Newly graduated nurses' socialisation resulting in limiting inquiry and one-sided use of knowledge sources-An ethnographic study.

AIM: To explore how the socialisation into the clinical setting and interaction between newly graduated nurses and experienced nurses influences the new graduates' use of knowledge sources. BACKGROUND: Newly graduated nurses' use of knowledge sources in decision-making has been subject to an increased interest in relation to evidence-based practice. Despite interventions to strengthen nurses' competencies required for making reflective clinical decisions within an evidence-based practice, studies highlight that new graduates only draw on knowledge from research, patients and other components within evidence-based practice to a limited extent. Research exploring new graduates' use of knowledge sources calls attention to the experienced nurses' decisive role as a valued knowledge source. The new graduates' process of socialisation and their interaction with the experienced nurse raises further questions. METHODS: Ethnography using participant-observation and individual semi-structured interviews of nine newly graduated nurses from a University Hospital in Denmark. Data were collected in 2014. The study adheres to COREQ. RESULTS: Two main structures were found: "Striving for acknowledgment" and "Unintentionally suppressed inquiry." CONCLUSIONS: New graduates are socialised into limiting their inquiry on clinical practice and unintentionally being restricted to using the experienced nurse as predominant knowledge source. Depending on how the experienced nurse responds to the role as predominant knowledge source, they could either limit or nurture the new graduates' inquiry into practice and thus the variety of knowledge sources used in clinical decision-making. Limited inquiry into the complexity of nursing practice indirectly excludes the use of a variety of knowledge sources, which are fundamental to an evidence-based practice. RELEVANCE: If clinical practice wishes to benefit from the newly graduated nurses' inquiring approach and skills within evidence-based practice, clinical practice will have to greet the nurses with a supportive culture where questioning practice is seen as a strength rather than a sign of insecurity and incompetence.

Shared care follow-up of patients with B-cell neoplasms based on nurse-led telephone consultations and PRO-data: a feasibility study from the North Denmark Region.

BACKGROUND: Patients with B-cell neoplasms in remission are monitored with regular physician visits at the hospital. The current standard follow-up procedure is not evidence-based or individualized to patient needs. To improve and individualize the follow-up, we investigated the feasibility of a shared care follow-up initiative, with alternating physician visits and nurse-led telephone consultations and assessments based on patient-reported outcome (PRO) data. METHODS: Patients ≥18 years diagnosed with B-cell neoplasms were eligible for the study when they were in remission and stable without treatment for at least 6 months. Patients were assigned to alternating visits with physicians and nurse-led telephone consultations. The nurse-led telephone consultations were based on PROs, which were collected with the European Organization for Research and Treatment of Cancer questionnaire (EORTC-QLQ-C30), the Myeloproliferative Neoplasm - Symptom Assessment Form, and the Hospital Anxiety and Depression Scale. Patients completed questionnaires before every nurse-led consultation. We also applied the Patient Feedback Form to survey patient acceptance of the requirement of questionnaire completion. We applied descriptive statistics, in terms of counts (n) and proportions (%), to describe the study population and all endpoints. RESULTS: Between February 2017 and December 2018, 80 patients were enrolled. Adherence, measured as the recruitment rate, was 96% (80/83), and the drop-out rate was 6% (5/80). During the study period, 3/80 (4%) patients relapsed, and 5/80 (6%) patients returned to the standard follow-up, because they required closer medical observation. Relapses were diagnosed based on unscheduled visits requested by patients (n = 2) and patient-reported symptoms reviewed by the nurse (n = 1). The response rate to questionnaires was 98% (335/341). A total of 58/79 (74%) patients completed the Patient Feedback Form; 51/57 (89%) patients reported improved communication with health care professionals; and 50/57 (88%) patients reported improved recollection of symptoms as a result of completing questionnaires. CONCLUSION: Based on patient adherence, a low relapse rate, and positive patient attitudes towards completing questionnaires, we concluded that a shared care follow-up, supported by PROs, was a feasible alternative to the standard follow-up for patients with B-cell disease in remission.

The Complexities of Everyday Life and Healthcare Utilization in Danish Children With ADHD: A Mixed Methods Study.

PURPOSE: To explore and describe everyday life and hospital-based healthcare experiences and utilization in families of children with ADHD in Denmark. DESIGN AND METHODS: The present work is a multistage, mixed methods study. The design consists of three individual studies: a meta-synthesis, a focused ethnographic study, and a historical cohort study. RESULTS: The integrated findings show that: 1) parental stressors affect everyday life and hospital-based service use; 2) parents have concerns for their child from early childhood and fight to have their concerns recognized; and 3) healthcare professionals are important for parents to navigate the persistent challenges of everyday life. CONCLUSIONS: Having a child with ADHD pervades everyday life and children with ADHD use more medical and psychiatric services in hospitals during the first 12 years of life than children without ADHD. The findings demonstrate a vulnerable everyday life experience and highlight the importance of the families being recognized, accepted, and respected in hospital-based healthcare services from early childhood. PRACTICE IMPLICATIONS: Healthcare professionals need to recognize the challenges the family of a child with ADHD faces and to acknowledge that ADHD pervades all aspects of everyday life and all other healthcare issues. It is important for healthcare professionals, regardless of specialty, to engage with individual families and to positively contribute to the medical and psychiatric healthcare experience.

Speaking Up for Fundamental Care: the ILC Aalborg Statement.

OBJECTIVE: The International Learning Collaborative (ILC) is an organisation dedicated to understanding why fundamental care, the care required by all patients regardless of clinical condition, fails to be provided in healthcare systems globally. At its 11th annual meeting in 2019, nursing leaders from 11 countries, together with patient representatives, confirmed that patients' fundamental care needs are still being ignored and nurses are still afraid to 'speak up' when these care failures occur. While the ILC's efforts over the past decade have led to increased recognition of the importance of fundamental care, it is not enough. To generate practical, sustainable solutions, we need to substantially rethink fundamental care and its contribution to patient outcomes and experiences, staff well-being, safety and quality, and the economic viability of healthcare systems. KEY ARGUMENTS: We present five propositions for radically transforming fundamental care delivery:Value: fundamental care must be foundational to all caring activities, systems and institutionsTalk: fundamental care must be explicitly articulated in all caring activities, systems and institutions.Do: fundamental care must be explicitly actioned and evaluated in all caring activities, systems and institutions.Own: fundamental care must be owned by each individual who delivers care, works in a system that is responsible for care or works in an institution whose mission is to deliver care. RESEARCH: fundamental care must undergo systematic and high-quality investigations to generate the evidence needed to inform care practices and shape health systems and education curricula. CONCLUSION: For radical transformation within health systems globally, we must move beyond nursing and ensure all members of the healthcare team-educators, students, consumers, clinicians, leaders, researchers, policy-makers and politicians-value, talk, do, own and research fundamental care. It is only through coordinated, collaborative effort that we will, and must, achieve real change.

A Realistic Evaluation of Danish Perioperative Nurses' Documentation Practices.

Nursing care documentation is an important aspect of clinical decision-making processes and affects patient safety. Documentation in the perioperative setting has been described as poor and incomplete and varies among nurses. The purpose of this qualitative study was to examine perioperative nurses' documentation practices using a realistic evaluation framework that focuses on relationships between context, mechanisms, and outcomes. Through participant observations using multiple qualitative data-generation methods, the study found that perioperative nurses' documentation practices are driven by a mix of educational, cultural, and organizational factors, including competing demands, local values and traditions, and everyday circumstances. Understanding the cultures of different subgroups in the perioperative setting may help improve nurses' documentation practices.

Communication and relationship dynamics in surgical teams in the operating room: an ethnographic study.

BACKGROUND: In surgical teams, health professionals are highly interdependent and work under time pressure. It is of particular importance that teamwork is well-functioning in order to achieve quality treatment and patient safety. Relational coordination, defined as "communicating and relating for the purpose of task integration," has been found to contribute to quality treatment and patient safety. Relational coordination has also been found to contribute to psychological safety and the ability to learn from mistakes. Although extensive research has been carried out regarding relational coordination in many contexts including surgery, no study has explored how relational coordination works at the micro level. The purpose of this study was to explore communication and relationship dynamics in interdisciplinary surgical teams at the micro level in contexts of variable complexity using the theory of relational coordination. METHODS: An ethnographic study was conducted involving participant observations of 39 surgical teams and 15 semi-structured interviews during a 10-month period in 2014 in 2 orthopedic operating units in a university hospital in Denmark. A deductively directed content analysis was carried out based on the theory of relational coordination. RESULTS: Four different types of collaboration in interdisciplinary surgical teams in contexts of variable complexity were identified representing different communication and relationship patterns: 1) proactive and intuitive communication, 2) silent and ordinary communication, 3) inattentive and ambiguous communication, 4) contradictory and highly dynamic communication. The findings suggest a connection between communication and relationship dynamics in surgical teams and the level of complexity of the surgical procedures performed. CONCLUSION: The findings complement previous research on interdisciplinary teamwork in surgical teams and contribute to the theory of relational coordination. The findings offer a new typology of teams that goes beyond weak or strong relational coordination to capture four distinct patterns of relational coordination. In particular, the study highlights the central role of mutual respect and presents proposals for improving relational coordination in surgical teams.

Psychotropic drug use following venous thromboembolism versus diabetes mellitus in adolescence or young adulthood: a Danish nationwide cohort study.

OBJECTIVES: Critical and chronic illness in youth such as diabetes can lead to impaired mental health. Despite the potentially traumatic and life-threatening nature of venous thromboembolism (VTE), the long-term mental health of adolescents and young adults with VTE is unclear. We compared the long-term mental health of adolescents and young adults with VTE versus adolescents and young adults with insulin-dependent diabetes mellitus (IDDM) using psychotropic drug purchase as proxy for mental health. DESIGN: Nationwide registry-based cohort study. SETTING: Denmark 1997-2015. PARTICIPANTS: All patients aged 13-33 years with an incident diagnosis of VTE (n=5065) or IDDM (n=6609). EXPOSURE: First time primary hospital diagnosis of VTE or IDDM. PRIMARY AND SECONDARY OUTCOME MEASURES: Adjusted absolute risk and risk difference at 1 and 5 years follow-up for first psychotropic drug purchase comparing patients with VTE and patients with IDDM. RESULTS: The absolute 1 year risk of psychotropic drug use was 6.2% among VTE patients versus 3.6% among patients with IDDM, at 5 years this was 19.3%-14.7%, respectively. After adjusting for the effect of sex, age and risk factors for VTE this corresponded to a 1 year risk differences of 1.9% (95 % CI 0.1% to 3.3%). At 5 years follow-up the risk difference was 1.9% (95% CI 0.5% to 3.3%). CONCLUSION: One-fifth of adolescents and young adults with incident VTE had claimed a prescription for a psychotropic drug within 5 years, a risk comparable to that of young patients with IDDM.

"WE do it together!" An Ethnographic Study of the Alliance Between Child and Hospital Clown During Venipunctures.

PURPOSE: Hospital clowns are widely used as a means of non-pharmacological intervention in the treatment of hospitalized children. However, little research has examined the impact of clowns on common painful needle-related procedures. This study explored children's pain experience and their ability to cope during a venipuncture while interacting with a clown in the acute admission unit. DESIGN AND METHODS: An ethnographic fieldwork study was conducted. Data were collected over a 10-month period through participant observation and informal interviews, supplemented by video recordings. The participants comprised 38 acutely admitted children aged 4 to 15 years undergoing a venipuncture in the presence of a hospital clown. Analysis was structured in three stages: before venipuncture; during venipuncture; and after venipuncture. RESULTS: The development of a responsive interaction between child and clown, identified as a WE, was found to be beneficial to the child during venipuncture procedure. The WE was characterized by three themes "How do WE do this together?"; "WE are together"; and "I/WE did it!" CONCLUSIONS: The study emphasizes the importance of a WE established between child and hospital clown from the first encounter until a final evaluation. This WE was verbalized repeatedly by the clown and the child and was essential in shaping a tailored approach which met the needs of each child. This approach seemed to strengthen the child's competence in pain management and ability to cope, thus building competence for future venipunctures. PRACTICE IMPLICATIONS: Establishing a WE might advance the psychosocial care of hospitalized children undergoing acute painful procedures.

An ongoing WE: A focused ethnographic study of the relationship between child and hospital clown during recurrent pain-related procedures and conditions.

Aim: This study explored the interaction between child and hospital clown during recurrent hospitalizations for repeated pain-related procedures and conditions. Background: Despite improvements in the management of pain in hospitalized children, procedural pain in particular is a common experience for hospitalized children, and they continue to report undertreated pain. Hospital clowns are widely used as a nonpharmacological intervention in hospitalized children. Little research has examined the influence of hospital clowns during recurrent hospitalizations on repeated painful procedures. Design and methods: Ethnographic fieldwork using focused ethnography was conducted. Data were collected during October-December 2017 using participant observation and informal interviews with children at one pediatric unit at a Danish university hospital. Data include 61 interactions between children aged 4-14 years and hospital clowns. The participants comprised 13 children undergoing recurrent hospitalizations. The data were coded using thematic analysis, and the research team verified the resulting themes. Results: The overarching theme was defined as An ongoing WE, based on two identified themes, that is, Stronger in a WE and Hope in the WE. The WE was characterized by a responsive interaction between the child and clown, which evolved over the course of an ongoing relationship. Conclusion: This study demonstrates how an ongoing WE was constructed with children during repeated painful procedures and conditions. Specifically, the study emphasizes the importance of developing a trusting relationship on the child's terms. Children seemed to experience enhanced coping with painful procedures during the recurring hospital clown encounters, thus reinforcing their competence and hope for coping with future painful procedures. These findings may improve psychosocial care for hospitalized children undergoing repeated painful procedures and conditions and may facilitate multidisciplinary initiatives, such as nurses' advocacy for the inclusion of hospital clowns during recurrent hospitalizations for repeated painful procedures to ensure optimal pain management.

Labour outcomes in caseload midwifery and standard care: a register-based cohort study.

BACKGROUND: Research on caseload midwifery in a Danish setting is missing. This cohort study aimed to compare labour outcomes in caseload midwifery and standard midwifery care. METHODS: A historical register-based cohort study was carried out using routinely collected data about all singleton births 2013-2016 in two maternity units in the North Denmark Region. In this region, women are geographically allocated to caseload midwifery or standard care, as caseload midwifery is only available in some towns in the peripheral part of the uptake areas of the maternity units, and it is the only model of care offered here. Labour outcomes of 2679 all-risk women in caseload midwifery were compared with those of 10,436 all-risk women in standard midwifery care using multivariate linear and logistic regression analyses. RESULTS: Compared to women in standard care, augmentation was more frequent in caseload women (adjusted odds ratio (aOR) 1.20; 95% CI 1.06-1.35) as was labour duration of less than 10 h (aOR 1.26; 95% CI 1.13-1.42). More emergency caesarean sections were observed in caseload women (aOR 1.17; 95% CI 1.03-1.34), but this might partly be explained by longer distance to the maternity unit in caseload women. When caseload women were compared to women in standard care with a similar long distance to the hospital, no difference in emergency caesarean sections was observed (aOR 1.04; 95% CI 0.84-1.28). Compared to standard care, infants of caseload women more often had Apgar ≤7 after 5 min. (aOR 1.57; 95% CI 1.11-2.23) and this difference remained when caseload women were compared to women with similar distance to the hospital. For elective caesarean sections, preterm birth, induction of labour, dilatation of cervix on admission, amniotomy, epidural analgesia, and instrumental deliveries, we did not obseve any differences between the two groups. After birth, caseload women more often experienced no laceration (aOR 1.17; 95% CI 1.06-1.29). CONCLUSIONS: For most labour outcomes, there were no differences across the two models of midwifery-led care but unexpectedly, we observed slightly more augmentation and adverse neonatal outcomes in caseload midwifery. These findings should be interpreted in the context of the overall low intervention and complication rates in this Danish setting and in the context of research that supports the benefits of caseload midwifery. Although the observational design of the study allows only cautious conclusions, this study highlights the importance of monitoring and evaluating new practices contextually.

The centrality of the nurse-patient relationship: A Scandinavian perspective.

AIMS AND OBJECTIVES: To address aspects of importance in the nurse-patient relationship, as conceptualised within the Scandinavian healthcare context. BACKGROUND: An experiment in Beth Israel Hospital uncovered a set of core values (ontology) that were wiped away by stronger forces. Despite this, some of the ideas impacted the development of nursing thought and values in the Scandinavian countries, partly because they connected with deeper social values and also because investment was being put into explicitly identifying and understanding the core elements of nursing (ontology) and how to provide evidence that they found were important (epistemology). From that beginning and through the work of key thought leaders, Scandinavian nursing is ready to embark on a new phase, which could be helped by the Fundamentals of Care framework. DESIGN: This discursive position study offers insights from a public healthcare setting, influenced by values such as equal rights to equal care and/or cure. This study presents two complementing perspectives: an ontological and an epistemological, on establishing caring relationships. CONCLUSION: There are different pathways to follow in building person-oriented care; however, the nursing approach is both ontologically and epistemologically grounded and based on dialogue. RELEVANCE TO CLINICAL PRACTICE: Patients meet different nurses, the meeting may be short and, routine actions may be on the agenda. However, nurses must engage with patients' experiences and knowledge, in order to add to patients' present and future well-being with their person-oriented care.

Integrating the fundamentals of care framework in baccalaureate nursing education: An example from a nursing school in Denmark.

AIMS AND OBJECTIVES: To describe and discuss the process of integrating the Fundamentals of Care framework in a baccalaureate nursing education at a School of Nursing in Denmark. BACKGROUND: Nursing education plays an essential role in educating nurses to work within healthcare systems in which a demanding workload on nurses results in fundamental nursing care being left undone. Newly graduated nurses often lack knowledge and skills to meet the challenges of delivering fundamental care in clinical practice. To develop nursing students' understanding of fundamental nursing, the conceptual Fundamentals of Care framework has been integrated in nursing education at a School of Nursing in Denmark. DESIGN AND METHODS: Discursive paper using an adjusted descriptive case study design for describing and discussing the process of integrating the conceptual Fundamentals of Care Framework in nursing education. RESULTS: The process of integrating the Fundamentals of Care framework is illuminated through a description of the context, in which the process occurs including the faculty members, lectures, case-based work and simulation laboratory in nursing education. Based on this description, opportunities such as supporting a holistic approach to an evidence-based integrative patient care and challenges such as scepticism among the faculty are discussed. CONCLUSION: It is suggested how integration of Fundamentals of Care Framework in lectures, case-based work and simulation laboratory can make fundamental nursing care more explicit in nursing education, support critical thinking and underline the relevance of evidence-based practice. The process relies on a supportive context, a well-informed and engaged faculty, and continuous reflections on how the conceptual framework can be integrated. RELEVANCE TO CLINICAL PRACTICE: Integrating the Fundamentals of Care framework can support nursing students' critical thinking and reflection on what fundamental nursing care is and requires and eventually educate nurses in providing evidence-based fundamental nursing care.

Attention Deficit Hyperactivity Disorder in Childhood: Healthcare Use in a Danish Birth Cohort during the First 12 Years of Life.

OBJECTIVES: To compare the mean number of medical and psychiatric hospital-based services in children with and without attention deficit hyperactivity disorder (ADHD) and to assess the effect of ADHD on hospital-based service use, including child-, parental-, and socioeconomic-related risk factors. STUDY DESIGN: A Danish birth cohort was followed through 12 years, and children with ADHD were identified using Danish nationwide registries. Poisson regression analyses were used to assess the association of ADHD with service use and to adjust for a comprehensive set of explanatory variables. RESULTS: Children diagnosed with ADHD used more medical and psychiatric hospital-based healthcare than those without ADHD. In children with ADHD, intellectual disability and parental psychiatric disorder were associated with increased medical and psychiatric service use. Low birth weight and low gestational age were associated with increased medical service use. Psychiatric comorbidity and having a divorced or single parent were associated with increased psychiatric service use. CONCLUSIONS: ADHD independently affected medical and psychiatric hospital-based service use even when adjusting for a comprehensive set of explanatory variables. However, the pattern of medical and psychiatric hospital-based service use is complex and cannot exclusively be explained by the child-, parental-, and socioeconomic-related variables examined in this study.

Associations and predictions of readmission or death in acutely admitted older medical patients using self-reported frailty and functional measures. A Danish cohort study.

OBJECTIVE: To assess whether frailty in acutely admitted older medical patients, assessed by a self-report questionnaire and evaluation of functional level at discharge, was associated with readmission or death within 6 months after discharge. A second objective was to assess the predictive performance of models including frailty, functional level, and known risk factors. METHODS: A cohort study including acutely admitted older patients 65+ from seven medical and two acute medical units. The Tilburg Frailty Indicator (TFI), Timed-Up-and-Go (TUG), and grip strength (GS) exposure variables were measured. Associations were assessed using Cox regression with first unplanned readmission or death (all-causes) as the outcome. Prediction models including the three exposure variables and known risk factors were modelled using logistic regression and C-statistics. RESULTS: Of 1328 included patients, 50% were readmitted or died within 6 months. When adjusted for gender and age, there was an 88% higher risk of readmission or death if the TFI scores were 8-13 points compared to 0-1 points (HR 1.88, CI 1.38;2.58). Likewise, higher TUG and lower GS scores were associated with higher risk of readmission or death. The area under the curve for the prediction models ranged from 0.64 (0.60;0.68) to 0.72 (0.68;0.76). CONCLUSION: In acutely admitted older medical patients, higher frailty assessed by TFI, TUG, and GS was associated with a higher risk of readmission or death within 6 months after discharge. The performance of the prediction models was mediocre, and the models cannot stand alone as risk stratification tools in clinical practice.

The state of Danish nursing ethnographic research: flowering, nurtured or malnurtured - a critical review.

BACKGROUND: Nursing was established in Denmark as a scholarly tradition in the late nineteen eighties, and ethnography was a preferred method. No critical review has yet summarised accomplishments and gaps and pointing at directions for the future methodological development and research herein. AIM: This review critically examines the current state of the use of ethnographic methodology in the body of knowledge from Danish nursing scholars. METHODS: We performed a systematic literature search in relevant databases from 2003 to 2016. The studies included were critically appraised by all authors for methodological robustness using the ten-item instrument QARI from Joanna Briggs Institute. RESULTS: Two hundred and eight studies met our inclusion criteria and 45 papers were included; the critical appraisal gave evidence of studies with certain robustness, except for the first question concerning the congruity between the papers philosophical perspective and methodology and the seventh question concerning reflections about the influence of the researcher on the study and vice versa. In most studies (n = 34), study aims and arguments for selecting ethnographic research are presented. Additionally, method sections in many studies illustrated that ethnographical methodology is nurtured by references such as Hammersley and Atkinson or Spradley. CONCLUSIONS: Evidence exists that Danish nursing scholars' body of knowledge nurtures the ethnographic methodology mainly by the same few authors; however, whether this is an expression of a deliberate strategy or malnutrition in the form of lack of knowledge of other methodological options appears yet unanswered.

Identifying Nurse Anesthetists' Professional Identity.

PURPOSE: To explore professional identity of registered nurse anesthetists (RNAs) and RNAs' expectations of their professional self and the expectations RNAs meet from interdisciplinary team members when preparing patients for general anesthesia. DESIGN: Focused ethnography was used for data collection. METHODS: Participant observations and interviews were conducted with patients scheduled for surgery and with RNAs in charge of the patients during the anesthetic procedures. Interviews with RNAs, anesthesiologists, and operation nurses with a specific focus on RNAs' professional identity were performed. The analysis was inspired by grounded theory. FINDINGS: A core variable of Identifying the professional self is presented, and two subcore variables are delineated: Gliding between tasks and structures and Depending on independence. CONCLUSIONS: RNAs are at risk of downsizing psychosocial and relational aspects of fundamentals of care in favor of performing technological procedures, and RNAs' professional values are influenced by the work culture in the Department of Anesthesiology.

Interaction Between Nurse Anesthetists and Patients in a Highly Technological Environment.

PURPOSE: To explore the specific interactions between patients and nurse anesthetists in the highly technological environment of anesthesia nursing, focusing on the time interval between patient entrance into the operating room and induction of general anesthesia. DESIGN: Focused ethnography was used for data collection. METHODS: Participant observation and interview of 13 hospitalized patients being admitted for major or minor surgical procedures and 13 nurse anesthetists in charge of their patients and anesthetic procedures. Photographs were taken of specific situations and technological objects in the observation context. The analysis was inspired by grounded theory. FINDING: A core variable of creating emotional energy is presented, and two subcore variables are delineated: instilling trust and performing embodied actions. CONCLUSION: Creating emotional energy has an important impact on the interaction between patients and nurse anesthetists. Furthermore, the motives underpinning nurse anesthetists' interactions with patients are a central constituent in developing anesthesia care.

ADHD and Everyday Life: Healthcare as a Significant Lifeline.

AIM: The aim of this qualitative study was to explore parental experiences of how healthcare practices and healthcare professionals in hospital clinics in Denmark influence everyday life of parents with a child with ADHD. DESIGN AND METHODS: The methodology was focused ethnography. Participant observation and interviews were used as the primary data collection methods. Fifteen families of children with ADHD were included from somatic and psychiatric hospital clinics. RESULTS: Three main themes emerged from the experiences of the families: When the house of cards collapses in everyday life, Treading water before and after receiving the ADHD diagnosis, and Healthcare as a significant lifeline. CONCLUSIONS: Accessibility to healthcare, trusting relationships and healthcare professionals recognizing how ADHD pervades all aspects of everyday life appear to be important factors in providing a lifeline for parents to help them regain confidence and control in disruptive phases. The parents depend on help from healthcare professionals and family-centred care to manage the complex challenges in everyday life.

Accuracy of a step counter during treadmill and daily life walking by healthy adults and patients with cardiac disease.

BACKGROUND: Step counters have been used to observe activity and support physical activity, but there is limited evidence on their accuracy. OBJECTIVE: The purpose was to investigate the step accuracy of the Fitbit Zip (Zip) in healthy adults during treadmill walking and in patients with cardiac disease while hospitalised at home. METHODS: Twenty healthy adults aged 39±13.79 (mean ±SD) wore four Zips while walking on a treadmill at different speeds (1.7-6.1 km/hour), and 24 patients with cardiac disease (age 67±10.03) wore a Zip for 24 hours during hospitalisation and for 4 weeks thereafter at home. A Shimmer3 device was used as a criterion standard. RESULTS: At a treadmill speed of 3.6 km/hour, the relative error (±SD) for the Zips on the upper body was -0.02±0.67 on the right side and -0.09 (0.67) on the left side. For the Zips on the waist, this was 0.08±0.71 for the right side and -0.08 (0.47) on the left side. At a treadmill speed of 3.6 km/hour and higher, the average per cent of relative error was <3%. The 24-hour test for the hospitalised patients showed a relative error of -47.15±24.11 (interclass correlation coefficient (ICC): 0.60), and for the 24-hour test at home, the relative error was -27.51±28.78 (ICC: 0.87). Thus, none of the 24-hour tests had less than the expected 20% error. In time periods of evident walking during the 24 h test, the Zip had an average per cent relative error of <3% at 3.6 km/hour and higher speeds. CONCLUSIONS: A speed of 3.6 km/hour or higher is required to expect acceptable accuracy in step measurement using a Zip, on a treadmill and in real life. Inaccuracies are directly related to slow speeds, which might be a problem for patients with cardiac disease who walk at a slow pace.