Post-simulation debriefing as a stepping stone to self-reflection and increased awareness - a qualitative study.

BACKGROUND: The voice of the students should be engaged in simulation curriculum development. Involving the students in the development of debriefing strategies might result in a deeper understanding of learning. However, few studies have investigated the students' perspectives on debriefing strategies. The aim of the study was to explore nursing students' perspectives on the post-simulation debriefing. METHODS: An explorative, descriptive design with a qualitative approach was used. Data were collected in December 2017 and May 2018 through focus group interviews with undergraduate nursing students in Norway immediately after a 2-day high-fidelity simulation course in the second year of their Bachelor of Nursing degree. Data were analysed using systematic text condensation. RESULTS: Thirty-two nursing students participated in the study. The data analysis identified two main categories. The category 'Facilitator as a catalyst for reflection' illustrated the facilitator's multifaceted and vital role in initiating and guiding the students' reflection process in the debriefing. The category 'A process towards increased awareness' encompasses the students' guided process of acquiring new insight into their professional development, and how they put parts together to see the wholeness in what was simulated. CONCLUSIONS: This study provides knowledge to facilitators regarding nursing students' perspectives on facilitating reflection and learning during debriefing discussions. The facilitator's multifaceted role in guiding the students' reflections and their process of acquiring new insight into their professional development were identified as critical to learning during debriefing.

Analysis of satisfaction levels and perceptions of clinical competency: a mixed method study on objective structured clinical examinations in undergraduate dental students.

OBJECTIVE: To analyze the satisfaction levels, perceptions of developing clinical competencies through objective structured clinical examination and to explore the experiences, challenges, and suggestions of undergraduate dental students. METHODS: The study adopted a mixed-method convergent design. Quantitative data were collected from 303 participants through surveys, evaluating satisfaction levels with objective structured clinical examination (OSCE). Additionally, qualitative insights were gathered through student focus group interviews, fundamental themes were developed from diverse expressions on various aspects of OSCE assessments. The Chi-Square tests, was performed to assess associations between variables. Data integration involved comparing and contrasting quantitative and qualitative findings to derive comprehensive conclusions. RESULTS: The satisfaction rates include 69.4% for the organization of OSCE stations and 57.4% for overall effectiveness. However, a crucial challenge was identified, with only 36.7% of students receiving adequate post-OSCE feedback. Furthermore, a majority of students (50%) expressed concerns about the clinical relevance of OSCEs. The study showed a significant associations (p < 0.05) between satisfaction levels and years of study as well as previous OSCE experience. Student focus group interviews revealed diverse perspectives on OSCE assessments. While students appreciate the helpfulness of OSCEs, concerns were raised regarding time constraints, stress, examiner training, and the perceived lack of clinical relevance. CONCLUSION: The students anticipated concerns about the clinical relevance of OSCEs, highlighting the need for a more aligned assessment approach. Diverse perspectives on OSCE assessments reveal perceived helpfulness alongside challenges such as lack of feedback, examiner training, time constraints, and mental stress.

How do patients experience and use home blood pressure monitoring? A qualitative analysis with UTAUT 2.

Background: Hypertension is an important cardiovascular risk factor with potentially harmful consequences. Home blood pressure monitoring is a promising method for following the effect of hypertension treatment. The use of technology-enabled care and increased patient involvement might contribute to more effective treatment methods. However, more knowledge is needed to explain the motivations and consequences of patients engaging in what has been called 'do-it-yourself healthcare'. Aim: This study aimed to investigate patients' experiences of home blood pressure monitoring through the theoretical frame of the Unified Theory of Acceptance and Use of Technology (UTAUT 2). Methods: The study had a qualitative design, with focus group interviews using the web-based platform Zoom. The data were analysed using qualitative deductive content analysis, inspired by Graneheim and Lundman. Results: The results are presented using the seven theoretical constructs of UTAUT 2: Performance Expectancy, Effort Expectancy, Social Influence, Facilitating Conditions, Hedonistic Motivation, Price Value and Habit. We found one overarching theme ‒ 'It's all about the feeling of security'. The patients were influenced by relatives or healthcare personnel and experienced the home monitoring process as being easy to conduct. The patients emphasised that the quality of the blood pressure monitor was more important than the price. Patients reported home monitoring of blood pressure as a feasible method to follow-up care of their hypertension. Discussion: This study indicates that among motivated patients, home blood pressure measurement entails minimal effort, increases security, and leads to better communication about blood pressure between healthcare personnel and patients.

Self-monitoring of hypertension is an increasingly common method and may increase measurement accuracy and patient involvement.Through the theoretical lens of the UTAUT2, home blood pressure monitoring seems to increase patients´ feeling of security.The respondents did not report negative experiences and might have been more prone to use technology-enabled care.Home blood pressure monitoring seems to be easily adopted by motivated patients with an interest in self-monitoring their disease.

Student nurses' experiences with a digital educational resource supporting learning in nursing home placements: A qualitative study.

BACKGROUND: Nursing education should improve clinical placements in nursing homes to foster and enhance student nurses' learning experiences. Initiatives for digital educational resource used to teach and supervise students to complement learning are increasingly being adopted and considered important in nursing education. However, little is known about how digital educational resources can facilitate learning in placements. Research on the value of such resources from student nurses' perspective is required. AIM: To explore first-year student nurses' experiences with a digital educational resource developed to support learning in nursing home placements. DESIGN: This study has a qualitative explorative design and is part of a larger research project in which a digital educational resource named DigiQUALinPRAX was developed. SETTINGS: This study was conducted at three publicly funded nursing homes affiliated with one Norwegian university. PARTICIPANTS: Twenty-three first-year student nurses. METHODS: Data was generated through pre- and post-placement group interviews and analysed using reflexive thematic analysis. Standards for Reporting Qualitative Research were applied in this stud. FINDINGS: One overreaching theme and three subthemes related to student nurses' experiences with a digital educational resource were identified. The digital educational resource gave a feeling of being acknowledged as a learner by (1) providing a structure and preparation that made the placement feel less overwhelming, (2) supporting professional reflection and assessment practices, and (3) facilitating collaboration when all stakeholders used the resource actively. CONCLUSIONS: This study indicates that student nurses' learning process in nursing home placements can be supported through digital educational resources customised for this learning arena. The findings indicate that the digital educational resource facilitated pre-placement preparedness, provided structure and flexibility, and enhanced reflection and assessment practices during clinical placement. However, encouraging tripartite usage is essential to exploit the full potential of digital educational resources.

Introducing waterbirth in a university hospital setting in Sweden: A qualitative study of midwives' experiences.

INTRODUCTION: Waterbirth is a popular and increasing care option in several countries but is still debated. In Sweden, there are challenges in the process of reintroducing waterbirth after decades of interruption invoked by a dissuasion. The aim of this study was to explore factors affecting midwives' provision of waterbirth at a university birthing clinic in Sweden. METHODS: A qualitative research design was used with three focus group interviews with 18 midwives at three birthing units. The data were analyzed using the principles of inductive content analysis. RESULTS: The midwives in the study expressed positive attitudes and potentiality about waterbirth, contributing to their desire to support physiological birth. However, obstacles were also disclosed, maiming waterbirth evolvement. Hence, two categories emerged, promoting factors and obstructing factors. The subcategories were: Provides a good experience whilst promoting physiological birth; Increased knowledge and information about waterbirth; Support from management; Updated guidelines; Ergonomic challenges; Lacking practical conditions; Lack of knowledge; Paradigm conflicts; and Limiting guidelines. CONCLUSIONS: The study concluded that midwives recognized both promoting and obstructing factors affecting the provision of waterbirth. The predominant factor highlighted was the care-culture, with a clear distinction between a risk-focused, medicalized approach that inhibits waterbirth and a salutogenic perspective advocating for it. This dichotomy underscores the importance of providing opportunities that support women's choices to facilitate an empowering birth experience.

Bridging technology and care: integrating web-based PROMs in mental health services for refugees: a study on clinician training and technology adoption.

This study explores the integration of a web-based electronic database technology containing patient-reported outcome measures (PROMs) with electronic health records for refugees with PTSD, emphasizing the systematic inclusion of patient perspectives in clinical decision-making. Our research addresses the notable gap in literature regarding training clinicians for the competent integration of health information technology in healthcare. The training program developed aimed at equipping clinicians, particularly inexperienced with technology, to effectively utilize an electronic PROM system for collecting systematic patient information. Our study is set in the context of the Mental Health Services (MHS) in Denmark, focusing on a specialized clinic for treating trauma-affected refugees. The multidisciplinary team involved in this project reflects a wide range of healthcare professionals. The training program employed a variety of activities over nearly 2 years, adapting to feedback and aiming to engage clinicians in continuous improvement processes. Analyzing qualitative data with thematic analysis we interpreted that the training's extended focus on discussion of the implementation process, with limited hands-on experience, potentially reinforced clinicians' hesitations toward new technology, rather than reducing them. Clinicians prioritized immediate concerns over potential long-term benefits. Despite this, their approach reflects a strong commitment to patient welfare and careful evaluation of new practices. Notably, there were also positive engagements with the technology, highlighting its potential in patient care. This study concludes that the successful integration of technology in clinical settings hinges on its alignment with clinicians' workflows, respect for their professional judgment, and clear benefits to patient care.

Healthcare and social care professionals' experiences of respite care: a critical incident study.

INTRODUCTION: Aging in place is favoured among older persons and supported by research in Sweden, although it poses challenges for overburdened informal caregivers. While respite care can offer support, its accessibility is hindered by organizational challenges and informal caregivers' delays in using it. The experiences of informal caregivers are well-studied, but the professionals' experiences of respite care quality and critical incident management are underexplored. AIM: To explore professionals' experiences of critical incidents in respite care, consequences for the persons being cared for, and strategies to manage critical incidents. MATERIALS AND METHODS: A qualitative, critical incident technique was used, and three group interviews with a total of 16 professionals were conducted. RESULTS: Barriers to quality respite care included communication gaps during care transitions, environmental shortcomings in respite care facilities, lack of support for informal caregivers, and inadequacies in respite care decisions. Strategies to manage critical incidents included individualized care, continuity and communication in care transitions, a conducive environment, support for informal caregivers, and care professionals' positive approach. CONCLUSIONS: The study emphasizes the need for focused efforts on communication, continuity, and a supportive environment. Addressing identified challenges and applying suggested strategies will be key to maximizing the potential of respite care as a vital support for care recipients and their informal caregivers.

Public health nurses' experiences with mental health promotion for adolescent immigrants in schools: A qualitative study.

AIMS AND OBJECTIVES: This study aimed to explore public health nurses' experiences with mental health promotion for adolescent immigrants in lower secondary and high school, aiming to enhance knowledge and insights for effective mental health promotion. METHODOLOGICAL DESIGN AND JUSTIFICATION: A qualitative design employing a hermeneutic approach was chosen. Thirteen public health nurses were selected using purposive criterion sampling and snowballing. Thematic analysis was applied, adhering to COREQ guidelines for transparency. ETHICAL ISSUES AND APPROVAL: The research was approved by the Norwegian Centre for Research Data. The guidelines of the National Committee for Research Ethics in the Social Sciences and the Humanities were followed. RESEARCH METHODS, INSTRUMENTS, AND/OR INTERVENTIONS: Data were collected through three focus-group interviews (n = 13), using semi-structured interview guides to explore the experiences of public health nurses in promoting mental health among adolescent immigrants. OUTCOME MEASURES: This study identified three key themes: (i) Striving to understand adolescent immigrants' mental health aspects, including both positive and negative aspects; (ii) Different strategies for promoting mental health, viewing adolescents as both recipients and contributors to their well-being; and (iii) Barriers to public health nurses' promotion of mental health, including language, cultural, and knowledge-related obstacles and trust issues. RESULTS: Public health nurses noted that language barriers and trust issues often delayed adolescent immigrants from seeking help for mental health concerns. Cultural competence and empathy were deemed crucial. To meet these needs, public health nurses must build rapport with parents, collaborate with professionals, implement follow-up programmes, and advocate for policy changes. STUDY LIMITATIONS: Limitations of this qualitative study include potential bias from the authors' background and non-generalizability of results to other contexts. CONCLUSIONS: In conclusion, public health nurses' experiences reveal the need for enhanced cultural competence, language proficiency, and trust-building to better serve adolescent immigrants. Collaborative efforts, follow-up programmes, and policy advocacy are essential to improve mental health promotion in school settings.

Students' perceptions of Toxicolitaire™- a digital card game for medical toxicology students.

INTRODUCTION: Toxicology students are frequently overwhelmed by the volume and complexity of information. To enhance the learning experience, medical toxicology lecturers created a digital card game named Toxicolitaire™. We sought to explore students' experiences with the online game. METHODS: We first sent an anonymous, closed-ended survey to 18 students. This survey allowed students to give quick binary answers about the game. We followed the survey with in-person focus group interviews to identify themes of student perceptions about the game. RESULTS: We identified several themes concerning the students' experiences. Students found the game amusing and reported that it stimulated critical thinking. Students perceived that the game fostered self-regulated learning, pinpointed gaps in their toxicology knowledge, and facilitated their examination preparation. Students mentioned software-related problems in the game and expressed a preference for the physical card game. Students suggested adjusting the game to varying levels of difficulty and complexity. Students praised the game as an excellent tool for medical professionals and expressed a strong inclination to recommend it to their colleagues. DISCUSSION: The effectiveness of an educational game depends on its design, execution, and alignment with the target audience's needs and likings. Player feedback may contribute to an educational game's effectiveness in supporting learning objectives. Encouraging participants to provide feedback fostered a sense of community and involvement in the game. Limitations of this study include the subjective interpretation by the researcher, the small sample size of 18 students, the students' prior knowledge gained from two years of toxicology education, and the students' awareness of the study's purpose. CONCLUSION: The students gave positive feedback and reported that the online Toxicolitaire™ game was fun, reinforced classroom learning, promoted self-regulated learning, and stimulated critical thinking and examination preparation.

The benefits of caregiver singing and receptive music in dementia care: a qualitative study of professional caregivers' experiences.

BACKGROUND: For persons with dementia, receptive music may reduce negative expressions and increase positive ones. Caregiver singing (CS) is an intervention aimed at facilitating care situations and involves caregivers singing for or together with persons with dementia during care activities. In the literature, CS is commonly addressed as a music activity rather than a care intervention. The aim was to describe caregivers' experiences of the reactions of persons with dementia when using CS and receptive music in dementia care. METHOD: The data comprised three focus group interviews with 12 professional caregivers in dementia care, analysed using qualitative content analysis. RESULTS: the analysis resulted in two themes: "CS increases interaction and builds companionship" and "Receptive music soothes, awakens memories and reflects the person's self". CONCLUSION: Both CS and receptive music was shown to have positive influences, and while the results were sometimes intertwined, CS was shown to better facilitate problematic care situations.

Ready to Go Home? Nurses' Perspectives of Prolonged Admission for Patients Undergoing Video-Assisted Thoracic Surgery for Non-Small-Cell Lung Cancer in Denmark.

Enhanced recovery after surgery programs with median postoperative hospitalization of 2 days improve outcomes after lung cancer surgery. This article explores nursing care practices for patients with lung cancer who remain hospitalized despite having recovered somatically. Qualitative focus group interviews were conducted with 16 nurses. Ricoeur's phenomenological hermeneutics underpins the methodology applied in this study, and we relied on Benner and Wrubel's theory. The nurses emphasized that the thoughts of patients with a recent lung cancer diagnosis revolve around more than the surgery. Nursing comprises not only practicalities but also attending to patients' stress and their coping with being struck with lung cancer and having undergone surgery. A counterculture emerged to counteract the logic of productivity, indicating that caring as a worthy end in itself may be underestimated in protocol-driven care. Prolonging hospitalization largely depends on clinical judgment. The nurses' aim is not to keep patients in the hospital but to avoid any needless suffering, allowing them to reclaim the primacy of caring.

A balancing act-midwives' and public health nurses' experiences with breastfeeding counselling.

AIMS AND OBJECTIVES: To explore midwives' and public-health nurses' experiences of breastfeeding counselling in order to provide a deeper insight into breastfeeding counselling. METHODOLOGICAL DESIGN AND JUSTIFICATION: A qualitative design was used, and qualitative content analysis was conducted to analyse the data in accordance with the phenomenological hermeneutic tradition. ETHICAL ISSUES AND APPROVAL: The Norwegian Centre for Research Data approved this study. All participants provided written consent. RESEARCH METHODS: Four focus-group interviews were conducted on a sample of eight midwives and 13 public-health nurses in Norway. RESULTS: Three interrelated themes describing the meaning of midwives' and public-health nurses' experiences with breastfeeding counselling emerged from the analysis: Breastfeeding Counselling Means Responsibility for Collaboration and Facilitation, Being Confident as a Breastfeeding Counsellor Means Striving for Professional Competence and Supporting the Individual Breastfeeding Family Means Being Sensitive and Adapting to Novel Situations. STUDY LIMITATIONS: The focus groups comprised a mix of midwives and public-health nurses, which may have inhibited honest declaration of these professionals' opinions of each other. CONCLUSION: Midwives and public-health nurses regard structural factors and prioritising breastfeeding support in society as important for providing good breastfeeding counselling. Midwives and public-health nurses strive to find a balance between relying on their own competence, promoting breastfeeding in accordance with guidelines and respecting mothers' choices. Healthcare professionals require knowledge about breastfeeding, good clinical judgement, a listening attitude and openness to how breastfeeding affects mother's everyday life to provide good breastfeeding care.

The role of perceived organizational support for nurses' ability to handle and resolve ethical value conflicts: A mixed methods study.

AIM: To explore if and how nurses' perceived organizational support affects their ability to handle and resolve ethical value conflicts. DESIGN: A mixed methods design with a longitudinal questionnaire survey and focus group interviews. METHODS: A questionnaire survey in six hospitals in two Swedish regions provided data from 711 nurses responding twice (November-January 2019/2020 and November-January 2020/2021). A cross-lagged path model tested the mutual prospective influence between the organizational climate of perceived organizational support, frequency of ethical value conflicts, and resulting moral distress. Four focus group interviews were conducted with 21 strategically selected nurses (April-October 2021). Qualitative data collection and analysis were inspired by Grounded Theory. RESULTS: A climate of perceived organizational support was empowering, contributing to role security. It prospectively decreased the frequency of ethical value conflicts but not the moral distress when conflicts did occur. CONCLUSION: It is important to facilitate the development of perceived organizational support among nurses, but also to reduce the occurrence of ethical value conflicts that the nurses cannot resolve. IMPLICATIONS FOR THE PROFESSION: By ensuring a shared care ideology, good inter-professional relations within the entire care organization, providing clear and supportive organizational structures, and utilizing competence adequately, healthcare managers can facilitate and support the development of perceived organizational support among nurses. Nurses who are empowered by perceived organizational support are stimulated by and take pride in their work and experience the work as meaningful and joyful. IMPACT: The study addressed the question of whether healthcare organizations could support nurses to resolving ethical value conflicts, and thus reduce moral distress. Perceived organizational support is related to factors such as ideological caring alignment and supportive organizational preconditions. This study contributes specific knowledge about how healthcare organizations can empower nurses to effectively resolve ethical value conflicts and thereby reduce their moral distress. PATIENT OR PUBLIC CONTRIBUTION: No patient or public contribution.

Need of support for significant others to persons with borderline personality disorder-A Swedish focus group study.

BACKGROUND: Being a significant other (SO) to a person with borderline personality disorder (BPD) affect their health. High incidence of substance use disorder, post-traumatic stress disorder, stress, fear, anxiety, depression, family burden and grief are common. Some specific therapies for BPD, have included support to SOs, however resources are scarce and to participate in the support it assumes that the person with BPD is included in these therapies. Although the SO support has been shown to be helpful, they all have a similar structure, and only a small exclusive group of SOs have access to the support. AIM: The aim was to describe experiences and need of support for significant others to persons with borderline personality disorder from the perspective of themselves and of health care workers. METHODS: Data was collected via two focus groups. One with five SOs to persons with BPD, one with five health care workers. Two interview sessions in each group were conducted and data were analysed with qualitative content analysis. The study was approved by the research ethics committee of Lund (2016-1026). RESULTS: The results revealed four themes; not being seen by health care professionals creates hopelessness, being seen by healthcare professionals creates trust, experience of support - helpful or shameful and the step from loosely structured support to a structured support group. Both groups expressed a need for further support as a complement to already existing support. CONCLUSIONS: The need of support is extensive. The results suggest a professional coordinator intended for SOs and peer support groups not linked to a particular psychiatric treatment yet offering support in a structured way. Further studies examining these complements to existing support, is therefore recommended.

Expectations related to home-based telemonitoring of high-risk pregnancies: A qualitative study addressing healthcare providers' and users' views in Norway.

INTRODUCTION: A pregnancy can be evaluated as high-risk for the woman and/or the fetus based on medical history and on previous or ongoing pregnancy characteristics. Monitoring high-risk pregnancies is crucial for early detection of alarming features, enabling timely intervention to ensure optimal maternal and fetal health outcomes. Home-based telemonitoring (HBTM) is a marginally exploited opportunity in antenatal care. The aim of this study was to illuminate healthcare providers' and users' expectations and views about HBTM of maternal and fetal health in high-risk pregnancies before implementation. MATERIAL AND METHODS: To address diverse perspectives regarding HBTM of high-risk pregnancies, four different groups of experienced healthcare providers or users were interviewed (n = 21). Focus group interviews were conducted separately with midwives, obstetricians, and women who had previously experienced stillbirth. Six individual interviews were conducted with hospitalized women with ongoing high-risk pregnancies, representing potential candidates for HBTM. None of the participants had any previous experience with HBTM of pregnancies. The study is embedded in a social constructivist research paradigm. Interviews were analyzed using a thematic approach. RESULTS: The participants acknowledged the benefits and potentials of more active roles for both care recipients and providers in HBTM. Concerns were clearly addressed and articulated in the following themes: eligibility and ability of women, availability of midwives and obstetricians, empowerment and patient safety, and shared responsibility. All groups problematized issues crucial to maintaining a sense of safety for care recipients, and healthcare providers also addressed issues related to maintaining a sense of safety also for the care providers. Conditions for HBTM were understood in terms of optimal personalized training, individual assessment of eligibility, and empowerment of an active patient role. These conditions were linked to the importance of competent and experienced midwives and obstetricians operating the monitoring, as well as the availability and continuity of care provision. Maintenance of safety in HBTM in high-risk pregnancies was crucial, particularly so in situations involving emerging acute health issues. CONCLUSIONS: HBTM requires new, proactive roles among midwives, obstetricians, and monitored women, introducing a fine-tuned balance between personalized and standardized care to provide safe, optimal monitoring of high-risk pregnancies.

Swedish stakeholders' views of the preparatory work needed before introducing the nurse practitioner role in municipal healthcare-A focus group study.

BACKGROUND: The nurse practitioner role has become important globally in handling the growing healthcare needs of older adults with chronic diseases. Nevertheless, research shows that introducing the role is a complex process, and more studies are needed to prepare for its introduction into different healthcare contexts, such as municipal healthcare. AIM: The aim is to investigate what Swedish stakeholders identify as the preparatory work needed before introducing the nurse practitioner role into municipal healthcare. METHODS: Data were collected through four focus group interviews conducted virtually on the TEAMS digital platform, with three to six participants in each group and 18 participants total. The transcribed interviews were analysed using a six-step thematic approach: familiarisation with the data, coding the data, generating initial themes, reviewing themes, defining and naming the themes and producing the report. FINDINGS: The findings are divided into two main themes, each with two sub-themes. In the first, clarifying why the nurse practitioner role is needed, participants stressed the importance of having a clear intention for introducing the role. The second, ensure a national framework to bolster the introduction at the local level, demonstrates the need for collaboration among national actors to clarify the role's mandate and authority before its introduction. CONCLUSIONS: Adding the nurse practitioner role to municipal healthcare can help increase the supply of nursing competence and the quality of patient care, but preparation for introducing the role requires extensive work. The development of the nurse practitioner role requires decision-makers and leaders to take primary responsibility for its introduction. This study can support countries in the early phase of developing the nurse practitioner role by identifying both best practices and pitfalls.

Medication-free mental health treatment: a focus group study of milieu therapeutic settings.

BACKGROUND: Medication-free treatment within mental health care aims to offer therapeutic support as an alternative to psychotropic medication. Introducing milieu therapy for severely mentally ill persons in a medication-free unit requires significant changes to the traditional medication-based psychiatric setting. The present study examines how milieu therapists experience working with medication-free treatment for people with severe mental health challenges. The research question was "What may be required to succeed with medication-free treatment in milieu therapeutic settings?" METHODS: A qualitative study with four focus groups were conducted with 23 milieu therapists from three inpatient units in two mental health institutions. Thematic analysis was performed. RESULTS: One main theme was identified: medication-free treatment involves therapists and patients working together on holistic and personal health promotion. This common thread links the four themes: helping patients to make changes in their life; having time to focus on the individual patient; being a professional companion; and working together as a team with the patient. CONCLUSIONS: A holistic approach is necessary for medication-free treatment to succeed. This requires working together in multidisciplinary teams with a focus on the individual patient. Milieu therapists must engage and take more responsibility in the patient's process of health promotion. A change from a medical to a humanistic paradigm within mental health care is needed.

Handling polypharmacy -a qualitative study using focus group interviews with older patients, their relatives, and healthcare professionals.

BACKGROUND: On average, older patients use five or more medications daily. A consequence is an increased risk of adverse drug reactions, interactions, or medication errors. Therefore, it is important to understand the challenges experienced by the patients, relatives, and healthcare professionals pertinent to the concomitant use of many drugs. METHODS: We conducted a qualitative study using focus group interviews to collect information from patients, relatives, and healthcare professionals regarding older patients' management of prescribed medicine. We interviewed seven patients using five or more medications daily, three relatives, three general practitioners, nine nurses from different healthcare sectors, one home care assistant, two hospital physicians, and four pharmacists. RESULTS: The following themes were identified: (1) Unintentional non-adherence, (2) Intentional non-adherence, (3) Generic substitution, (4) Medication lists, (5) Timing and medication schedule, (6) Medication reviews and (7) Dose dispensing/pill organizers. CONCLUSION: Medication is the subject of concern among patients and relatives. They become confused and insecure about information from different actors and the package leaflets. Therefore, patients often request a thorough medication review to provide an overview, knowledge of possible side effects and interactions, and a clarification of the medication's timing. In addition, patients, relatives and nurses all request an indication of when medicine should be taken, including allowable deviations from this timing. Therefore, prescribing physicians should prioritize communicating information regarding these matters when prescribing.

Empowerment through participation in community-based participatory research-effects of a physical activity promotion project among socially disadvantaged women.

Introduction: Community-based participatory research (CBPR) approaches are associated with a range of positive impacts on empowerment. However, only a few studies have investigated the influence of different modes of target group participation on empowerment. The present study examined the empowerment processes and outcomes of women in difficult life situations through their participation as co-researchers in the form of Photovoice in "Stark durch Bewegung" (English: "Strong through Movement"), a CBPR project for physical activity (PA) promotion. The extent to which women's participation as co-researchers leads to empowerment was compared with other forms of participation. Methods: The Photovoice approach consisted of three components: (1) photo task, (2) focus group interviews, and (3) exhibition of photos. It was then extended through participant observation. A total of 18 women took part in Photovoice. They took photos, were involved in four focus groups, helped in the analysis of data, and supported their exhibition. Two additional short focus group interviews in which four more women participated were conducted at the end of the project. The interview guideline was based on the SHOWeD questions proposed within the framework of Photovoice and enriched with various other questions (e.g., self-efficacy, social contacts, and community involvement). The data were analyzed based on a grounded theory approach. Results: "Stark durch Bewegung" contributed to women's empowerment in several ways. By participating in the project's PA programs, the women reported numerous empowerment effects, such as improved self-efficacy, perceived competencies like swimming and language skills, and social networks. By participating as co-researchers, they perceived empowering processes on organizational and community levels that are comparable with other forms of participation (e.g., participation in a cooperative planning group) but also differ from them at relevant points (e.g., encouraging them to reflect on their own PA behaviors). The willingness to get involved in Photovoice was estimated to be significantly higher than in other possible forms of participation. Conclusion: Our findings support the notion that health promotion interventions with marginalized groups can contribute to their empowerment on multiple levels when participants become equal partners in the CBPR project. Involving women as co-researchers has advantages over other forms of participation in terms of their empowerment.

Exploring intersectoral collaboration in diabetes care: A positioning theoretical perspective.

Intersectoral collaboration (IC) plays a significant role in the delivery of diabetes care and treatment of patients with type 2 diabetes (DM2), as the treatment and care of these patients take place in both primary care and specialist settings. The collaboration involves a large number of actors from primary and secondary healthcare sectors, who are expected to fulfil various roles when they engage in IC. We explored the actors' roles by applying the framework of positioning theory with the aim of revealing seemingly embedded understandings of such roles. The empirical data consisted of individual and focus group interviews. Our results indicate that naturalised understandings of the roles of actors interact with the way in which health professionals, patients, managers and relatives strive to develop IC that aims to help and guide patients who live with DM2.