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Aim: To identify and address ethical challenges in doctoral supervision within nursing and health sciences and propose strategies to overcome them.

Design: Following PRISMA guidelines, this mixed-method systematic review synthesises findings from quantitative, qualitative, and mixed-methods studies published in English between 2014 and 2025. Studies were included if they examined ethical challenges in doctoral supervision and strategies to address them within nursing and health sciences. Exclusion criteria encompassed reviews, books, editorials, opinion papers, conference papers, studies unrelated to nursing or health sciences or published before 2014.

Data Sources: A systematic search was conducted in CINAHL, Education Source, ERIC, PubMed, Scopus and Web of Science Core Collection, yielding 1100 citations.

Review Methods: The methodological quality of included studies was assessed using the STROBE checklist for quantitative studies and the COREQ framework for qualitative studies. The findings were then synthesised and thematically organised.

Results: Eleven studies met the inclusion criteria: four quantitative, four qualitative, and three mixed methods. Ethical challenges in doctoral supervision emerged at three levels: individual (e.g., misaligned expectations, inadequate feedback, student adjustment difficulties), institutional (e.g., high student–supervisor ratios, limited support structures), and cultural (e.g., differing norms around autonomy and academic authority). Supervisors also reported role conflicts. Strategies to address these challenges included improved communication, supervision agreements, institutional support, and targeted training.

Conclusions: Ethical challenges in supervision are shaped by individual, institutional, and cultural factors. Addressing them requires multi-level strategies, including clear expectations, feedback mechanisms, structured training, and culturally sensitive supervision practices. Applying ethical principles fosters a transparent and supportive academic environment that enhances doctoral outcomes.

Implications for the Institutions: Universities should adopt multi-level strategies, including supervisor training, mentorship structures, and culturally informed policies, to strengthen the ethical integrity and effectiveness of doctoral supervision.

Impact: What problem did the study address? This study synthesises ethical challenges in doctoral supervision within nursing and health sciences, focusing on communication barriers, institutional constraints, and the transition from clinical practice to academia.

What were the main findings? Misaligned expectations between supervisors and students, inadequate feedback and structural limitations negatively impact the quality of supervision. Doctoral students struggle to adapt to academic expectations, while supervisors face challenges in balancing multiple roles. Effective communication, institutional support and targeted training programs are essential for improving supervisory experience.

Where and on whom will the research have an impact? The research will inform universities and institutions offering doctoral education in nursing and health sciences. It will benefit doctoral students, supervisors, and academic administrators by providing insights and strategies to enhance supervision quality and promote ethical practices.

Reporting Method: This systematic review follows the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines.

This study investigated Swedish school nurses experiences, self-perceived knowledge, and attitudes towards HPV vaccination. A cross-sectional repeated questionnaire study was conducted. The results were compared to a previous study conducted in 2016. Additionally, open-ended responses were thematically analysed. A total of 344 nurses participated. Overall, more participants reported good self-perceived knowledge and favourable attitudes towards HPV vaccination compared to 2016. Still, nearly half expressed a need for further education. The thematic analysis revealed barriers including lack of training, inconsistent guidelines for addressing vaccine hesitancy and ensuring children's participation in decision-making, limited access to diverse information materials, and time constraints related to vaccination tasks. Since school nurses in Sweden are responsible for all aspects of school-aged vaccinations within the national immunization program, it is essential that they receive support to feel motivated and confident in addressing vaccine hesitancy. Continued education and the implementation of uniform guidelines are therefore necessary.

Objective

One key component in preventing unplanned pregnancies is to provide effective contraceptive counselling. This study aimed to investigate what characterises good contraceptive counselling from the woman's perspective.

Methods

A qualitative study with a phenomenological approach. Twenty-four women aged 15–45 participated in semi-structured, individual, face-to-face interviews that lasted, on average, one hour. Data were analysed by latent content analysis.

Results

One overall theme emerged, person-centred contraceptive counselling – an interactive process, with three main categories: (i) a trustworthy healthcare provider, (ii) creating a liaison and (iii) the right time and place.

Conclusions

The healthcare provider’s attributes as well as what happened between the healthcare provider and the woman, and the surrounding context, had a bearing on the women’s descriptions of good contraceptive counselling. The process of the counselling was described as more important than the actual outcome; thus, healthcare providers need to be aware that this seemingly straightforward consultation is rather multi-layered and has great health promoting potential.

Aim

There is limited knowledge about the perceptions of HPV vaccination in middle-school children. This qualitative study aimed to explore their views.

Methods

We conducted focus group interviews with children, 10–11 years of age, who had been offered HPV vaccination through the school health services in mid-north Sweden in spring of 2023. Data were analysed with qualitative content analysis.

Results

This study included six focus group interviews with 49 children (boys n = 29; girls n = 20), mean of 11 years of age. Participating children expressed the need to feel safe to be of utmost importance and the means to do so was to be prepared and informed by someone the child trusted. The school nurse was perceived as the expert, best suited to provide factual information, support and motivation, both to children and their parents.

Conclusion

We confirm that healthcare providers' recommendations are crucial for HPV vaccine acceptance also from the child's perspective. Improved information about HPV vaccination to children is necessary. Children's right to participate on their own terms is not fulfilled today. Vaccine promotion, both to children and parents, should be actively managed by the school nurse.

The present qualitative study is a part of the process evaluation of a complex intervention, the randomized controlled trial, “Prevention of human papillomavirus (HPV) in a school-based setting.” We aimed to explore participating school nurses’ perceptions and experiences of delivering the educational HPV intervention to adolescents aged 16. Focus group interviews were conducted with school nurses (n = 20) and analyzed with inductive qualitative content analysis. The overall theme Easily adapted into the existing role as a school nurse permeated the participants’ views. The nurses were in favor of delivering an intervention that increased the HPV vaccination rates and improved beliefs and awareness about HPV prevention. It suits their work and health-promoting aspect of their role well and can easily be adapted into the current school health consultant curriculum. Having material in different languages to share with adolescents and their parents to promote equal health was deemed important.

Aim: There has been limited research about the associations between pre-eclampsiaand neonatal complications in relation to gestational age. This register-basedstudyaimed to address that gap in our knowledge.

Methods: We used Swedish Medical Birth Register to carry out a population-basedstudy on primiparas with singleton pregnancies from 1999 to 2017. Descriptivestatistics and logistic regressions were used to study the associations betweenpre-eclampsiaand neonatal complications in different gestational ages. The data ispresented as adjusted odds ratios (aORs) with 95% CI.

Results: The study comprised 805 591 primiparas: 2.9% had mild to moderate pre-eclampsiaand 1.4% had severe pre-eclampsia.Neonates born to women with pre-eclampsiahad increased risks of several complications compared to those born tomothers without pre-eclampsia.After adjustment for confounding variables, therisk of being small for gestational age (aOR 5.3, CI: 5.1–5.5) and needing resuscitation(aOR 2.6, CI: 2.4–2.7) were increased. The risk of a low Apgar score and convulsions/hypoxic ischemic encephalopathy was increased at 32–41 weeks of gestation.Moreover, the overall risk of sepsis (aOR 1.9. CI: 1.8–2.1) and perinatal death (aOR 1.2,CI: 1.1–1.5) was also increased.

Conclusion: Compared with infants of mothers without pre-eclampsia,those exposedto pre-eclampsiahad higher risks of all the studied neonatal complications.

Background: Human papillomavirus (HPV) vaccines effectively prevent, and can even eliminate, HPV-related cancers. Currently, vaccination rates are suboptimal in the national Swedish school-based vaccination program. School nurses play a key role in all aspects of the vaccination process. Therefore, this study aims to explore school nurses' perceived HPV vaccination challenges.

Methods: Seven focus group interviews were conducted with school nurses (n = 35) working in nine socio-demographically diverse municipalities in mid-Sweden. Data were analyzed using qualitative content analysis.

Results: Participants described difficulties in encountering and handling the diversity of reasons for vaccine hesitancy. Parents known to be skeptical of vaccines in general were seen as most difficult to reach. Uncertainty was expressed concerning the extent of professional responsibility for vaccine promotion. The informants expressed a lack of guidelines for vaccine promotion and described challenges in supporting the child's own wishes. Creating a safe space for the individual child was seen as crucial. Other problems described were the challenges of overcoming children's fear of needles, supporting unvaccinated children, and being confronted with the remaining gender inequities of the pan-gender vaccination program.

Conclusions: Our results suggest that school nurses, especially those new to their profession, may benefit from training and guidance22 material on how to address vaccine hesitancy.

Background: Conflicting advice and non-evidence-based recommendations have a negative effect on breastfeeding. Since 2011, the National Food Agency in Sweden has informed parents that they can introduce tiny tastings (1 mL of solid food, i.e. other sources of nutrition than breastmilk/formula) to infants from four months of age. It is unknown how national recommendations, which differ from the Word Health Organisation's recommendation, affect breastfeeding. We hypothesised that introduction of tiny tastings of solid foods would shorten the duration of continued breastfeeding.

Methods: This retrospective study utilises data from the longitudinal 'Swedish Pregnancy Planning Study', in which mothers were recruited at antenatal clinics on a national level. The participants completed three questionnaires up to one year after birth (n = 1,251). Linear regression models were used to analyse the association between the introduction of solid foods and the duration of breastfeeding.

Results: As hypothesised, introduction of tiny tastings shortened the duration of continued breastfeeding. Half of all infants (48%) were fed with tiny tastings already in the fourth month. The correlation analysis showed that the earlier the infants started with tiny tastings, the earlier they ate larger amounts of solid food. In a multivariate linear regression analysis, five factors were identified as having a negative effect on the duration of breastfeeding: low infant age upon introduction of tiny tastings, low maternal age, low level of maternal education, high maternal BMI and twin birth.

Conclusions: Early introduction of tiny tastings of solid foods shortened the duration of breastfeeding. It is difficult to influence most conditions that affect breastfeeding, for example, the mother's educational level, BMI, age and if she has given birth to twins. In contrast, national guidelines can always be updated. Recommendations from the Swedish authorities should adhere to the WHO's recommendation, which states exclusive breastfeeding for six months and continued breastfeeding for at least two years or longer.

Background: 

The COVID-19 pandemic resulted in changes in neonatal care, sometimes resulting in a separation between parents and their newborn. Knowledge about parents' experiences of this separation is limited.

Purpose: 

To explore parents' experiences of separation from their newborn due to COVID-19.

Methods: 

Interviews with parents (n = 11) separated from their newborn.

Results: 

The parents' experiences of being separated from their newborn were expressed under 3 themes: “To create a sense of safety in an insecure situation”; “Unexpected start to parenthood”; and “To be reunited.” Parents felt abandoned and alone, even if they had support from significant others. Although they considered the separation as undesired, wanting to be with their newborn infant, it was secondary to not wanting to infect the infant with COVID-19. Furthermore, lacking information about a potentially lethal virus adds to the uncertainty that comes with having a newborn. The separation affected the whole family, some for a long time afterward.

Implications for Practice and Research: 

If a new situation with potentially life-threatening effects, like the COVID-19 pandemic, occurs again, considering the experiences of these parents is paramount. Precautions should be taken to minimize the potential harm. If a separation between newborns and parents is inevitable, parents need preparation and transparent information prior to the separation and before the reunion. Well-thought-out policies must be in place to minimize the impact of a separation on both parties. Parents should be able to have a deputy parent present during an undesired but necessary separation from their newborn.

BACKGROUND: HPV vaccination of both girls and boys can protect against infection and eliminate the risk for HPV-associated cancer. Due to a common misconception that the virus only poses risks to women, vaccine coverage is suboptimal among men in many countries. It is urgent to identify barriers to vaccination of boys and men.

METHODS: We conducted a narrative review of publications examining attitudes and beliefs regarding HPV vaccination for boys and young men. The electronic databases searched were PubMed, PsychInfo and Scopus (December 2020; last update July 2021). A total of 103 original articles were included in the final analysis.

RESULTS: The central barriers against vaccination of boys and men are: (1) lack of knowledge, (2) vaccine hesitancy in general, (3) lack of recommendation from and/or discussions with healthcare providers, (4) cost and logistics, and (5) the idea that HPV vaccination may promote promiscuity. Men who have sex with men and families belonging to ethnic minorities express a need for information tailored to their situation.

CONCLUSIONS: Boys should be included in national immunization programs and men should also be offered catch-up vaccinations. Future studies should focus on addressing vaccine hesitancy and developing interventions to promote pan-gender HPV vaccination.