Anna-Lena Stenlund

Aim: To explore how cardiovascular risk communication is constructed, negotiated and enacted in practice to persons with type 2 diabetes. Design: Qualitative. Methods: Individual interviews were conducted with 14 HCPs in primary care. Data were analysed using the constructivist grounded theory method. Results: The core category, ‘Striving to enhance cardiovascular risk awareness in persons with type 2 diabetes while balancing responsibility and uncertainty’, captures the challenges in making CVD risk understandable and meaningful for patients. Four categories describe the HCPs' work: Navigating a complex assessment of cardiovascular risk, struggling to communicate cardiovascular risk in a pedagogical way, trying to build a trusting relationship and simultaneously highlighting the disease severity, and experiencing loneliness and requesting organisational changes. Conclusions: Healthcare professionals (HCPs) recognised their significant responsibility for cardiovascular risk communication, but simultaneously experienced uncertainty about how to assess patients' individual CVD risk. Diabetes specialist nurses described feelings of professional isolation, limited medical support from physicians and a lack of shared responsibility within the diabetes care team. HCPs also requested sufficient organisational resources. Implications for the Profession: Communicating cardiovascular risk remains difficult. Strengthening the role of HCPs in risk communication and ensuring they adopt a more person‐centred approach are essential to improving risk communication in primary healthcare. Impact: To assess cardiovascular risk and reveal patients' understanding, HCPs must go beyond education, build trust and understanding, and balance encouragement with demands. Reporting Method: COREQ checklist. Patient or Public Contribution: No patient or public contribution.

Background: Many persons with type 2 diabetes (T2D) lack risk awareness or underestimate their cardiovascular risk. Although health care professionals in primary health care strive to implement risk-awareness strategies for cardiovascular risk, persons with T2D report a lack of meaningful dialogue with health care professionals. Co-creation is grounded in participatory action research and involves participants as equal partners across all stages of a project. This study describes the development of an intervention to increase cardiovascular risk awareness in people with T2D. Objective: This study aims to describe the co-creation process of developing an intervention to increase awareness of cardiovascular risk in persons with T2D. Methods: A co-creative design was used to develop an intervention following a participatory action research framework. Four workshops with persons with T2D, diabetes specialist nurses, and physicians in primary health care explored communication about cardiovascular risk, co-identified needs, co-designed solutions, tested prototypes, and redefined and retested the content of the intervention. The data were analyzed using reflexive thematic analysis. Results: The analysis identified 4 themes: co-define: taking the person’s voice into account; co-design: problem-solving and generating ideas; prototype and test: drafting intervention proposals; and redefine and retest: reviewing suggested interventions. The workshop discussions highlighted the need for new interventions, including a risk assessment tool, a patient handbook, material to prompt reflection, and a web education for specialist diabetes nurses. Conclusions: This study demonstrates the value of co-creation, which was used to develop an intervention to enhance cardiovascular risk awareness in persons with T2D. Diabetes specialist nurses need to explore patients’ perceptions of risk and provide space for emotional responses. The web education is intended to strengthen the person-centered approach of diabetes specialist nurses, the patient handbook encourages reflection and dialogue on personal risk, and the risk assessment tool visualizes individual risk. These components may contribute to increased awareness of cardiovascular risk.

BACKGROUND Many persons with type 2 diabetes lack risk awareness or underestimate their cardiovascular risk. Although healthcare professionals in primary healthcare strive to implement risk-awareness strategies for cardiovascular risk, persons with type 2 diabetes report a lack of meaningful dialogue with the healthcare professionals. Co-creation is grounded in Participatory Action Research (PAR) and involves participants as equal partners across all stages of a project. This study describes the development of an intervention to increase cardiovascular risk awareness in people with type 2 diabetes. OBJECTIVE To describe the co-creation process of developing an intervention to increase awareness of cardiovascular risk in persons with type 2 diabetes (T2D). METHODS Design:A co-creative design was used to develop an intervention following a Participatory Action Research (PAR) framework. Methods: Four workshops with persons with T2D, diabetes specialist nurses, and physicians in primary healthcare explored communication about cardiovascular risk, co-identified needs, co-designed solutions, tested prototypes, and redefined and retested the content of the intervention. Data were analysed using reflexive thematic analysis. RESULTS The analysis identified four themes: Co-define: Taking the person’s voice into account; Co-design: problem-solving and generating ideas; Prototype and test: drafting intervention proposals; and Re-define and re-test: reviewing suggested interventions. The workshop discussions highlighted the need for new interventions, including a risk-assessment tool, a patient handbook, material to prompt reflection, and a webb education for specialist diabetes nurses. CONCLUSIONS This study demonstrates the value of co-creation, which was used to develop an intervention to enhance cardiovascular risk awareness in persons with T2D. Diabetes specialist nurses need to explore patients’ perceptions of risk and provide space for emotional responses. The Webb education is intended to strengthen the person-centred approach of diabetes specialist nurses, the patient handbook encourages reflection and dialogue on personal risk, and the risk-assessment tool visualises individual risk. These components may contribute to increased awareness of cardiovascular risk.

To describe the process of becoming aware of and acting on personal cardiovascular (CVD) risk in type 2 diabetes (T2D). A purposive sample of 14 persons living with T2D participated in semi-structured, open-ended, in-dept interviews. The interviews were analysed with grounded theory. The analysis identified the core category "Balancing emotions, integrating knowledge and understanding to achieve risk awareness and act on it." Five categories describe the movement from not being aware of the risk of cardiovascular disease (CVD) to becoming aware of this risk and taking action to reduce it. Persons with T2D need to transform their knowledge and experience of CVD risk and incorporate it in their individual situations. Emotional and existential experiences of CVD risk can lead to awareness about the severity of the condition and contribute to increased motivation for self-management. However, an overly high emotional response can be overwhelming and may result in insufficient self-management. Persons with T2D seemed not to fully grasp their increased risk of CVD or recognize that self-management activities were aimed at reducing this risk. However, their awareness of CVD risk gradually increased as they came to understand the severity of T2D and became more emotionally and existentially engaged.

The Covid-19 pandemic has generated new experiences of intensive care. It has entailed new working methods, treatment strategies, and ethical dilemmas. The aim of this study was to describe intensive care nurses’ experiences of Covid-19 care and its ethical challenges. Data collection consisted of 11 individual semi-structured interviews and a qualitative content analysis was used. The COREQ checklist was followed. Three main themes emerged: to meet Covid-19 patients’ needs for specifically tailored intensive care; to have a changed approach to the excluded relatives is unethical, but defensible; and to strive to protect ethical values needs to be considered as good enough. In conclusion, ICU nurses shouldered a heavy burden in taking responsibility for the safety of these patients, continuously learning about new treatment strategies. Caring for Covid-19 patients was to strive to make the best of the situation.