Lena Nordgren

Objectives This study aimed to explore the process of moral resilience among frontline healthcare professionals. By delving into experiences of handling moral challenges during a pandemic crisis, we aimed to understand dimensions of moral resilience, affecting factors and consequences. This understanding can inform the implementation of interventions to support healthcare professionals’ well-being and ability to deliver high-quality care, under both routine and extreme conditions. Design A qualitative exploratory study was conducted using grounded theory methodology. Data were collected retrospectively through written narratives and individual interviews (September to November 2020). Setting General hospital wards allocated for patients with COVID-19 in two Swedish healthcare regions. Participants 46 informants, comprising registered nurses, nursing assistants, physicians, managers and allied health professionals. Results A conceptual model is presented that describes and explains the process of moral resilience among frontline healthcare professionals working in general hospital wards during a pandemic crisis. The model reveals a complex and dynamic iterative process, with components at both the individual and system levels being inevitably inter-related. Conclusions The findings emphasise that moral resilience within healthcare organisations is not solely dependent on individual qualities but also influenced by the working groups or teams, leadership and prevailing organisational structures. Supportive interventions should target workgroup dynamics and organisational culture while providing tailored support for individuals.

Many adolescent males report negative experiences of consultations with general practitioners (GPs), which contrasts with the importance of patient-centredness that GPs themselves emphasise. A better understanding of this discrepancy might facilitate improvements. The aim was to explore and describe adolescent males' encounters with GPs in Swedish primary healthcare centres using a lifeworld perspective. Qualitative lifeworld-based study. Video-recorded observations were analysed using a phenomenological-hermeneutical method. Two primary healthcare centres in mid-Sweden. Nine males aged 15 to 19, video-recorded during their encounters with GPs in March through May 2022. Adolescent males navigate between being children in need of parental support and men who can take initiative and responsibility. They face cognitive, emotional, and relational demands, the complexity of which renders them particularly vulnerable. When feeling exposed and not knowing what to expect, they struggle to make themselves understood, and to understand what the GP is saying and what is happening. The difficulties that they have disclosed to the GP in trust need to be recognised and carefully acted upon. Thus the GP must respond appropriately to this complex mix of vulnerabilities to prevent feelings of disappointment or of having exposed themselves in vain. The complexity of encounters with adolescent males imposes great demands on GPs to identify and adapt to their individual needs. A proper ethical response involves helping them navigate the challenges of the consultation while also respecting them as persons and meeting their age-dependent needs.

Background: Sick leave and ill health due to stress are significant concerns today and negatively affect the individual, the organisations, and the community. High demands, multitasking, and inexplicit boundaries between different occupations contribute to an explanation. However, research shows that more qualitative studies are needed to better understand this issue and how to promote health in the working population. Objective: The study aims to explore participants’ experiences of maintaining or regaining occupational health in their everyday life, including paid work, several years after sick leave. Method: Nine semi-structured interviews were conducted and analysed using inductive content analysis. The analysis resulted in one major theme and three categories describing the current experiences handling their everyday life and work situations. Results: The result showed that returning to work and maintaining occupational health after sick leave due to occupational ill health calls for “flex-ability”. The term describes that individuals need to be open to change and adapt to new challenges at work and in everyday life. Conclusion: The findings highlight the importance of health-promotive organisations where the individual factor is more considered. Furthermore, a broader view of health-promotive work in society where work is included in everyday life, instead of divided into and outside of work, is needed.

To improve health in a growing population with increasing life expectancy, a stepwise health care program for citizens aged 65 years and older will be implemented in Region Västmanland in Central Sweden. This scoping review builds on a previous review and aims to map interventions in a larger number of countries and from 2019 to present. The objective of this scoping review is to map the literature on the components of health promotion and preventive interventions in countries that provide accessible and funded health care. The JBI methodology will be employed for good structure. Searches will be conducted in databases and websites, for grey literature. The searches will include health promotion studies, preventive health measures, intervention methods, intervention delivery, outcome measures, or health-economic evaluations for people aged 65 years and older. Two reviewers will individually assess each study and extract data. Data analysis will consist of basic frequencies and percentages. The results will be presented in tables and/or diagrams and a narrative summary.

Background: Nutrition counselling is characterised by a collaborative approach where the patient and the dietitian establish goals that promote health and self‐management. Little is known about goal‐setting in nutrition interventions of patients at risk of malnutrition. The present study aims to describe the perspectives and needs of patients at risk of malnutrition regarding goals of nutrition interventions.Methods: Semi‐structured interviews were conducted with 15 patients from three primary care centres and one hospital in mid‐Sweden selected through purposive sampling. Interview transcripts were analysed using reflexive thematic analysis following the six‐phase guidelines of Braun and Clarke to identify patterns of shared meaning and themes in the data.Results: The findings highlight that the participants rarely reflected on their personal goals of the nutrition intervention. Instead, they strived to maintain strength and energy, with the nutrition counselling being seen as supportive in managing nutrition impact symptoms. They described discrepancies between their perspectives and the dietitian's regarding weight goals and the diet prescribed to gain weight.Conclusions: The study findings suggest that elucidating patients’ goals is key to counteracting the discrepancies between the dietitians’ clinically oriented goals and patients’ perspectives. Goal‐setting is part of the dietitian's structured working process, whereas the patient's lifeworld is complex and unstructured. To provide person‐centred nutrition care, new strategies and tools are needed to facilitate collaborative goal‐setting. These approaches will bridge the gap between clinical goals and patients’ individual needs, promoting better alignment and improved outcomes.

Background: Among the myriad voices advocating diverging ideas of what general practice ought to be, none seem to adequately capture its ethical core. There is a paucity of attempts to integrate moral theory with empirical accounts of the embodied moral knowledge of GPs in order to inform a general normative theory of good general practice. In this article, we present an empirically grounded model of the professional morality of GPs, and discuss its implications in relation to ethical theories to see whether it might be sustainable as a general practice ethic. Methods: We observed and interviewed sixteen GPs and GP residents working in health care centres in four Swedish regions between 2015–2017. In keeping with Straussian Grounded Theory, sampling was initially purposeful and later theoretically guided, and data generation, analysis and theoretical integration proceeded in parallel. The focal concept of this article was refined through multidimensional property supplementation. Results: The voice of the profession is one of four concepts in our emerging theory that attempt to capture various motives that affect GPs’ everyday moral decisionmaking. It reflects how GPs appreciate the situation by passing three professional–moral judgments: Shall I see what is before me, or take a bird’s-eye view? Shall I intervene, or stay my hand? And do I need to speak up, or should I rather shut up? By thus framing the problem, the GP narrows down the range of considerations, allowing them to focus on its morally most pertinent aspects. This process is best understood as a way of heeding Løgstrup’s ethical demand. Refracted through the lens of the GP’s professional understanding of life, the ethical demand gives rise to specific moral imperatives that may stand in opposition to the express wishes of the other, social norms, or the GP’s self-interest. Conclusions: The voice of the profession makes sense of how GPs frame problematic situations in moral terms. It is coherent enough to be sustainable as a general practice ethic, and might be helpful in explaining why ethical decisions that GPs intuitively understand as justified, but for which social support is lacking, can nevertheless be legitimate.

Introduction: Poor health-related quality of life (HRQoL) and high health care utilization are common in more severe cardiac disease. Prior research reveals that continuity of care, self-care, and perceived control are fundamental factors for improving clinical and patient-reported outcomes, especially in the post-hospital period. However, there is a lack of knowledge regarding the complex relationships between these factors and their influence on outcomes such as HRQoL and rehospitalizations. Aim: To examine if a conceptual model including the associations between continuity of care, perceived control, and self-care could explain variations in HRQoL and rehospitalizations in chronic cardiac conditions after an unplanned hospitalization. Method: Patients hospitalized due to angina, atrial fibrillation, heart failure, and myocardial infarction and suffering from at least one other co-morbid condition from 4 hospitals were consecutively invited to participate in the study. They completed a battery of questionnaires 6 weeks after discharge. Based on prior research, a conceptual model was formulated, including continuity of care (Patient Continuity of Care Questionnaire 12-item version), perceived control in relation to the heart condition (Item 1 from Control Attitude Scale), self-care (Self Care of Chronic Illness Inventory), and HRQoL (Eq5d-5L) and rehospitalization (Figure 1). The model was evaluated using Structural Equation Modeling, and the criteria for model fit were: root means square error of approximation (RMSEA) ≤0.08, Comparative fit index (CFI) of ≥0.90, Tucker-Lewis index (TLI) of >0.90. Results: In total, 542 patients were included (mean age 75 years (SD = 9) 37% females). The conceptual model (Figure 2) had an acceptable model fit: RMSEA = 0.058, 90% CI, 0.055–0.061; CFI= 0.903; TLI= 0.896. As hypothesized, a positive association between continuity of care and self-care was found (β=0.404 p<0.001), indicating that perceiving continuity of care facilitates self-care. Further, continuity of care was associated with perceiving control over the heart condition (β= 0.195 p<0.001), which was positively associated with self-care (β= 0.111 p 0.023), indicating that perceiving control has a positive influence on self-care. Further, self-care was associated with good health-related quality of life (β=−0.232 p<0.0001, and not being rehospitalized (β=−0.189 p=0.033) (Figure 2). Conclusion: The present study indicates that patients who perceive continuity of care experience a higher perceived control over their heart condition and perform more sufficient self-care, significantly improving health-related quality of life and reducing the risk of rehospitalizations. Our analyses revealed important relationships between continuity of care, perceived control, and self-care and that these concepts are important targets for interventions to improve quality of life and health care utilization. Funding Acknowledgement: Type of funding sources: Private grant(s) and/or Sponsorship. Main funding source(s): Medical Research Council of Southeast Sweden.Center for clinical research Sörmland/Uppsala University

Perceived stress can affect people’s lifestyle behaviours and self-rated health. A balanced, healthy lifestyle can alleviate experiences of stress. For clinicians to use evidence-based and theory-based knowledge in health dialogues with people with non-communicable diseases, and in order to develop more effective behavioural counselling, more knowledge is needed. Hence, this study aimed to examine the mediating role of sedentary behaviour, daily physical activity, physical exercise, and dietary habits on the association between perceived stress and self-rated health in people with or without one to four self-reported non-communicable diseases (myocardial infarction, stroke, hypertension, diabetes). The study used a cross-sectional design. Responses from in total 10,583 individuals were collected in 2016 and 2019 by a self-report questionnaire. A series of simple and multiple regression analyses were conducted to examine the mediating effects of healthy lifestyle behaviours on the association between perceived stress and self-rated health. The results show that the investigated healthy lifestyle behaviours partly mediated the association between perceived stress and self-rated health in people with no diagnosis, and in people with one or two diagnoses. It can be concluded that healthy lifestyle behaviours could probably be targeted in relation to the number of noncommunicable diseases that the individuals have.

Introduction: It is well-known that people with dementia living in residential care facilities spend most of their time not engaged in meaningful activities. Being involved in activities can improve their quality of life. Animal-assisted therapy is an activity that can evoke engagement and joy. Another way to create engagement and promote communication between people with dementia and caregivers is to use photos. Methods: In this observational study, the researchers combined animal-assisted therapy and photobooks in order to explore whether photos of people with dementia who were engaged in animal-assisted therapy could be used as a tool for communication in dementia care. Ten persons (4 men and 6 women; aged 72–92) with dementia were video recorded during photo-elicited conversations with a dog handler/assistant nurse. The recordings were conducted in two residential care facilities in Sweden during 2017–2018. Each participant was video recorded 2–4 times. The recordings were analysed using The Observed Emotion Rating Scale and The Observational Measurement of Engagement-OME Modified. In addition, the video recordings were interpreted from a hermeneutic perspective. Findings: The findings showed that the most frequently observed effects were pleasure and general alertness, and the participants were observed to be attentive most of the time. The most common attitude during the conversations was ‘somewhat positive’. The hermeneutic interpretations were grouped into four themes: Conveys a structure for the conversation with an inherent beginning and ending; An opportunity to recognise oneself and recall a sense of belonging; Awakens emotions and creates fellowship and Entails confirmation and revitalises their identity. Conclusion: Photobooks can be used by caregivers as a tool for meaningful and joyful communication with people with dementia, even those with severe dementia.

Aim To evaluate an intervention where nurses in child health care services routinely talk to and inform parents about violence. Methods The intervention included providing information during home visits and individual conversations with mothers and fathers/partners in connection with screening for parental depression. A convergent mixed-methods design was used with a documentation form for each child (n = 475) and results from focus group interviews with nurses. Quantitative data were analysed using descriptive statistics and qualitative with manifest content analysis. Results Almost all families participated in the intervention; individual conversations were conducted with nearly all the mothers, and to a somewhat lesser extent with the fathers/partners. Initially, the nurses felt slightly uncomfortable about these conversations, but described experiencing development and professionalisation in their role of talking about violence. Parents' reactions were generally positive and they expressed appreciation for this topic being raised. Conclusion The results show that the intervention has been carried out successfully. The newborn period is a phase in which mothers and fathers are interested and receptive to knowledge and support in sensitive matters. Prerequisites for implementation were the preparation phase for the nurses, the use of routine questioning and a questionnaire as a basis for the conversations.