Having Reliable Support: A Prerequisite to Promote Sexual and Reproductive Health in Young Women with ADHD.

Living with attention deficit hyperactivity disorder (ADHD) may influence sexual behaviors and intimate relationships in young women, resulting in a higher risk of unwanted pregnancy, sexual victimization, and sexual dysfunction. To develop adequate support, the study aimed to describe conceptions of how to promote sexual and reproductive health (SRH) in young women with ADHD. A secondary analysis using phenomenography was performed on qualitative interview data exploring variations of support. The study involved 15 young women with ADHD, aged 15-29 years, and 16 health care professionals, with various professions, working in the fields of gynecology, youth health, and psychiatry. Having reliable support was conceptualized as fundamental for promoting SRH. Access to information concerning SRH and living with ADHD as well as early support from health care contributed to a reliable support enabling self-knowledge and management of sexual relationships. Trustful relationships in health care were perceived as important because of previous experiences of feeling misunderstood and criticized in life, making them feel comfortable discussing SRH. Clinical encounters with a clear structure were further perceived to make information more accessible and clinics that provided appropriate organizational conditions and collaborated with other clinics were described to enhance the availability of support. This study reveals the need for clinics to provide conditions that ensure SRH support is available, accessible, and free of stigmatization. Early intervention programs for young women with ADHD may be considered, offering guidance on SRH issues in both psychiatric and sexual health clinics.

Phenomenography: An emerging qualitative research design for nursing.

BACKGROUND: Phenomenography emerged from pedagogy to examine the qualitatively different ways that individuals experience and perceive the same phenomenon. Despite its uniqueness, the uptake of phenomenography in nursing research is still limited. Potentially, this may be related to confusion regarding what the design is about, its philosophical underpinnings and how distinct it is from other qualitative designs. OBJECTIVES: To offer a better understanding of phenomenography by comparing it with other established qualitative research designs, examining its theoretical foundations, highlighting some studies that have employed the approach in nursing and offering methodological guidance to improve its uptake in nursing. DESIGN: Discussion paper. FINDINGS: Compared to the traditional qualitative designs employed in nursing, phenomenography has been utilized in fewer studies. The ontological, epistemological and methodological basis of phenomenography highlights it as a distinct design. The strength of phenomenography lies in its emphasis on understanding the collective variations between participants and presenting these holistically as an 'outcome space'. DISCUSSION: Phenomenography is a distinct qualitative research approach that presents a unique opportunity for nursing to further its use. Issues regarding bracketing, the inclusion of phenomenography studies in qualitative meta-synthesis and employing a hermeneutic approach to phenomenography are avenues for further work in nursing. PATIENT AND PUBLIC CONTRIBUTION: No patient or public contribution.

Ways of interdisciplinary approaches to advocating for nursing home residents with dementia.

AIM: To explore how nursing home staff advocate for residents with dementia. DESIGN: Phenomenographic qualitative research. METHODS: Twenty nursing home staff from four disciplines (six nurses, four physical therapists, five social workers and five care workers) were purposively recruited from three different nursing homes. Data were collected through semi-structured interviews conducted from February 2023 to March 2023, and the analysis followed the sequential steps of phenomenographic analysis. RESULTS: The analysis identified five categories of description: focusing on what happened, finding the gaps in perspectives, how to bridge for finding a common perspective, how to tailor care such that each resident receives equitable care and how to establish interdisciplinary sharing for a consistent advocative pattern. Their structural relationship was also identified as an outcome space. CONCLUSION: The cyclical advocacy structure illustrated that nursing home staff engage in an ongoing process of advocacy during conflict situations as part of interdisciplinary care, emphasizing continuity of care rather than separate occurrences of care. IMPLICATIONS FOR THE PROFESSION: This study revealed that, in advocating for residents with dementia, nursing home staff adopted an approach that fosters consistent care and proactive prevention, achieved through the formation of shared knowledge applicable uniformly across similar situations. IMPACT: This study contributes significantly to the continuing education or training of interdisciplinary staff in nursing homes. The revelations of the study hold significance not only for the practical application but also for the theoretical advancement of concepts related to safeguarding the dignity, human rights and personhood of residents with dementia, with the ultimate goal of enhancing their quality of life within nursing homes. REPORTING METHOD: Reporting complied with the COREQ criteria for qualitative research. PATIENT OR PUBLIC CONTRIBUTION: Nursing home directors have contributed to the validation of data analysis and interpretation.

Family members' conceptions of their supportive care needs across the colorectal cancer trajectory - A phenomenographic study.

AIM: To describe the variations of family members' conceptions of their supportive care needs (SCN) across the colorectal cancer (CRC) trajectory. DESIGN: A descriptive qualitative study with a phenomenographic approach. METHOD: Individual semi-structured interviews were conducted from May 2022 to October 2022 with 23 family members of persons diagnosed with colorectal cancer. The interviews were analysed using phenomenographic analysis following the Consolidated criteria for reporting qualitative research (COREQ) checklist. RESULTS: The phenomenographic analysis resulted in five categories. Not of importance describes family members' needs as unimportant due to the good prognosis and the organization of care and in relation to the needs of others. Only satisfiable by professionals describes information possessed by the healthcare professionals as key, as well as the need for professional counselling for the family members to process their emotions. Managed by themselves describes family members preferring to manage their SCN themselves by turning to the appropriate social support and/or by using coping skills. Understood retrospectively describes SCN as only understandable when things have calmed down and as requiring one's own experience to understand. Left unmet describes SCN as unnoticed by the healthcare professionals or not brought to light by the family members, or family members not knowing where to turn for support. CONCLUSION: Supportive care should involve individualized information, proactive and repeated assessments of needs across the trajectory, as well as encouragement of family members to reflect on their needs and to accept support when needed. IMPACT: There is a gap in the literature regarding family members' SCN across the CRC trajectory which this study addresses. Findings show five categories of family members' conceptions of their SCN. Those findings could serve as a basis for the development of clinical colorectal supportive care across the cancer trajectory. IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE: Findings show that to offer family members of persons diagnosed with colorectal cancer support only at the time of diagnosis is insufficient. Instead, the healthcare team is recommended to proactively and repeatedly try to identify those in need and the characteristics of their needs. In addition, it is important to offer individualized information and strive to encourage family members to reflect on their situation and to not suppress their own needs if emerging. REPORTING METHOD: Reporting adheres to the consolidated criteria for reporting qualitative research (COREQ) checklist. PATIENT OR PUBLIC CONTRIBUTION: No patient or public contribution.

Perceptions of surveillance with magnetic resonance imaging among women with a hereditary risk of breast cancer-A phenomenographic study.

AIM: To explore perceptions of annual surveillance with magnetic resonance imaging and perceptions of care during the examination among women with a hereditary risk of breast cancer. DESIGN: Phenomenography. METHODS: Fourteen face-to-face interviews using a semi-structured interview guide were conducted among women undergoing surveillance in the southern region of Sweden. A seven-step phenomenographic analysis with investigator triangulation was performed. RESULTS: 'Considering own risk of developing breast cancer', 'Entrusting oneself to surveillance' and 'Living in a cycle' represented descriptive categories of perceptions. Family narratives introduced comprehension of own risk of breast cancer, followed by appraisal of own benefits of participating in surveillance. Entrusting oneself to surveillance included handing over management of diagnostic examinations and dealing with practical issues and diverse emotions related to surveillance. Planning life based around surveillance, struggling with fluctuating emotions, also between the examinations and questioning own identity implied the perception of living in a cycle. CONCLUSION: Surveillance for hereditary breast cancer implies living in a cycle of dealing with fluctuating emotions and planning life based around surveillance. Comprehension of one's own risk for breast cancer arises from awareness in the family. Women value the surveillance programme and trust the healthcare system. IMPLICATION FOR THE PROFESSION AND PATIENT CARE: Knowledge of women's perceptions of the surveillance programme and care is vital for supporting women in their decision-making on attendance and providing person-centred care during surveillance. IMPACT: A gap in explorative studies from the perspective of the individual woman in the context of surveillance for breast cancer and care in magnetic resonance imaging in surveillance was addressed. 'Considering own risk of developing breast cancer', 'Entrusting oneself to surveillance' and 'Living in a cycle' represented women's perceptions of surveillance and care. The study results have implications for person-centred care among women in the surveillance programme. PATIENT OR PUBLIC CONTRIBUTION: No patient or public contribution.

Navigating the complex dynamics of anesthesiologists' professional identity formation in the context of their specialty training program: a phenomenographic perspective.

BACKGROUND: A specialty training program is crucial for shaping future specialist doctors, imparting clinical knowledge and skills, and fostering a robust professional identity. This study investigates how anesthesiologists develop their professional identity while navigating unique challenges specific to their specialty. The formation of professional identity in anesthesiology significantly influences doctors' well-being, teamwork, and ultimately patient care, making it a crucial aspect of anesthesiology education. Utilizing a phenomenographic approach, the research explores the learners' personal experiences and perspectives of professional identity formation in their specialty training programs, providing valuable insights for enhancing future anesthetic educational programs. METHOD: The data for this phenomenographic study were collected through semi-structured interviews with anesthesiology trainees and specialists, guided by open-ended questions. The interviews were conducted at a Swedish university hospital, and participant selection used purposive sampling, providing rich and diverse data for analysis after 15 interviews. Iterative analysis followed the seven-step phenomenographic approach. The research team, comprising qualitative research and anesthesiology education experts, ensured result validity through regular review, discussion, and reflective practices. RESULTS: The study reveals three fundamental dimensions: 'Knowledge of Subject Matter,' 'Knowledge of Human Relations,' and 'Knowledge of Affect.' These dimensions offer insights into how anesthesiologists comprehend anesthesiology as a profession, navigate interactions with colleagues and patients, and interpret emotional experiences in anesthesiology practice - all crucial elements in the formation of professional identity. The findings could be synthesized and further described by three conceptions: The Outcome-Driven Learner, the Emerging Collaborator, and the Self-Directed Caregiver. CONCLUSION: The study uncovers differing learner understandings in the development of anesthesiologists' professional identity. Varying priorities, values, and role interpretations highlight the shortcomings of a generic, one-size-fits-all educational strategy. By acknowledging and integrating these nuanced learner perspectives, as elucidated in detail in this study, the future of anesthesia education can be improved. This will necessitate a holistic approach, intertwining both natural sciences and humanities studies, focus on tacit knowledge, and flexible teaching strategies, to guarantee thorough professional development, lifelong learning, and resilience.

Symbolic access: medical students' awareness of institutional culture and its influence on learning, a phenomenographic study.

BACKGROUND: The discussion of access in medical education has its focus largely on physical and epistemological access, leaving a qualitative gap regarding sociocultural factors which enable access in this context. This study introduces and defines symbolic access, a concept with a specific lens on sociocultural inclusion, and the influence it has on student learning within the South African medical education landscape. METHODS: A phenomenographic design was used to explore students' conceptions of symbolic access and its impact on learning. One-on-one exploratory interviews were conducted with fifteen final year medical students at the University of Witwatersrand in Johannesburg. Interviews were analysed using Sjöström and Dahlgren's seven-step phenomenography model. RESULTS: Four categories of description were induced, which described students' understanding of symbolic access, these were rejection, disregard, invalidation, and actualization. Four dimensions of variation were discovered expressing the diversity of events which informed the collectives' understanding of the phenomenon. These dimensions were; interactions with educators, peer relationships, educational environment, and race. Categories of description and dimensions of variation formed the Outcome Space, a visual representation of the student experience of symbolic access. The outcome space had a double narrative related to symbolic access; exclusion (major) and actualization (minor). Medical student's chief experience within the medical community was exclusion, however clinical immersion, meaningful participation, peer-relationships, and clinical skills lessons facilitated community enculturation, and impacted learning. CONCLUSION: Despite deeply exclusionary experiences throughout their programme, medical students articulated a paradox of both awareness and no awareness of symbolic access. The awareness of symbolic access was predominantly influenced by clinical experiences and clinical immersion during the pre-clinical and clinical years of study. Further, descriptions of valuable learning experiences were connected to clinical events and the involvement with patient care. This study suggests that the actualization of symbolic access and description of meaningful learning experiences are linked. Medical educationalists should design undergraduate curricula with early clinical immersion at the fore and explore symbolic concepts pertaining to access, as they are linked to transformative learning experiences for the medical student.

First-line managers´ perceptions of missed nursing care in community health care for older people-A phenomenographic study.

INTRODUCTION: First-line managers in Swedish communities have responsibility for that care to older people is provided, staffing is sufficient and the budget is balanced in their unit. It is a struggle with limited resources due to a growing population in need of care. This can lead to missed nursing care. The aim was to describe first-line managers´ perceptions of missed nursing care in community health care for older people. METHODS: A qualitative design with a phenomenographic approach, interviewing 24 first-line managers. Ethics approval for the study was received from the Research Ethics Committee at Karlstad University (Dnr HNT 2020/566). RESULTS: The results are shown in six descriptive categories containing 15 perceptions. The descriptive categories are 'occurrence of missed nursing care', 'becoming aware of missed nursing care', 'reasons for missed nursing care', 'missed nursing care has consequences for the older persons', 'missed nursing care has consequences for the staff' and 'taking action to decrease missed nursing care'. CONCLUSIONS: It is important for first-line managers to become aware of the existence and reasons for missed nursing, as it has consequences for older people and staff. Managers need to take missed nursing care seriously in order to work with improvements for maintaining good quality of care and patient safety.

Being a Doctor: From Treating Individual Patients to Maximising Community Health and Social Justice.

This study examined variation in medical practitioners' practice-based conceptions of what it means to be a doctor, based on interviews with 30 clinicians who were also medical educators. Participants included general practitioners, surgeons and physicians (non-surgical specialists). Participants were asked to draw a concept map of 'being a doctor', followed by semi-structured interviews using a phenomenographic research design. Three conceptions were identified, varyingly focused on (1) treating patients' medical problems; (2) maximising patients' well-being; and (3) maximising community health. Each conception was distinguished by variation in awareness of six underlying dimensions of being a doctor: (1) doctors' actions; (2) treatment success; (3) patients' actions; (4) patients' well-being; (5) community needs; and (6) social justice. Whilst all participants included dimensions 1 and 2 in their described practice, numerous participants did not include dimensions 3 and 4, i.e. did not take the patients' role and the impact of patients' psychosocial context into account in their practice. This is concerning, especially amongst medical educators, given the widely acknowledged importance of patient-centred care in medical practice. Similarly, only some of the participants considered community health needs and felt a broader social responsibility beyond their responsibility to individual patients. These findings highlight aspects of the medical profession that need to be further emphasised in medical training and continuing professional development.

Nurses' models of spiritual care: A cross-sectional survey of American nurses.

OBJECTIVES: Despite there being many models for how spiritual care should be provided, the way nurses actually provide spiritual care often differs from these models. Based on the premise that the way a person enacts their work role is related to how they understand that role, this study aims to describe the qualitatively different ways that nurses understand their spiritual care role. METHODS: A convenience sample of 66 American nurses completed an anonymous, online questionnaire about what spiritual care means for them and what they generally do to provide spiritual care. Their responses were analyzed phenomenographically. RESULTS: Four qualitatively different ways of understanding emerged: active management of the patient's experience, responsive facilitation of patient's wishes, accompaniment on the patient's dying journey, and empowering co-action with the patient. Each understanding was found to demonstrate a specific combination of 5 attributes that described the spiritual care role: nurse directivity, the cues used for spiritual assessment, and the nurse's perception of intimacy, the patient, and the task. SIGNIFICANCE OF RESULTS: The findings of this study may explain why nurses vary in their spiritual care role and can be used to assess and develop competence in spiritual care.

How do nursing home nurses conceptualize the management of behavioral and psychological symptoms of dementia? A phenomenographic study.

The behavioral and psychological symptoms of dementia (BPSD) present complex challenges for nursing home (NH) nurses, leading to confusion and difficulties in providing effective care. To address these issues, investigating how NH nurses perceive and manage the BPSD is crucial since it can lead to the development of tailored and effective care plans. This study therefore aimed to explore the ways in which NH nurses approach the management of the BPSD by using phenomenography. The study identified five categories of assessment and four categories of intervention in managing the BPSD, with their hierarchical structure represented as an outcome space. Each category's description provides a clear conceptualization of the complex and challenging nature of the BPSD care, offering insights into how NH nurses perceive the BPSD management. The study's findings can enhance NH nurse education and lead to effective care plans for residents with BPSD.

Students' Experiences with the Science and Engineering Practices in a Workshop-Based Undergraduate Research Experience.

This paper presents a phenomenographic investigation on students' experiences about research and poster presentations in a workshop-based undergraduate research experience with a focus on how the experience connects to the Science and Engineering Practices (SEPs) of the NRC A Framework for K-12 Science Education and the principles of CUREs. This provides insight into how these structured research experiences reflect particular SEPs and also elements of scientific practice that are not captured in the SEPs as they have been formulated previously. This work showcases the importance of future applications, failure, and creativity as additional science practices necessary for students to engage in authentic science. The SEPs and the additional elements of scientific practice are related to how students experience meaningful learning in the cognitive, psychomotor, and affective domains. Students highlighted the components of CUREs: importance of contributing relevant discoveries as a motivation for their research, the value of repetition and iteration in ensuring reliable and valid results, and the role of collaboration in seeing new perspectives and solving problems. As a result of presenting their results through a poster, students reported deeper understanding of their research topic, increased ability to articulate scientific concepts, and a better understanding of how to create a visually appealing poster. Students changed the vocabulary they used in their presentations to fit the knowledge level of their audience and highlighted their data in figures and explained other parts of their work in text. Moreover, they saw the poster as an outlet for their creativity.

Clinician educators' conceptions of assessment in medical education.

In pursuing assessment excellence, clinician-educators who design and implement assessment are pivotal. The influence of their assessment practice in university-run licensure exams on student learning has direct implications for future patient care. While teaching practice has been shown to parallel conceptions of teaching, we know too little about conceptions of assessment in medical education to know if this is the case for assessment practice and conceptions of assessment. To explore clinician-educators' conceptions of assessment, a phenomenographic study was undertaken. Phenomenography explores conceptions, the qualitatively different ways of understanding a phenomenon. Data analysis identifies a range of hierarchically inclusive categories of understanding, from simple to more complex, and the dimensions that distinguish each category or conception. Thirty-one clerkship convenors in three diverse Southern settings were interviewed in three cycles of iterative data collection and analysis. Four conceptions of assessment were identified: passive operator, awakening enquirer, active owner and scholarly assessor. Six dimensions were elucidated to describe and distinguish each conception: purpose of assessment; temporal perspective; role and responsibility; accountability; reflexivity and emotional valence. Additionally, three characteristics that appeared to track the progressive nature of the conceptions were identified: professional identity, assessment literacy and self-efficacy. These conceptions encompass and extend previously described conceptions across different educational levels, disciplines and contexts, suggesting applicability to other settings. There is some evidence of a relationship between conceptions and practice, suggesting, together with the hierarchical nature of these conceptions, that targeting conceptions during faculty development may be an effective approach to enhance assessment practice.

Metacognition in oral health education: A pedagogy worthy of further exploration.

AIM: This study aimed to investigate the perceptions of dental students and teachers about introducing metacognition pedagogy within an established clinical professional curriculum to provide primary data informing its feasibility. METHODOLOGY AND METHOD: A qualitative study using phenomenography methodology was undertaken as part of a master's dissertation. Semi-structured interviews were conducted on 16 participants which included 9 clinical teachers and 7 dental students. FINDINGS: Metacognition pedagogy was positively perceived by most of the participants as being beneficial to students' learning in oral health education. A few reported some negativity. All participants identified some challenges to be addressed if a metacognition pedagogy was to be implemented in the undergraduate curriculum. CONCLUSION: According to the perceptions of most participants in the study, metacognition emerged as a potential factor in improving student learning and exam performance, and facilitating the development of critical thinking, professionalism, and clinical skills. In the context of rigorous, demanding, and challenging courses, and recognising the complexities and uncertainties inherent in health professional working environments, metacognition emerges as a valuable tool, fostering self-awareness, regulation, and adaptability. Ultimately, metacognition has the capability to shape more adept learners and clinicians, yielding benefits for students, teachers, and patients alike.

The educational paradigm shift-a phenomenographic study of medical teachers' experiences of practices.

BACKGROUND: This paper proposes a novel approach to the development of competence-oriented higher education, a national transformation aimed at harmonising and digitising undergraduate medical and dental education in Finland. METHODS: We apply phenomenography as a viable qualitative method for medical education research. To better understand medical teachers' expectations towards the change in the educational paradigm, we need to study teachers' experiences of the current practices in undergraduate medical and dental education. The phenomenographic approach facilitates solid links between research, educational development, and change. RESULTS: The phenomenographic study maps the qualitatively different ways in which medical teachers experience undergraduate medical and dental education practices. The answers reflect the changing educational paradigm in medical schools, suggesting practical implications for further development of medical and dental education and training. Core content analysis is preferred instructional scaffold for both teachers and students to prioritise the extensive medical education objectives. The change towards competence-based orientation is in progress and national co-operation accelerates its impact. CONCLUSION: There is an obvious need to enrich the content of the current curriculum with national guidelines that aim for congruence in assessment and objectives. Our results suggest an assessment application for the theoretical concepts presented and promote the competence orientation of education throughout the curricula of medical and dental undergraduate education. Moreover, our results contribute to current European discourses on competence-based approaches in higher education. Up-to-date pedagogical faculty development programmes are a key prerequisite for teacher empowerment and future orientation in teaching and learning for healthcare professions.

Mental health services in the school environment-Future visions using a phenomenographic approach.

AIMS AND OBJECTIVES: First, to describe the variation in stakeholders' perceptions related to the desirable mental health services in school environments. Second, to construct alternative future visions based on these perceptions. Finally, to describe stakeholders' perceptions about the actions needed to reach such an ideal state. BACKGROUND: The increased need for mental health care has challenged the role of schools and school health care in the area of mental health services for those of school-age. There is a need for future visions and comprehensive statements concerning the mental health services provided in the school environment. DESIGN: The study was undertaken in Finland, between February 2020 and February 2021. Qualitative individual interviews were conducted with 15 professional stakeholders and focus group interviews with 10 stakeholders advocating for adolescents or parents. METHOD: The study was conducted with the phenomenographic approach using a visioning methodology. The study is reported following the COREQ checklist. RESULT: Four alternative future visions were formulated based on the perceptions of the stakeholders. They emphasised different aspects: (1) non-medicalising the school environment, (2) early and extensive intervention by school nurses enabled by work distribution with mental health specialists, (3) a multiprofessional team providing help on overall health questions and (4) a focusing of the services on mental disorders. Necessary changes were identified at the micro-, mezzo- and macro-level. CONCLUSION: The future visions are based on opposite perceptions related to the mission and focus of school health care. One extreme emphasises overall health promotion for everyone, while the other accentuates treatment for those suffering from mental disorders. The former may lead to inadequate help for mental health problems and the latter insufficient help for other health problems. RELEVANCE TO CLINICAL PRACTICE: This study contributes alternative future visions, promotes strategic planning and helps to clarify the future role of school nurses.

How nursing students learn infection control education through undergraduate nursing programs: a phenomenographic research study.

BACKGROUND: Competency in infection control is crucial for implementing nursing best practices to ensure patient safety. However, research is lacking on the infection control education received by nursing students prior to entering clinical settings as nurses. This study aimed to explore how nursing students conceptualize infection control care in undergraduate nursing programs. METHODS: This study employed a qualitative research method using phenomenography. Universities providing undergraduate nursing programs in Korea. Thirty nursing students: 10 students each from the 2nd, 3rd, and 4th years of five undergraduate programs. Data were collected from May 2019 to February 2020 through semi-structured interviews and analyzed using a phenomenographic analysis procedure. RESULTS: Six descriptive categories were derived inductively for nursing students' frames of reference regarding infection control care and six descriptive categories of how nursing students learned about infection control care. The structural framework of the identified categories, about how nursing students learn about infection control care, was presented as an outcome space. CONCLUSIONS: Given that nursing students demonstrate diverse conceptualizations of infection control and are at varying levels of learning, professors and clinical mentors need to develop theoretical education and clinical practice opportunities that consider these differences.

Nurse anesthetists' perceptions of heat conservation measures in connection with surgery - a phenomenographic study.

BACKGROUND: To minimize the risk of perioperative hypothermia, it is recommended that healthcare professionals be familiar with heat conservation measures and use passive and active warming methods, in line with international guidelines. However, there is a low level of adherence perioperatively to the use of heat conservation measures. To understand why, there is a need to capture the nurse anesthetists' perspective. The aim is to describe nurse anesthetists' perceptions of heat conservation measures in connection with surgery. METHODS: An inductive descriptive design with a phenomenographic approach was chosen. A total of 19 nurse anesthetists participated and were interviewed. Data were analyzed according to Larsson and Holmström's phenomenographic seven-step model. RESULTS: Six ways of understanding the phenomenon heat conservation measures in connection with surgery were found: the preventive, the useable, the untenable, the caring, the adaptive, and the routine care approach. These approaches were related to each other in a flexible way, allowing for several to co-exist at the same time, depending on the situation. CONCLUSIONS: Nurse anesthetists want to prevent the patients' heat loss and maintain normothermia, regardless of the type of surgery. This willingness, motivation, and intention enable the use of heat conservation measures. However, there are perceptions that have an impact, such as doubts and uncertainty, access, time and financial constraints, preconditions, routines or habits, and lack of availability of education/training. These barriers will require support from an organizational level to promote lifelong education and guidelines. As well as offer education at the nurse anesthetists' program.

How experienced wound care nurses conceptualize what to do in pressure injury management.

BACKGROUND: Conceptual understanding of the perceptions that wound care nurses use to determine how to manage pressure injuries may provide information for improving their pressure injury care competency. The aim of this study is to explore and describe the way wound care nurses experience and perceive pressure injury management. METHODS: A qualitative, phenomenographic approach, a method designed to explore the different ways in which people comprehend a phenomenon and develop a practical knowledge-based framework, was used in this study. Semi-structured interviews were used for data collection with twenty wound care nurses. All participants were female with a mean age of 38.0, mean total clinical experience of 15.2 years and mean clinical experience as wound care nurse of 7.7 years. The eight steps of qualitative data analysis for a phenomenographic study were employed to develop an understanding of participants' experience of pressure injury management. RESULTS: The analysis resulted in an assessment domain and an intervention domain, each containing three descriptive categories based on five identified conceptions. The categories were as follows: "comparison", "consideration", and "monitoring" in assessment, and "creation", "conversation" and "judgement" in intervention. CONCLUSIONS: This study has created a framework for understanding pressure injury management based on practical knowledge. This framework of the nurses' pressure injury care reflected the need for an awareness of a harmonious approach to patients and wounds. There is a pattern of transcending a reliance on only theoretical knowledge, and this key factor in the framework should be considered when developing education programs and tools for improving nurse pressure injury care competency and patient safety.

Ambulance clinicians' responsibility when encountering patients in a suicidal process.

BACKGROUND: Even though the traditional focus in emergency care is on life-threatening medical crisis, ambulance clinicians frequently encounter patients with mental illness, including suicidal ideation. A suicide is preceded by a complex process where most of the suicidal ideation is invisible to others. However, as most patients seek healthcare in the year before suicide, ambulance clinicians could have an important part to play in preventing suicide, as they encounter patients in different phases of the suicidal process. AIM: The aim of this study was to describe ambulance clinicians' conceptions of responsibility when encountering patients in a suicidal process. RESEARCH DESIGN: A qualitative inductive design using a phenomenographic approach was used. PARTICIPANTS AND RESEARCH CONTEXT: Twenty-seven ambulance clinicians from two regions in southern Sweden were interviewed. ETHICAL CONSIDERATIONS: The study was approved by the Swedish Ethical Review Authority. FINDINGS: Three categories of descriptions captured a movement from responding to a biological being to responding to a social being. Conventional responsibility was perceived as a primary responsibility for emergency care. In conditional responsibility, the patient's mental illness was given only limited importance and only if certain conditions were met. Ethical responsibility was perceived to have its primary focus on the encounter with the patient and listening to the patient's life story. CONCLUSIONS: An ethical responsibility is favourable regarding suicide prevention in ambulance care, and competence development in mental illness and conversation skills could enable ambulance clinicians to have conversations with patients about suicidal ideation.