Guideline evaluation and implementation mechanisms in school health services (GuideMe): protocol for a hybrid randomized factorial trial.

BACKGROUND: Norwegian school health services received a national best-practice guideline in 2017. To promote healthy life skills and identify adolescents needing support, the guideline includes strong recommendations for individual consultations with all 8th graders and increased collaboration with schools. To help implement the recommendations, a blended implementation strategy (SchoolHealth) was co-created with school nurses, students, and stakeholders. SchoolHealth consists of three implementation elements: Digital dialog and administration tool (audit and feedback +), Dialog support (external consultation), and Collaboration materials (targeted dissemination). This hybrid study will test the main and combined effects of the elements on guideline fidelity and effectiveness. METHODS: The GuideMe study is a factorial cluster randomized controlled trial examining SchoolHealth's effectiveness on guideline fidelity and guideline effectiveness goals. Forty Norwegian secondary schools will be randomized to eight different combinations of the elements in SchoolHealth. Participants will include school nurses and school personnel from these schools, and 8th grade students (n = 1200). Primary outcomes are school nurses' fidelity to the guidelines and student's ability to cope with their life (i.e., health literacy, positive health behaviors and self-efficacy). Quantitative methods will be used to test effects and mechanisms, while mixed- and qualitative methods will be used to explore mechanisms, experiences, and other phenomena in depth. Participants will complete digital questionnaires at the start and end of the schoolyear, and after the consultation during the schoolyear. The study will run in two waves, each lasting for one school year. The multifactorial design allows testing of interactions and main effects due to equal distribution of all factors within each main effect. Sustainment and scale-up of optimized SchoolHealth elements using national infrastructure are simultaneously prepared. DISCUSSION: The study will investigate possible effects of the implementation elements in isolation and in combination, and hypothesized implementation mechanisms. In-depth study of user experiences will inform improvements to elements in SchoolHealth. The results will yield causal knowledge about implementation strategies and the mechanisms through which they assert effects. Mixed-methods will provide insights into how and when the elements work. Optimizing guideline implementation elements can support adolescents in a crucial life phase. TRAIL REGISTRATION: ISRCTN24173836. Registration date 8 August 2022.

Young peoples' involvement in welfare service development-Is voice enough?-A thematic synthesis of qualitative studies.

BACKGROUND: Young people need to be heard and take an active role in developing welfare services. When they are recognized as having skills and expertize, the advantages young people's involvement brings to both themselves and the organizations, are mobilization and empowering with impact on national decision-making. OBJECTIVE: To synthesize existing literature on how young people's involvement in coproduction can contribute to better welfare services. SEARCH STRATEGY: We performed a systematic literature search in four databases (MEDLINE, EMBASE, PsycINFO and Cinahl). INCLUSION CRITERIA: Publications whose abstracts contained themes as: Young people 12-25 years of age, receiving welfare, youth coproduction/involvement/participation and qualitative studies. DATA EXTRACTION AND SYNTHESIS: Of the 5469 documents retrieved, the full text of 58 studies was read, of which seven studies met the inclusion criteria. A thematic synthesis following Thomas and Harden was used. MAIN RESULTS: Young people being involved in coproduction of developing welfare services experienced to be valued and supported by partnerships, but they also pointed out deficiencies in welfare services. Some of the adolescents expressed not being listened to, lack of trusted relations and not being involved in policy making or prospects. The staff members saw some challenges with partnering with youth; as the need for flexibility, to keep the youth engaged and to purposefully meet the adolescents where they need help, guidance or resources. CONCLUSIONS: More involvement should be stressed. Coproduction is often symbolic more than resulting in real changes in the welfare services. Consequently, what is crucial when young people are involved is that they are encouraged by adults to be clear about the degree of involvement they want. PATIENT OR PUBLIC CONTRIBUTION: Patient and public involvement was not explicit in this review.

"Like Walking in a Fog"-Parents' perceptions of sleep and consequences of sleep loss when staying overnight with their child in hospital.

Disruption of parental sleep in hospital, with frequent awakenings and poor sleep quality, limits the parents' resources to meet the child's needs and maintain parental wellbeing. The aim of the study was to explore and describe how parents perceive their sleep when staying overnight with their sick child in hospital. A further aim was to explore and describe parents' perception of what circumstances influence their sleep in the hospital. Twenty-two parents who were accommodated with their sick child (0-17 years) in paediatric wards in Norway and Sweden participated. Interviews were conducted during the hospital stay to elicit their perspectives. Phenomenography was used to analyse data. Two descriptive categories were found: (a) "Perceptions of sleep", with two sub-categories: "Sleep in the paediatric ward" and "Consequences of sleep loss"; and (b) "Circumstances influencing sleep in the paediatric ward" with three sub-categories: "The importance of the family", "Information and routines at the paediatric ward", and "Accommodation facilities". Parents' sleep and needs must be acknowledged in paediatric wards. An individual plan of care for the upcoming night could be a valuable tool for both the parents and nurses. The child's medical needs must be met with respect to the parents' willingness to take part in the child's care during the night, and the need for rest and sleep for both parent and child.

A systematic integrative review of parents' experience and perception of sleep when they stay overnight in the hospital together with their sick children.

AIMS AND OBJECTIVES: To elucidate knowledge available on parents' experience and perception of sleep when they stay overnight in hospital together with their sick children. BACKGROUND: In Nordic countries, children are entitled to have at least one parent with them during hospitalisation. Parents' sleep, when accommodated at the hospital during the child's admission, may be a challenge. DESIGN: A systematic literature search was conducted in EMBASE, MEDLINE and PsycINFO; period is restricted from 1 January 2007 to 1 April 2019. Studies included were those in which parents were accommodated in hospital with their child, 0-18 years of age, for at least one night. Original peer-reviewed scientific research papers conducting qualitative, quantitative or mixed designs were included. Systematic reviews were not included. This systematic integrative review was registered in PROSPERO and performed according to the PRISMA guidelines. All authors participated in study selection, data extraction and quality assessment of the literature. RESULTS: Fifteen studies were included, and they varied in terms of origin, aims, design, methods used and sample size. Three overall main themes appeared: sleep quality, factors affecting sleep and consequences of sleep loss. Combined psychological factors were found to affect parents' sleep, as well as isolated psychological factors, for example, stress, anxiety, worries and difficult thoughts. Environmental and social factors were also identified, for example, privacy and caring for family. CONCLUSION: Study of this subject is still in its exploratory phase. There is a need for the development of theory of substance in the clarification of the meaning of sleep among parents during difficult times such as children's hospitalisation. RELEVANCE TO CLINICAL PRACTICE: Understanding risk factors associated with sleep and sleep deprivation in parents staying overnight in the hospital with their sick child is important, since lack of sleep may lead to serious stress-related outcomes for the parents.

Professionals' Experiences of the Relations between Personal History and Professional Role.

The purpose of this paper is to explore whether and how workers in a crisis resolution home treatment (CRHT) team experience the relationship between their personal history and professional role. This paper is based on 13 in-depth interviews with health professionals working in CRHT. The interviews were analysed using a hermeneutic-phenomenological approach. Participants expressed that there is a relationship between their personal history and professional role, and three themes are highlighted as particularly important in, namely experiences related to the participants as individuals, work-related experiences and family-related experiences. The participants write meaning into the relationship between their personal history and professional role. By relating and exploring their own life stories in the interviews, they work on forming meaning and identity.