Background: Suffering a myocardial infarction (MI) is a life-threatening event that impacts not only on the individual concerned but also on the next of kin. However, there seems to be a paucity of naturalistic inquiries that focus specifically on midlife next of kin and their experience of being close to a relative who has suffered an MI. This study aims to elucidate the experience of being a midlife next of kin of a relative who has suffered a myocardial infarction. Method: Nine women and four men in midlife participated in the focused interviews, which were conducted and analysed during 2010/2011 using Lindseths and Norbergs' description of the phenomenological hermeneutical method. Findings: Four themes - Solely responsible, Lurking unease, Left out of the picture and Life on hold - formed the basis of the core theme Standing alone when life takes an unexpected turn. The core theme was interpreted as a central phenomenon encompassing the experience of being solely responsible for the well-being of their relative and the family, thus putting their own life on hold. The core theme also reflected the next of kin's experience of being left out of the picture when it came to the relative's care before and after the MI. Conclusion: The next of kin's negative feelings of standing alone were further intensified by their experience of being left out of the picture by the healthcare professionals concerning their relative's care. As a cardiac nurse, it would seem essential to have knowledge about the experiences of next of kin in connection with a relative's MI event. Such knowledge can facilitate the planning and organisation of nursing care and at the same time address the next of kin's role in the recovery and rehabilitation process.

he population is ageing the world over, and there is an increasing prevalence of chronic illness and complex conditions. Older people are at greater risk of having several complications than the general population, leading to more time spent in hospital and an increased risk of readmission. The most specific need of older patients is often the multiple need of care. The aim of this study was to describe older patients’ experiences of caretime during a hospitalization in a medical ward. Data were collected with semi-structured interviews with nine older patients, and analysed using qualitative thematic content analysis. The analysis resulted in two themes and five categories. The results show that caretime during hospitalization includes a lot of waiting and that patients manage the waiting in different ways. The results also point out the importance of patients developing good relationships with professionals since good relations creates feelings of security and can reduce anxiety and fear during a hospital stay. The patients pointed out the importance of being more involved in their own care and asked for more detailed information about the hospital stay. The results revealed that information makes patients’ more secure and safe during a hospitalization and makes them participate and affect their own care and treatment more.

The implementation of clinical practice guidelines (CPGs) has become an increasingly common element of clinical care, but little qualitative research has been conducted in real-life settings. The aim was to elucidate experiences and factors of importance for the implementation of CPGs in hospital care. Twenty interviews were conducted, audio-taped and transcribed verbatim. A manifest and latent content analysis was performed to interpret the text. A system of subcategories related to five categories and one overall theme were developed. the data reveal that the implementation of CPGs is continnuous processes of creating reliable and tenable routines that involve all staff members and expect to lead to better and safer patient care as well as to increased knowledge and confidence among staff. The process is initiated by internal or external demands and represents a way to keep abreast of knowledge development. Several factors facilitate the implementation and have influence on the use and compliance with CPGs. To increase support for and willingness to use the CPGs, it appears important to involve all staffs in the implementation process as well as to follow up and give feedback continuously to staff and management. It seems necessary toevaluate the process to supervise compliancewith CPGs and to balance priorities and costs. Evaluationcan also demonstrate importance of the application.

Pain is a common problem for older persons who need professional help for their daily living. In this study 94 older persons (75+) in persistent pain were compared with 52 care providers concerning the pain management methods they had used/administered during the previous week and how helpful they perceived these methods to be. interviews were based on 16 items from the original version of the pain management inventory (PMI). Both groups perceived prescribed medication, rest and distraction as the most frequently utilized methods. Specific methods such as transcutaneous electrical nerve stimulation (TENS) or bracing/splinting or bandaging the affected body part were seldom employed, although most users perceived these methods as helpful. Care providers perceived most methods for managing pain as more effective than older persons did. The results imply that care providers need skills in a variety of pharmacological and nonpharmacological methods to manage pain and a need to evaluate effectiveness of the methods in a systematic way.

Nowadays, nursing research is seen as an integral part of professional nursing although implementing knowledge derived from nursing research into the practice setting is still problematic. Current research, conducted mainly with a descriptive quantitative design, highlights the struggle experienced by Registered Nurses (RNs) to use and implement research findings in clinical practice. Therefore, the aim of this naturalistic inquiry was to explore nurses' perception of nursing research and its implementation in a clinical context. Method and sample: A qualitative approach was chosen, and four focus group discussions were conducted. The groups comprised a total of 16 RNs (three men and 13 women) working in a secondary care setting. The transcribed texts were analysed, inspired by Burnard's description of content analysis. Findings: The texts were interpreted as representing three predominant themes: scholastic, individual and contextual influences highlighted as influential components impacting on the RNs' views on research and its implementation as well as on their readiness to accept and support it. However, the most influential aspect permeating our themes was their educational background - the type of qualification they held. In general, the RNs with a Bachelor of Science in Nursing viewed research and the implementation of knowledge in practice more favourably than those RNs with a diploma. Conclusion: Our findings, although based on a small qualitative study, are congruent with others, indicating that further research is warranted concerning the impact of education on RNs' views of nursing research and its implementation. Hence, it might well be that the RNs' educational point of departure needs to be stressed more than what so far have been anticipated. In the meanwhile, it is possible that a number of strategies could be tested to promote a more favourable view in these issues and where the nursing education has the possibility to influence this endeavour.

This study describes the intergenerational relations influence on the care of the aged in a transitional period expressed by a group of aged South Africans and their family members. Focused ethnographic research was carried out from 2001 to 2006 in a semi-rural area in central South Africa. Twenty-nine participants representing 16 families took part in multiple group interviews. The data was supplemented through individual interviews with 10 of the participants as well as home visits, participation in community activities, notes and video recording. The transcribed interview texts were analysed using qualitative content analysis. The study shows aspects of tradition in transition as reciprocal care between generations, the significance of traditional values and the impact of modernization on care. The findings reveal the on going transition in Africa influencing the role of the aged as well as the reciprocal care within the extended family. The study also discloses that in reciprocal relationships, family members do not necessarily have a biological bond and that revaluing of traditions can be seen as a response to social and economic change and as a tool to maintain influence. This ethnographic study contributes knowledge in the field of gerontological care, by illuminating the impact of transition on the role of aged as well as the caring of the aged in the extended family an important issue for health professionals caring for a growing number of older persons in Southern Africa and in countries with a large representation of minority groups from developing countries.

Being a caregiver with responsibility for someone with reduced health compared with not being a caregiver maymean different views of life satisfaction. Knowledge of what leads to reduced life satisfaction in caregivers may be helpful in interventions. Informal caregivers gainfully employed or not, aged 50–89 years, were studied with regard to life satisfaction depending on the extent of caregiving to identify types of social support of value for caregivers. A cross-sectional study was conducted including a sample of 151 informal caregivers with a high caregiving extent, 392 caregivers with a lower caregiving extent and 1258 non-caregivers. The sample was randomly selected to correspond with older Swedes as a whole aged 50–89 years. A questionnaire containing a modified form of Older Americans’ Resources Schedule (OARS) and Life Satisfaction Index Z (LSIZ) was used; 19.6% helped someone with activities of daily living and of these 27% stated that they did so frequently. Frequent caregivingimplied significantly higher age, being more often married and retired, than less frequent caregivers and non-caregivers. Frequent caregivers also performed personal activities of daily living (PADL) to a higher extent than less frequent caregivers and had significantly lower LSIZ (mean 14.8) than less frequent caregivers (mean 17.6) and noncaregivers (mean 17.7). No significant differences were found between less frequent caregivers and non-caregivers in LSIZ. One-fourth had support from others, the commonesttype being able to converse with a next of kin, and help and advice from professionals. Lower life satisfaction was associated with not being employed, low social resources, not refreshed after a night’s sleep, overall poor health and frequent caregiving in the entire sample. High caregiving extent was associated with lower life satisfaction. The most important factors explaining lower life satisfaction among frequent caregivers were having low social resources and having poor health. Economic compensation or payment was the support most desired.

The aim was to illuminate elderly persons' experiences of living with venous leg ulcer. Fifteen persons 74-89 years of age with active leg ulcer were interviewed. Data were analysed utilizing a phenomenological-hermeneutic approach inspired by Ricoeur. The analysis includes dialectic movement between understanding and explanation of the text as a whole and its parts, In the structural analysis four themes were identified: emotional consequences of altered body image, living a restricted life, achievement of well-being in connection with a painful wound and bandage, and struggle between hope and despair with regard to a lengthy healing process. The comprehensive understanding indicated that the meaning of living with venous leg ulcer can be understood as a dialectal relationship between, on the one hand the feeling of being imprisoned in the body, the bandage and the home, and on the other hand, hope of freedom from a burdensome body. The results indicate that the concept, body of image, is vitally relevant to the caring, of elderly people with venous leg ulcer. The study shows the importance of recognizing the persons' perceptions of their leg ulcers and the impact of these perceptions on well-being. Nurses can thereby anticipate problems and provide more sensitive care.

Although the ability to perform activities of daily living (ADL) is frequently used to identify the impact on daily living caused by health problems such as diseases, impaired eyesight or hearing, it is still not well known what makes people feel hindered in daily living with more or less inability to perform ADL. The aim of this study was to investigate feeling hindered by health problems in daily living among people (n = 958, 60-96 years) in relation to ADL capacity, health problems as well as social and financial resources, sense of coherence and life satisfaction. The data are taken from a baseline survey in one of the four included centres (Blekinge) of the longitudinal multicentre cohort study, The Swedish National Study on Aging and Care. The result showed that people felt hindered by their health problems despite no impairment in ADL capacity. Feeling greatly hindered by health problems was associated with factors linked to mobility but also to fatigue, no help when needed, and avoiding being outdoors due to fear of falling. Factors associated with feeling greatly hindered differed depending on whether people were impaired in ADL capacity or not. In people with excellent ADL capacity feeling hindered was associated with picking up things from the floor and rising from a chair and fatigue, whereas avoiding being outdoors, no help when needed and rising from a chair were found to be associated with feeling hindered by health problems among people with impaired ADL capacity. Combining people's ADL capacity with questions about feeling hindered may provide knowledge of determinant factors of feeling hindered in relation to ADL capacity, impaired or not, to identify people in need of rehabilitation or other interventions.

Background: The Swedish healthcare system employs information and communication technologies (ICT) in nursing practice to meet quality-, security- and efficiency-related demands. Although ICT is integrated with nursing practices, nurses do not always feel that they are convenient to use it. We need to improve our knowledge of the role of ICT in healthcare environments and so we decided to complement existing experience of how ICT influences nursing practice. Aim: This study aimed to review and synthesise the available literature on the role of ICT in nursing practice in Swedish healthcare settings. Method: To consolidate previous studies based on diverse methodologies, an integrative literature review was carried out. Three databases were used to search for literature, 20 articles met the inclusion criteria. Results: The literature review indicates that ICT integration into nursing practice is a complex process that impacts nurses’ communication and relationships in patient care, working conditions, and professional identities and development. Nurses are found to express ambiguous views on ICT as a usable service in their everyday practice since it impacts both positively and negatively. Discussion and conclusion: Although ICT cannot replace physical presence, it can be considered a complementary service that gives rise to improved patient care. However, nonverbal communication cues may be missed when ICT is used as mediating tool and ICT can be limiting because it is not always designed to meet nurse and patient needs. The meaning of an encounter appears to change when ICT is used in nursing practice, not only for patient relationships but also for interpersonal communication.

Aims and objectives: To describe and analyse to what extent the goals of the education in promoting culturally competent nursing care have been achieved from a student perspective. B: As Sweden has transformed into a multicultural society over the past 50 years, there is a need to specify, at all levels of the nursing programme, transcultural concepts for the success of integration. A research-based didactic model was designed for the nursing programme at Malmö University and this was followed by investigations of its outcome. Method: The study is a prospective cohort study with an outcome analysis. A descriptive research study with a longitudinal design was performed, with the focus on Swedish nursing students´experiences of transcultural nursing knowledge and their attitudes before and after implementation of the didactic model. The students evaluate highly their competence to meet demands of multicultural health and medical service. Additionally, their ability to recognise and understand the consequences of international migration on health also received a high mean. Conclusions: The study revealed the knowledge and experience acquired by Swedish students in transcultural nursing. The assumption was that a visible development of knowledge should occurduring the three years of education. Interpreting the findings, such effectiveness can be found and hopefully the students will be able to give holistic nursing care based on a person's individual culture.

The aim of this study was to investigate determinants of help from informal or formal caregivers or a combination of both among people aged 75 or more and living at home, and the characteristics of the recipients, the help they received and their quality of life (QoL). The sample for this study was 448 elderly people, 75-99 years of age, living at home and receiving help with activities for daily living, instrumental or both instrumental and personal. Regression analysis showed high QoL not to be significantly related to who was providing the help, whilst it was related to higher age, living with someone, lower number of complaints and managing to be alone at home. Multinomial regression analysis showed age, number of children, number of complaints, the ability to stay alone at home and living alone to predict receiving help from different kinds of caregivers. Recipients receiving help from informal caregivers were younger, more often married and living together with someone, whilst those receiving help from both informal and formal caregivers had more help with instrumental and personal activities for daily living and were not able to stay alone at home as much as those receiving help from other kinds of caregivers. Those receiving help from formal caregivers had fewer children, were single and were living alone more often than the other recipients. Thus the responsibility for help for elderly people rests heavily on informal caregivers, whom it seems essential to support. As public service at home is preferably given to those living alone or able to stay alone at home, those without relatives may not be able to remain at home when their need of help increases.

Little is known about the dyadic experience over time of people with dementia and their next of kin. The aim of this study was to investigate the state of mind of people with dementia, their next of kin’s experience of burden and satisfaction, and factors associated with these experiences over a 3-year period. The sample consisted of 32 people with dementia living at home with family caregivers in the south of Sweden. Data were collected during the period 2004–2007 and consisted of patients self reports (GDS), dementia nurse assessment (MMSE, Berger and ADL) and next-of-kin assessment (patient’s state of mind and care provision). Data also consisted of nextof- kin’s self reports concerning health, burden and satisfaction. The result showed that patients’ state of mind was mainly positive at baseline but a deterioration was seen over time in the patient’s mood and cognitive functioning together with an increase in ADLdependency and suspected depression. Dependency in personal ADL entailed a higher risk of being in a negative state of mind. For next of kin the experience of burden increased while satisfaction decreased over the 3 years. The inter-relationship between the patients’ mood and the caregiver’s satisfaction and burden seems to get stronger over time. At baseline caregiver burden was mainly related to the next of kins’ general health and to patient behaviours that were difficult to handle. During the progression of the disease caregiver satisfaction becomes increasingly related to patient state of mind and dependency. There is, however, a need for more research focusing on the specific inter-relational aspects as previous studies have mainly focused on either the situation for the person with dementia or on the caregiver.

Older people are at risk of developing multi-comorbidity and thus being exposed to multiple treatments and drugs to manage the emerging health complaints. More focus has been put on nonpharmacological alternatives. However, studies revealing the healthcare staff perspective on using nonpharmacological methods (NPMs) in the care of older people are still lacking. Thus, the aim of this study was to map the use of NPMs in daily practices and the follow-up thereof. A population-based survey with questionnaires was performed, included all healthcare professionals (n = 163; nurses and paramedical professionals) working in one district of elderly care in Sweden. The older person's anxiety and worry (76.1%), sleeping problems (53.1%) and pain (41.1%) were the health problems in daily life most likely to trigger use of NPMs. To manage the emerging health problems, interactions (87.1%), diet and nutrition supplements (63.2%) and physical activity were commonly used, particularly by nurses. One third (n = 54) stated that they did not evaluate the NPMs used, with no statistical differences between nurses and paramedical professionals. The present study indicated that NPMs were used in care of older people among nurses and paramedical professionals, but not in a systematic way and often without follow-up.

Older individuals with chronic atrial fibrillation (AF) often experience physical symptoms and feel psychologically unwell. In addition, these persons are prescribed lifelong medical treatment that requires regular monitoring. Through 11 individual interviews, this interpretive description study aimed to explore and describe lifelong medical treatment and the need for medical controls as experienced from the perspective of older individuals living with chronic AF. The interviews were performed during 2014–2015; furthermore, they were recorded, transcribed verbatim and analysed for thematic patterns using thematic analysis inspired by Braun and Clarke. Ethical standards were followed throughout the study. The findings revealed one main theme: ‘ambivalence in the need of knowledge’ showing that lifelong medical treatment and the need for medical controls, in general, meant experiencing feelings of ‘it doesn't matter, but it does matter’ and ‘being in the hands of the healthcare system’. The older persons lacked knowledge about their condition, which generated poor insight into their medical treatment and this in turn affected their daily life. They had thoughts and questions about their medication, but did not have an opportunity to ask the questions because of lack of follow-up from the healthcare system. The findings underscore the negative impact chronic AF has on older people's life and emphasises the need for follow-up and providing information from health care to these individuals. © 2017 Nordic College of Caring Science

This is an inquiry into how significant others experience being close to a woman suffering from breast cancer. In order to find this out, theme interviews were arranged with 17 women and 16 significant others from four different caring cultures in Sweden and Finland. A phenomenological case study methodology was adopted and in the analysis of the data a scientific teamwork model was employed, based on ideas developed at the Vancouver School of Doing Phenomenology. The findings show that the significant others experience deep often unrelieved suffering. They consider themselves prisoners of a situation of uncertainty and powerlessness when standing by the woman. They are torn between their own suffering and their desire to alleviate the woman's suffering. A vicious circle of mutual protection intensifies the suffering of the significant other, while actively sharing the suffering brings relief. The gravity of the situation creates an ethical urge in the significant other to assume responsibility for life in common with the woman.

Introduction: The efforts of relatives in providing palliative care (PC) at home are important. Relatives take great responsibility, face many challenges and are at increased risk of poor physical and mental health. Support for these relatives is important, but they often do not receive the support they need. When PC is provided at home, the support for relatives before and after a patient's death must be improved. This study aimed to describe relatives' suggestions to improve the support from health professionals (HPs) before and after a patient's death in general PC at home. Methods: This study had a qualitative descriptive design based on the data from open-ended questions in a survey collected from the Swedish Register of Palliative Care. The respondents were adult relatives involved in general PC at home across Sweden. The textual data were analysed using thematic analysis. Results: The analysis identified four themes: (1) seeking increased access to HPs, (2) needing enhanced information, (3) desiring improved communication and (4) requesting individual support. Conclusions: It is important to understand and address how the support to relatives may be improved to reduce the unmet needs of relatives. The findings of this study offer some concrete suggestions for improvement on ways to support relatives. Further research should focus on tailored support interventions so that HPs can provide optimal support for relatives before and after a patient's death when PC is provided at home. © 2024 The Authors. Scandinavian Journal of Caring Sciences published by John Wiley & Sons Ltd on behalf of Nordic College of Caring Science.

The aim of this case study was to describe two District Nurses' (DN) experiences of using information and communication technology (ICT) to communicate with chronically ill people in their homes. An electronic messaging program via computers and mobile phones with an Internet connection was used, enabling DNs and the ill people to exchange messages to and from anywhere. The program comprised different virtual rooms, and communication was via text messages. The DNs in this study used the program two to four times each week from November 2003 to March 2004. Semi-structured interviews were performed before, during and after the implementation of the new technology and were analysed using thematic content analysis. The results showed that the DNs felt that the technology increased accessibility to nursing care through a more direct communication with the ill person meaning that a more trusting relationship could be created. The DNs also experienced that the use of ICT saved working time. This study indicates that the use of ICT for communication allowed the DN to better support a chronically ill person at home leading to improved home nursing care. This method of communication cannot replace physical presence, but can be seen as a complement to nursing care at home.

The objective was to investigate the quality of standardized care plans and the extent to which they are used within Swedish in-hospital somatic care. Further, to examine the quality of the knowledge summaries on which existing standardized care plans were supposed to be based. Submitted documents were reviewed with studyspecific protocols. The setting was a national survey, based on a structured selection of Swedish hospitals. A total of 25 Swedish hospitals participated, and were asked to submit all documents in use that were labelled standardized care plans. Only 4% (34 out of 782) of the reviewed documents fulfilled the criteria for being a standardized care plan. None of the 34 knowledge summaries (an accompanying document with a compilation of scientif facts and reliable experience) was evidence-based. the conclusion is that there is a lack of knowledge regarding what a standardized care plan is, and how such a document should emanate from evidence-based knowledge. Our results raise the question of how recent developments in research are used to create standardized care plans for the best possible care. In the process of developing standardized care plans it is important to acknowledge that staff who develop these plans need scientific training end experience. Standardized care plans are in the early stages of development, and at this stage it seems appropriate to initiate a discussion regarding possible cooperation at national level when developing standardized care plans for certain groups of patients suffering from specific diseases, or undergoing the same treatment.

Background Health communication (HC) is a vast research field focusing on changing health behaviours, and rapidly evolving technology is creating different ways and possibilities to reach target groups and audiences. In the context of home care, a deeper understanding of HC is lacking, specifically for older persons with care needs and their informal caregivers. The aim of this concept analysis is to identify and construct the meaning of HC from the perspective of older persons in need of care in the home environment and their informal caregivers. Materials and methods This study utilised Rogers' (2000) Evolutionary Concept Analysis Method (EMCA) to create and construct a meaning of the concept of HC. The EMCA was based on a systematic literature review of scientific articles, using CINAHL, Pubmed and Inspec (2000-2017). A total of 29 articles were retrieved and analysed. Results The identified attributes of the concept were as follows: resources of the recipient, influence on decisions and advantages of tailored information. HC was described as both contributing to knowledge as well as being overwhelming where habits and resources influenced the use of information. The attributes led to the following descriptive definition of HC: 'Tailored HC, based on needs and resources of the recipient influence care decisions'. The home environment influenced HC by habits and interactions between older persons and their informal caregivers. Conclusions The home environment influenced HC in terms of social aspects of interactions and habits and between the older person and the informal caregiver. Tailored information with the use of technology contributed to knowledge in care of older persons and their informal caregivers. HC was shown to contribute to improve care for older people in their home environment.

Background: Cancer treatment often causes side effects, among which fatigue is common and can persist for years among disease-free cancer survivors. Living with fatigue can lead to reduced life expectancy and quality of life. Aims and objectives: To describe oncology nurses’ experiences of meeting with men with cancer and talking about cancer-related fatigue. Design and Methods: The data were collected via semi-structured interviews with nine oncology nurses recruited using a purposeful sampling method and analysed using thematic content analysis. This qualitative design was conducted to describe and interpret the content of experiences. Ethical issues and approval: The study was approved by a regional Ethical Review Board, and research ethical principles were followed. Results: The analysis revealed one major theme, namely take the whole person into consideration, and three subthemes: the importance of (i) establishing trust in the nurse–patient relationship, (ii) supporting the patient’s understanding of cancer-related fatigue, and (iii) managing the challenging emotions experienced by patients. The major theme describes the oncology nurses’ approach when meeting with men with cancer-related fatigue. Conclusion: The results provide insight into how oncology nurses can increase their knowledge about fatigue to establish trust in nurse–patient relationships. They can acquire knowledge about how to make men with cancer-related fatigue feel safe when handling their daily lives despite their fatigue. Oncology nurses require knowledge, presence and commitment in their interactions with men with cancer-related fatigue to be able to take the whole person into consideration. This study demonstrates the importance of the approach oncology nurses take when interacting with men with cancer-related fatigue and the strategies required when talking about cancer-related fatigue. © 2020 The Authors. Scandinavian Journal of Caring Sciences published by John Wiley & Sons Ltd on behalf of Nordic College of Caring Science

The purpose of the study was to gain a deeper understanding of how children with disabilities perceive their technical aids in play situations. Transcribed interviews with eight children with disabilities were analysed according to the constant comparative method of grounded theory described by Glaser & Strauss. Three categories were found in the data, forming a model describing the child's relations in play situations (core category): to technical aids, to assistance and to the play environment. Two of the categories included relations to adults. The children's opportunities to play required that a parent or an assistant be present. Access to the playground also required the assistance of adults. The third category, relation to technical aids, is an individual one, as the technical aids were perceived differently by all the children. The technical aids were also seen as an extension of the child. The implications for parents and service providers are discussed

The purpose of this study was to describe how a child with obesity perceived participation in play activities. A single-case study design was chosen to optimize the understanding of the complexities of the research question. A 9-year-old boy diagnosed with obesity was studied. This is a typical case and is studied mainly to provide understanding to the issue. The data were collected from interviews with the boy, his mother and his teacher. Data were also collected through observations and a self-report assessment instrument called Kid Play Profile. The results showed that the boy was ridiculed by his peers and that at times he felt excluded from them, which prevented him from participating in play activities. The boy's experience came from different perceived problems such as lack of friends to play with, his inability to know how to perform in different play activities, and lack of proper support and encouragement from adults. Supporting children to overcome social skills deficits could prevent them from being teased and may have a positive effect on health. To optimize children's participation in play activities, it is important for adults to give them proper support and encouragement. The results were discussed with regard to earlier research, and topics for further research are suggested.

Complaints with encounters in healthcare - men's experiences Good encounters within healthcare are important for the manner in which ill people facilitate their health and their perception of quality of care. Research about quality of care are important, but point out that dissatisfaction with healthcare may in the future be even more common regarding the demands for a more effective healthcare. The aim of this study was therefore to describe experiences of dissatisfaction with encounters in healthcare among men who personally filed a complaint to the Patients' Advisory Committee in the county council. Qualitative data were collected in semi-structured interviews with a purposive sample of nine men who have filed a complaint to the Patients' Advisory Committee. The analysis resulted in two categories: being met with a disrespectful manner and not receiving a personal apology. The results in the first category describe that the men were treated with disrespect and suspicions by healthcare professionals. This was related to lack of communication which made the men sensitive to negative attitudes on the part of professionals. The results in the second category show that the men expected amends to be made in form of a personal apology about the dissatisfaction. The men were given no opportunities to influence the encounters and the professionals were unconscious of their behaviour in form of bad treatment. In conclusion, the results indicate the importance of meeting patients and their relatives with respect and dignity, listening to their experiences and proceeding with the treatment without insulting anyone as a person. © 2011 The Authors. Scandinavian Journal of Caring Sciences

BackgroundFatigue is reported to be one of the most common symptoms among people with chronic obstructive pulmonary disease COPD. However, there is hardly any qualitative research describing how fatigue affects people living with this illness.AimTo describe people's experience of fatigue in daily life when living with moderate to very severe COPD.MethodsA purposive sample of 20 people with COPD stages II–IV was recruited from the Obstructive Lung Disease in Northern Sweden COPD study. Data were collected through semi-structured interviews with participants regarding their experience of fatigue. The interviews were subjected to qualitative content analysis.ResultsOne theme was identified: Reconcile with the dimensions of fatigue, and four categories were identified: To understand the reasons of fatigue, To preserve fatigue unexpressed, When fatigue takes control and How to manage fatigue. Fatigue seems to be an always-present feeling, involving the whole body, raising feelings of hopelessness and controlling one's life. It seems to be accepted as a natural consequence of COPD and may therefore remain unexpressed. Further, when experienced with dyspnoea, fatigue becomes even heavier and more difficult to manage. To gain control of fatigue, people plan daily life and continue with physical activities.ConclusionFatigue affects the daily lives of people with COPD. Perceived with dyspnoea, fatigue was described as overwhelming. Most importantly, fatigue seems to be unexpressed to healthcare professionals and relatives.

The aim of this study was to describe female patients' experiences of dissatisfaction with healthcare. People who have been treated with dignity during healthcare encounters are more prone to report better adherence to treatment and higher satisfaction with their care. Good quality care is commonly described as individualized and related to individual needs. This study has a qualitative approach, as the aim was to describe female patients' experiences of dissatisfaction with healthcare from a first person perspective. A purposive sample of fourteen women was interviewed about their experiences of dissatisfaction with healthcare. The interviews were subjected to a qualitative content analysis. The findings show that the women were treated with indifference when they were being withheld information, felt distrusted, and when they were treated badly they did not receive an apology. The findings also show that the women experienced that they did not feel safe when they had no one liable to turn to within the healthcare when the encounter did not correspond to the women's needs and expectations. The women's experiences of being withheld explanations can be seen as a violation of their dignity and a hidden suffering from care. In conclusion, the study shows the importance of receiving a personal explanation after filing a complaint about healthcare and recommends that clinics that receive a complaint from a patient should contact that patient and provide an individualized explanation

Good encounters are fundamental for good and professional nursing care, and can be described as treating patients with respect and protecting their integrity and autonomy. This study describes district nurses' views on quality of healthcare encounters in primary healthcare. A purposive sample of 27 district nurses participated in five focus group interviews. The focus groups interviews were digitally recorded and transcribed verbatim. The interview texts were analysed using a thematic content analysis. The analysis resulted in four themes, including being aware of the importance and difficulties during encounters, being the patient's advocate, being attentive to the unique person and being informed when a meeting turned out poorly. The results show that district nurses believed that encounters formed the basis of their work and it was vital for them to be aware of any difficulties. District nurses found that acting in a professional manner during encounters is the most significant factor, but this type of interaction was sometimes difficult because of stress and lack of time. The district nurses considered themselves to be the patients' advocate in the healthcare system; in addition, the acts of seeing, listening, believing and treating the patient seriously were important for providing good quality care. If a poor encounter occurred between the district nurse and the patient, the district nurses found that it was necessary to arrange a meeting to properly communicate what problems arose during the interaction. The district nurses highlighted that providing an apology and explanation could improve future encounters and establish a better nurse–patient relationship. In conclusion, this study shows the importance of confirming and respecting patients' dignity as the fundamental basis for a good quality encounter in primary healthcare