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  • 1. Abarca-Goméz, Leandra
    et al.
    Abdeen, Ziad A
    Abdul Hamid, Zargar
    Abu-Rmeileh, Niveen M
    Acosta-Cazares, Benjamin
    Acuin, Cecilia
    Adams, Robert J
    Aekplakorn, Wichai
    Forsner, Maria
    Dalarna University, School of Education, Health and Social Studies, Caring Science/Nursing.
    Ezzati, Majid
    Worldwide trends in body-mass index, underweight, overweight, and obesity from 1975 to 2016: a pooled analysis of 2416 population-based measurement studies in 128·9 million children, adolescents, and adults.2017In: The Lancet, ISSN 0140-6736, E-ISSN 1474-547X, Vol. 390, no 10113, p. 2627-2642Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Underweight, overweight, and obesity in childhood and adolescence are associated with adverse health consequences throughout the life-course. Our aim was to estimate worldwide trends in mean body-mass index (BMI) and a comprehensive set of BMI categories that cover underweight to obesity in children and adolescents, and to compare trends with those of adults.

    METHODS: We pooled 2416 population-based studies with measurements of height and weight on 128·9 million participants aged 5 years and older, including 31·5 million aged 5-19 years. We used a Bayesian hierarchical model to estimate trends from 1975 to 2016 in 200 countries for mean BMI and for prevalence of BMI in the following categories for children and adolescents aged 5-19 years: more than 2 SD below the median of the WHO growth reference for children and adolescents (referred to as moderate and severe underweight hereafter), 2 SD to more than 1 SD below the median (mild underweight), 1 SD below the median to 1 SD above the median (healthy weight), more than 1 SD to 2 SD above the median (overweight but not obese), and more than 2 SD above the median (obesity).

    FINDINGS: Regional change in age-standardised mean BMI in girls from 1975 to 2016 ranged from virtually no change (-0·01 kg/m2 per decade; 95% credible interval -0·42 to 0·39, posterior probability [PP] of the observed decrease being a true decrease=0·5098) in eastern Europe to an increase of 1·00 kg/m2 per decade (0·69-1·35, PP>0·9999) in central Latin America and an increase of 0·95 kg/m2 per decade (0·64-1·25, PP>0·9999) in Polynesia and Micronesia. The range for boys was from a non-significant increase of 0·09 kg/m2 per decade (-0·33 to 0·49, PP=0·6926) in eastern Europe to an increase of 0·77 kg/m2 per decade (0·50-1·06, PP>0·9999) in Polynesia and Micronesia. Trends in mean BMI have recently flattened in northwestern Europe and the high-income English-speaking and Asia-Pacific regions for both sexes, southwestern Europe for boys, and central and Andean Latin America for girls. By contrast, the rise in BMI has accelerated in east and south Asia for both sexes, and southeast Asia for boys. Global age-standardised prevalence of obesity increased from 0·7% (0·4-1·2) in 1975 to 5·6% (4·8-6·5) in 2016 in girls, and from 0·9% (0·5-1·3) in 1975 to 7·8% (6·7-9·1) in 2016 in boys; the prevalence of moderate and severe underweight decreased from 9·2% (6·0-12·9) in 1975 to 8·4% (6·8-10·1) in 2016 in girls and from 14·8% (10·4-19·5) in 1975 to 12·4% (10·3-14·5) in 2016 in boys. Prevalence of moderate and severe underweight was highest in India, at 22·7% (16·7-29·6) among girls and 30·7% (23·5-38·0) among boys. Prevalence of obesity was more than 30% in girls in Nauru, the Cook Islands, and Palau; and boys in the Cook Islands, Nauru, Palau, Niue, and American Samoa in 2016. Prevalence of obesity was about 20% or more in several countries in Polynesia and Micronesia, the Middle East and north Africa, the Caribbean, and the USA. In 2016, 75 (44-117) million girls and 117 (70-178) million boys worldwide were moderately or severely underweight. In the same year, 50 (24-89) million girls and 74 (39-125) million boys worldwide were obese.

    INTERPRETATION: The rising trends in children's and adolescents' BMI have plateaued in many high-income countries, albeit at high levels, but have accelerated in parts of Asia, with trends no longer correlated with those of adults.

    FUNDING: Wellcome Trust, AstraZeneca Young Health Programme.

  • 2. Arouca, Aline B
    et al.
    Santaliestra-Pasías, Alba M
    Moreno, Luis A
    Marcos, Ascensión
    Widhalm, Kurt
    Molnár, Dénes
    Manios, Yannis
    Gottrand, Frederic
    Forsner, Maria
    Dalarna University, School of Education, Health and Social Studies, Caring Science/Nursing. Umeå universitet.
    Michels, Nathalie
    Diet as a moderator in the association of sedentary behaviors with inflammatory biomarkers among adolescents in the HELENA study2019In: European Journal of Nutrition, ISSN 1436-6207, E-ISSN 1436-6215, Vol. 58, no 5, p. 2051-2065Article in journal (Refereed)
    Abstract [en]

    AIM: To assess if a healthy diet might attenuate the positive sedentary-inflammation relation, whereas an unhealthy diet may increase the effect of sedentary behaviors on inflammatory biomarkers.

    METHODS: In 618 adolescents (13-17 years) of the European HELENA study, data were available on body composition, a set of inflammation markers, and food intake assessed by a self-administered computerized 24 h dietary recall for 2 days. A 9-point Mediterranean diet score and an antioxidant-rich diet z-score were used as dietary indices and tested as moderators. A set of low-grade inflammatory characteristics was used as outcome: several cytokines in an inflammatory ratio (IL-6, IL-10, TNF-α, TGFβ-1), C-reactive protein, three cell-adhesion molecules (sVCAM-1, sICAM-1, sE-selectin), three cardiovascular risk markers (GGT, ALT, homocysteine) and three immune cell types (white blood cells, lymphocytes, CD3). Sedentary behaviors were self-reported and analyzed as total screen time. Multiple linear regression analyses tested moderation by diet in the sedentary behaviors-inflammation association adjusted for age, sex, country, adiposity (sum of six skinfolds), parental education, and socio-economic status.

    RESULTS: Both diet scores, Mediterranean and antioxidant-rich diet, were significant protective moderators in the effect of sedentary behaviors on alanine-transaminase enzyme (P = 0.014; P = 0.027), and on the pro/anti-inflammatory cytokine ratio (P = 0.001; P = 0.004), but not on other inflammatory parameters.

    CONCLUSION: A higher adherence to the Mediterranean diet or an antioxidant-rich diet may attenuate the onset of oxidative stress signs associated by sedentary behaviors, whereas a poor diet seems to increase inflammation.

  • 3. Bentham, James
    et al.
    Ezzati, Majid
    A century of trends in adult human height2016In: eLIFE, E-ISSN 2050-084X, ISSN 2050-084X, Vol. 5, p. 1-29, article id e13410Article in journal (Refereed)
    Abstract [en]

    Being taller is associated with enhanced longevity, and higher education and earnings. We reanalysed 1472 population-based studies, with measurement of height on more than 18.6 million participants to estimate mean height for people born between 1896 and 1996 in 200 countries. The largest gain in adult height over the past century has occurred in South Korean women and Iranian men, who became 20.2 cm (95% credible interval 17.5–22.7) and 16.5 cm (13.3– 19.7) taller, respectively. In contrast, there was little change in adult height in some sub-Saharan African countries and in South Asia over the century of analysis. The tallest people over these 100 years are men born in the Netherlands in the last quarter of 20th century, whose average heights surpassed 182.5 cm, and the shortest were women born in Guatemala in 1896 (140.3 cm; 135.8– 144.8). The height differential between the tallest and shortest populations was 19-20 cm a century ago, and has remained the same for women and increased for men a century later despite substantial changes in the ranking of countries.

  • 4.
    Elvhage, Gudrun
    et al.
    Stockholms Universitet.
    Forsner, Maria
    Dalarna University, School of Education, Health and Social Studies, Caring Science/Nursing.
    Identifying children at risk in Swedish schools2016Conference paper (Refereed)
  • 5. Esteban-Cornejo, Irene
    et al.
    Henriksson, Pontus
    Cadenas-Sanchez, Cristina
    Vanhelst, Jérémy
    Forsner, Maria
    Dalarna University, School of Education, Health and Social Studies, Caring Science/Nursing.
    Gottrand, Frederic
    Kersting, Mathilde
    Moreno, Luis A
    Ruiz, Jonatan R
    Ortega, Francisco B
    Early life programming of attention capacity in adolescents: The HELENA study2018In: Maternal and Child Nutrition, ISSN 1740-8695, E-ISSN 1740-8709, Vol. 14, no 1, article id e12451Article in journal (Refereed)
    Abstract [en]

    The study aims to examine the individual and combined association of early life factors (birth weight, birth length, and any and exclusive breastfeeding) with attention capacity in adolescents. The study included 421 European adolescents (243 girls), aged 12.5-17.5 years, who participated in the Healthy Lifestyle in Europe by Nutrition in Adolescence Study. Body weight and length at birth of adolescents were collected from parental records. The duration of any and exclusive breastfeeding were self-reported. The d2 Test of Attention was administered to assess attention capacity. The main results showed that birth weight, birth length, breastfeeding, and exclusive breastfeeding were related to attention capacity in boys (β ranging from 0.144 to 0.196; all p < .05) after adjustment for age, centre, gestational age, maternal education, family affluence scale, and body mass index. Among boys, differences in attention capacity were found according to tertiles of birth weight and birth length (p < .05), as well as borderline significant differences across groups of any and exclusive breastfeeding (p = 0.055 and p = 0.108, respectively) after adjusting for potential confounders. In addition, boys with 3 early life risk factors (low birth weight, low birth length, and <3 months of breastfeeding) had significantly lower scores in attention capacity compared with boys with 0 risk factors (percentile score - 15.88; p = 0.009). In conclusion, early life factors, both separately and combined, may influence attention capacity in male European adolescents. Importantly, the combination of the 3 early life risk factors, low birth weight, low birth length, and <3 months of breastfeeding, even in normal ranges, may provide the highest reduction in attention capacity.

  • 6.
    Forsner, Maria
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Pediatrik.
    Att vara barn i sjukdom och sjukvård: barns berättelser om sina upplevelser av sjukdom och sjukvårdsrädsla2006Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    The overarching aim of this thesis is to illuminate the experience of illness and the meaning of fear of medical care through children’s narratives.

    A purposive sample of 22 children and youths, aged from 2 to 18 years, narrated through play and conversation their experiences of illness and of their fear of contact with medical care. The data were analysed using thematic qualitative content analysis and the phenomenological hermeneutic method.

    In childhood, the experience of being ill seems to vary with the child’s age. At the ages of 7 to 10 years, the child’s way of thinking can colour the experience;imagination can produce both problems and opportunities. Children seem to combine imagination and reality, and contrasts in the experience coexist such as being scared/confident, sad/cosy and hurt/having fun. At the age of 11 to 18,being ill seemed to imply being lost, hurt and in need of comfort from themselves and others. Medical care can be frightening to children and what is fearful can differ with age. To a 2-year-old child, medical care seemed to be dangerous; to children aged 7 to 11 years, it seemed threatening, like a monster. To the 2-year-old child, there seemed to be a conflict between, on the one hand, living up to expectations by ‘being good’ and hiding their feelings or, on the other hand, communicating their fear.

    The narrations by children in the 7–11 year age group, point to the importance of empathy when caring for children, i.e., to be receptive of the child’s fear in order to help the child through and out of the fear. To be afraid for a two-yearold was to have one’s trust broken yet still be searching for a trustful relationship. However, if the child is received along with the fear, this opened up an opportunity for the child to develop courage and to gain control over the fear when under gentle care.

    The results of this research revealed the possibility of using play to create stories in a creative relationship with the child. To express one’s inner feeling is a gift of trust, a gift of hospitality. Thus when caring for children we can be the ones who are receiving that gift. We can accept the offer of being a guest in the child’s world.

  • 7.
    Forsner, Maria
    Dalarna University, School of Education, Health and Social Studies, Caring Science/Nursing.
    Behandling av barn i samband med smärtsamma procedurer i hälso- och sjukvård– kunskapsdokument2014In: Information från Läkemedelsverket, ISSN 1101-7104, no 3, p. 9-22Article in journal (Other academic)
  • 8.
    Forsner, Maria
    Dalarna University, School of Education, Health and Social Studies, Caring Science/Nursing.
    Guided Imagery2014In: Information från Läkemedelsverket, ISSN 1101-7104, no 3, p. 43-44Article in journal (Other academic)
  • 9. Forsner, Maria
    Guided imagery: Fantasin som hjälper barn i smärta2006In: Barn & psykosomatik: i teori och klinik / [ed] Alfvén, Gösta, Stockholm: Norstedts akademiska förlag , 2006Chapter in book (Other academic)
  • 10.
    Forsner, Maria
    Dalarna University, School of Education, Health and Social Studies, Caring Science/Nursing.
    Omvårdnad vid procedurer2015In: Pediatrisk omvårdnad / [ed] Inger Hallström och Tor Lindberg, Stockholm: Liber , 2015, 2Chapter in book (Other academic)
  • 11.
    Forsner, Maria
    Dalarna University, School of Education, Health and Social Studies, Caring Science/Nursing.
    Omvårdnad vid procedurer2009In: Pediatrisk omvårdnad / [ed] Inger Hallström, Tor Lindberg, Stockholm: Liber, 2009Chapter in book (Other academic)
  • 12.
    Forsner, Maria
    Dalarna University, School of Health and Social Studies, Caring Science/Nursing.
    Smärta hos barn2013In: Kvalitetsindikatorer inom omvårdnad / [ed] Ewa Idvall, Stockholm: Gothia Förlag AB, 2013, 6, p. 24-27Chapter in book (Other academic)
  • 13.
    Forsner, Maria
    et al.
    Dalarna University, School of Education, Health and Social Studies, Caring Science/Nursing.
    Berggren, Jenny
    Masaba, Jennipher
    Ekbladh, Annelie
    Children's and Youths' Clinic, Central Lasarettet, Växjö, Sweden.
    Lindholm Olinder, Anna
    Department of Clinical Science and Education, Karolinska Institute, Södersjukhuset, Stockholm, Sweden; Uppsala University, Department of Medical Sciences, Akademiska Sjukhuset, Uppsala, Sweden.
    Parents’ experiences of caring for a child younger than two years of age treated with continuous subcutaneous insulin infusion2014In: European Diabetes Nursing, ISSN 1551-7853, E-ISSN 1551-7861, Vol. 11, no 1, p. 7-12Article in journal (Refereed)
    Abstract [en]

    Diabetes during infancy is uncommon and continuous subcutaneous insulin infusion (CSII) is the recommended treatment with such young children. However, this form of treatment has not been investigated previously from the perspective of the parents.

    The aim of this study was to determine parents' experiences of caring for a child less than two years old who had diabetes mellitus and was being treated with CSII therapy.

    Three pairs of parents were interviewed twice to elucidate their views on the initial period and on daily living. Data were submitted to qualitative content analysis and resulted in seven categories and one theme, the latter being: ‘The diabetes disease was threatening our baby's life, but then the insulin pump came as a rescuing, though challenging, angel’. Parents initially felt life had been turned upside down, but later they felt in control nearly all the time.

    It was concluded that parents of infants with diabetes are in great need of support in order to manage the disease and CSII technology. The fear of losing control and the lack of relief lead to social isolation. Educating someone close to the family could be a valuable intervention.

  • 14.
    Forsner, Maria
    et al.
    Dalarna University, School of Education, Health and Social Studies, Caring Science/Nursing.
    Elvhage, Gudrun
    Stockholm Universitet.
    Narratives about concerns for child maltreatment.2016Conference paper (Refereed)
  • 15.
    Forsner, Maria
    et al.
    Dalarna University, School of Education, Health and Social Studies, Caring Science/Nursing.
    Eriksson, Katarina
    Svedberg, Marianne
    Furingsten, Lovisa
    Dalarna University, School of Education, Health and Social Studies, Caring Science/Nursing.
    When children die: a survey in Sweden about hospital guidelines related to care after death2014Conference paper (Refereed)
  • 16.
    Forsner, Maria
    et al.
    Dalarna University, School of Education, Health and Social Studies, Caring Science/Nursing.
    Goodholm, Marie
    Andersson, Malin
    Karlsson, Pernilla
    Umeå Universitet.
    Lindh, Viveca
    Umeå Universitet.
    Nordyke, Katrina
    Umeå Universitet.
    Ivarsson, Anneli
    Umeå Universitet.
    Guided Imagery during venipuncture in twelve year old school children Guided Imagery during venipuncture, 12-year old children’s experiences from a CD screening: An intervention evaluated with FAS, VAS and written narratives2010Conference paper (Refereed)
  • 17.
    Forsner, Maria
    et al.
    Dalarna University, School of Education, Health and Social Studies, Caring Science/Nursing.
    Heimdal, Sara
    Jacobsson, Marlene
    Furingsten, Lovisa
    Dalarna University, School of Education, Health and Social Studies, Caring Science/Nursing.
    Lûtzén, Kim
    Karolinska Institutet.
    Health care professionals’ experiences of moral stress when children are dying2014Conference paper (Refereed)
  • 18.
    Forsner, Maria
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap.
    Jansson, Lilian
    Kriström, Berit
    Söderberg, Anna
    Being afraid of medical care: a narrative mediated through the symbolic play of one 2 year-old boyManuscript (preprint) (Other (popular science, discussion, etc.))
  • 19. Forsner, Maria
    et al.
    Jansson, Lilian
    Soerlie, Venke
    Being ill as narrated by children aged 11-18 years2005In: Journal of Child Health Care, Vol. 9, no 4, p. 314-323Article in journal (Refereed)
    Abstract [en]

    Being ill from a child’s perspective has not been often investigated. The aim of this study was to illuminate the experience of being ill between the ages of 11-18 years. Four girls and one boy who were suffering short-term illness were interviewed and the data obtained subjected to qualitative content analysis. Illness disrupted their daily lives and made things unrecognizable. Being ill at the age of 11-18 seemed to imply being lost, hurt and in need of comfort from themselves and others. These narrations may indicate to health care professionals how they can improve their practice. This study suggests what is appreciated by children of this age when ill, namely being spoken to and informed about the illness and treatment. The children valued peace and quiet and wanted to listen to and adjust to their bodies.

  • 20.
    Forsner, Maria
    et al.
    Dalarna University, School of Education, Health and Social Studies, Caring Science/Nursing.
    Jansson, Lilian
    Söderberg, Anna
    Afraid of medical care: school-aged children’s narratives about medical fear2009In: Journal of Pediatric Nursing: Nursing Care of Children and Families, ISSN 0882-5963, E-ISSN 1532-8449, Vol. 24, no 6, p. 519-528Article in journal (Refereed)
    Abstract [en]

    Fear can be problematic for children who come into contact with medical care. This study aimed to illuminate the meaning of being afraid when in contact with medical care, as narrated by children 7–11 years old. Nine children participated in the study, which applied a phenomenological hermeneutic analysis methodology. The children experienced medical care as “being threatened by a monster,” but the possibility of breaking this spell of fear was also mediated. The findings indicate the important role of being emotionally hurt in a child's fear to create, together with the child, an alternate narrative of overcoming this fear.

  • 21.
    Forsner, Maria
    et al.
    Umeå universitet, Medicinsk fakultet, Klinisk vetenskap, Pediatrik.
    Jansson, Lilian
    Sørlie, Venke
    The experience of being ill as narrated by hospitalized children aged 7-10 years with short-term illness.2005In: Journal of Child Health Care, Vol. 9, no 2, p. 153-165Article in journal (Refereed)
    Abstract [en]

    Children's illness has been investigated through the eyes of parents and nurses but the child's own perspective has been largely ignored. The aim of this study is to illuminate the 7-10-year-olds' experiences of being ill. Three girls and four boys were interviewed and narrated their experience about short-term illness. The data obtained was subjected to a thematic qualitative content analysis. The analysis suggests that the children combined reality and imagination and contrasts seemed to coexist such as being scared/confident, sad/cosy and hurt/having fun. They felt caught and tried to escape. The experience of illness as narrated by children can lead to a richer understanding and influence the way we care for paediatric patients.

  • 22.
    Forsner, Maria
    et al.
    Dalarna University, School of Health and Social Studies, Caring Science/Nursing.
    Mörelius, Evalotte
    Linköpings universitet.
    Läkemedelshantering för barn2013In: Kvalitetsindikatorer inom omvårdnad / [ed] Idvall, Ewa, Stockholm: Gothia Förlag AB, 2013, 6, p. 62-64Chapter in book (Other academic)
  • 23.
    Forsner, Maria
    et al.
    Dalarna University, School of Education, Health and Social Studies, Caring Science/Nursing.
    Mörelius, Evalotte
    Linköpings universitet.
    Hanberger, Lena
    Linköpings universitet.
    Kvalitetsindikatorer inom omvårdnad i barnsjukvården: en pilottest2013Conference paper (Refereed)
  • 24.
    Forsner, Maria
    et al.
    Dalarna University, School of Education, Health and Social Studies, Caring Science/Nursing.
    Mörelius, Evalotte
    Linköpings universitet.
    Hanberger, Lena
    Linköpings Universitet.
    Ygge, Britt-Marie
    Karolinska Universitetet.
    Nursing quality indicators in paediatric hospital care2013Conference paper (Refereed)
  • 25.
    Forsner, Maria
    et al.
    Dalarna University, School of Education, Health and Social Studies, Caring Science/Nursing.
    Nilsson, S
    Finnström, B
    Mörelius, E
    Expectation prior to human papilloma virus vaccination: 11 to 12-year-old girls' written narratives2016In: Journal of Child Health Care, ISSN 1367-4935, E-ISSN 1741-2889, Vol. 20, no 3, p. 365-373Article in journal (Refereed)
    Abstract [en]

    Expectations prior to needle-related procedures can influence individuals’ decision making and compliance with immunization programmes. To protect from human papilloma virus (HPV) and cervical cancer, the immunization needs to be given before sexual debut raising interest for this study’s aim to investigate how 11 to 12-year-old girls narrate about their expectations prior to HPV vaccination. A total of 27 girls aged 11 to 12 years participated in this qualitative narrative study by writing short narratives describing their expectations. The requirement for inclusion was to have accepted HPV vaccination. Data were subjected to qualitative content analysis. Findings showed the following expectations: going to hurt, going to be scared and going to turn out fine. The expectations were based on the girls’ previous experiences, knowledge and self-image. The latent content revealed that the girls tried to transform uneasiness to confidence. The conclusion drawn from this study is that most girls of this age seem confident about their ability to cope with possible unpleasantness related to vaccinations. However, nurses need to find strategies to help those children who feel uneasy about needle-related procedures.

  • 26.
    Forsner, Maria
    et al.
    Dalarna University, School of Health and Social Studies, Caring Science/Nursing.
    Nilsson, Stefan
    Göteborgs universitet.
    Kommunikation om smärta2014In: Kommunikation med barn och unga i vården / [ed] Söderbäck, Maja, Stockholm: Liber, 2014Chapter in book (Other (popular science, discussion, etc.))
  • 27.
    Forsner, Maria
    et al.
    Dalarna University, School of Education, Health and Social Studies, Caring Science/Nursing.
    Nilsson, Stefan
    Göteborgs Universitet.
    Finnström, Berit
    Högskolan Väst.
    Mörelius, Evalotte
    Linköpings Universitet.
    Pain, anxiety and hope to manage, girl´s expectations prior to HPV vaccination2015Conference paper (Refereed)
  • 28.
    Forsner, Maria
    et al.
    Dalarna University, School of Education, Health and Social Studies, Caring Science/Nursing.
    Norström, Fredrik
    Department of Public Health and Clinical Medicine, Epidemiology and Global Health, Umeå University.
    Nordyke, Katrina
    Department of Public Health and Clinical Medicine, Epidemiology and Global Health, Umeå University.
    Ivarsson, Anneli
    Department of Public Health and Clinical Medicine, Epidemiology and Global Health, Umeå University.
    Lindh, Viveca
    Department of Nursing, Umeå University.
    Relaxation and guided imagery used with 12-year-olds during venipuncture in a school-based screening study2014In: Journal of Child Health Care, ISSN 1367-4935, E-ISSN 1741-2889, Vol. 18, no 3, p. 241-252Article in journal (Refereed)
    Abstract [en]

    Needle-related procedures are reported to be problematic for children. In a school-based celiac disease screening, 12-year-olds’ experiences with relaxation and guided imagery (R-GI) during venipuncture were investigated. One group tried nurse-led R-GI (n = 60) and another group received standard care (SC; n = 49). A mixed method design was applied using short written narratives, facial affective scale (FAS), and visual analog scale (VAS) for pain intensity. Qualitative content analysis highlighted that diversity and contradictions when facing blood tests. FAS scores were significantly lower in the SC group before (p = 0.01), during (p = 0.01), and after (p = 0.01) venipuncture. VAS scores did not differ between the groups. The blood test was mostly experienced as unproblematic, and GI during venipuncture did not decrease pain or affect. However, the fact that a number of children scored high FAS indicates a need for effective methods to help children cope with needle-related school-based procedures.

  • 29.
    Forsner, Maria
    et al.
    Dalarna University, School of Education, Health and Social Studies, Caring Science/Nursing.
    Siljebo, Petra
    Umeå Universitet.
    Björklund, Maria
    Dalarna University, School of Education, Health and Social Studies, Caring Science/Nursing.
    Medical fear in chronically ill children2010Conference paper (Refereed)
  • 30.
    Forsner, Maria
    et al.
    Dalarna University, School of Health and Social Studies, Caring Science/Nursing.
    Ygge, Britt-Marie
    Karolinska Institutet.
    Venösa infarter hos barn2013In: Kvalitetsindikatorer inom omvårdnad / [ed] Idvall, Ewa, Gothia Förlag AB, 2013, 6, p. 118-121Chapter in book (Other academic)
  • 31.
    From, Ingrid
    et al.
    Dalarna University, School of Education, Health and Social Studies, Caring Science/Nursing.
    Forsner, Maria
    Dalarna University, School of Education, Health and Social Studies, Caring Science/Nursing.
    Portfolio in Nursing Education2014Conference paper (Refereed)
  • 32.
    Furingsten, Lovisa
    et al.
    Dalarna University, School of Health and Social Studies, Caring Science/Nursing.
    Sjögren, Reet
    Mälardalen university, Sweden.
    Forsner, Maria
    Dalarna University, School of Health and Social Studies, Caring Science/Nursing.
    Caring for dying children in an acute paediatric ward2013Conference paper (Other academic)
    Abstract [en]

    Introduction

    Swedish acute paediatric wards usually focuses on children with urgent and short-time illnesses and the care is not always suited for a dying child. Caring for dying children in this context therefor faces special challenges and needs to be further investigated through research from the health care professionals´ (HCP) perspective.

     

    Purpose

    The aim was to describe caring as presented in professional caregivers’ experiences of caring for dying children in paediatric ward.

     

    Material

    Four HCP in a paediatric ward, which had been caring for at least one dying child during the last five years, participated.

     

    Methods

    A phenomenological approach was chosen using qualitative in-depth interviews, starting with one opening question, continuing with follow-up questions according to responsive listening. Data were analysed following four steps suggested by Giorgi: reading to capture the global sense, constitution of parts into ‘meaning units’, transformation from implicit meaning to explicit constituents and gaining structure.

     

    Results

    The findings are represented in five constituents. Presence is a prerequisite for caring when a child is dying. Self-knowledge and support from others are suggested to help when the HCP is suffering and struggling with the injustice in dying. The essence of caring for dying children is like a musical attuned composition. The moments are vulnerable and could easily be disrupted and turn into disharmony.

     

    Conclusions

    The HCP needs self-knowledge to be true and sensitive in the perceived situation of injustice when caring for dying children and their families. Caring assumes presence; however, caring for dying children is found to mean suffering to HCP and raises the need for support from others.

  • 33.
    Furingsten, Lovisa
    et al.
    Dalarna University, School of Education, Health and Social Studies, Caring Science/Nursing.
    Sjögren, Reet
    Mälardalen University and Linnaeus University.
    Forsner, Maria
    Dalarna University, School of Education, Health and Social Studies, Caring Science/Nursing.
    Ethical challenges when caring for dying children2015In: Nursing Ethics, ISSN 0969-7330, E-ISSN 1477-0989, Vol. 22, no 2, p. 176-187Article in journal (Refereed)
    Abstract [en]

    Background: Caring for dying children presents special challenges, according to the children themselves, their relatives and healthcare professionals. 

    Objective: The aim of this study was to describe caring as represented in healthcare workers' experiences of caring for dying children. 

    Method: A phenomenological approach was chosen, in-depth interviews were carried out and data were analysed in four steps focusing on (a) open reading, (b) meaning units, (c) constituents and (d) essence. 

    Ethical considerations: Four nurses in a general acute paediatric care setting in Sweden participated after providing written informed consent. Voluntary participation and confidentiality were ensured, and the study was ethically approved. 

    Findings: The essence of caring for dying children was likened to a musically attuned composition, comprising five constituents: presence, self-knowledge, injustice in dying, own suffering and in need of others. Presence was found to be a prerequisite for caring when a child is dying. Self-knowledge and support from others can be of help when struggling with emotional pain and injustice. 

    Discussion: Caring for dying children has been found to be a delicate task for healthcare workers all over the world, and the ethical dimension is emphasized in international research. In this study, emotional pain and suffering accompanied caring, but an atmosphere in which it is possible to give and get support from colleagues and to have time to grieve and time to focus on the patient's needs may ease the burden, as can having time to process thoughts about life and death, and a possibility to grow in self-knowledge. 

    Conclusion: Caring in ethically demanding situations may be facilitated through presence, atmosphere, self-knowledge and time. The challenge does not demand highly technological solutions; these assets are readily available, no matter where on earth. However, there is a need to further investigate the