Logo: to the web site of Uppsala University

Objective

Assessing parents’ perceived stress, psychological distress, and health-related quality of life (HRQoL) before their child's craniosynostosis surgery and one year after.

Setting/Participants

Parents of children with nonsyndromic craniosynostosis, scheduled to undergo surgery at the Uppsala Craniofacial Centre, were invited to participate. Data were collected between May 2016 and February 2025. There were 157 eligible patients; 103 (66%) parents participated, and 29 (28%) provided data at both time points.

Main Outcome Measures:

Swedish parenting stress questionnaire (SPSQ), Hopkins Symptom Checklist (HSCL-25), EQ VAS.

Results

The HSCL-25 total score and the subscale depression were rated higher before the surgery than one year after. There were no differences in the SPSQ total score, or EQ VAS scores before and after surgery, but parents rated their feelings of incompetence higher at follow-up. Participants did not report more parental stress on SPSQ subscales than the average population of parents, either before or after surgery. Before surgery, SPSQ subscales incompetence and role restriction were associated with symptoms of depression. After, the association between these subscales remained. Moreover, an association was found between the subscale incompetence and symptoms of anxiety.

Conclusions

Parents whose children underwent surgery for craniosynostosis did not seem to experience higher levels of parental stress than Swedish parents in general. There were no differences in perceived parental stress and HRQoL before and one year after surgery, while the psychological distress was higher before. A positive association between parental stress and symptoms of depression was seen both before and after surgery.

Background: The Interdisciplinary Education Perception Scale (IEPS) is an instrument that measures students' perceptions of interprofessional learning. It has shown satisfactory internal consistency for the total scale; however, problems regarding the psychometric properties of the subscales have resulted in several different versions of the instrument. The aim of this study is to further evaluate the psychometric properties of the Swedish version of IEPS using Rasch analysis.

Methods: The Swedish translation of the 12-item, 3 subscale version of the IEPS was used in a student population (n = 704) from eight healthcare programmes. The psychometric properties were evaluated using Rasch analysis based on five aspects: rating scale functioning, unidimensionality, reliability, targeting, and differential item functioning.

Results: The total scale showed satisfactory internal consistency. However, the scale was suboptimal regarding the response categories, where three response categories had to be combined into one to achieve a more optimal number of observations per category. Regarding the second subscale, Perceived need for cooperation, item 4 and particularly item 6 showed local dependency and disordered thresholds.

Conclusion: To improve the evaluation of interprofessional education, future research should rephrase the response categories or minimize the number of response options. Additionally, the removal of item 6 and possibly item 4 from the second subscale may improve the psychometric properties of the scale.

  Aim

To explore how factors in the complex aortic surgical care context can affect care provision towards patients' postoperative recovery.

Design

Secondary qualitative analysis.

Methods

Results about patients' recovery after complex aortic surgery was presented in focus groups with healthcare professionals in 2022. Reflexive thematic analysis, using the Fundamentals of Care framework, was conducted to explore contextual factors affecting care provision.

Results

Healthcare professionals' descriptions resulted in one main theme: Care provision is challenged by discrepancies in values, goals and norms and unclear responsibilities within the context, and two subthemes: Values, goals and norms determine what care is provided; Taking responsibility for care requires resources, evaluation and feedback.

Conclusion

Healthcare professionals describe care provision as affected by a dynamic integration of contextual factors. Healthcare professionals need to be made aware of their own role in this context. Care provision needs to be guided by feedback from patients and healthcare professionals, and work with patients' resources at both an individual, system and societal level.

  Implications for the Profession

The results provide knowledge regarding how contextual factors in dynamic integration can affect care provision in a complex surgical context. Healthcare professionals, leaders and policy makers all have responsibility to focus on patients' values and goals, and empower adequate care through feedback loops and resource management.

Impact

The context-of-care dimension of the Fundamentals of Care framework has been scarcely described. Our results illustrate how an integration of factors affects care provision, where values, goals, and norms affect what care is provided, and responsibility for care belongs to everyone in the care system. The results can contribute to the description of the context-of-care dimension within the framework and enable professionals to understand how they, as part of the context, could affect care towards patient recovery.

Reporting Method

This study adhered to the Equator research reporting checklist: Consolidated criteria for reporting qualitative research: a 32-item checklist for interviews and focus groups.

Patient or Public Contribution

No patient or public contribution.

Introduction

Patient experiences of recovery-oriented nursing practices in psychiatric inpatient care are understudied. Steps Towards Recovery (STR) is a nursing-led programme developed to promote personal recovery through empowering each patient's ability to identify resources, find solutions and gain control over one's life.

Aim

The aim was to evaluate patients' experiences of participating in STR.

Method

Interviews with 18 patients participating in STR group sessions at a psychiatric inpatient clinic. Data were inductively analysed with applied thematic analysis.

Results

Three themes were identified. STR group sessions, with the manual-based contents, seem beneficial for taking the first steps towards a personal recovery process. Participants described an increased ability to see things from different angles, could focus their thoughts more positively, and underlined the importance of maintaining these strategies after discharge. Group leaders' skills related to psychiatric inpatient care were also reflected on.

Discussion

STR seems to promote personal recovery. Psychiatric inpatient care requires group leaders trained in STR with competence to manage advanced psychiatric nursing care.

Limitations

Data were collected at one clinic, decreasing transferability.

Implications

Recovery-oriented programmes in psychiatric wards can support patients' first steps towards recovery.

Recommendations

Nursing-led programmes supporting personal recovery should be implemented in psychiatric wards.

People who undergo bariatric surgery have a higher risk of alcohol use disorder. This can be explained by a mix of biological and psychosocial factors, with various theories for this suggested. After bariatric surgery, long-term follow-up by healthcare is recommended, focusing mainly on diet. Patient views on the association between alcohol use disorder and bariatric surgery are sparsely studied, as are patient perceptions of care needs. This study aimed to explore perceptions of patients with addiction problems on the associations between bariatric surgery and addiction. A further aim was to explore patients' perceptions on what kind of support would be useful to handle alcohol-related problems in connection with bariatric surgery. Data were collected through semi-structured interviews with 10 individuals seeking treatment at an addiction clinic after bariatric surgery and inductively analyzed using applied thematic analysis. We identified four themes reflecting addiction problems and associations with bariatric surgery and one theme related to unmet care needs. The participants reported heightened vulnerability before surgery in terms of alcohol use and mental well-being. Alcohol problems could develop or worsen after bariatric surgery and were perceived to be associated with both biological and psychosocial aspects. Surgery follow-up did not occur or was not person-centered. Patients wanted supportive talks that encompassed difficulties, for example, alcohol use, related to their bariatric surgery. The results indicate that a holistic approach to alcohol-related problems after bariatric surgery and person-centered care could be beneficial to support patient recovery.

Purpose: The study aimed to (1) explore nursing staff attitudes towards evidence-based practice in conjunction with implementation of Steps Towards Recovery, and (2) describe nurses' and nurse managers' experiences of working with Steps Towards Recovery, as an example of evidence-based practice.

Materials and methods: The study was carried out in two parts. Part 1 incorporated quantitative questionnaire data using descriptive, non-parametric statistical analyses. Part 2 incorporated qualitative data, from both individual and focus group interviews, using qualitative content analysis and focus group data analysis.

Results: In part 1, positive attitudes were reported. Openness to evidence-based practice was significantly higher after implementation. In part 2, the nursing programme was found to be seen as an important contribution to nursing in psychiatric in-patient care. Evidence-based practice was seen as important but insufficiently used.

Conclusion: Integrating results from nursing research into daily nursing work is described as challenging in psychiatric in-patient care. There is a need to illuminate the gap between theory and practice to achieve evidence-based nursing. Nurses' professional role and responsibility for the development and improvement of nursing are crucial in doing so and must be addressed in nursing education, by nurses themselves, as well as by managers at all levels of health care.

Objective: Complex endovascular aortic repair (EVAR) involves tertiary surgical care, with short in-hospital recovery. This study aimed to explore patients’ and healthcare professionals’ experiences of what can improve patient recovery after complex EVAR.Methods: Three qualitative data collection stages building on each other were analysed with thematic analysis. Stages 1 and 2 separately explored patients’ and healthcare professionals’ experiences of what works well and what can be improved with current care. In stage 3, participants reviewed the relevance and feasibility of intervention suggestions.Results: Three matching themes were identified in stages 1 and 2: Adequate information; Patient involvement; Continuity and follow-up. In stage 3: Individual care plan, Team meetings, and Contact nurse were all found relevant, while only Information routines was found both relevant and feasible.Conclusion: What patients and healthcare professionals experienced could improve patients recovery after complex EVAR seem universal for complex surgical patients, and relevant interventions were identified. However, the feasibility of person-centred interventions seem affected by various contextual factors, like current routines and availability of staff.Practice implications: Interventions that facilitate communication, both involving and supporting the patient, should be tested to strengthen patients’ ability to self-care, and ensure access to care and support when needed.

BACKGROUND: In Attention-deficit/hyperactivity disorder (ADHD) the transition from childhood to adolescence encompass changes in symptom manifestation and related challenges. Given the potential negative impact of ADHD on adolescents, and the increased risk for dropping out from treatment, there is a need to understand more about how adolescents experience their condition. The aim of this study was to explore adolescents' perceptions of how it is to live with ADHD.

METHODS: Twenty adolescents (15-17 years old, 12 girls) diagnosed with ADHD who had completed a skills training group were interviewed. Data was analysed using thematic analysis.

RESULTS: Four themes emerged: 'I find it hard to regulate what I take in and what comes out', 'I've really struggled but it does not seem to work', 'ADHD impacts my vitality and my relationships', and 'I can be successful and things are getting better'.

CONCLUSION: Adolescents with ADHD experience problems with self-regulation with regards to cognitive, emotional and behavioural processes. They describe being either on or off. This difficulty to self-regulate is related to primary and secondary consequences such as stress, anxiety, loss of control, and by extension exhaustion, depressed mood, challenges in social interactions, self-accusations and a tendency of giving up. The experience of 'being on' has positive connotations of vigour and creativity. The challenges related to ADHD can to some extent be overcome with time for recovery, coping strategies, and medical treatment. Symptoms of ADHD can also decrease over time.

TRIAL REGISTRATION: This qualitative study was not pre-registered.

We aimed to explore how specialist nurses and psychiatrists perceive and conceptualize their own responsibility and autonomy in relation to interprofessional colleagues when caring for inpatients with deliberate self-harm. Eight psychiatrists and 10 nurses were interviewed. The interviews underwent thematic analysis by an interdisciplinary group of experts in ethics, law, mental health nursing, and psychiatry. Three themes were found. The first theme focused on role-specific tasks and perceived responsibility. Psychiatrists more often emphasized the legal perspective and specialist nurses the ethical perspective. The second theme was to adapt to other professionals' opinions. When someone else had made a decision, autonomy was perceived to decrease, whereas responsibility increased. The third theme was renunciation of autonomy for achieving cooperation. It was considered important to strive for consensus in the team. Both nurses and psychiatrists believed they had a high degree of autonomy and responsibility when their roles were well-defined. The respondents considered clear roles, good communication, shared expectations, and mutual respect to be prerequisites for interprofessional collaboration in hospital care of patients with deliberate self-harm.

Enduring loneliness has serious physical and mental health implications. Patients with mental health problems are at risk of experiencing problems related to loneliness. Therefore, it is important to increase knowledge about how loneliness is experienced and managed in this particular group. The aim of the study was to explore (1) psychiatric patients' experiences of different forms of loneliness, (2) associated problems, including difficulties with prosocial signaling, and (3) strategies used to combat loneliness, to better understand how loneliness affects psychiatric patients and how patients manage their loneliness. A total of 110 psychiatric patients were recruited at eight outpatient clinics in Region Stockholm for a larger study of loneliness. The first fifteen patients who also agreed to participate in the present substudy were invited to meet a trainee psychologist who conducted a semi-structured interview. A reflexive thematic analysis with a codebook approach was used to analyze the transcripts. The described experiences of loneliness were primarily examples of social and emotional loneliness with one prominent theme: "Hopelessly lonely". Associated problems were summarized in two themes: "The inevitable road to loneliness" and "Social signals are confusing and push others away". Regarding patients' strategies for combating loneliness, one theme emerged: "Using strategies that focus on the current moment". The results also included a total of sixteen subthemes. Loneliness was described as something painful that is inevitable and unchangeable, with a self-reinforcing loneliness loop leading to social and emotional loneliness, and as something that is intertwined with mental health problems. These results are in accordance with research. In addition, patients described a variety of prosocial signaling deficits and feelings of being disconnected from others. They also reported using strategies that primarily alleviated their immediate suffering when they were alone, rather than focusing on approaches with long-term effects on reducing loneliness, such as participating in social activities combined with effective social signaling. Future research should investigate whether increased awareness of social signaling, as well as social activities combined with improved prosocial signaling and strengthened self-belief, would constitute effective steps for patients to combat enduring loneliness. It also seems important to help patients reduce hopelessness related to loneliness.