Vi fick möjlighet att resa till den 13:e Internationella Council of Nurses (ICN) Nätverkskonferens för Nurse Practitioner/Advanced Practice Nurse som hölls den 9–12 september 2024 i Aberdeen, Skottland. Där presenterade vi en studie om distriktssköterskors erfarenheter av att vårda patienter med multisjuklighet och psykisk ohälsa i primärvården. Konferensen samlade cirka 600 specialistsjuksköterskor från 45 olika länder, med en majoritet av deltagarna från Storbritannien, USA, Kanada, Kina och Europa. Från Norden var deltagandet begränsat, men vi träffade några kollegor från Universitetet i östra Finland (UEF) i Kuopio, även från Norge samt några deltagare från Vrinnevisjukhuset i Norrköping. 

Background: In Sweden, the number of populations aged 80 and older are increasing. The care needs of the population are changing as more people live at home longer with chronic conditions. District nurses (DNs) are specialist nurses in primary health care, and they have a leading role especially in care of patients with multiple chronic conditions. To meet this growing population, it is critical to understand how DNs currently see their work with these patients and how they consider care can be optimized.

Aim: To examine DNs experiences caring for people with multiple chronic conditions in an aging population.

Design: A qualitative study of five focus group interviews with fifteen DNs working at five primary health care centers in the Stockholm Region. Data was analyzed using reflective thematic analysis. Interviews were conducted between May 2023 and September 2023.

Results: We generated one central theme; Ready to take responsibility if there is room for complexity. Complexity was understood as not only related to patient factors, but also to the structure and limits provides by the health care organization, and the effects of communication and cooperation within and outside of health care. The four subthemes: 1) Seeing the complex patient as a coherent and whole person 2) Taking responsibility for identifying and adapting to complexity 3) Lack of effective cooperation forces increased responsibility 4) Too little space for DN's to use their knowledge and competencies.

Conclusion: Patients with an increased care need, poor psychosocial situation, and lack of an ongoing structure of care need more holistic care. DNs perceived there was lack of effective cooperation with GPs at the primary care unit and lack of knowledge among some of the home care staff. They expressed ethical stress and frustration involving increased workload and poor ability to practically provide nursing care. This study showed DN's expertise is not fully utilized. More clarity in the role of DN and more resources and support are needed.

Background: The aim of this study was to assess acceptance, feasibility and further need of development of the intervention Health and Life in Balance (HLB) for improving patient capacity for older people with multimorbidity.

Methods: A convergent mixed-methods non-randomised pilot study in one intervention (IU) and one control primary care unit (CU) in Region Stockholm, Sweden. General practitioners (GPs) in both units recruited individuals fulfilling eligibility criteria: ≥ 65 years of age, ≥ 2 chronic diseases, and an increased care need. The intervention involved: creating a care plan with a district nurse (DN); DN follow-ups over 6 months; improved communication between DN and GP. The control group received usual care. Quantitative data on preliminary primary, Illness Intrusiveness Rating Scale (IIRS), and secondary outcomes were collected from patient reported outcome measures and medical charts and analysed using statistical analysis. Qualitative data came from patient and healthcare provider interviews and medical charts, analysed using inductive thematic analysis. The mixed-methods analysis used joint display.

Results: Between February and June 2022, 24 and 29 participants were recruited from the intervention and control units respectively. Participants had mean age 79 years and mean number of 18 diagnoses and 10 medications. 56.6% were female. There were no significant differences in preliminary primary (IIRS within group change IU p = 1.0, CU p = 0.43) or secondary quantitative outcomes. Two themes were identified in the qualitative analysis: Vulnerable patients need the intervention most and Relational continuity and (w)holism are positive and satisfactory but threatened by lack of time and priority. The joint interpretation identified scheduled holistic nurse follow-ups being acceptable and feasible for individuals in need. However, HLB requires further development to better target individuals with the greatest care needs and to improve the delivery of person-centred care, particularly in terms of aligning with patient priorities and enhancing teamwork.

Conclusions: This mixed-methods pilot study indicates partial acceptance and feasibility of HLB, but the intervention should be further developed to target at-need individuals and to raise priority, assess patient-centredness practically and improve teamwork to improve patient centeredness.

Background: This study aimed to examine district nurse (DN) experiences caring for people with multiple chronic conditions in an aging population. Over the next 10-year period in Sweden, the number of people aged 80 and older is will increase by about 50 percent. The care needs of the population are changing as more people live at home longer with chronic care needs. Since 2022, primary care has been acknowledged politically as the hub of health and medical care, interacting with other health and medical care and social services. DNs in primary care often have the first contact with patients of all ages and are especially involved in care of older individuals with multiple chronic conditions, common mental health problems, and complex care needs. 

Objectives: To examine DNs' experiences of caring for patients with multimorbidity and mental illness 

Methods: This was a qualitative study of six focus group interviews made with fifteen DNs working at five primary care centers in the Stockholm Region, Sweden. Data was analyzed using reflective thematic analysis. Analysis is in progress and results will presented at the conference.

Results: Preliminary analysis has resulted in four subthemes: 1) DNs take responsibility for identifying and adapting to complexity; 2) Lack of effective cooperation leads to increased DN responsibility; 3) DNs see patient complexity as coherent and whole; 3) Too little space for DNs to use knowledge and competencies.

Conclusions: Further analysis is expected to produce findings that can be useful for development of primary care and in particular the role of the DN in caring for older individuals with multiple chronic conditions. 

Significance: To meet the care needs of this growing population, it is critical to understand how DNs currently see their work with these patients and how they consider care can be optimized.

Background: Universities enroll students from diverse backgrounds every year, with 300 million students expected in higher education by 2025. However, with widening participation, increasing numbers of students enrolling in higher health education and future health professions will be underprepared to meet demands of academic literacies, i.e. ability to read, interpret and critically evaluate academic texts and communicating the understanding verbally or in writing. The aim of this scoping review was to describe and explore methods and strategies to promote development of academic literacies.

Results: Thirty-one relevant studies were included and analyzed according to scoping review guidelines. The results showed four strategies: (1) integrating learning activities to develop academic literacies in the regular curriculum, (2) changing the course design with new methods for teaching and learning, (3) establish collaborations amongst academics and librarian faculty, and (4) adding courses or foundation year focusing on development of academic literacies. The results are discussed in light of the United Nations Agenda 2030 Sustainable Development, Goal 4, Quality Education, and widening participation.

Conclusions: Aspects of widening participation and inclusion in higher education have been debated, and increasing numbers of students from diverse backgrounds are expected to enter health studies in higher education. We encourage integration of teaching and learning activities targeting parallel learning of course materials and development of academic literacies, beyond study skills. Embracing epistemic complexity and diversity as well as choosing strategic work with academic literacies may provide a starting point toward realizing sustainable development goals and widening participation.

The aim of this article is to present a communication skills training curriculum for nursing students, based upon phenomenology. Research shows that nurses have difficulty prioritizing dialogue with patients, due to lack of time, organizational and cultural factors. Like other health care professionals, nurses may also have difficulties communicating with patients due to personal fears and shortcomings. The communication training curriculum based upon phenomenology aims at systematically training students to stay focused upon patients' and relatives' narratives, allowing them to reflect upon and better understand their current situation. This approach to communication is applicable in any clinical situation where it important to provide space for the patients' experiences. The philosophical principles guiding the training are presented here as well as the practical steps in the program. Finally, the approach is compared to other common communication methods used in nursing (motivational interviewing, caring conversations, empathy training). The authors hope that the article will highlight the nurses’ role as dialogue partner as well as emphasize the importance of communication skills training in nursing education. This approach can be refined, tested and modified in future research and may serve as an inspirational model for creating a generic communicative competence for nurses.

Background Learning in the clinical environment is an important part of nursing education. Several recent studies focusing on clinical learning have been based on hospital settings. Little is known about primary health care (PHC) as clinical environment where district nurses (DNs) or nurses supervise students. It is important to understand more about opportunities and difficulties in supervising in this area in order to develop PHC as an optimal learning environment for nursing students. The main objective of this study was to gain an understanding of supervisors’ experiences of supervising undergraduate students at PHC units.

Methods A qualitative research approach was used to collect data and analyse supervisors’ experiences. Six focus groups were carried out with 24 supervisors. Focus group data were audio-taped. The data were analysed using an inductive content analysis.

Results Three themes illustrated supervisors’ experiences: abandonment, ambivalence and sharing the holistic approach. Supervisors felt abandoned by their managers, colleagues and nurse teachers from universities. They experienced ambivalence due to simultaneously being supervisors for students and carrying out their daily work with patients. At the same time, they were proud to be DNs and willing to share their unique role to apply a holistic approach and continuity in patient care with students.

Conclusion When supervising students in PHC, social support and communication between supervisors and their colleagues and management as well as nurse teachers need to be taken into consideration both at universities and at primary health care units.

BACKGROUND: Clinical placement plays a key role in education intended to develop nursing and caregiving skills. Studies of nursing students' clinical learning experiences show that these dimensions affect learning processes: (i) supervisory relationship, (ii) pedagogical atmosphere, (iii) management leadership style, (iv) premises of nursing care on the ward, and (v) nursing teachers' roles. Few empirical studies address the probability of an association between these dimensions and factors such as student (a) motivation, (b) satisfaction with clinical placement, and (c) experiences with professional role models.

OBJECTIVE: The study aimed to investigate factors associated with the five dimensions in clinical learning environments within primary health care units.

DESIGN AND METHODS: The Swedish version of Clinical Learning Environment, Supervision and Teacher, a validated evaluation scale, was administered to 356 graduating nursing students after four or five weeks clinical placement in primary health care units. Response rate was 84%. Multivariate analysis of variance is determined if the five dimensions are associated with factors a, b, and c above.

RESULTS: The analysis revealed a statistically significant association with the five dimensions and two factors: students' motivation and experiences with professional role models. The satisfaction factor had a statistically significant association (effect size was high) with all dimensions; this clearly indicates that students experienced satisfaction.

CONCLUSIONS: These questionnaire results show that a good clinical learning experience constitutes a complex whole (totality) that involves several interacting factors. Supervisory relationship and pedagogical atmosphere particularly influenced students' satisfaction and motivation. These results provide valuable decision-support material for clinical education planning, implementation, and management.

Background: Clinical learning is a key part for developing nursingursing education. Previous studies concentrated on hospitals as placement sites. Research results reported in this dissertation identify factors that encourage good learning environments in primary health care (PHC) placements.

Aims and methods: The overall aim of the present research was to identify factors that promote good clinical learning environments in PHC settings. Clinical learning environment was investigated from students 'and supervisors' perspectives and their perceptions of the clinical part of nursing education in PHC settings. The present research implemented three quantitative studies (I, II, III) and one qualitative study (IV). In study I investigated district nurses’ (DNs’) student supervision experiences in PHC units before and after implementation of a new supervision model; 98 of 133 DNs (74%) responded to a questionnaire before and 84 (65%) respondes after implementation. In study II validated the Clinical Learning Environment, Supervision, and Nurse Teacher (CLES+T) scale. In study III investigated students’ motivation, total satisfaction, and experience of professional role models associated with dimensions in clinical learning environments. In studies II and III collected data from undergraduate nursing students (n=356) using the CLES+T scale. In study IV interviewed six focus groups with 24 supervisors (DNs); these data provided understanding of student supervision in PHC units.

Results: Study I revealed significant need for a new supervision model in PHC units. Supervisors had difficulties staying updated on changes in nursing curricula and experienced insufficient support from universities. They felt that they had to set aside time from their regular duties and get permission from unit managers to supervise students. The supervisors felt confident in the supervisory role, but few had formal educational and academic credentials. After the new supervision model implementation, several supervisors were more satisfied with the supervision organization. The model implementation resulted in improvements within PHC units. Study II confirmed good internal reliability in the CLES+T scale and demonstrated that the five-factor model within the scale is the best-fit model. Supervisory relationship was the most important factor and it strongly correlated with these factors: (i) pedagogical atmosphere and (ii) premises of nursing. Supervisory relationship was moderately correlated with the role of the nurse teacher, and leadership style correlated with PHC units. Study III revealed a statistically significant association between (i) students’ motivation, total satisfaction, and experiences of professional role models and (ii) five dimensions of clinical learning environments. The satisfaction factor had a statistically significant association (effect size was high) with the dimensions; this clearly indicated that students experienced satisfaction. Supervisory relationship and pedagogical atmosphere particularly influenced students’ satisfaction and motivation. Study IV revealed three themes related to supervisors’ experiences during student supervision in PHC units: abandonment, ambivalence, and sharing the holistic approach. Supervisors felt abandoned by their managers, colleagues, and nurse teachers rom universities. They were proud to be DNs and willing to share experiences with students – yet torn between being students’ supervisors and patients’ nurses.

Conclusion: This dissertation reports six main factors for good learning environments in PHC units. Supervisors must be prepared and engaged, and students must be motivated. A close, reflective supervisory relationship is one of the most important factors for learning in PHC units. Successful supervision requires clear structure and organization. Adequate support and resources from PHC units are needed for supervisors. Collaboration and liaison between universities and PHC units are needed to link theoretical and practical parts of nurse education. PHC-unit circumstances contribute to holistic nursing care, which is an important factor for student learning. Furthermore, the CLES+T scale was shown to be a reliable tool to use for evaluating PHC settings as clinical learning environment.