The Swedish National Clinical Final Examination (NCFE) was established in 2007 in order to examine nursing students' clinical competence upon completing their Bachelor's degree in nursing. The NCFE constitutes an innovative method of examination, divided into two parts: a written and bedside test. The aim of this study was to evaluate nursing students' experiences of being assessed by means of the NCFE, in order to obtain information that could be used to improve the examination. A survey was conducted using a questionnaire with open-ended questions concerning the written and the bedside part of the NCFE. The answers from 577 third-year nursing students were analysed using content analysis. The nursing students regarded the NCFE as promoting further learning and as an important means of quality assurance. Its comprehensive nature was perceived to tie the education together and contributed to the students' awareness of their own clinical competence. The strengths of the NCFE especially highlighted were its high degree of objectivity and the fact that it took place in a natural setting. However, the students felt that the NCFE did not cover the entire nursing programme and that it caused stress. It thus appears to be important to reconsider the written theoretical part of the examination and to standardise the bedside part. (C) 2011 Elsevier Ltd. All rights reserved.

Family plays an important role in the care provided for patients in all areas of nursing. However, relatively few studies deal with the focus of the present study: the ways that nurses experience family participation in acute psychiatric inpatient settings. Data were collected by interviewing 18 nurses who had experience working in such settings. A phenomenographical approach was used to analyse the interviews. Three descriptive categories were found: family participation as a part of the caring process, barriers to family participation, and nurses' resources in family participation. The findings show that the nurses' conceptions of family participation varied, and that the family was not always a priority in this caring context. The implementation of family participation was often only based on the nurses' own interests and insights. This could mean that family participation differed substantially, depending on which nurse a family encountered, and which unit the patient was admitted at. Finally, nurses had little professional autonomy, and organizational support and education were also lacking.

BACKGROUND: Previous research has reported that women who are admitted to delivery wards in early labour process before an active stage of labour has started run an increased risk of instrumental deliveries. Therefore, it is essential to focus on factors such as self-efficacy that can enhance a woman's own ability to cope with the first stage of labour. However, there was no Swedish instrument measuring childbirth self-efficacy available. Thus, the aim of the study was to translate the Childbirth Self-efficacy Inventory and to psychometrically test the Swedish version on first- time mothers within the Swedish culture.

METHODS: The method included a forward-backward translation with face and content validity. The psychometric properties were evaluated using a Principal Component Analysis and by using Cronbach's alpha coefficient and inter-item correlations. Descriptive statistics and non-parametric tests were used to describe and compare the scales. All data were collected from January 2011 to June 2012, from 406 pregnant women during the gestational week 35-42.

RESULTS: The Swedish version of the Childbirth Self-Efficacy Inventory indicated good reliability and the Principal Component Analysis showed a three-component structure. The Wilcoxon Signed-Ranks Test indicated that the women could differentiate between the concepts outcome expectancy and self-efficacy expectatancy and between the two labour stages, active stage and the second stage of labour.

CONCLUSIONS: The Swedish version of Childbirth Self-efficacy Inventory is a reliable and valid instrument. The inventory can act as a tool to identify those women who need extra support and to evaluate the efforts of improving women's self-efficacy during pregnancy. © 2014 Carlsson et al.; licensee BioMed Central Ltd.

OBJECTIVE: this study aimed to examine how women׳s childbirth self-efficacy beliefs relate to aspects of well-being during the third trimester of pregnancy and whether there was any association between childbirth self-efficacy and obstetric factors.

DESIGN: a cross-sectional design was used. The data was obtained through the distribution of a composite questionnaire and antenatal and birth records.

SETTING: data were recruited from antenatal health-care clinics in Halland, Sweden.

PARTICIPANTS: a consecutive sample of 406 pregnant women was recruited at the end of pregnancy at gestational weeks of 35-42.

MEASUREMENTS: five different measures were used; the Swedish version of Childbirth Self-Efficacy Inventory, the Wijma Delivery Expectancy/Experience Questionnaire, the Sense of Coherence Questionnaire, the Maternity Social Support Scale and finally the Profile of Mood States.

FINDINGS: results showed that childbirth self-efficacy was correlated with positive dimensions as vigour, sense of coherence and maternal support and negatively correlated with previous mental illness, negative mood states and fear of childbirth. Women who reported high childbirth self-efficacy had less epidural analgesia during childbirth, compared to women with low self-efficacy.

KEY CONCLUSIONS: this study highlights that childbirth self-efficacy is a positive dimension that interplays with other aspects and contributes to well-being during pregnancy and thereby, acts as an asset in the context of childbirth. © 2015 Elsevier Ltd.

Background: in Sweden pregnant women are encouraged to remain at home until the active phase of labour. Recommendation is based on evidence, that women who seek care and are admitted in the latent phase of labour are subjected to more obstetric interventions and suffer more complications than women who remain at home until the active phase of labour. The aim of this study was to obtain a deeper understanding of how women, who remain at home until the active phase of labour, experience the period from labour onset until admission to labour ward. Method: interviews were conducted with 19 women after they had given birth to their first child. A Constructivist Grounded theory method was used. Findings: 'Maintaining power' was identified as the core category, explaining the women's experience of having enough power, when the labour started. Four related categories: to share the experience with another', to listen to the rhythm of the body', to distract oneself and to be encased in a glass vessel', explained how the women coped and thereby maintained power. Conclusions: the first time mothers in this study, who managed to stay at home during the latent phase of labour, had a sense of power that was expressed as a driving force towards the birth, a bodily and mental strength and the right to decide over their own bodies. This implies that women who maintain power have the ability to make choices during the birth process. The professionals need to be sensitive, supportive and respectful to women's own preferences in the health-care encounter, to promote the existing power throughout the birthing process. © 2010 Elsevier Ltd.

Web-SP is a system for virtual patient, developed at Karolin- ska Institutet (KI) in Sweden. In this study, we examine Web- SP cases for assessing paediatric nursing students.To investi- gate the possibility of using Web-SP for assessing clinical reasoning skills and to study students acceptance and to de- termine whether the skills required of experienced paediatric registered nurses could be adequately assessed by the system. The intervention included a two-part of exams. The results show high levels of acceptance of the Web-SP as an examin- ation method. Students also thought it was a good way to practice their clinical skills. Findings have relevance in the development of clinical information systems where clinical decision making is important.

In different nursing programmes, one important learning outcome is clinical reasoning (CR) skills. However, to date, there is limited number of methods available for assessment of CR skills; especially for distance-based courses. This study investigates students' opinions about the feasibility of using Virtual Patients (VPs) for assessing CR in nursing education. VPs were introduced as an assessment tool in three different nursing courses at two universities, comprising 77 students in total. Students' overall acceptance of this assessment tool, including its applicability to the practise of nursing and the potential of VP-based assessment as a learning experience, were investigated using questionnaires. Course directors used the Web-SP system to assess students' interactions with VPs and their answers regarding diagnoses, caring procedures and their justifications. Students' found the VP cases to be realistic and engaging, and indicate a high level of acceptance for this assessment method. In addition, the students' indicated that VPs were good for practising their clinical skills, although some would prefer that the VP system be less "medical" and asked for more focus on nursing. Although most students supplied correct diagnoses and made adequate clinical decisions, there was a wide range in their ability to explain their clinical reasoning processes. (C) 2010 Elsevier Ltd. All rights reserved.

Background

There have been discussions to use more formative assessments in health care education to contribute to students’ deep learning. Feedback is important, but a lot of student’s do not do anything with it. Thus, interventions which force students to reflect the new knowledge need to be introduced.

In order to explore if formative VP-based exams had an impact on development of clinical reasoning ability and achievement of clinical decision making, we let postgraduate pediatric nurse students complete self-evaluation forms in connection with three VP- based assessments to follow their progress.

Summary of Work

After performed assessment and before answering the self-evaluation form, the students’ were asked to take part of the feedback section of the VP-system and the recommended interactions in the VP system. Data was conducted using content analysis with a deductive approach. Kolb’s’ model of Learning Cycle guided the analysis.

Summary of Results

The result showed a perceived progression of clinical reasoning skills by the students. After the first assessment the students described uncertainty and that knowledge gaps were exposed, at the second exam the awareness of clinical reasoning was obvious and the students were more certain of knowing how. Finally, self-efficacy in patient solving was expressed.

Conclusions

VP-based assessments with self-evaluation early in the education resulted in a gain of students’ own identification of the concept of clinical reasoning, awareness of what to focus on, and pay attention to during clinical practice.

Take-home Messages

VP with reflective tools is excellent to use in formative assessments to identify progress and to visualize the expected clinical competence.

To avoid test-driven learning, there have been discussions regarding the use of more formative assessments in health care education to promote students' deep learning. Feedback is important in formative assessment, but many students ignore it; therefore, interventions should be introduced which stimulate them to reflect on the new knowledge.

The aim for this study was to explore if Virtual Patient (VP)-based formative assessments, in connection with self-evaluations, had an impact on postgraduate pediatric nursing students' development of clinical reasoning abilities. Students' self-evaluations served as the basis for measuring progress. Data was analysed using deductive content analysis.

The findings showed a clear progression of the clinical reasoning ability of the students. After the first assessment, the students described feelings of uncertainty and that their knowledge gaps were exposed. At the mid-course assessment the awareness of improved clinical reasoning was obvious and the students were more certain of knowing how to solve the VP cases. In the final assessment, self-efficacy was expressed.

VP-based assessments, in connection with self-evaluations, early in the education resulted in a gain of students' own identification of the concept of clinical reasoning, awareness of what to focus on during clinical practice and visualised expected clinical competence. © 2015 Elsevier Ltd. All rights reserved.

In health-care education, it is important to assess the competencies that are essential for the professional role. To develop clinical reasoning skills is crucial fornursing practice and therefore an important learning outcome in nursing education programmes. Virtual patients (VPs) are interactive computer simulations of real-life clinical scenarios and have been suggested for use not only for learning, but also for assessment of clinical reasoning. The aim of this study was to investigate how experienced paediatric nurses reason regarding complex VP cases and how they make clinical decisions. The study was also aimed to give information about possible issues that should be assessed in clinical reasoning exams for post-graduate students in diploma specialist paediatric nursing education. The information from this study is believed to be of high value when developing scoring and grading models for a VP-based examination for the specialist diploma in paediatricnursing education. Using the think-aloud method, data were collected from 30 RNs working in Swedish paediatric departments, and child or school health-care centres. Content analysis was used to analyse the data. The results indicate that experienced nurses try to consolidate their hypotheses by seeing a pattern and judging the value of signs, symptoms, physical examinations, laboratory tests and radiology. They show high specific competence but earlier experience of similar cases was also of importance for the decision making. The nurses thought it was an innovative assessment focusing on clinical reasoning and clinical decision making. They thought it was an enjoyable way to be assessed and that all three main issues could be assessed using VPs. In conclusion, VPs seem to be a possible model for assessing the clinical reasoning process and clinical decision making, but how to score and grade such exams needs further research. © 2013 Elsevier Ltd. All rights reserved.

For Virtual Patient-based exams, several scoring and grading methods have been proposed, but none have yet been validated. The aim of this study was to evaluate a new scoring and grading model for VP-based exams in postgraduate paediatric nurse education.The same student group of 19 students performed a VP-based exam in three consecutive courses. When using the scoring and grading assessment model, which contains a deduction system for unnecessary or unwanted actions, a progression was found in the three courses: 53% of the students passed the first exam, 63% the second and 84% passed the final exam. The most common reason for deduction of points was due to students asking too many interview questions or ordering too many laboratory tests.The results showed that the new scoring model made it possible to judge the students' clinical reasoning process as well as their progress. © 2015 Elsevier Ltd.

Aims and objectives: To explore the experiences of using an app among older people with home-based health care and their nurses. Background: Few information and communication technology innovations have been developed and tested for older people with chronic conditions living at home with home-based health care support. Innovative ways to support older people's health and self-care are needed. Design: Explorative qualitative design. Methods: For 3 months to report health concerns, older people receiving home-based health care used an interactive app, which included direct access to self-care advice, graphs and a risk assessment model that sends alerts to nurses for rapid management. Interviews with older people (n = 17) and focus group discussions with home care nurses (n = 12) were conducted and analysed using thematic analysis. Results: The findings reveal that a process occurs. Using the app, the older people participated in their care, and the app enabled learning and a new way of communication. The interaction gave a sense of security and increased self-confidence among older people. The home care nurses viewed the alerts as appropriate for the management of health concerns. However, all participants experienced challenges in using new technology and had suggestions for improvement. Conclusions: The use of an app appears to increase the older people's participation in their health care and offers them an opportunity to be an active partner in their care. The app as a new way to interact with home care nurses increased the feeling of security. The older people were motivated to learn to use the app and described potential use for it in the future. Implications for practice: The use of an app should be considered as a useful information and communication technology innovation that can improve communication and accessibility for older people with home-based health care. © 2017 John Wiley & Sons Ltd

Background: During the last decade, there has been an increase in studies describing use of mHealth, usingsmartphones with apps, in the healthcare system by a variety of populations. Despite this, few interventions including apps are targeting older people receiving home care. Developing mobile technology to its full potential of being interactive in real time remains a challenge. The current study is part of a larger project for identifying and managing health concerns via an app by using real-time data. The aim of the study was to describe older people’s usage of an app and to evaluate the impact of usage on aspects of health and health literacy over time.Methods: A quasi-experimental design was employed. Seventeen older people self-reported health concerns via Interaktor twice a week for 3-months and answered questionnaires at baseline, the end of the intervention and at a 6–month follow-up. Logged data on app usage and data on Sense of Coherence, Health Index, Nutrition Form for the Elderly, Geriatric Depression Scale-20, Swedish Communicative and Critical Health Literacy and Swedish Functional Health Literacy were collected and analysed using descriptive and non-parametric inferential statistics.Results: The median usage of the app as intended was 96%. Pain was one of the most reported health concerns and was also the health concern that triggered an alert (n = 33). The older people’s communicative and critical health literacy improved significantly over time. Regarding the scores of Sense of Coherence, Health Index, Nutritional Form for the Elderly, Geriatric Depression Scale-20 and Swedish Functional Health Literacy scale, there were no significant differences over time.Conclusions: The high app usage showed that an app may be a suitable tool for some older people living alone and receiving home care. The results indicate that the usage of Interaktor can support older people by significantly improving their communicative and critical health literacy. Aspects of health were not shown to be affected by the usage of the app. Further research with larger sample is needed for evaluation the effect on health literacy, andwhich aspects of health of importance to support by an app. © 2020 The Author(s).

Background

More and more elderly persons are living in their own home and with support from home care due to health deterioration. This puts demands on society and especially health care to support health and self-care for the elderly persons. Therefore its essential to develop new innovative solutions which both enhance communication between the elderly person and the nurse and also increase the elderly persons´ involvement in their everyday care. An information- and communication technology (ICT)-platform was developed with content from the perspective from elderly persons, health care professionals and the literature. The platform is developed in collaboration with a Swedish company specialized in health care management consulting and new innovative care (Health Navigator). The aim with the project is to describe experiences an ICT-platform with focus on user friendly and acceptability by elderly persons living in own homes with assistance of home care nurses.

Method

The study has a mixed methods approach advocated for the evaluation of new technologies within health care. The design is underpinned by the Medical Research Council´s complex intervention framework.

Elderly persons > 65 years, living in own homes, with assistance from home care nurses have regularly reported health status for three months. They have also access to evidence-based self-care advice with links to web-based pages and graph on reported health status. The home care nurse receive an alarm according to a risk assessment model and can instant  contact the elderly persons for discussion the health concerns.

Individual interviews with the elderly persons are conducted after the intervention on the experience of using the ICT-platform, with focus on user friendly and acceptability .

Results

Preliminary results will be presented of the elderly persons experiences with focus on user friendly and acceptability of using an ICT-platform from reporting health status, using self-care advice and graph of reported health status.

The study's rationale: The need for home care among older persons is increasing, and mHealth is evolving to help meet the challenge. When developing an app to help maintain their health, it is essential to incorporate older persons' preferences.

Aims and objectives: To describe and evaluate the experiences of self-care support and sense of security among older persons using an interactive app to report health concerns.

Methodological design and justification: The study had a descriptive and evaluative design. Qualitative and quantitative methods were applied to achieve a broader understanding.

Ethical issues and approval: Ethical approval was obtained from the Regional Ethical Review Board. The older persons received verbal and oral information about the study and gave written informed consent.

Research methods: Questionnaires (n = 17 older persons) answered at baseline, end of the intervention and at a 6-month follow-up were analysed with statistical analysis. Interviews (n = 17 older persons) conducted at the end of the intervention were analysed using a qualitative directed approach.

Measurements and intervention: The questionnaire included the Appraisal of Self-care Agency Scale and a question concerning sense of security. For 3 months, the older persons used an app for regular reporting of health concerns. The app included self-care advice, graphs and a risk assessment model that generated alerts directly to the nurses.

Results: The older persons described how self-care and sense of security increased at the end of intervention, but statistically, it was shown to decrease afterwards.

Study limitations: The small sample size for statistical analysis.

Conclusions: This study shows that an app can be a complementary tool to conventional home care that can increase older persons' sense of security and self-care ability. The results mirror the older persons' awareness that the support they received with the app was only temporary. Larger studies are needed for generalisation. 

© 2019 Nordic College of Caring Science.

Aim and objectives: To acquire knowledge regarding the contents to be implemented in an interactive information and communication technology-platform perceived to be relevant to health and self-care among older persons based on the literature, healthcare professionals and the older persons themselves. Background: The growing ageing population places demands on the healthcare system to promote healthy ageing and to strengthen the older person's self-care ability. This requires innovative approaches to facilitate communication between the older person and healthcare professionals, and to increase the older person's participation in their care. An information and communication technology-platform could be used for this purpose, but the content needs to be relevant to both the older persons and the healthcare professionals. Design: Descriptive qualitative design. Methods: This study was based on three samplings: a scoping review of the literature (n = 20 articles), interviews with healthcare professionals (n = 5) and a secondary analysis of interviews with older persons (n = 8) and nursing assistants (n = 7). The data were analysed using qualitative content analysis. Results: Four areas were identified to be of relevance to older persons' perceived health: frame of mind, having relationships and social activities, physical ability and concerns, and maintaining self-care. Self-care was described in the literature and by the healthcare professionals more than by the older persons. Conclusions: The results show a concordance in the data samplings that give a clear indication of the areas relevant to older persons' health and self-care that can be integrated in an interactive information and communication technology-platform for use in regular daily care assessments. Descriptions of self-care were limited indicating a possible gap in knowledge that requires further research. Relevance to clinical practice: Areas relevant to older persons' health and self-care could be used for regular assessment to support and promote healthy ageing. © 2017 John Wiley & Sons Ltd

Background

The increasing ageing population puts demands on society and particularly on health care system to promote a health related qualityof life. Thus, it is necessary to develop strategies that promote self-care among older adults that enable them to live in their own homes as long as possible and to make them feel safe and involved in their care. In order to encourage their participationin their care, new innovative solutions are needed. The market of information-and communication technology (ICT)-based platforms directed to the health care arena has exploded during recent years. Despite the large range of products few are developed withinteractive components. In collaboration within a multicenter research group and a Swedish health care company (Health Navigator) an ICT-platform is developed for use in a mobile phone or tablet that includes an interactive mobile application for reporting problems and concerns. This platform is unique through the real-time communication enabling rapid management of early-detected problems.

Aim

The aim with the project is to evaluate an ICT-platform by older adults living in own homes with assistance from home care nurses in a community in Sweden.

Method

The study is prospective and has a mixed methods approach advocated for the evaluation of new technologies within healthcare. This includes a quantitative approach to evaluate effects, qualitative methods such as interviews and focus group discussions to evaluate how patients and health care professionals perceive the intervention. The design is underpinned by the Medical Research Council’s complex intervention evaluation framework. Thirty older adults >65 years or above, living in their own homes, with assistance from home care nurses have through an application in a tablet reported health status twice a week and when needed during three months. They have continuous access to evidence based self-care advice directly related to their reported problems and concerns. The risk assessment model sends alarms to involved nurses via text messaging (SMS). This initiates an interaction between the nurse and the older adult who is contacted by telephone to discuss the reported problems. Furthermore, the nurses in charge can also log into a web-interface and view the reports of the participants. Individually interviews with the older adults and focus groups interviews with nurses are conducted after the study period. Questionnaires are given to the older adults before intervention, after the study ́s completed and after six months with primarily main outcomes as self-care, health literacy and well-being. A control group with older adults 65 years and above is used as a comparison.

Results

Preliminary results will be presented with focus on feasibility, acceptability and benefit of the ICT-platform from the perspective of older adults and home care nurses. Additional logged data on the frequency of symptom reports, alerts, and page views will also be presented.

Summary

An interactive ICT-platform is developed and used by older adults to report problems and concerns which enabling rapid management of early-detected problems. This study aims to evaluate the ICT-platform by thirty older adults living in own home with assistance from home care nurses.

Chronic obstructive pulmonary disease (COPD) is expected to be the third common disease worldvide and third common cause of death in Sweden 2020.The main cuase is smoking and build up an irreversible respiratory obstruction of the small bronchioles. With time some patiens have frequent acute exacerbations wich demand repeatedly need of treatment. Studies have shown different factors of individual-and organization which influence on patients needs of care due to acute exacerbation.The aim of this study was to investigate connection for patients with COPD when they seek emergency ward due to acute exacerbation and their early need for care. Data was collected between january-may 2009. All consecutive patients who seek acute to emergency ward due to acute exacerbation was included. Patient´s medical records was examined for socio-demographic and clinical characteristics, which time they seek and early care. A questionnaire was constructed based on literature and own empirical experience.Only in-patiens have sureyed regard to lack of registratin routine for patients who was directly discharged. 160 patients seek of current diagnosis related groups of whom 98 had COPD and 30 meet inclusionscriteria. Distributed on 17 women and 13 men. Most patients seek daytimes and nearly as often weekdays as weekends. Patients with shorter duration of disease seek day and night while patiens with longer duration seek daytime. This studie is based on a small sample and only discern some trends. However,it show new aspect regarding timeaspect when patients with COPD seek due to acute exacerbation. Further research is required for improve patients coping and optimize organization

Nationell klinisk slutexamination för sjuksköterskeexamen startade hösten 2003 som ett projekt i samarbete mellan fyra lärosäten och Svensk sjuksköterskeförening. Läkarnas s.k. AT-prov har delvis utgjort modell för examinationen. En styrelse är bildad med ansvar för samordning, kvalitetssäkring och vidareutveckling. Idag är mer än hälften (n=13) av de lärosäten som bedriver sjuksköterskeprogram (n=25) involverade i examinationen. Deltagandet sker enligt avtal för att åstadkomma en nationell kvalitetskontroll med tydlig verksamhetsförankring av sjuksköterskans kliniska kompetens. Examinationen som genomförs i slutet av sista terminen avser att möta Socialstyrelsens och verksamhetens krav på nyexaminerad sjuksköterska. Examinationen består av en skriftlig och en praktisk del, och skall kunna genomföras oavsett i vilken klinisk verksamhet studenten fullgör sin sista termin, under förutsättning att den kliniska verksamheten motsvarar den grundutbildade sjuksköterskans kompetensområde. Den skriftliga delen består av två patientfall som studenten analyserar.  I den praktiska delen bedöms studenten enligt särskild instruktion av en ”bedömningsansvarig sjuksköterska” i samband med vård av en utvald patient. Bedömningen avslutas med en dialog mellan student, bedömningsansvarig sjuksköterska och examinator. Examinationen följer intentionerna i Bolognaprocessen d.v.s. utbildningarna och utbildningsnivåer ska vara jämförbara med varandra oavsett var utbildningen genomförs. Högskoleverkets utvärdering av sjuksköterskeutbildningarna visar också på behov av att utveckla framförallt kliniska examinationer.  

Styrelsen har under vårterminen 2010 genomfört en enkätutvärdering. Syftet var att utvärdera om Nationell klinisk slutexamination mäter den kliniska kompetens som krävs för en nyexaminerad sjuksköterska på grundnivå utifrån förväntade krav på yrkeskompetens enligt Kompetensbeskrivning för legitimerad sjuksköterska (Socialstyrelsen, 2005) och Högskoleförordningens examensordning (SFS 2006:1053). Enkäten riktades till fyra grupper; rättande lärare av skriftlig del, bedömningsansvarig sjuksköterska vid praktiskt prov, klinisk lärare/examinator praktiskt prov och sjuksköterskestudent. Under symposiet kommer enkätutvärderingen att presenteras och diskuteras. Nationell klinisk slutexamination för sjuksköterskeexamen tillhör en av de mest välutvecklade, standardiserade, systematiskt prövade examinationer som sjuksköterskestudenter genomgår. 

Objective: The objective of this study was to evaluate the perceptions of students, lecturers, nurses and clinical lecturers regarding the ability of the National Clinical Final Examination (NCFE) to assess clinical competence, and whether the assessment was consistent with the qualifications for a Bachelor of Science in Nursing as outlined by the Swedish Higher Education Authority. The NCFE is divided into two parts (written and bedside) and aims to evaluate third-year nursing students’ clinical competence. Methods: Data were collected at 10 universities using study-specific questionnaires. The total response rate was 84% (n = 1652). Results: The clinical lecturers indicated that there was a need for improvement in the written part of the examination in order to adequately assess clinical competence. Regarding the bedside part the clinical lecturers, nurses and students perceived that the bedside part of the examination assessed whether the student had the clinical competence required by a newly registered nurse. Conclusion: The two-part examination described in this study was perceived as useful for assessing clinical competence and for the qualification requirements for a Bachelor of Science in Nursing as outlined by the Swedish Higher Education Authority. However, especially the written part requires further development. The model and form of assessment ought to be applicable to graduate nursing programme internationally.

The aim of the study was to describe the basis on which municipal care registered nurses (RN) make decisions and their experiences when referring older persons from nursing homes to emergency departments (EDs). RNs in the community are to ensure that older adults receive good care quality in nursing home. This study used a descriptive design with a qualitative content analysis. The analysis of the data from the 13 interviews revealed one theme “Shared responsibilities in the best interests of the older person reduce feelings of insufficiency”. The content was formulated, which revealed the RNs’ feelings, reasoning and factors influencing them and their actions in the decision-making situation, before the patients were referred to an emergency department. Complex illnesses, non-adapted organizations, considerations about what was good and right in order to meet the older person’s needs, taking account of her/his life-world, health, well-being and best interests were reported. Co-worker competencies and open dialogues in the “inner circle” were crucial for the nurses’ confidence in the decision. Hesitation to refer was associated with previous negative reactions from ED professionals. The RN sometimes express that they lacked medical knowledge and were uncertain how to judge the acute illness or changes. Access to the “outer circle”, i.e. physicians and hospital colleagues, was necessary to counteract feelings of insecurity about referrals. When difficult decisions have to be made, not only medical facts but also relationships are of importance. To strengthen the RNs’ and staff members’ competence by means of education seems to be important for avoiding unnecessary referrals. Guidelines and work routine need to be more transparent and referrals due to the lack of resources are not only wasteful but can worsen the older persons’ health.

Introduction

Health and well-being are two concepts that are widely discussed within today’s society. A major perspective in health and lifestyle research is to investigate what determinants are associated with health. When it comes to the delivery of health interventions several different approaches have been suggested.

Methods

The meta-synthesis was chosen for synthesis of research studies using a health and lifestyle the review format and analyse meta-questions. The process included the following five phases:

1. Literature search for articles.

2. Selection of relevant articles after repeated reading and appraisal of the articles.

3. Extraction of data from each article and creating a list of findings as key phrases, ideas and concepts for each individual study.

4. Determining how the findings of the selected studies are related and translating findings into one another.

5. Synthesizing the translations to produce a new theoretical interpretation.

Results

The search yielded a total of 561 unique citations and finally 24 citations remained. Of those 11 studies focused on health determinants, while 13 focused on interventions for health promotion. The meta-synthesis led to four recommendations for the design of future intervention studies. (1) scientific disciplines should collaborate in the design, implementation and evaluation of the study. (2) to use theoretical frameworks that focus on health determinants and to apply longitudinal studies with a repeated measures design.(3) involve behavioral interventions. (4) to design face-to-face intervention studies.

Discussion

Determinants was related to a physical active lifestyle, more specifically high quality school programs for physical education. It could be a starting point for a nationwide approach of daily physical activity in whole society. In all intervention studies physical activity behaviors were included as outcome or intervention program. It is therefore speculated that physical activity behavior could be discussed as one mediator between health determinants and health outcomes.

References

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Kahn, E. B., Ramsey, L. T., Brownson, R. C., Heath, G. W., Howze, E. H., Powell, K. E., & Corso, P. (2002). The effectiveness of interventions to increase physical activity: A systematic review. American journal of preventive medicine, 22, (4), 73-107.

Paterson, B.L., Thorne, S., Canam, C., Jilings, C., (2001). Meta-Study of Qualitative Health Research: A Practical Guide to Meta-Analysis and Meta-Synthesis. Sage, Thousand Oaks,CA.

Södergren, M. (2013). Lifestyle predictors of healthy ageing in men. Maturitas, 75, 113-117.

Corresponding author email: Lars.Kristen@hh.se

The overall aim of this systematic meta-literature review was to (1) summarize the findings of review studies focusing on health determinants, (2) give an overview of intervention studies that have been used to facilitate health and lifestyle, and (3) provide recommendations for future studies in health promotion. A literature review, using a meta-method, was conducted to identify health and lifestyle research based on research articles related to health changes. The search yielded a total of 561 unique citations and finally 24 citations remained. Of those, 11 studies focused on health determinants, whereas 13 focused on interventions for health promotion. Results from this meta-synthesis led to four recommendations for the design of future intervention studies. (1) To increase the likelihood of capturing different biopsychosocial aspects of health, researchers from different scientific disciplines should collaborate in the design, implementation, and evaluation of the study. (2) It is recommended to use theoretical frameworks that focus on health determinants in longitudinal studies with a repeated measures design. (3) Studies should involve behavioral interventions. (4) Design face-to-face intervention studies where the participant can interact with other persons.

Introduction: Research has described improved health for persons with Parkinson's Disease (PD) who participate in dance classes. However, few studies focus on how relatives experience their life together with a partner who has PD and how the impact of Dance for Parkinson's Disease (DfPD) influences everyday life.

Objective: The aim of the study was to identify and describe the impact of DfPD on subjective experiences of well-being and functioning in daily living as experienced by dancers and their relatives.

Methods: The study used a descriptive method design combining a questionnaire for the dancers at the end of the dance semester and focus group interviews with relatives during a national dance camp.

Results: Most of the dancers experienced DfPD as improving their balance, and both the dancers and relatives experienced increased joy and happiness in life. The results highlight health factors such as improved body movements and social interactions, which makes life easier and raises awareness of the importance of DfPD.

Conclusion: Dancers and relatives consistently experienced being part of a joyful and healthy exercise, testifying to the positive effects that DfPD has on subjective well-being and body functioning for persons with PD and their relatives. © 2024 The Authors

The Rapid Emergency Triage and Treatment System (RETTS) is used by the Swedish ambulance care organization for assessment of patients medicalcondition. The aim of the present study was to evaluate prehospital assessment in collaboration with the ambulance nurse and primary health care physicians. If the patient's condition was priority GREEN by RETTS then the ambulance nurse decided to contact the primary care physicians for a dialogue and together they decided which level of care was the most appropriate for the patient's condition. 

© 2016 IMIA and IOS Press

Introduction: The Ambulance Organization of Sweden provides qualified medical assessment and treatment by ambulance nurses based on patient needs regarding appropriate levels of care. A new model for patients with non-urgent medical conditions has been introduced. The main objective of this study was to examine early prehospital assessment of non-urgent patients, and its impact on the choice of the appropriate level of care.

Methods: The study design was a 1-year, prospective study, involving an ambulance district in southwestern Sweden with a population of 78,000. Eligible patients were from18 years of age, assessed as priority GREEN by Rapid Emergency Triage and Treatment System (RETTS). Ambulance nurses contacted primary care physicians on decisions on whether a patient should be transported to a primary healthcare unit or an A&E. Data was collected from electronic health records from April 2014 to July 2015. A comparison was made with a retrospective control group without consulting a physician concerning the appropriate level of care.

Results: 394 patients were included, 184 in the intervention group, and 210 in the control group. There were statistically significant differences in favor of the study group (p < 0.001) regarding no transport, or transport and admission to an A&E. The groups did not differ significantly regarding transport to a primary care unit.

Conclusion: This prehospital assessment model indicates a decrease in ambulance transports to an A&E and admissions to a hospital ward. Collaboration between ambulance nurses and primary physicians affects the decision for the appropriate level of care for patients with a non-urgent condition. © 2017 Elsevier Ltd

A Dual Career (DC) scenario perspective was introduced in the European project “Gold in Education and Elite Sport” (GEES) and is characterized by integration of student-athletes’ athletic and non-athletic demands into difficult situations or periods (i.e., scenarios) requiring coping efforts. In this study we consider balance as the primary challenge for student-athletes and set out to identify DC scenarios that influenced university student-athletes’ optimal DC balance, and the factors involved in coping with such scenarios. We implemented a post-positivist qualitative design through semi-structured interviews with six university student-athletes. Our thematic analysis generated seven DC scenarios, for example, A sport event coincides with exams, and Finalize degree project and continue to train and compete. The scenarios, their characteristics and student-athletes’ corresponding coping are described. Based on the findings, we suggest an updated definition of DC scenarios and present their taxonomy, with four types of DC scenarios in which student-athletes’ circumstances challenge them to (a) maintain sport and study, (b) maintain study, (c) maintain sport, and (d) maintain personal life. We discuss how these developments can be useful for DC research and practice.

Background: There is clearly a need for research in the field of occupational health service (OHS) for applying new perspectives. Proactive collaboration is needed between the OHSs and the companies. The customers of the companies using the services should be able to safeguard themselves from the health problems caused by the work environment through proactive collaboration with the OHSs.

Objective: The main purpose of this interdisciplinary study was to explore how the stakeholders reflected to create and agree on core values for future challenges in OHS, as seen from the perspectives of OHS professionals and customer companies.

Methodology: An action research process was conducted. This study was divided into three phases. In phase I, the data were collected from interviews and diaries of interdisciplinary occupational health professionals (n=12). A focus group that sampled the eight managers of the customer companies was also included. In phase II, a questionnaire was developed with 24 questions focusing on examining the future challenges for OHS. The questionnaire was sent to customer companies (n=116). In phase III, a scoping review was undertaken.

Results: Three categories emerged from the analysis: “Balancing complex situations” clarified the complexity regarding senior employees; “Working with a proactive approach” indicated the need for working with a new proactive approach supporting sustainable health; and “Collaborate internally and externally” showed good relationships between the customer and the OHS, which is a mutual responsibility to both the partners.

Conclusion: The results outlined that it is necessary to take action to apply new proactive health promotions, with a focus on workplace health promotion. The results also indicated that interventions for senior employees are of importance. This study was done in collaboration with the stakeholders from the occupational health care service center and the managers from the customer companies. The use of a participatory research design, including close collaboration with the participants, allows the researchers to see the challenges.

Background

Occupational health services (OHS) are often working from a pathogenic perspective, seeing the customer as a patient. To meet the future challenges in a more holistic way there is a need of changing perspective. The occupational health services must promote health and prevent the problems before they appear.

The study will answer the following questions: What experiences do the employees at an OHS have regarding their daily work? What experiences do the employers have regarding the OHS? What challenges do the employers see for the future and how can OHS be supportive?

Methods

This study included a three-stage process; the first stage included qualitative data from diaries, collected during one and a half year, interviews with occupational health professionals (n = 12) in an occupational health service center as well as focus groups interviews with managers of the customer companies affiliated to the occupational health service center. The second stage was a quantitative part with a questionnaire to managers of the customer companies (n = 116) and the third stage will be a review of existing literature in occupational health.

Results

Findings from stage 1, 2 and 3 are presented in three categories:

Balancing complex situations was e.g. about the difficulty between loyalty to the client and the company's profits and also that major changes in the workplace are leading to difficulties for many employees. Working with a proactive approach was e.g. about new approaches that are needed in the OHS. Collaborate internal and external showed e.g that more collaboration between companies, OHS and external actors was of importance.

Conclusions

• a. Change and apply new perspectives in occupational health services.

• b. There is clearly a need for research in OHS using a comprehensive approach to health promotion.

• c. There must be interactions between the occupational health services and the management of the customer companies for designing new proactive health promotion interventions.

Key messages

• It is significant for occupational health centers taking into account the importance of balancing complex situations, having a proactive approach and collaborating in working life

• To change perspective and approaches in occupational health centers are of importance in order to meet future challenges in working life

© The Author 2015. Published by Oxford University Press on behalf of the European Public Health Association. All rights reserved.

Background. Health is important in workplaces. A good organisational climate in a workplace plays a major role in the employees’ well-being at work and is also associated with increased productivity. Today, employees are expected to work into older age and it is a challenge for companies to promote health and well-being for this growing group. Purpose. The purpose of this study was to explore how to promote workplace health at present time and for the end of working life in the perspective of employees. Design/Methodology/Approach. The study had an explorative design, and a thematic analysis was chosen. The inclusion criteria were persons 50 years and older, working in the company and planning to continue working into old age. A total of 21 coworkers (14 men) participated in the study. Three focus group interviews were conducted. Findings. The results from the focus group interviews are presented in four themes: handle change in a changeable workplace, take responsibility for health concerns, get confirmation for feeling needed, and support and tolerance adapted for each employee. Practical Implications. Promoting health should be an urgent mission for employees themselves as well as for managers in order to support employees in working into old age. The health promotion must be suitable for each employee and should be designed in such a way as to avoid inequality in workplace health. Originality/Value. There is a need for more health-promoting behaviours, support, and activities for employees in order to work into old age.

Common in Swedish elderly home care is that Registered Nurses work independently, and lead the care team without being a part of it. People involved in the care of the patient can be social services, physician, Registered Nurse (RN), nurses in inpatient care and family. Inaccording to current model for nursing documentation RNs interventions is described as participation, information/education, support, environment, general care, training, observation/surveillance, special care drug administration and coordination. Time pressure isperceived as high, but the nurses have the opportunity to influence their daily work situation and make priorities. The purpose of this study was to investigate how RNs prioritise interventions in municipal elderly care settings. A quantitative descriptive method was used for the study. Data were collected during the months of April and October 2004 – 2008, using a web-based form. The nurses filled in patient’s type of housing, performed interventions, and if the interventions were delegated. Interventions were described as keywords and wereattributed a certain amount of time, calculated in previous time studies. The inclusion criteria were: all patients 80 years of age and older, in a municipality in southwestern Sweden, who received some form of health care from a RN, or performed by non-certified staff by delegation. Results indicate that differences in priority could be observed, depending on the patient’s gender, or whether the patient was living in independent or sheltered housing. Drug administration was prioritised for female patients, while coordination became a priority for patients living in ordinary housing. Support received the highest priority, regardless if the patient lived in ordinary or sheltered housing. However, it is not entirely clear what support signifies in municipal health care settings, and this issue would therefore require further investigation. © 2012 Nordic College of Caring Science.

There are diverse descriptions of supportive activities in nursing to be found in the literature. That which they have in common is their association with good care outcomes, but they may differ depending on the context in which the care is given. In a Swedish municipal elderly care setting registered nurses work in a consultative way and they describe a part of their tasks as being comprised of supportive activities without specifying what kind supportive activities they mean. The aim of the study was to explore the main concern of the support given by registered nurses to a group of patients in an elderly home care setting. The study was conducted using Grounded Theory (GT). Data was collected using non participant observations regarding the supportive activities of 12 registered nurses at the home of 36 patients between 80 and 102 years. The core category was about dealing with today's emotions. This was done by encouraging the situation and reducing patient's limitations, but situations also occurred in which there was a gap of support. Support was about capture the emotions that the patient expressed for the moment, but there were also situations in which registered nurses chose not to give support. In order to develop a holistic eldercare more knowledge is needed about the factors causing the registered nurses to choose not to provide support on some occasions. Copyright © 2012 N. Dauman & S. I. Erlandsson.

Background; There are diverse descriptions of supportive activities in nursing to be found in the literature. That which they have in common is their association with good care outcomes, but they may differ depending on the context in which the care is given. In a Swedish municipal elderly care setting registered nurses work in a consultative way and they describe a part of their tasks as being comprised of supportive activities without specifying what kind supportive activities they mean. Aim; The aim of the study was to explore the main concern of the support given by registered nurses to a group of patients in an elderly home care setting. Method; The study was conducted using Grounded Theory (GT). Data was collected using non participant observations regarding the supportive activities of 12 registered nurses at the home of 36 patients between 80 and 102 years. Result; The core category was about dealing with today's emotions. This was done by encouraging the situation and reducing patient's limitations, but situations also occurred in which there was a gap of support. Support was about capture the emotions that the patient expressed for the moment, but there were also situations in which registered nurses chose not to give support. Conclution; The main purpose of supportive activities to a group of elderly persons in a municipal care setting is about dealing with today's emotions. The core category reflects the moment and emotions significance in the care of elderly. In some occasions it occurred a gap of support and this coincided with the inability of the RN to identify the patient’s inner needs. In order to develop a holistic elderly care more knowledge about psychological and spiritual needs is needed.

Literature describes supportive activities in nursing in many different ways. In common they have that they are associated with good care outcomes, but may differ depending on the context in which it is given. In Swedish municipal elderly care setting registered nurses works consultative. They describes part of their tasks as supportive activities without specifying what or what kind of support that is meant and it looks as in this form of organization supportive activities expanded to not only include patients. The aim of the study was to obtain a deeper understanding of which support RN express to elderly and explore the main concern of support in municipal care setting. The study was conducted using Grounded Theory. Data was collected using non participant observations. The observations were concerning registered nurses supportive activities interacting with the patient. A total of 12 registered nurses participated in the study which was performed at the home of 36 patients between 80- 102 years. The main concern of registered nurses supportive activities was maintaining wellness in everyday life. This was made by support patient’s internal and external resources, but it also turned out to be situations where it was lack of support.

Aim: The purpose of the study was to investigate how RN prioritizes their activities in their clinical daily work in municipal elderly care setting. Study questions was: Where are the activities performed? How much nursing are performed of non certified personal? What activities are prioritized in time? Methods: The study used a quantitative descriptive method. Data collection took place during the months of April and October during 2004 –2008. For each patient the RN had a responsibility for during the corresponding measurement month, she/ he would fill in a web-based form with data on patient's gender, age, type of housing, performed actions, and if the actions were delegated. Actions were described as keywords in the web-based form and have been assigned a certain amount of time in minutes. The specified time for each keyword were calculated on the basis of data from previously conducted time studies in the municipality. A total of 4,000 different actions were clocked by RNs working in the same area and same organization. Each action was labeled with the related keyword and a mean time for each keyword was calculated. The web-based form summarizes delegated care time and the RN’s time separately. The web-based form also documented the action RN devoted most time to. All information was stored in a database. Result: Support was the activity RN prioritized in time in clinical daily work, but there was even difference in activities depending on patient’s gender or if the patient was living in sheltered or ordinary housing. Drug administration was prioritized for female patients, coordination for patients living in ordinary housing and monitoring for patients living in sheltered housing. RN spent more time to patients in sheltered than in ordinary housing, but the biggest difference was in the delegated time. Patient in sheltered housing received almost double position so much delegated health and care time than patients living in ordinary housing. Conclusion: The study shows that RN prioritized activities to patients 80 years and elderly depending of housing and gender. The activity that was most prioritized regardless housing or gender was support, but what support means in municipal health care setting is not clear and requires more knowledge.

Objectives: This study intends to explore older patients’ experiences of the emotional support received from registered nurses (RNs). We also aimed to gain deeper knowledge about the process of how getting the support they need is managed by the patient.

Methods: The study was conducted using the grounded theory method. Data were collected by interviewing 18 patients between 80 and 96 years old.

Results: Reasons why older patients experienced the emotional support received from the RN are reflected in the categories ‘Meets my needs when I am irresolute’, ‘Meets my needs when I am vulnerable’ and ‘Meets my needs when I am in need of sympathy’. Reasons to the emotional support resulted in that patients experienced ‘A sense of being able to hand over’, which is therefore the core category of this study.

Conclusion: Older patients’ experiences of emotional support are about obtaining relief. Patients were active participants and had strategies for which they wanted to share their emotions with the RN. In order to develop participatory care for older patients, we need more knowledge about how emotional support can be used as a nursing intervention. © 2014 Taylor & Francis.

Emotional support is considered to be important to older patients because it is a contributing factor to experiencing goodhealth and it has been shown that it can prevent depression after a hip fracture. Opinions differ on whether emotionalsupport falls within the field of nursing, and studies also show that nurses in an elderly home care setting fail when it comesto giving emotional support. The aim of this study was to explore reasons for registered nurses to give emotional support toolder patients in a municipal home care setting. The study was conducted using Grounded Theory. Data collection wascarried out through interviews with 16 registered nurses. The inclusion criteria were emotional support given to patientsaged 80 years and above living in ordinary or sheltered housing and who were in need of help from both the home helpservice and registered nurses. The results show that the main concern of emotional support was ‘‘Trying to relieve thepatient from their emotions so they are able to cope with everyday life.’’ This core category illustrates how registered nursestried to support the patients’ own strength, so that they were able to move forward. Registered nurses consider that theycould support the patients because they give them access to, or could create access to, their emotions, but there were alsotimes when they felt helplessness and as a result, consciously opted out. The results also indicate that registered nurses werekeen to give emotional support. To develop patient-centered elderly care, more knowledge of emotional support and theelderly’s need for this support is required. © 2012 N. Dauman & S. I. Erlandsson.

Background: Timely identification of patients with palliative care needs is a prerequisite for being able to carry out effective and equal palliative care. The Supportive and Palliative Care Indicators Tool (SPICT) identifies patients likely to benefit from a palliative approach.

Aim: The main objective was to describe the translation, cross-cultural adaptation and content validation process of the SPICT-SE. In this process, the prefinal SPICT-SE was tested in focus group interviews to explore how the tool was perceived and interpreted by healthcare professionals in a Swedish healthcare context.

Methods: In this qualitative descriptive study, the translation, cross-cultural adaptation and content validation process of the SPICT-SE was based on a recommended method for cross-cultural adaptation of self-report measures. The process included two independent forward translations, a synthesis, and one independent back-translation. An expert committee consolidated all the versions and developed the prefinal version of the SPICT-SE. The prefinal version of the SPICT-SE was tested in four focus group interviews with physicians and nurses engaged in inpatient or outpatient care in south-west Sweden. A thematic analysis of the transcribed interviews was performed. The SPICT-SE was then revised to the final version.

Results: In the thematic analysis, four themes were constructed that together described how the SPICT-SE was perceived and interpreted by healthcare professionals: The mindset is familiar and relevant; the tool needs to be adjusted in order to be clearer; the purpose and consequences of the tool are ambiguous; and the tool supports a palliative approach.

Conclusion: The SPICT-SE has now been successfully translated, culturally adapted and content validated in a Swedish healthcare context. © 2019 Nordic College of Caring Science

Changing the determinants of health also requires modifying aspects of the settings that has not been done sufficiently in occupational health service. The European Network for workplace health recommended a holistic approach in workplace health promotion including programs concerning individual’s lifestyle and safety management as well as psychosocial and organizational work factors. To this end, we utilize a decision making model that captures the key components of explain how the aging issues pertaining to healthcare employees employ their perception, information, and judgment on decision choices. We collected 116 questionnaire responses from affiliated to the occupational health care center in Sweden. We found that employees’ perception of health care challenges and staffing had a significant impact on their decision choices regarding whether to request, stimulate and collaborate on activities. Finally, our results indicated that aging options related to healthcare issues to request, stimulate and collaborate on activities influence employees’ decision choices.

Chronic kidney disease is a major health problem due to the significant financial burden for the healthcare system and likewise for the patient who needs the treatment. The patient’s whole life situation is turned upside down with chronic kidney disease when they are confronted with the forced change to start treatment with hemodialysis. Patients with chronic kidney disease experience a lack of adequate emotional support from nurses during the transition to hemodialysis. The purpose of this study was to explore nurses’ experiences of giving support to patients during the transition to hospital-bound hemodialysis. The study had a qualitative descriptive design with a content analysis approach; eight nurses from four hospitals in the south of Sweden participated. The results showed that the nurses gave threshold support with an openness and awareness of the patient’s individual needs during the transition, except that there seemed to be a lack of knowledge and ability to provide emotional support. Patient support during the transition could therefore be absent. Education, at local and national levels, is needed for the nurse to be able to give professional emotional support. Further research is also desired in order to provide nurses with the tools they need to give emotional support, which is of utmost importance. © 2014 A. Sturesson & K. Ziegert.

When the COVID-19 pandemic began to spread around the world, Swedish municipalities were unprepared. Different guidelines on how to act in relation to the disease varied and protective equipment was lacking. This study aims to describe the experiences of health and social care providers of working at municipality level during the COVID-19 pandemic. A total of 12 assistant nurses, 13 registered nurses, and three physicians were interviewed, individually or in groups, between fall 2020 and spring 2021. The interviews were semi-structured and were analyzed using thematic analysis, utilizing a design following the COREQ-checklist. Three main themes were identified as follows: ‘Initial chaotic situation and uncertainty regarding how to deal with the pandemic’; ‘Continuous changes in organization and work routines’, and ‘Management of the pandemic has become the new normal’. Though health and social care workers eventually managed to embed dealing with COVID-19 as a routine feature of their daily work, municipalities must prepare for future crises. © The Author(s) 2022

Background

In the ordinary everyday existence of individuals, life usually goes by without them reflecting on its fragility or their relationships. Individuals in a close relationship are united with each other in a mutual dependency and share memories from the past, perceptions of the present and dreams and hopes for the future. When one of them suddenly seriously ill and thereby assumes the role of seriously ill patient while the other takes on the role of close relative, their normal life is changed into an extraordinary situation. Everyday life can be complex when next of kin are preoccupied with taking responsibility of the care, which in turn lead to a changed life situation and restrictions in everyday life. The summary of the current knowledge highlighted the importance of understanding of next of kin´ coping approaches during responsibility for caring at home. 

Aim and method

This study explores the process of changes for next of kin´ in a care home for older relatives from the perspectives of the responsibility for caring. Data were collected using narrative interview with 8 next of kin’ at home. The following questions were asked: Please describe the changed situation you have gone through, when you having the difficult care situation and what did you do to cope with your situation? The individual interviews were nearly all transcribed verbatim, a few were listen to and taking notes during listening. The data set were analyzed by using thematic analysis.

Findings and conclusion

Four themes revealed from narrative interviews with the next of kin´. The four themes were: Sources of responsibility related to family interaction; Consequences of changes for everyday; Importance on maintaining their own conditions; Roles and relationships over time. Based on a synthesis of data the themes and basic transitions that emerged were termed “re-constructing roles and relationships”. This highlights the subtle and dynamic way of changes and reinforces the importance of understanding the transitions from multiple perspectives. The results of the study may encourage people to engage themselves in self-help activities and strengthen them to believe they are to care for each other.