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INTRODUCTION: Many tools support housing decisions for older adults but often overlook mobility patterns and social health. We explored these factors in older Canadians living at home to inform housing decisions.

METHODS: We conducted a mixed-methods study with 20 older adults (65+) from Quebec and Alberta living independently or in senior residences with outdoor mobility. Data collection included sociodemographic information, GPS tracking, walking interviews, daily journals, and in-depth interviews. Data from interviews, which explored physical and social assets and barriers to social health and mobility, were analyzed using deductive content analysis in NVivo 12. GPS data were subjected to spatial analysis in QGIS (Quantum Geographic Information System) to map activity spaces and mobility patterns by the number and distance of activities, activity types, and modes of transportation. Daily journals were transcribed into an Excel spreadsheet and compared with GPS data. Overall analysis was guided hierarchically by qualitative data, utilizing verbatim narratives and visualization (activity space maps) to illustrate data convergence.

RESULTS: Among 20 participants, 14 completed all activities, including GPS trackers. GPS maps showed participants mostly left home to drive for shopping or walking. Over 14 days, participants made an average of 10.4 (±5.8) trips and traveled 186.9 km (±130.4), averaging 16.8 km (±29.8) per day. Transportation modes included car (n=9), walking (n=5), and bus (n=2). Daily journals revealed that participants typically traveled alone. Interviews identified physical assets as libraries and supermarkets (n=10), while social assets were family support when desired (n=13) neighborhood familiarity (n=14), both contributing to social health. Winter weather was the most cited mobility barrier (n=13).

CONCLUSIONS: These findings provide actionable insights to guide the development of user-informed decision support tools tailored to the housing decisions of Canadian older adults.

BACKGROUND: Distance nurse education is an essential contribution to sustainable access for nurses in rural and remotes areas. However, distance nurse education requires pedagogical changes, and we need more knowledge to design education programmes that can accommodate students who study off-campus.

OBJECTIVE: To explore how undergraduate nursing students experience a distance education programme.

METHODS: A qualitative explorative design. Students in a distance nurse education programme participated in six focus group interviews from March to September 2022. Data were subjected to qualitative content analysis.

RESULTS: Students had a generally positive experience of the distance nurse education programme and were especially pleased with its flexibility. The two main themes were students' sense of belonging and social interactions and their participation in learning activities. Students cited face-to-face meetings as an important factor in having a sense of community, involvement, and continuous motivation for their studies. Students found study groups to be useful for learning and progress in the study subjects. Physical teaching sessions at a non-university site facilitated and motivated them to follow live streaming of lectures at home and to collaborate online with the study group between those meetings. Social interaction with the educator and other students in physical teaching sessions was important for discussions of the subject matter and for assistance with technical challenges. A predictable timetable was essential for the students to balance time for their studies with family and work responsibilities.

CONCLUSION: Students in the distance nurse programme preferred a combination of face-to-face meetings and live streaming. Study groups contributed to motivation, understanding of the course content, and a sense of community. It also helped to improve students' collaboration skills. These students have many professional and family obligations, so a predictable course plan was important to them.

Klimatförändringar utgör ett allvarligt hot mot människors hälsa och kräver att hälso- och sjukvården tar en aktiv roll i klimatanpassningen. Denna kunskapsöversikt visar att sjukvårdens anpassning måste utgå från dess kärnuppdrag: att skydda människors liv och välbefinnande. 

Ökad frekvens av extremväder, luftföroreningar och infektionssjukdomar skapar nya utmaningar för vården. Trots detta saknas en tydlig strategi för hur sjukvården ska hantera dessa förändringar. Kunskapsöversikten visar att det behövs en samordnad nationell plan där resurser avsätts för att både förebygga och hantera klimatrelaterade hälsorisker. Idag ser vi en obalans där klimatanpassning ofta prioriteras bort i en redan pressad vårdsektor. Detta leder till att ansvaret faller på enskilda regioner och vårdinrättningar, vilket skapar ojämlikheter och ineffektivitet. 

En viktig del av klimatanpassningen är att integrera klimatfrågor i hälso- och sjukvårdens styrning, utbildning och forskning. Ett ökat fokus på klimat och hälsa i vårdutbildningar behövs, så att framtida vårdpersonal är rustade för de utmaningar som klimatförändringarna innebär. Samtidigt måste forskning finansieras och riktas mot lösningar som möjliggör en mer klimattålig sjukvård, inklusive utveckling av klimatanpassad infrastruktur och sjukvårdssystem. Kunskapsöversikten rekommenderar att:

• Hälsa bör införlivas i all utformning och genomförande av klimatanpassning, med hälso- och sjukvårdspersonal engagerade i varje steg. 
• Den politiska ledningen bör prioritera klimatåtgärder inom landet, regioner och kommuner och över nationsgränserna med fokus på miljörättvisa och främjande av hälsan hos utsatta befolkningar.
• Klimatutbildning bör införlivas i hälso- och sjukvårdens professionsutbildningar för att säkerställa att en grundläggande kunskap byggs upp inom alla sektorer och att kritiskt tänkande utvecklas.
• Forskningsfinansiering bör stimulera klimatsmarta initiativ, inklusive grön och klimattålig infrastruktur och sjukvårdssystem, samt hälsosamma miljöer.

INTRODUCTION: Participatory, emergent, and reflective approaches are needed in research on person-centred integrated care. This paper describes and explores the process of developing a complex care transition intervention for stroke survivors, along with the lessons learned.

DESCRIPTION: This study concerns the Missing Link project, which aimed to develop and evaluate a care transition intervention from hospital to home. The care transition was developed according to the Medical Research Council (MRC) Framework and included studies on context, co-design workshops, and prototype development.

DISCUSSION: The development process faced challenges relating to understanding the emergence within the studied context and the complex adaptive systems. We failed to have a continuous and sustained involvement of healthcare professionals, patients, and significant others during the different phases of the project. Hence, a lack of shared understanding is conceivable as the emergence might have been interpreted and understood differently by the actors.

CONCLUSION: Challenges in achieving shared understanding throughout the project underline the importance of investing in relationship building, meaningful interaction, and continuous feedback loops. While the MRC framework provides guidance for developing complex interventions, the phased approach may only partially capture the emergence and self-organisation within complex adaptive systems.

Background: In response to rural nursing shortages, some traditional on-campus bachelor of science in nursing degree programs have transitioned to a blended learning approach at satellite campuses. This significant shift requires an understanding of how students view the learning activities involved in skills training. Aim: The aim of this study was to assess students in an education program in Southern Norway regarding their satisfaction in and self-confidence with skills training using blended learning. The program was hosted at satellite campuses of two universities. Methods: For this cross-sectional study, 54 students completed a Student Satisfaction and Self-confidence in Learning scale and open-ended questions. Quantitative data were analyzed with descriptive statistics and qualitative data assessed using content analysis. Results: Students who completed skills training reported high levels of satisfaction with the learning activities and support from their teachers. In addition, they demonstrated high self-confidence in practicing skills. Conclusion: The current findings indicate that students appreciate blended learning strategies and the availability of skills training on satellite campuses along with supportive teaching practices. © 2025 The Authors

PURPOSE: Self-management has increased in recognition in stroke research and rehabilitation along with growing trends of shorter hospital stays and more patient-centred care. Family members are key persons in the self-management process, but their views and experiences of self-management have not been studied in detail. This study aimed to explore family members' understanding of self-management, the strategies they use and the challenges they face when providing support.

METHODS: For this descriptive study, semi-structured interviews with family members (n = 27) were conducted. Data were analysed using inductive content analysis.

RESULTS: The analysis resulted in three main categories and eight subcategories. Most family members saw self-management as performing practical tasks, such as daily living activities and rehabilitation training. However, family members described a broad range of actions to support self-management, including emotional and motivational support. They found it challenging to give the right amount of support and expressed a need of more information after discharge.

CONCLUSIONS: Family members' conceptualisations of self-management differ from the strategies they use to provide support. A clearer understanding of self-management as a collective process can benefit the development and delivery of efficient self-management support.

INTRODUCTION: Care transitions following a stroke call for integrated care approaches to reduce death and disability. The proposed research described in this study protocol aims to evaluate the effectiveness of a person-centred multicomponent care transition support and the process in terms of contextual moderators, implementation aspects and mechanisms of impact.

METHODS: A non-randomized controlled trial design will be used. The intervention includes person-centred dialogue intended to permeate all patient-provider communication, various pedagogical modes of information, a person-centred care and rehabilitation plan, and a bridging e-meeting to prepare patients for homecoming. Patients with stroke or TIA who are to be discharged from the participating hospitals to home and referred to a neurorehabilitation team for continued rehabilitation will be included. Follow-ups will be conducted at one week, 3 months and 12 months. Data will be collected on the primary outcome of perceived quality of the care transition, and on the secondary outcomes of health literacy, medication adherence, and perceived person-centeredness. Data for process evaluation will be collected through semi-structured interviews, focus groups, participatory observations, and the Normalisation Measure Development Questionnaire.

DISCUSSION: The study will provide insights on implementation, mechanisms of impact, contextual moderators, and effectiveness of a care transition support, targeting a poorly functioning part of the care trajectory for people with stroke and TIA.

CLINICAL TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT05646589.

OBJECTIVE: This study utilized the evidence-gap map method and critically examined the scope, methodologies, and focus of the studies that investigated the influence of the built environment on inpatient healthcare settings over a decade (2010-2021).

METHODS: We conducted a systematic review per the preferred reporting items for systematic reviews and meta-analyses guidelines and surveyed 406 articles, primarily from North America and Europe.

RESULTS: Our findings revealed a dominant focus on architectural features (73%), such as room design and ward layout. Comparatively, there was less emphasis on interior-, ambient-, social-, and nature-related features. Most previous studies explored multiple environmental features, which indicated the intricacy of this field. Research outcomes were diverse, with person-centered care (PCC) being the most frequently investigated, followed by safe care, emotional well-being, activity, and behavior. Furthermore, research methods varied considerably based on the study's outcomes and features. Clinical outcomes and safe care favored quantitative methods, activity and behavior favored mixed methods, and PCC favored qualitative research.

CONCLUSION: This review provides an in-depth overview of the existing studies on healthcare design research and sheds light on the current trends and methodological choices. The insights garnered can guide future research, policy-making, and the development of healthcare facilities.

Idag bor många äldre personer kvar i sin bostad trots omfattande hälsoproblem i form av fysiska och kognitiva funktionsnedsättningar och långvariga sjukdomstillstånd. Miljöns utformning har potential att stödja personer med skör hälsa och således krävs fungerande boendemiljöer som är anpassade till äldre personers behov och skapar förutsättningar att leva ett gott liv. Mot denna bakgrund ville vi undersöka miljömässiga aspekter av betydelse för äldre personer och deras aktiviteter i boendemiljön. För att få en heltäckande bild av äldres boendemiljöer tillämpades olika metoder. Data har använts från SWEOLD Dalarna, en databas som fångar ett brett spektrum av levnadsvillkor för äldre personer. I SWEOLD-urvalet ingick drygt 400 personer där medelåldern var 82 år. Vidare har en mindre grupp äldre personer med hemtjänst deltagit där data har insamlats med intervjuer, observationer, aktivitetsdagböcker, frågeformulär och GPS-sändare. I den gruppen ingick 20 personer där medelåldern var 87 år. För att få ett bredare perspektiv kring äldres boendemiljöer har även hemtjänstpersonal och anhöriga till personer med hemtjänst deltagit.

Några av resultaten visade att boendemiljön kunde relateras till en känsla av gemenskap, trygghet och tillhörighet. Äldre personer hade rutiner i vardagen i form av aktiviteter i och utanför bostaden och det var av central betydelse att känna sig självständig i det dagliga livet trots hälsoproblem och försämrad funktionsförmåga. Miljöhinder förekom i samtliga bostäder både utomhus, vid entréer och inomhus, något som kunde begränsa äldre personers mobilitet och delaktighet. Av resultaten framkom även könsskillnader där kvinnor i jämförelse med män uppgav sämre mobilitet, använde hjälpmedel i större utsträckning och upplevde fler tillgänglighetshinder. Sammantaget framkom att boendemiljöns utformning har stor påverkan på äldre i deras vardag, inte minst vad gäller förutsättningar för socialt umgänge där bostadens inomhusmiljö, utomhusmiljö och närliggande omgivning måste vara tillgänglig och användbar.