteracting the discrepancies between the dietitians' clinically oriented goals and patients' perspectives. Goal-setting is part of the dietitian's structured working process, whereas the patient's lifeworld is complex and unstructured. To provide person-centred nutrition care, new strategies and tools are needed to facilitate collaborative goal-setting. These approaches will bridge the gap between clinical goals and patients' individual needs, promoting better alignment and improved outcomes.

The voice of the profession: how the ethical demand is professionally refracted in the work of general practitioners.

BACKGROUND: Among the myriad voices advocating diverging ideas of what general practice ought to be, none seem to adequately capture its ethical core. There is a paucity of attempts to integrate moral theory with empirical accounts of the embodied moral knowledge of GPs in order to inform a general normative theory of good general practice. In this article, we present an empirically grounded model of the professional morality of GPs, and discuss its implications in relation to ethical theories to see whether it might be sustainable as a general practice ethic. METHODS: We observed and interviewed sixteen GPs and GP residents working in health care centres in four Swedish regions between 2015-2017. In keeping with Straussian Grounded Theory, sampling was initially purposeful and later theoretically guided, and data generation, analysis and theoretical integration proceeded in parallel. The focal concept of this article was refined through multidimensional property supplementation. RESULTS: The voice of the profession is one of four concepts in our emerging theory that attempt to capture various motives that affect GPs' everyday moral decisionmaking. It reflects how GPs appreciate the situation by passing three professional-moral judgments: Shall I see what is before me, or take a bird's-eye view? Shall I intervene, or stay my hand? And do I need to speak up, or should I rather shut up? By thus framing the problem, the GP narrows down the range of considerations, allowing them to focus on its morally most pertinent aspects. This process is best understood as a way of heeding Løgstrup's ethical demand. Refracted through the lens of the GP's professional understanding of life, the ethical demand gives rise to specific moral imperatives that may stand in opposition to the express wishes of the other, social norms, or the GP's self-interest. CONCLUSIONS: The voice of the profession makes sense of how GPs frame problematic situations in moral terms. It is coherent enough to be sustainable as a general practice ethic, and might be helpful in explaining why ethical decisions that GPs intuitively understand as justified, but for which social support is lacking, can nevertheless be legitimate.

Taking control of one's everyday life - a qualitative study of experiences described by participants in an occupational intervention.

BACKGROUND: Sick leave due to stress-related ill-health is increasing and is often caused by occupational imbalance. These types of issues tend to affect both the ability to work and cope with everyday life, as well as the overall experience of health, negatively. There is still little knowledge on how to prepare people and workplaces for the return-to-work process after participation in a work rehabilitation program due to stress and occupational ill-health. Therefore, this study aimed to describe what is needed to achieve a balanced everyday life that includes paid work as experienced by individuals who had participated in a ReDO® intervention due to occupational imbalance and ill-health. METHODS: The concluding notes from 54 informants' medical records were used for qualitative content analysis. The informants had participated in an occupational therapy group intervention to promote occupational health and regain full work capacity. RESULTS: The analysis resulted in one major theme and four categories describing how the informants perceive that they must take control of their everyday life as a whole. By doing so, they need to work with structurization and prioritization, social interaction, boundary setting, and occupational meaningfulness. CONCLUSION: The study indicates a highly relational process, where it is impossible to divide life into private and work, and presupposes balance in everyday life in multiple dimensions. Its contribution includes the formulation of perceived needs in the transition between intervention and return to work and could, through further research, be used to generate a more effective and sustainable return- and rehabilitation models.

Associations between continuity of care, perceived control and self-care and their impact on health-related quality of life and hospital readmission-A structural equation model.

AIM: The aim of this study is to examine whether a conceptual model including the associations between continuity of care, perceived control and self-care could explain variations in health-related quality of life and hospital readmissions in people with chronic cardiac conditions after hospital discharge. DESIGN: Correlational design based on cross-sectional data from a multicentre survey study. METHODS: People hospitalized due to angina, atrial fibrillation, heart failure or myocardial infarction were included at four hospitals using consecutive sampling procedures during 2017-2019. Eligible people received questionnaires by regular mail 4-6 weeks after discharge. A tentative conceptual model describing the relationship between continuity of care, self-care, perceived control, health-related quality of life and readmission was developed and evaluated using structural equation modelling. RESULTS: In total, 542 people (mean age 75 years, 37% females) were included in the analyses. According to the structural equation model, continuity of care predicted self-care, which in turn predicted health-related quality of life and hospital readmission. The association between continuity of care and self-care was partly mediated by perceived control. The model had an excellent model fit: RMSEA = 0.06, 90% CI, 0.05-0.06; CFI = 0.90; TLI = 0.90. CONCLUSION: Interventions aiming to improve health-related quality of life and reduce hospital readmission rates should focus on enhancing continuity of care, perceived control and self-care. IMPACT: This study reduces the knowledge gap on how central factors after hospitalization, such as continuity of care, self-care and perceived control, are associated with improved health-related quality of life and hospital readmission in people with cardiac conditions. The results suggest that these factors together predicted the quality of life and readmissions in this sample. This knowledge is relevant to researchers when designing interventions or predicting health-related quality of life and hospital readmission. For clinicians, it emphasizes that enhancing continuity of care, perceived control and self-care positively impacts clinical outcomes. PATIENT OR PUBLIC CONTRIBUTION: People and healthcare personnel evaluated content validity and were included in selecting items for the short version.

Development and psychometric properties of a short version of the Patient Continuity of Care Questionnaire.

INTRODUCTION: Hospitalization due to cardiac conditions is increasing worldwide, and follow-up after hospitalization usually occurs in a different healthcare setting than the one providing treatment during hospitalization. This leads to a risk of fragmented care and increases the need for coordination and continuity of care after hospitalization. Furthermore, international reports highlight the importance of improving continuity of care and state that it is an essential indicator of the quality of care. Patients' perceptions of continuity of care can be evaluated using the Patient Continuity of Care Questionnaire (PCCQ). However, the original version is extensive and may prove burdensome to complete; therefore, we aimed to develop and evaluate a short version of the PCCQ. METHODS: This was a psychometric validation study. Content validity was evaluated among user groups, including patients (n = 7), healthcare personnel (n = 15), and researchers (n = 7). Based on the results of the content validity and conceptual discussions among the authors, 12 items were included in the short version. Data from patients were collected using a consecutive sampling procedure involving patients 6 weeks after hospitalization due to cardiac conditions. Rasch analysis was used to evaluate the psychometric properties of the short version of the PCCQ. RESULTS: A total of 1000 patients were included [mean age 72 (SD = 10), 66% males]. The PCCQ-12 presented a satisfactory overall model fit and a person separation index of 0.79 (Cronbach's α: .91, ordinal α: .94). However, three items presented individual item misfits. No evidence of multidimensionality was found, meaning that a total score can be calculated. A total of four items presented evidence of response dependence but, according to the analysis, this did not seem to affect the measurement properties or reliability of the PCCQ-12. We found that the first two response options were disordered in all items. However, the reliability remained the same when these response options were amended. In future research, the benefits of the four response options could be evaluated. CONCLUSION: The PCCQ-12 has sound psychometric properties and is ready to be used in clinical and research settings to measure patients' perceptions of continuity of care after hospitalization. PATIENT OR PUBLIC CONTRIBUTION: Patients, healthcare personnel and researchers were involved in the study because they were invited to select items relevant to the short version of the questionnaire.

Routine conversations about violence conducted in Swedish child health services-A mixed methods study of nurses' experiences.

AIM: To evaluate an intervention where nurses in child health care services routinely talk to and inform parents about violence. METHODS: The intervention included providing information during home visits and individual conversations with mothers and fathers/partners in connection with screening for parental depression. A convergent mixed-methods design was used with a documentation form for each child (n = 475) and results from focus group interviews with nurses. Quantitative data were analysed using descriptive statistics and qualitative with manifest content analysis. RESULTS: Almost all families participated in the intervention; individual conversations were conducted with nearly all the mothers, and to a somewhat lesser extent with the fathers/partners. Initially, the nurses felt slightly uncomfortable about these conversations, but described experiencing development and professionalisation in their role of talking about violence. Parents' reactions were generally positive and they expressed appreciation for this topic being raised. CONCLUSION: The results show that the intervention has been carried out successfully. The newborn period is a phase in which mothers and fathers are interested and receptive to knowledge and support in sensitive matters. Prerequisites for implementation were the preparation phase for the nurses, the use of routine questioning and a questionnaire as a basis for the conversations.

Confidentiality matters! Adolescent males' views of primary care in relation to psychosocial health: a structural equation modelling approach.

OBJECTIVE: To investigate to what degree adolescent males (1) value confidentiality, (2) experience confidentiality and are comfortable asking sensitive questions when visiting a general practitioner (GP), and (3) whether self-reported symptoms of poor mental health and health-compromising behaviours (HCB) affect these states of matters. DESIGN: Cross-sectional. SETTING: School-based census on life, health and primary care in Region Sörmland, Sweden. SUBJECTS: 2,358 males aged 15-17 years (response rate 84%). MAIN OUTCOME MEASURES: The impact of poor mental health and HCBs on adolescent males' valuing and experiencing private time with the GP, having professional secrecy explained, and being comfortable asking about the body, love and sex, analysed with structural equation modelling. RESULTS: Almost all respondents valued confidentiality regardless of their mental health or whether they engaged in HCBs: 86% valued spending private time with the GP, and 83% valued receiving a secrecy explanation. Among those who had visited a GP in the past year (n = 1,200), 74% had experienced private time and 42% a secrecy explanation. Three-quarters were at least partly comfortable asking sensitive questions. Adolescent males with HCBs were more likely to experience a secrecy explanation (approximative odds ratio [appOR] 1.26; p = 0.005) and to be comfortable asking about sex than their peers (appOR 1.22; p = 0.007). Respondents reporting experienced confidentiality were more comfortable asking sensitive questions (appOR 1.25-1.54; p ≤ 0.010). CONCLUSION: Confidentiality matters regardless of poor mental health or HCBs and makes adolescent males more comfortable asking sensitive questions. We suggest that GPs consistently offer private time and explain professional secrecy.Key PointsConfidentiality for adolescent males has been scantily studied in relation to mental health and health-compromising behaviours.In this study, most adolescent males valued confidentiality, regardless of their mental health and health-compromising behaviours.Health-compromising behaviours impacted only slightly, and mental health not at all, on experiences of confidentiality in primary care.When provided private time and an explanation of professional secrecy, adolescent males were more comfortable asking the GP sensitive questions.

The Mediating Role of Healthy Lifestyle Behaviours on the Association between Perceived Stress and Self-Rated Health in People with Non-Communicable Disease.

Perceived stress can affect people's lifestyle behaviours and self-rated health. A balanced, healthy lifestyle can alleviate experiences of stress. For clinicians to use evidence-based and theory-based knowledge in health dialogues with people with non-communicable diseases, and in order to develop more effective behavioural counselling, more knowledge is needed. Hence, this study aimed to examine the mediating role of sedentary behaviour, daily physical activity, physical exercise, and dietary habits on the association between perceived stress and self-rated health in people with or without one to four self-reported non-communicable diseases (myocardial infarction, stroke, hypertension, diabetes). The study used a cross-sectional design. Responses from in total 10,583 individuals were collected in 2016 and 2019 by a self-report questionnaire. A series of simple and multiple regression analyses were conducted to examine the mediating effects of healthy lifestyle behaviours on the association between perceived stress and self-rated health. The results show that the investigated healthy lifestyle behaviours partly mediated the association between perceived stress and self-rated health in people with no diagnosis, and in people with one or two diagnoses. It can be concluded that healthy lifestyle behaviours could probably be targeted in relation to the number of noncommunicable diseases that the individuals have.

Photo-elicited conversations about meetings with a therapy dog as a tool for communication in dementia care: An observational study.

INTRODUCTION: It is well-known that people with dementia living in residential care facilities spend most of their time not engaged in meaningful activities. Being involved in activities can improve their quality of life. Animal-assisted therapy is an activity that can evoke engagement and joy. Another way to create engagement and promote communication between people with dementia and caregivers is to use photos. METHODS: In this observational study, the researchers combined animal-assisted therapy and photobooks in order to explore whether photos of people with dementia who were engaged in animal-assisted therapy could be used as a tool for communication in dementia care. Ten persons (4 men and 6 women; aged 72-92) with dementia were video recorded during photo-elicited conversations with a dog handler/assistant nurse. The recordings were conducted in two residential care facilities in Sweden during 2017-2018. Each participant was video recorded 2-4 times. The recordings were analysed using The Observed Emotion Rating Scale and The Observational Measurement of Engagement-OME Modified. In addition, the video recordings were interpreted from a hermeneutic perspective. FINDINGS: The findings showed that the most frequently observed effects were pleasure and general alertness, and the participants were observed to be attentive most of the time. The most common attitude during the conversations was 'somewhat positive'. The hermeneutic interpretations were grouped into four themes: Conveys a structure for the conversation with an inherent beginning and ending; An opportunity to recognise oneself and recall a sense of belonging; Awakens emotions and creates fellowship and Entails confirmation and revitalises their identity. CONCLUSION: Photobooks can be used by caregivers as a tool for meaningful and joyful communication with people with dementia, even those with severe dementia.

The voice of the self: a typology of general practitioners' emotional responses to situational and contextual stressors.

OBJECTIVE: To develop a comprehensive typology of emotional reactions associated with stress among general practitioners (GPs), grounded in their own experiences. DESIGN: Data was generated using observations and unstructured interviews, using Straussian grounded theory as the overarching methodology. The typology was built using multidimensional property supplementation. SETTING: Eleven health care centres in urban and rural communities in four Swedish regions. SUBJECTS: Sixteen GPs and GP residents. MAIN OUTCOME MEASURES: Characteristics of GPs' emotional reactions in everyday work situations. RESULTS: Accounts of negative emotions connected to stress revealed four principal personal needs of the GP: trust, efficacy, understanding, and knowledge. Simultaneous threats to more than one of these needs invariably increased the level of tension. From these more complex accounts, six second-order needs could be identified: integrity, judgment, pursuit, authority, autonomy, and competence. The most extreme encounters, in which all four principal needs were threatened, were characterised by the experience of being reduced into an assistant. CONCLUSION: The considerable resilience of GPs may belie some of the pressures that they are facing while being far from a fail-safe defence against being diverted from purposeful and morally responsible action. Our typology distinguishes between different forms of stress that may affect how GPs carry out their work, and connects to the vast literature on GP wellness. The results of this study could be used to develop tools for self-reflection with the aim of countering the effects of stress, and are potentially relevant to future research into its causes and consequences.Key pointsWhat is known•Stress among GPs may have severe consequences for themselves and their patients, and levels of stress appear to be increasing.What this article adds•Stressful situations threaten at least one of four principal needs of the GP: trust, efficacy, understanding, and knowledge.•More complex threats increase the level of tension and bring out second-order needs: integrity, judgment, pursuit, authority, autonomy, and competence.•The wealth of literature on GP stress can be clearly understood through the lens of our four-dimensional typology.

Understanding adolescent males' poor mental health and health-compromising behaviours: A factor analysis model on Swedish school-based data.

AIM: The aim was to develop a factor model of the clustering of poor mental-health symptoms and health-compromising behaviours (HCBs) in adolescent males. METHODS: The study was based on two cross-sectional school-based Swedish surveys in 2011 (response rate 80%, N=2823) and 2014 (response rate 85%, N=2358), both of which comprised questionnaires from males aged 15-16 and 17-18 years. A factor model was developed by exploratory factor analysis on the 2011 survey and validated by confirmatory factor analysis on the 2014 survey. RESULTS: Four aspects of poor mental health and HCBs emerged in the exploratory factor analysis: (a) deviancy as a tendency to substance use and delinquency, (b) unsafety as an inclination towards feelings of unsafety in different environments, (c) gloominess as a tendency towards pessimism and feeling unwell and (d) pain as an inclination to experience physical pain. The model was validated with good model fit. Age did not affect the model structure, but older adolescent males were more influenced by deviancy and gloominess and less by unsafety compared to their younger peers. Conclusions: Separating symptoms of poor mental health and HCBs into four areas - deviancy, unsafety, gloominess and pain - brings new perspectives to the understanding of adolescent males' health. To the best of our knowledge, our factor model is the first to include unsafety and pain in this context. Whenever a comprehensive approach to the health of adolescent males is needed in the clinic or in the field of public health, this factor model may provide guidance.

Perceived needs for team-based visits in Swedish child healthcare services exceed its existence-A mixed-methods study targeting healthcare professionals.

AIM: To investigate both quantitatively and qualitatively the differences between participation in team-based visits (TBVs) and perceived needs for TBVs from the perspectives of healthcare professionals, in the context of the Swedish 3-tier national Child Healthcare programme. METHODS: A study-specific questionnaire, including multiple-choice questions with fixed and free-text response options, was developed, and used. To capture healthcare professionals' experiences and find explanations for the quantitative results in qualitative data, a convergent parallel mixed-methods study design was used. Descriptive statistics and McNemar's test were used to analyse the quantitative data, and content analysis was used to analyse the qualitative data. RESULTS: Healthcare professionals perceived the need for TBVs in the Swedish Child Healthcare Services (CHS) to a high extent. The largest difference between the perceived need for TBVs and experienced TBVs was for indications associated with psychosocial problems. The quantitative findings were explored by the qualitative findings. Both individual and organisational factors influenced TBVs. CONCLUSION: Perceived needs for TBVs in Swedish CHS exceed its existence. Healthcare professionals require TBVs delivered by interprofessional teams, in line with proportionate universalism. Accordingly, organisational structures (e.g. colocation and clear instructions on how to distribute TBVs) and human resources (e.g. psychologists and social worker) are needed.

Resilient performance in healthcare during the COVID-19 pandemic (ResCOV): study protocol for a multilevel grounded theory study on adaptations, working conditions, ethics and patient safety.

INTRODUCTION: Since early 2020, the COVID-19 pandemic has challenged societies and revealed the built-in fragility and dependencies in complex adaptive systems, such as healthcare. The pandemic has placed healthcare providers and systems under unprecedented amounts of strain with potential consequences that have not yet been fully elucidated. This multilevel project aims to explore resilient performance with the purpose of improving the understanding of how healthcare has adapted during the pandemic's rampage, the processes involved and the consequences on working conditions, ethics and patient safety. METHODS: An emerging explorative multilevel design based on grounded theory methodology is applied. Open and theoretical sampling is performed. Empirical data are gathered over time from written narratives and qualitative interviews with staff with different positions in healthcare organisations in two Swedish regions. The participants' first-person stories are complemented with data from the healthcare organisations' internal documents and national and international official documents. ANALYSIS: Experiences and expressions of resilient performance at different system levels and times, existing influencing risk and success factors at the microlevels, mesolevels and macrolevels and inter-relationships and consequences in different healthcare contexts, are explored using constant comparative analysis. Finally, the data are complemented with the current literature to develop a substantive theory of resilient performance during the pandemic. ETHICS AND DISSEMINATION: This project is ethically approved and recognises the ongoing strain on the healthcare system when gathering data. The ongoing pandemic provides unique possibilities to study system-wide adaptive capacity across different system levels and times, which can create an important basis for designing interventions focusing on preparedness to manage current and future challenges in healthcare. Feedback is provided to the settings to enable pressing improvements. The findings will also be disseminated through scientific journals and conferences.

Team-based visits within Swedish child healthcare services: a national cross-sectional study.

Complex healthcare needs can be met through effective interprofessional collaboration. Since 2014, Swedish Child Healthcare Services (CHS) include universal team-based visits with a nurse and a physician who perform such visits at the age of 4 weeks, 6 months, 12 months, and 2.5 to 3 years, as well as targeted team-based visits to address additional needs. The aim of this study was to describe the prevalence of team-based visits in the Swedish CHS and possible associations between team-based visits and contextual factors that may affect its implementation. A national cross-sectional survey was conducted using a web-based questionnaire distributed to all reachable nurses, physicians, and psychologists (n =3,552) engaged in the CHS. Data were analyzed using descriptive statistics and binary and multivariate logistic regressions. The response rate was 32%. Team-based visits were reported by 82% of the respondents. For nurses and physicians, the most frequent indication was specific ages, while for psychologists it was to provide parental support. Respondents working at Family Centers were more likely to perform team-based visits in general, at 2.5 to 3 years and in case of additional needs, compared to respondents working at Child Health Centers (CHC) and other workplaces. In conclusion, team-based visits are well implemented, but the pattern differs depending on the contextual factors. Targeted team-based visits and team-based visits at the age of 2.5 to 3 years are most unequally implemented.

Action research improved general prerequisites for evidence-based practice.

The present study was part of an action research project that was performed to implement a clinical pathway for patients on mechanical ventilation and simultaneously explore the implementation process in a Swedish intensive care unit. The aim of this questionnaire study was to evaluate whether an action research methodology could affect the general prerequisites for evidence-based practice (EBP). Informed by the Promoting Action on Research Implementation in Health Services (PARIHS) framework, the study included registered nurses, assistant nurses and anesthesiologists in the unit at start of the project (n = 50) and at follow-up (n = 44). Data was collected with the Evaluation Before Implementation Questionnaire and the Attitudes towards Guidelines Scale. The results revealed that the general prerequisites for EBP in the setting improved. Compared to baseline measurements, the staff at follow-up conversed significantly more about the importance of the patients' experiences, research utilization, context and facilitation, while changes with respect to clinical experiences were not significant. The attitudes towards guidelines were perceived as positive at baseline as well as at follow-up and did not significantly change. Longer professional experience was associated with a slightly lower probability of perceiving that the importance of research utilization was discussed and reflected upon, while belonging to a profession with longer education was associated with a higher probability of this perception. Compared to registered nurses and assistant nurses, the anesthesiologists perceived, to a greater extent, that the importance of clinical experience was discussed and reflected upon in the setting, while there was no significant association with the length of professional experience and/or specific professions regarding the other components. In conclusion, using action research to implement a clinical pathway methodology seems to set in motion various mechanisms that improve some but not all prerequisites that, according to the PARIHS framework, are advantageous for EBP.

Healthcare professionals' perceptions about interprofessional teamwork: a national survey within Swedish child healthcare services.

BACKGROUND: Globally, interprofessional teamwork is described as a key method to promote health and prevent illness in children, namely, to achieve the goals of Child Healthcare Services (CHS). However, how teamwork should be designed within CHS to achieve the goals is unclear. This study aimed to investigate healthcare professionals' perceptions about 1) taking part in interprofessional teamwork, 2) team characteristics, and 3) whether the perceptions were related to professional affiliation or workplace. METHODS: A national cross-sectional survey was conducted using a web-based study-specific questionnaire sent to all accessible nurses, physicians, and psychologists in Swedish CHS (n = 3552). The response rate was 31.5%. To identify possible associations, logistic regressions were conducted. RESULTS: Almost all respondents, 1096/1119 (97.9%), reported taking part in some type of interprofessional teamwork within the Swedish CHS. Among those, the most common was team-based visits (82.2%). It was perceived that performing team-based visits resulted in fulfilled goals, expertise exceeding individual team members' competences, provision of high-quality care, and meeting children's and families' needs, to a greater extent, than if not performing team-based visits. Correspondingly, working as a team in parental groups was perceived as resulting in fulfilled goals, meeting the needs of children and their families, and continuity within the team to a greater extent than if not working together in a team. Professional affiliation was associated with different perceptions and types of teamwork. Family Centers were positively associated with all types of teamwork as well as continuity within the team. CONCLUSIONS: Healthcare professionals' perceptions about team characteristics were associated with professional affiliation, workplace, and type of teamwork (defined as team activities) within the CHS. Professionals within Swedish CHS, taking part in team-based visits and in interprofessional teamwork in parental groups, perceived that the team fulfilled its goals and met the needs of children and families to a greater extent than professionals not taking part in these types of teamwork. Professionals at Family Centers were more likely to work in teams in different ways. Knowledge about interprofessional teamwork for individuals and groups in Swedish CHS might also be valuable in other healthcare settings, dealing with complex needs.

Diabetes care provided by national standards can improve patients' self-management skills: A qualitative study of how people with type 2 diabetes perceive primary diabetes care.

BACKGROUND: The increasing incidence of type 2 diabetes mellitus [T2DM] has resulted in extensive research into the characteristics of successful primary diabetes care. Even if self-management support and continuity are increasingly recognized as important, there is still a need for deeper understanding of how patients' experiences of continuity of care coincide with their needs for self-management and/or self-management support. OBJECTIVE: To gain a deeper understanding of how people with T2DM perceive Swedish primary diabetes care and self-management support. METHODS: This qualitative study used focus groups as the means for data collection. Participants were identified through a purposive sampling method differing in age, sex, diabetes duration and latest registered glycated haemoglobin level. Twenty-eight participants formed five focus groups. Qualitative content analysis was applied to interview transcripts. RESULTS: The main theme emerging from the focus group data was that diabetes care provided by national standards improved self-management skills. Two themes that emerged from the analysis were (a) the importance of a clarification of structures and procedures in primary diabetes care and (b) health-care staff 'being there' and providing support enables trust and co-operation to enhance self-management. CONCLUSIONS: Individual patients' self-management resources are strengthened if the importance of providing relational continuity, management continuity and informational continuity is considered. Patients also need assistance on 'how' self-management activities should be performed. PATIENT CONTRIBUTION: Prior to the study, one pilot focus group was conducted with patients to obtain their perspectives on the content of the planned focus groups; thus, patients were involved in both planning and conduct of the study.

Long emergency department length of stay: A concept analysis.

INTRODUCTION: Emergency Department (ED) Length of stay (LOS) has been associated with poor patient outcomes, which has led to the implementation of time targets designed to keep EDLOS below a specific limit. The cut-offs defining long EDLOS varies across settings and seem to be arbitrarily chosen. This study aimed to clarify the meaning of long EDLOS. METHODS: A concept analysis using the Walker and Avant approach was conducted. It included a literature search aiming to identify all uses of the concept, resulting in a set of defining attributes and a way of measuring the concept empirically. RESULTS: Long EDLOS was primarily used as proxy for other phenomena, e.g. boarding or crowding. The definitions had cut-offs ranging between 4 and 48 h. The attributes defining long EDLOS was waiting, a crowded ED environment and an inefficient organization. DISCUSSION: Time targets are probably more suitable when directed towards and tailored for specific sub-groups of the ED population.

An evidence-based structured one-year programme to sustain physical activity in patients with heart failure in primary care: A non-randomized longitudinal feasibility study.

Aim: The primary objective of this non-randomized feasibility study was to test a 1-year model programme for sustaining/increasing patients' motivation to perform daily physical activity. Design: Non-randomized longitudinal feasibility study with a one-group repeated measures design. Methods: The study took place at a primary care centre in mid-Sweden in 2017-2018. The model programme included individual and group-based support, individualized physical activity prescriptions, a wrist-worn activity tracker and an activity diary. The main outcomes were the participants' perceptions of programme feasibility and scores on the Exercise Self-Efficacy Scale. Results: Seven patients were recruited. Six patients completed the programme that was perceived to imply learning, motivation and support. Compared with baseline, the median score of the Exercise Self-Efficacy Scale improved 3 months after participants completed the programme.