Monica Bergqvist

The number of older adults living with multiple long-term conditions is steadily increasing [1,2]. As these conditions progress, frailty – characterized by declining functions and decreased resilie...

Background: Family members are often the primary caregivers for individuals with dementia, but they face significant challenges in navigating health care and social services, especially as the disease progresses. Many caregivers experience loneliness, social isolation, and stress from sacrificing their own well-being. This study aimed to describe the daily experiences of family caregivers of individuals with dementia, with the objective of better understanding and addressing their specific needs. Methods: Qualitative interviews with 11 family caregivers in Sweden. Data were analyzed by inductive thematic analysis. Results: Three themes were identified: (1) Struggling with conflicting emotions and social challenges - caregivers reported experiencing stress, physical exhaustion, and emotional strain due to constant availability and the challenges of managing behavioral changes, further intensified by isolation and shrinking social networks. (2) Balancing autonomy in care decisions - caregivers described the paradox of bearing full responsibility for care decisions despite having limited access to information, and, (3) Dependence on home care and nursing homes that are not adapted to needs - caregivers expressed a reliance on home care and nursing homes, yet noted that these services are often ill-equipped to address the specific demands of dementia care. Conclusion: Caring for a family member with dementia reshapes family roles and creates ongoing challenges in balancing safety, well-being, and limited support. This study highlights the need for person- and family-centered care, grounded in the home context and developed in partnership with family caregivers. Improved coordination, trained staff, and supportive policies are essential, alongside continued conceptual development to define best practices in dementia care.

Background: Adherence to guideline-recommended drug treatment for heart failure (HF) is lower among patients managed in primary care compared with cardiology care. Understanding more about the patient group managed in primary care only is important. Aim: To compare the sociodemographic characteristics, comorbidities, care use, and drug dispensation of older patients with HF managed exclusively in primary care with those who are also managed in cardiology care. Design and setting: A register-based study using real-world administrative data from Stockholm, Sweden. Method: The study population comprised all individuals aged ≥60 years resident in Stockholm on 31 December 2022 with an HF diagnosis. The Total Population Register and several national health registers were linked, providing information on comorbidities, HF hospital admissions, primary care visits, and dispensed drugs. Individuals were categorised into those managed exclusively in primary care or those who were also managed in cardiology care by the absence/presence of an in-/outpatient appointment with a cardiologist during the past 5 years. Results: HF was prevalent in 33 872 of 524 250 (6.5%) individuals of whom 50.4% ( n = 17 067) were exclusively managed in primary care. Among patients also managed in cardiology care, two-thirds of HF drugs were prescribed by primary care. Primary care-managed patients were on average 3 years older, more often female, of lower socioeconomic status, had fewer comorbidities, received fewer guideline-recommended drugs, and had lower rates of admissions to hospital for HF than cardiology care-managed patients. Residing in a nursing home and having dementia were the factors most strongly associated with exclusive primary care management. Conclusion: Primary care manages the majority of individuals with HF, who are typically older than those patients who are also managed in cardiology care. These characteristics may explain differences in drug use.

Background: The early phase of the COVID-19 pandemic affected nursing homes and their residents heavily. Guidelines on how to mitigate the virus’s spread and ensuring safe healthcare delivery were continually evolving. Concurrently, nursing homes faced intense media scrutiny. This challenging environment severely impacted registered nurses and physicians employed within these facilities. Aim: To understand the ethical challenges experienced by registered nurses and physicians working in nursing homes during the COVID-19 pandemic. Research design: Qualitative descriptive research using thematic analysis. Participants and research context: Individual online interviews with four registered nurses and eight physicians clinically active at nursing homes in Sweden. Ethical considerations: The study was approved by the Swedish Ethical Review Authority. All participants provided written consent. Results: Registered nurses and physicians working in nursing homes perceived ethical challenges stemming from early COVID-19 pandemic guidelines and media coverage. The main theme generated was ‘Struggling to maintain professional and ethical standards under pressure’ incorporating two subthemes: ‘Guidelines developed without the profession put pressure on staff’ and ‘Media’s biased reporting was perceived as unethical and undermined care’. Guidelines from the authorities were considered as developed without professional involvement. It made them difficult to adhere to without deviating from professional and ethical compasses. Media coverage adversely influenced relatives’ perceptions, resulting in mistrust towards physicians’ and registered nurses’ in delivering optimal care for the residents. Conclusions: Resilient care in nursing homes necessitates the collaborative development of guidelines involving registered nurses and physicians, particularly amidst crises. Moreover, it is vital to provide support to registered nurses navigating ethical dilemmas, especially during pandemics. Guidelines and principles for care during a crisis should be development with professional involvement, be transparent, and be available to the public, to promote neutral media coverage. Future research is crucial to enhance ethical standards and tackle challenges in this context.

Background: NHs have been severely exposed during the COVID‐19 pandemic. Little is known about how staff who provide practical daily care of older residents experienced work during the pandemic. The aim of this study was to understand how nursing assistants (NAs) experienced their work at nursing homes (NHs) for older people during the first wave of the COVID‐19 pandemic.Methods: We conducted a qualitative study of focus group discussions with in total 20 participants from four NHs in Stockholm, Sweden. Discussions were held in November 2020. Transcripts were analyzed using inductive thematic analysis.Results: We identified three major themes: 1) We felt abandoned, scared and disrespected, 2) We made sure we made it through, and 3) We can do good work with appropriate resources. NAs felt disregarded as they were often left alone without adequate support from managers, registered nurses and the municipalities. NAs felt distressed and guilty and developed their own strategies to cope and manage their work.Conclusion and Implication for Practice: During the first wave of the COVID‐19 pandemic NAs felt abandoned and burdened due to lack of leadership. Organizational improvements are required to protect the wellbeing of NAs and to ensure sustainability of patient safety. NAs are crucial in the care for vulnerable older people and their experiences should constitute a keystone for development of future policy and practice in NHs.

Many studies address the prevalence of medication errors but few address medication errors serious enough to be regarded as malpractice. Other studies have analyzed the individual and system contributory factor leading to a medication error. Nurses have a key role in medication administration, and there are contradictory reports on the nurses’ work experience in relation to the risk and type for medication errors. All medication errors where a nurse was held responsible for malpractice (n = 585) during 11 years in Sweden were included. A qualitative content analysis and classification according to the type and the individual and system contributory factors was made. In order to test for possible differences between nurses’ work experience and associations within and between the errors and contributory factors, Fisher’s exact test was used, and Cohen’s kappa (k) was performed to estimate the magnitude and direction of the associations. There were a total of 613 medication errors in the 585 cases, the most common being “Wrong dose” (41 %), “Wrong patient” (13 %) and “Omission of drug” (12 %). In 95 % of the cases, an average of 1.4 individual contributory factors was found; the most common being “Negligence, forgetfulness or lack of attentiveness” (68 %), “Proper protocol not followed” (25 %), “Lack of knowledge” (13 %) and “Practice beyond scope” (12 %). In 78 % of the cases, an average of 1.7 system contributory factors was found; the most common being “Role overload” (36 %), “Unclear communication or orders” (30 %) and “Lack of adequate access to guidelines or unclear organisational routines” (30 %). The errors “Wrong patient due to mix-up of patients” and “Wrong route” and the contributory factors “Lack of knowledge” and “Negligence, forgetfulness or lack of attentiveness” were more common in less experienced nurses. The experienced nurses were more prone to “Practice beyond scope of practice” and to make errors in spite of “Lack of adequate access to guidelines or unclear organisational routines”. Medication errors regarded as malpractice in Sweden were of the same character as medication errors worldwide. A complex interplay between individual and system factors often contributed to the errors.