Impacts on oral health attitude and knowledge after completing a digital training module among Swedish healthcare professionals working with older adults.

Oral health care is essential, and digital training may influence healthcare professionals' attitudes to and knowledge of oral health. The aim, therefore, was to evaluate the impact on attitudes to and knowledge of oral health after using a digital training module among Swedish healthcare professionals working within a municipality-run healthcare service for older adults. A secondary aim was to explore the healthcare professionals' experiences of using the digital module. The study comprised a survey of healthcare professionals (registered nurses (RNs), assistant nurses, and care assistants) caring for older adults in a municipality in Sweden. Pre-post-tests were conducted to evaluate the outcomes for attitudes to and knowledge of oral health and of their experiences of completing the digital training module in oral health. These were statistically explored by comparing differences between the pre-post-tests, while the open-ended questions were analysed with qualitative content analysis. The findings of this study indicate that healthcare professionals had similar perceptions of their attitudes to and knowledge of oral health both before and after the digital training module in oral health. The study also indicates that healthcare professionals experienced that it is easier to perform practical oral health care after completing the digital training. The results also show that healthcare professionals value oral health knowledge and that the digital training module was easy to use and to disseminate knowledge throughout the municipality. The findings have implications for developing, implementing, and promoting healthcare professionals' attitudes to and knowledge of oral health and in using a digital training module in combination with practical exercises in oral health in municipality health care.

Psychometric evaluation of a short-form version of the Swedish "Attitudes to and Knowledge of Oral Health" questionnaire.

BACKGROUND: Healthcare professionals' attitudes to and knowledge of oral health are fundamental to providing good oral health care to older adults. One instrument that assesses healthcare professionals' attitudes to and knowledge of oral health in a Swedish context is the "Attitudes to and Knowledge of Oral health" (AKO) questionnaire. Two of the three item-groups of the AKO have previously been validated in a Swedish context. However, it is crucial that all three item-groups are validated, and beneficial to design a shorter, easy-to-use questionnaire for healthcare professionals while maintaining adequate integrity of its reliability and validity. Therefore, the present study aims to develop a short-form version of AKO and to secure its psychometric properties. METHODS: Psychometric evaluation with Classical Test Theory and Item Response Theory to validate and shorten AKO with 611 healthcare professionals from a population of 1159 working in a municipality in an urban area in western Sweden. RESULTS: Of the original 16 items in the AKO, 13 were shown to warrant retention in the abbreviated/shortened form. These showed acceptable validity and reliability for assessing healthcare professionals' attitudes to and knowledge of oral health. CONCLUSION: This validated short-form version of AKO shows acceptable validity and reliability after being reduced to 13 items, structured in a 3-part scale. The items are consistent with the total scale, indicating that the internal consistency is acceptable. Future studies should be performed to evaluate AKO in other groups of healthcare professionals, across cultures, languages, and so on, to investigate its use and strengthen its validity and reliability.

Teaching about death and dying-A national mixed-methods survey of palliative care education provision in Swedish undergraduate nursing programmes.

BACKGROUND: In coming decades, the number of people affected by illnesses who need palliative care will rise worldwide. Registered Nurses are in a central position in providing this care, and education is one of the necessary components for meeting coming requirements. However, there is a lack of knowledge about palliative care in undergraduate nursing education curricula, including the extent of the education provided and the related pedagogical methods. AIM: The aim was to investigate the extent, content and pedagogical methods used and to explore lecturers' experiences of being responsible for teaching and learning about palliative care for undergraduate nursing students on nursing programmes at Swedish universities. SETTING: All 24 universities responsible for providing undergraduate nursing education in Sweden participated. PARTICIPANTS: One lecturer with in-depth knowledge about palliative care or end-of-life care education participated in the quantitative (n = 24) and qualitative (n = 22) parts of the study. METHOD: A mixed-method research study with an explorative design was used. Descriptive statistics were used to analyse quantitative data, and content analysis for qualitative, with both also analysed integratively. RESULTS: Few undergraduate nursing programmes included a specific course about palliative care in their curricula, however, all universities incorporated education about palliative care in some way. Most of the palliative care education was theoretical, and lecturers used a variety of pedagogical strategies and their own professional and personal experience to support students to understand the palliative care approach. Topics such as life and death were difficult to both learn and teach about. CONCLUSIONS: There is a need for substantial education about palliative care. Lecturers strive on their own to develop students' understanding and increase the extent of palliative care education with innovative teaching strategies, but must compete with other topics. Palliative care teaching must be prioritised, not only by the universities, but also by the national authority.

Undergraduate nursing students' transformational learning during clinical training.

BACKGROUND: Undergraduate nursing students encounter patients at the end of life during their clinical training. They need to confront dying and death under supportive circumstances in order to be prepared for similar situations in their future career. AIM: To explore undergraduate nursing students' descriptions of caring situations with patients at the end of life during supervised clinical training. METHODS: A qualitative study using the critical incident technique was chosen. A total of 85 students wrote a short text about their experiences of caring for patients at the end of life during their clinical training. These critical incident reports were then analysed using deductive and inductive content analysis. FINDINGS: The theme 'students' transformational learning towards becoming a professional nurse during clinical training' summarises how students relate to patients and relatives, interpret the transition from life to death, feel when caring for a dead body and learn end-of-life caring actions from their supervisors. IMPLICATIONS: As a preparation for their future profession, students undergoing clinical training need to confront death and dying while supported by trained supervisors and must learn how to communicate about end-of-life issues and cope with emotional stress and grief.

Factors influencing attitude toward care of dying patients in first-year nursing students.

AIM: To describe Swedish first-year undergraduate nursing students' attitudes toward care of dying patients. Possible influences such as age, earlier care experiences, care education, experiences of meeting dying patients and place of birth were investigated. METHOD: The Frommelt Attitude Toward Care of the Dying Scale (FATCOD) was used in six universities. Descriptive statistics and regression analysis were used. RESULTS: Some 371 students (67.3%) reported overall positive attitude toward caring for dying patients (total mean FATCOD 119.5, SD 10.6) early in their first semester. Older students, students with both earlier care experience and earlier education, those with experience of meeting a dying person, and students born in Sweden reported the highest scores, a more positive attitude. CONCLUSION: Age, earlier care experience and education, experiences of meeting a dying person and place of birth seems to affect students' attitudes toward care of the dying and need to be considered among nursing educators.

'The challenge to take charge of life with long-term illness': nurses' experiences of supporting patients' learning with the didactic model.

AIMS AND OBJECTIVES: The aim of this implementation study is to describe nurses' experiences of supporting patient learning using the model called 'The challenge to take charge of life with long-term illness'. BACKGROUND: Supporting patient learning for those suffering from a long-term illness is a complex art in nursing. Genuine learning occurs at a deep and existential level. If the patient's resistance to illness can be challenged and reflected upon, the patient may take charge of his/her life. DESIGN: The project lasted for 2 years and was initiated by a former patient on an assisted haemodialysis ward and involved 14 registered nurses. The project began with a session to review patients' learning and the didactic model. Monthly reflective meetings and group supervisions were held that focused on the nurses' experiences of supporting patient learning. Notes were written during these reflective meetings and group sessions. METHODS: Data collected from interviews, notes and written stories were subjected to phenomenological analysis. RESULTS: Three aspects of nurses' experiences of the learning support approach were assessed: To have the courage to listen sincerely, a movement from providing information to supporting learning, and to let the patient indicate the direction. The approach resulted in an increased focus on genuine dialogue and the courage to encourage patients to take charge of their health process. CONCLUSIONS: The changes in nurses' approach to learning support reveal that they shift from providing information on the disease, illness and treatment to strengthening and supporting the patient in making decisions and taking responsibility. For nurses, the change entails accepting the patient's goals and regarding their own role as supportive rather than controlling. The didactic model and involved supervision contributed to the change in the nurses' approach. RELEVANCE TO CLINICAL PRACTICE: The didactic model might be useful in caring for persons with long-term illness, making the care more person-centred and enhancing the patient's self-care ability.

"The unpredictable death"-The last year of life for patients with advanced COPD: Relatives' stories.

OBJECTIVE: The end stage of chronic obstructive pulmonary disease (COPD) is described as prolonged, and the symptom burden for patients with COPD is often high. It progresses slowly over several years and can be punctuated by abrupt exacerbations that sometimes end in sudden death or a recovery of longer or shorter duration. This makes it difficult to identify the critical junctures in order to prognosticate the progress and time of death. Patients with COPD often express a fear that the dying process is going to be difficult. There is a fear that the dyspnea will worsen and lead to death by suffocation. The present article aimed to retrospectively describe the final year of life for patients with advanced COPD with a focus on death and dying from the perspective of relatives. METHOD: Interviews were conducted with the relatives of deceased family members who had advanced COPD. In total, 13 interviews were conducted and analyzed by means of content analysis. RESULT: All relatives described the patients as having had a peaceful death that did not correspond with the worry expressed earlier by both the patients and themselves. During the final week of life, two different patterns in the progress of the illness trajectory emerged: a temporary improvement where death was unexpected and a continued deterioration where death was inevitable. SIGNIFICANCE OF RESULTS: The patients and their relatives lived with uncertainty up until the time of death. Little support for psychosocial and existential needs was available. It is essential for the nurse to create relationships with patients and relatives that enable them to talk about dying and death on their own terms.

Death and caring for dying patients: exploring first-year nursing students' descriptive experiences.

AIM: To describe first-year nursing students' experiences of witnessing death and providing end-of-life care. METHODS: This study is part of a larger longitudinal project. Interviews (n=17) were conducted with nursing students at the end of their first year of education. To analyse the interviews (lived-experience descriptions), a thematic analysis, 'a search for meaning' ( Van Manen, 1997 ) was applied. RESULTS: The results are presented within the framework of four separate themes: (1) The thought of death is more frightening than the actual experience, (2) Daring to approach the dying patient and offering something of oneself, (3) The experience of not sufficing in the face of death and (4) Being confronted with one's own feelings. CONCLUSION: Nursing students require continuous support and opportunity to reflect and discuss their experiences about caring for dying patients and confronting death throughout the entirety of their education. In addition, teachers and clinical supervisors need to give support using reflective practice to help students to develop confidence in their capacity for caring for dying patients.

Swedish nursing students' reasoning about emotionally demanding issues in caring for dying patients.

AIM: To describe nursing students' reasoning about emotionally demanding questions concerning the care of dying patients. METHODS: The Frommelt Attitude Toward Care of the Dying (FATCOD) Scale was completed by students at the beginning of their education, and there was great variation in the responses to five items. At a follow-up measurement in the second year, an open-ended question, 'How did you reason when completing this question?', was added to each of the these five items. Qualitative content analysis was used to analyse the responses. RESULTS: Of 140 students who completed the FATCOD, 111 provided free-text responses. The analysis of these responses revealed three themes: death perceptions, the students' understanding of their current situation, and the nurse's responsibility. CONCLUSION: This study provides useful information on students' reasoning about emotionally demanding questions relating to the care of dying patients. Such knowledge is valuable in helping students to overcome their fear and fulfil their expectations concerning their future proficiency.

Struggling to retain living space: patients' stories about living with advanced chronic obstructive pulmonary disease.

AIM: This paper is a report of a study of the experience of living with advanced chronic obstructive pulmonary disease and long-term oxygen therapy when living alone. BACKGROUND: Chronic obstructive pulmonary disease affects an increasing number of people. Breathlessness, fatigue and dejection are common symptoms during the last years of life. METHOD: Repeated qualitative interviews with four participants were conducted over an 8-month period in 2008. The data comprised 17 interviews, 15 telephone conversations and various field notes. A phenomenological hermeneutical method was used to interpret the text. FINDINGS: The analysis resulted in two main themes and five sub-themes. The first main theme, Being subordinated to the sick body, implies that the body, assistive devices and entrusting oneself to the hands of others can both extend and restrict the living space. The second main theme, Protecting significant values of identity, encompasses both the struggle to maintain self-image and the awareness of one's own death. CONCLUSION: Living alone with advanced chronic obstructive pulmonary disease is a challenging and complex phenomenon. The everyday life was characterized by a struggle to keep autonomy during a time of increasing dependency and need for help. A person-centred nursing care, built upon peoples' own experiences, may be one way to promote identity and dignity in patients even when they are close to death.

Shifting life rhythms: Couples' stories about living together when one spouse has advanced chronic obstructive pulmonary disease.

AIM: This study examines couples' experiences of living together when one partner has advanced chronic obstructive pulmonary disease (COPD). METHOD: Repeated qualitative interviews with four couples over an eight-month period, where one spouse in each couple suffered from advanced COPD. The final dataset comprised 19 interviews. A phenomenological-hermeneutical method was used to interpret the interview text. FINDINGS: One main theme, "living with the disease and one's spouse in a new and changeable life rhythm", emerged from three subthemes: "living with uncertainty", "living in a changed intimate relationship", and "finding new ways of living together". A mutual sense of companionship between the spouses facilitated their chances of reshaping their relationship and adapting it to the new life rhythm required by everyday life with the disease. CONCLUSION: The healthy spouse had major responsibility for the health of their sick spouse. Awareness of the couple's own conceptions and knowledge of health and illness is central to person-focused care, as is awareness of what values are important to them when restructuring their everyday life.

The impact of community-based prevention on quality of life-The necessity to control for general health trends the Northern Sweden MONICA study in 2014.

BACKGROUND: The Västerbotten intervention program (VIP), is a public health promotion program in northern Sweden with the aim of preventing cardiovascular disease. Positive effects have been reported although the evidence is not unequivocal. Since only historical controls have been used, effects from other sources than the program have largely been uncontrolled for and health related quality of life (HRQoL) has not been evaluated. PURPOSE: By using the neighbouring county of Norrbotten (NB) as the reference population, we compare HRQoL in Västerbotten (VB) and in NB. METHODS: In 2014 the Northern Sweden survey, Monitoring of Trends and Determinants in Cardiovascular Disease (MONICA), examined a random sample from the two counties. HRQoL was measured with the EQ-5D-3L. In total, 1112 subjects aged 40-74 years participated, 516 in VB and 594 in NB. Differences in mean QoL between VB and NB were analysed via Student's t-test and the Pearson chi-square test. RESULTS: Average HRQoL measured by the EQ-5D-index was 0.798 in VB and 0.811 in NB, a difference of 0.013 (p = 0.2, CI -0.009 to 0.036). For subjects aged 45-54 years, the HRQoL was lower in VB than in NB, a difference of 0.048 (p = 0.041; CI 0.002 to 0.0094). Men had higher HRQoL than women, and university educated had higher HRQoL than those without university education. EQ-VAS showed similar results. Subjects from NB and from VB did not differ regarding age, gender and level of education. In NB, HRQoL decrease with age, a pattern not seen in VB. CONCLUSIONS: We found similar levels of HRQoL in VB and in NB.

Motives for walking and cycling when commuting - differences in local contexts and attitudes.

Background: The purpose of this study is to analyse what factors that explain individual differences in walking and cycling when commuting in different parts of Sweden. Walking and cycling is potentially accessible all over the country, while well developed public transport is mainly a viable option in densely populated areas. Methodology: The importance of differences in local characteristics for the choice of transport mode will be scrutinised, together with individual differences in attitudes andpreferences. Data is collected through a survey sent to people living in five Swedish municipalities with different demographic, socio-economic ,infrastructural and geographical characteristics. Results: The results for the pooled sample indicate that the choice to walk/cycle when commuting is related to health considerations and environmental concerns. Distance to work/school is also an important factor. Men tend to be more prone to choose active transport, and so do respondents with lower income. The results further reveal that availability of safe routes for walking and cycling are important for the choice to walk/cycle when commuting. As health considerations are important, we suggest policy makers to stress health motives when they promote walking and cycling in the future. Our results further suggest that it is important to consider availability and accessibility in community planning, and to prioritize safety and comfort of walking and cycling, not least in parts of the country where public transport is not an economically viable option.

To feel emotional concern: A qualitative interview study to explore telephone nurses' experiences of difficult calls.

AIM: To describe telenurses' experiences of difficult calls. DESIGN: A qualitative approach with a descriptive design was used to gain a deeper understanding of the telenurses' experiences. METHODS: The data were collected in spring 2017 through semi-structured interviews with 19 telenurses at call centres and primary healthcare centres and were analysed with qualitative content analysis. RESULTS: Becoming emotionally concerned is central to the telenurse's experiences of difficult calls. Difficult calls are accompanied by feelings such as inadequacy, uncertainty and anxiety, which can be described as emotional tension. Emotional tension refers to situations when the caller's expressed emotions were conveyed to the telenurses and altered their state of mind. The telenurses stated that difficult calls that cause them to become anxious remain in their thoughts and go through their minds repeatedly, making a deep impression.

Living with chronic obstructive pulmonary disease at the end of life: a phenomenological study.

AIM: This paper is a report of a study to describe the essential structure of the lived experience of living with severe chronic obstructive pulmonary disease (COPD) during the palliative phase of the disease. BACKGROUND: Chronic obstructive pulmonary disease is one of the most common diseases throughout the world. Shortness of breath, fatigue and cough are the most troublesome symptoms, and living with COPD often imposes limitations on daily living. The disease has a great impact on quality of life and affects the extent to which people can be active in daily life. METHODS: We conducted qualitative interviews of eight people with COPD and collected data over a 2-month period in 2003. Our patients were recruited from two pulmonary disease clinics in West Sweden. We used a phenomenological methodology to analyse the interviews. FINDINGS: Daily life for people with COPD is affected in several different ways. The patients described how their physical limitations forced them to refrain from meaningful activities in everyday life and led to social isolation. Everyday emotions vacillated between viewing life as meaningful and meaningless. A sense of involvement and the belief that life was meaningful gave the individual the energy and the desire to continue living and to envision a future. CONCLUSION: Nursing care should include support and facilitation, so that patients can live rather than exist to the end of their lives. It is important to learn from patients and tailor activities to their social, existential and physical priorities, where appropriate family-centred support may be most effective.

Healthcare providers' experiences of assessing and performing oral care in older adults.

AIMS AND OBJECTIVES: The purpose of this study was to describe healthcare providers' experiences, knowledge and attitudes in relation to the assessment of oral health in older adults. BACKGROUND: Oral health is an important element in the care of older adults. An increasing proportion of older people need the help and support of community-based healthcare services, which are responsible for providing oral health assessment for this group. Although oral care is an important part of nursing care, studies show that it is often an overlooked area in the care of older people. DESIGN: An inductive qualitative description design was used. METHODS: The participating healthcare providers were selected from a municipality in western Sweden. Purposeful sampling was employed and data were collected through focus-group interviews and were analysed with content analysis. RESULTS: The analysis resulted in four categories: healthcare providers' knowledge and attitudes to oral health; routines affect flexibility; challenges in assessing and performing oral care and ethical dilemmas. The results showed that oral health was neglected because of several factors. Lack of knowledge, inadequate procedures and time constraints were most prominent. The healthcare providers' own attitudes affected the performing of oral health assessments. Ethical dilemmas related to the attitudes of those people in receipt of care and their relatives, and their integrity and autonomy, could be seen as complicating factors. CONCLUSIONS: The healthcare providers expressed that they did not have the necessary knowledge of oral health that was required in their area of responsibility. In addition, they described their own attitudes as being important when attending to the patients' oral health. IMPLICATIONS FOR PRACTICE: The healthcare providers themselves identified lack of knowledge and their own attitudes as being especially important factors in the oral care of older adults, and further research in this area is needed.

Undergraduate nursing students' attitudes and preparedness toward caring for dying persons - A longitudinal study.

Nursing education needs to prepare students for care of dying patients. The aim of this study was to describe the development of nursing students' attitudes toward caring for dying patients and their perceived preparedness to perform end-of-life care. A longitudinal study was performed with 117 nursing students at six universities in Sweden. The students completed the Frommelt Attitude Toward Care of the Dying Scale (FATCOD) questionnaire at the beginning of first and second year, and at the end of third year of education. After education, the students completed questions about how prepared they felt by to perform end-of-life care. The total FATCOD increased from 126 to 132 during education. Five weeks' theoretical palliative care education significantly predicted positive changes in attitudes toward caring for dying patients. Students with five weeks' theoretical palliative care training felt more prepared and supported by the education to care for a dying patient than students with shorter education. A minority felt prepared to take care of a dead body or meet relatives.

Nursing students' perceptions of caring for dying people, after one year in nursing school.

AIM: To describe Swedish nursing students' perceptions of caring for dying people after the first year of a three year in a nursing programme at three university nursing schools in Sweden. METHODS: Interviews (n=17) were undertaken with nursing students at the end of their first year. A phenomenographic approach was used to design and structure the analysis of the nursing students' perceptions. RESULTS: The analysis resulted in five categories: 1) from abstract to reality, 2) from scary to natural, 3) increased knowledge can give bad conscience, 4) time limits versus fear of end-of-life conversations, and 5) meeting with relatives. CONCLUSION: Nursing students need to be prepared both theoretically and within practice to encounter death and dying and to care for dying persons. By combining their theoretical knowledge of dying and death with their own encounters of death and dying people in practice, the students can be supported to develop an understanding of dying and death as a natural part of life rather than something frightening.

Home healthcare teams' assessments of pain in care recipients living with dementia: a Swedish exploratory study.

BACKGROUND: Pain assessment in people living with dementia is a challenge due to the complexity of pain and dementia and the difficulties in self-reporting. In home healthcare, nurses are frequently involved in pain assessment situations and there is a need to explore how home healthcare teams' manage pain assessment in this setting. AIM: The study aimed to explore home healthcare teams' experiences of pain assessment among care recipients with dementia. DESIGN: An exploratory qualitative design was used. METHODS: Open-ended individual interviews were conducted with thirteen registered nurses and ten nursing assistants, working in three different home healthcare teams in one municipality in western Sweden. Philosophical hermeneutics was utilised to interpret the home healthcare teams' experiences. RESULTS: Four interpretations emerged: the need for trusting collaboration, the use of multiple assessment strategies, maintenance of staff continuity in care and assessment situations, and the need for extended time to assess pain. CONCLUSIONS: The home healthcare teams recognise pain assessment in people with dementia as involving a complex interaction of sensory, cognitive, emotional and behavioural components in which efforts to acquire understanding of behavioural changes mainly guides their assessments. The solid team coherence between registered nurses and nursing assistants aided the assessment procedure. To assess pain, the teams used multiple methods that complemented one another. However, no systematic routines or appropriate evidence-based pain tools were used. IMPLICATIONS FOR PRACTICE: The team members'concern for care recipients when assessing pain is evident and needs to be acknowledged by the organisation which is responsible for the quality of care. Future studies should focus on further exploration of nurses' experiences with pain and dementia in home healthcare settings and address what nurses identify and how they deal with their findings. It is imperative to investigate how organisations and nurses can ensure best practices and how the implementation of evidence-based routines for assessing pain may aid in pain assessment situations.

Midwifery students' conceptions of worst imaginable pain.

BACKGROUND: The Visual Analogue Scale (VAS) is one of the most widely used pain assessment scales in clinical practice and research. However, the VAS is used less frequently in midwifery than in other clinical contexts. The issue of how people interpret the meaning of the VAS endpoints (i.e. no pain and worst imaginable pain) has been discussed. The aim of this study was to explore midwifery students' conceptions of 'worst imaginable pain'. METHODS: A sample of 230 midwifery students at seven universities in Sweden responded to an open-ended question: 'What is the worst imaginable pain for you?' This open-ended question is a part of a larger study. Their responses underwent manifest content analysis. RESULTS: Analysis of the midwifery students' responses to the open-ended question revealed five categories with 24 sub-categories. The categories were Overwhelming pain, Condition-related pain, Accidents, Inflicted pain and Psychological suffering. CONCLUSIONS: The midwifery students' conceptions of 'worst imaginable pain' are complex, elusive and diverse.