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Background Enhancing communication in everyday nursing conversations is essential for promoting person-centred care and preserving the dignity of older persons. This qualitative study was performed to gain an in-depth understanding of the nursing assistants’ person-centred communication skills and their communication style. The aim was to explore the communication styles of nursing assistants during home care visits to older persons.

Methods This deductive qualitative study was based on observational data gathered with audio recordings of naturally occurring communication between nursing assistants and older persons during home care visits. Data collection was part of an educational intervention study for in-home nursing assistants and took place from March to December 2022. Data were analysed with a method for deductive qualitative content analysis. The deductive analysis was guided by the framework developed by Bottorff and Morse, and the communication styles identified in the current study, doing more, doing with, doing for, and doing tasks.

FindingsA total of 70 audio recording home care visits, including 39 nursing assistants and 37 older persons were included. Based on conversations during these visits, four distinct communication styles employed by NAs in their everyday interactions with older persons were described in depth with focus on communication patterns observed. The different styles included nuances of communication ranging from being more relational and collaborative to more task-oriented interactions. A pattern of doing too much was also observed.

Conclusions The communication styles used influenced the degree of person-centredness. Nurse assistants’ communication styles can vary during conversations and appear to reflect individual traits. The emotional demands of home care work may require more recognition and support from policymakers and managers. Strengthening person-centred communication and care for older persons requires both training and organizational support.

BackgroundCaesarean section on maternal request (CSMR) raises ethical and clinical challenges despite Sweden’s low overall caesarean section (CS) rate. National written recommendations are restrictive, yet regional differences suggest unequal care. While previous research has focused on women and healthcare professionals, little is known about the views on CSMR of policymakers and other key stakeholders. The aim of this study was to investigate how stakeholders in the Swedish healthcare system view CSMR in relation to medical considerations, individual autonomy and societal values.

MethodsA qualitative study with an inductive approach was conducted using reflexive thematic analysis of semi-structured interviews. Sixteen stakeholders were recruited, including regional politicians, policymakers, national authority representatives, and members from organisations and associations with relevant interest and expertise in the field.

ResultsFive themes were generated: (1) Caesarean section is a valid way of giving birth for some; (2) The right to choose and the decision process are complex issues; (3) Individual options for childbirth are desirable; (4) There is a lack of trust in maternity care; (5) Economic and ethical challenges in maternity care exist. The participants viewed CSMR as a legitimate option for some women, despite the increased medical risks, which were considered concerning but not disqualifying. Support and guidance in decision-making were considered essential by the participants. They valued continuity in care and emotional support highly. The participants expressed the views that distrust in Swedish maternity care was linked to media portrayals and inconsistent handling of CSMR. Economic and ethical concerns included questions of resource allocation and the scope of public healthcare responsibilities. The option to pay privately for a planned CS was broadly rejected by the participants.

ConclusionsThis study highlights the complexity of CSMR and its varied perspectives. While individual risks may be low, population-level risks could rise with increased prevalence, and the perception of risk varies depending on perspective. Both medical and psychological risks should inform decisions, with counselling seen as crucial by the participants. Continuity of midwife care models may offer an alternative to CSMR for some. Stakeholders are key to ensuring clear guidelines, equal care, and trust in the system.

Background At emergency medical dispatch centres (EMDCs) telephone triage takes place in three steps: identifying the event, assessing the callers' need for support, and prioritizing the response. Some calls are considered to be more difficult to handle than others, and decision support systems may in these situations be of limited help. The aim of this study was to describe and characterize difficult calls to EMDCs. Methods Retrospective call data from 2022 to 2023 was extracted for Registered Nurse (RN) dispatchers at three EMDCs in Sweden agreeing to participate in this mixed-method study. Categories of difficult calls were identified based on prior research and operationalized as key-word searches in the free text call notes or as indicators based on structured data. A purposeful selection of calls meeting these criteria were extracted, anonymized, and data regarding categories and the phase on the call in which they occurred then coded. A descriptive quantitative analysis was performed, and logistic regression was used to estimate the association between demographics and the likelihood of high-priority ambulance dispatch. Results Over the two-year study period, 14 included RNs handled 27,805 calls. Of these, 4888 calls (17.6%) were identified as potentially difficult calls based on free-text notes and structured data, from which 123 calls were selected for further analysis. The median age of callers were 49 years, and 49% were female. Median call duration was 5.6 min, compared to 5.1 min in the full dataset, and 39.5% of calls resulted in a lights and sirens response.Vague or unclear symptoms and psychiatric problems were the most common difficulties. These could occur in all three phases of the calls and in several of the phases in one single call, with a combination of "assessing and prioritizing" being the most common. Male sex was found to be associated with a higher likelihood of receiving an ambulance with high priority. Conclusions Difficult calls, mainly with vague or unclear symptoms and psychiatric problems, are common at EMDCs. The reason for the tendency to prioritize young males higher are seen in other contexts but not in truly high priority cases at dispatch and needs further investigation.

Purpose

To explore how stroke survivors experience and prefer to participate in clinical reasoning processes in the subacute phase of stroke rehabilitation.

Methods

An explorative qualitative design was used. Individual interviews were conducted with 10 stroke survivors (4 women and 6 men, mean age 68 years) 4 weeks after their stroke, and follow-up interviews were conducted with 6 of them after 10 weeks. The interview settings were the patient’s home during their home rehabilitation, an inpatient and an outpatient rehabilitation unit. A reflexive thematic analysis was performed.

Results

Four themes were identified: discharge as a critical point for participation, describing a stressful time with varying involvement; supportive actions and context as crucial for participation, describing collaboration with the stroke team, the team’s consideration of the stroke survivor’s resources and needs, and a supportive home environment; the importance of goals and follow-up, describing goals as motivational and an unstructured use of goals; and difficulties in participation, describing a lack of dialogue with the stroke team and undetected resources and needs.

Conclusions

The stroke survivors experienced changes in their participation in the clinical reasoning process as their rehabilitation progressed. They moved from perceiving themselves as passengers at the time of their hospital discharge to gradually seeing themselves as the driver of their rehabilitation process. Some person-centered attributes, such as respectful relationships and a health focus, were incorporated into the clinical reasoning, while others, such as a holistic view and shared goal-setting, required further emphasis for improved person-centeredness in stroke rehabilitation.

Aim: This paper examines a theory and practice developed framework aimed at guiding person‐centred communication in registered nurse–patient encounters. The primary objective is to refine and present a data‐ and theory‐driven framework tailored to the demands of nursing practice and those receiving care. To achieve this, the COMCARE model is introduced, providing practical guidance for understanding and implementing strategies for nurses' communication and caring behaviours.

Design: This theoretical paper addresses theory and research on communication strategies during registered nurse–patient encounters based on the principles of caring and person‐centredness.

Results: The COMCARE model outlines communication strategies to guide registered nurses to ensure caring and supportive interactions, aligning with the principles of person‐centred care. COMCARE builds on the necessary communication skills for person‐centred registered nurses–patient encounters and clarifies key components of such communication, with related goals. The key components proposed are related to empathic listening and asking questions, responding and acknowledging, guiding and using clear communication, supportive communication, and appraising and confirming communication. Person‐centred communication requires a broad repertoire of skills to be applied and tailored to individuals in various situations and practices.

Conclusion: The COMCARE model provides an overview of the communication skills essential for person‐centred care, emphasising guidance for nursing practice to support patients' optimal well‐being and health. This framework highlights the importance of communication skills in shaping patient experiences and outcomes and underscores the need for their application and implementation in caring and nursing practice. Effective communication by registered nurses and other healthcare professionals is vital for delivering high‐quality care. The COMCARE framework offers practical guidance and serves as a foundation for future training and education for nursing students, as well as informing policy and research in this area. Further research is needed to test and validate the COMCARE model in clinical settings.

Objectives

Early parental support, provided by nurses within child health services, aims to strengthen parents in their parenthood. The aim of this integrative review is to describe communication in parental support in encounters between child health nurses and parents in child health services.

Methods

An integrative review was conducted. The databases Cinahl+ , MedLine, Psych Info, and Scopus were searched, 312 articles were screened, and 16 articles were found to be eligible.

Results

The studies included qualitative and quantitative methods, using interviews, focus group interviews, and observations. The findings show an overarching theme: The significance of mutuality in communication in a professional-parental relationship, further described in the following categories, 1) Authoritarian approach: a controlling manner, a neglecting manner, and a teaching manner; 2. Guiding approach: a counselling manner and a compliant manner.

Conclusions

The communication between nurses and parents can be understood as having several layers; the organisational context, the professional skills, knowledge, and experiences, and parents’ knowledge, expectations, and needs. There is a lack of studies of authentic communication between nurses and parents; thus, future research is warranted.

Practice implications:

The authoritarian and guiding approaches in parental support show the required skills a nurse is expected to have, but sufficient organizational prerequisites are also crucial.

BackgroundToday, person-centred care is seen as a cornerstone of health policy and practice, but accommodating individual patient preferences can be challenging, for example involving caesarean section on maternal request (CSMR). The aim of this study was to explore Swedish health professionals' perspectives on CSMR and analyse them with regard to potential conflicts that may arise from person-centred care, specifically in relation to shared decision-making.MethodsA qualitative study using both inductive and deductive content analysis was conducted based on semi-structured interviews. It was based on a purposeful sampling of 12 health professionals: seven obstetricians, three midwives and two neonatologists working at different hospitals in southern and central Sweden. The interviews were recorded either in a telephone call or in a video conference call, and audio files were deleted after transcription.ResultsIn the interviews, twelve types of expressions (sub-categories) of five types of conflicts (categories) between shared decision-making and CSMR emerged. Most health professionals agreed in principle that women have the right to decide over their own body, but did not believe this included the right to choose surgery without medical indications (patient autonomy). The health professionals also expressed that they had to consider not only the woman's current preferences and health but also her future health, which could be negatively impacted by a CSMR (treatment quality and patient safety). Furthermore, the health professionals did not consider costs in the individual decision, but thought CSMR might lead to crowding-out effects (avoiding treatments that harm others). Although the health professionals emphasised that every CSMR request was addressed individually, they referred to different strategies for avoiding arbitrariness (equality and non-discrimination). Lastly, they described that CSMR entailed a multifaceted decision being individual yet collective, and the use of birth contracts in order to increase a woman's sense of security (an uncomplicated decision-making process).ConclusionsThe complex landscape for handling CSMR in Sweden, arising from a restrictive approach centred on collective and standardised solutions alongside a simultaneous shift towards person-centred care and individual decision-making, was evident in the health professionals' reasoning. Although most health professionals emphasised that the mode of delivery is ultimately a professional decision, they still strived towards shared decision-making through information and support. Given the different views on CSMR, it is of utmost importance for healthcare professionals and women to reach a consensus on how to address this issue and to discuss what patient autonomy and shared decision-making mean in this specific context. Person-centered care is today a widespread approach, but accommodating individual patient preferences can be challenging, for example involving caesarean section on maternal request (CSMR). This study examines Swedish health professionals' views on CSMR. Interviews with 12 health professionals reveal conflicts between CSMR and key aspects of person-centered care, in particular shared decision-making. While professionals acknowledge women's autonomy, they question CSMR without medical need. Concerns include for example treatment quality and patient safety, and avoiding treatments that harm others. The Swedish context, balancing collective solutions with individualized care, complicates decision-making. Unlike countries with more private healthcare, where CSMR support might be higher, Swedish health professionals emphasize shared decision-making despite viewing the mode of delivery as primarily a professional decision. This study sheds light on the challenges in integrating CSMR into person-centered care frameworks.

BackgroundPersons who become life-threateningly ill or injured (due to for example trauma or cardiac arrest) are cared for in hospitals' designated emergency rooms at the emergency department (ED). In these rooms, the life-threatening condition and biomedical focus may reinforce a culture that value the medical-technical care. Meeting patients fundamental care needs (integrating physical, psychosocial and relational care needs) in a person-centred way might hence be challenging in emergency rooms. Little is known about how person-centred fundamental care is experienced and valued by vulnerable and exposed patients in emergency rooms. This study aims to describe fundamental care needs experienced by patients with a life-threating condition in the emergency room.MethodsA descriptive deductive qualitative study with individual interviews were carried out with 15 patients who had been life-threateningly ill or injured and admitted in an emergency room, in Sweden. Data collection was conducted during 2022. Transcribed interviews were analyzed with deductive content analysis, based on the Fundamentals of Care framework.ResultsDespite being life-threateningly ill or injured, patients were still able to describe their unique needs-which were not only related to biomedical care. A relationship was established between healthcare professionals and the patient in the initial stage, but not maintained during their stay at the emergency room. Patients felt their physical needs were met to a greater extent than psychosocial and relational needs, despite their prioritizing the latter. Patients preferred personalized care but described care as task oriented. The physical environment limited patients from having their fundamental care needs met, and they adopted to a "patient role" to avoid adding to staff stress. The emergency room situation evoked existential thoughts.ConclusionsThis paper provides unique insights into patients' experiences of being cared for in an emergency room. From the patient perspective, physical care was not enough. Relationship, timely and personalized information, and existential needs were identified as essential fundamental care needs, which were not, or only partly met. The finding highlights the need to embed and prioritize fundamental care in practice also for patients who are life-threateningly ill or injured, which in turn calls for focus on organizational prerequisites to enable person-centred fundamental care.