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Sweden, like many other European countries, has received a large number of immigrants in the past few years. To tackle the challenge connected with this, a policy for integration including an establishment programme was adopted by the Swedish Government which speeded up the introduction of newly arrived immigrants into the labour market and social life. The implementation of the programme is performed by various stakeholders in the fields of the labour market, language education and non-governmental organisations.The aim of this study was to investigate challenges and barriers to integration from the perspective of stakeholders’ experiences of encounters with newly arrived immigrants. The study used open-ended data collected in a Delphi project targeting civil servants and volunteers working within the policy establishment programme, and a thematic analysis was conducted. The results indicate that focus on organisational structures, issues concerning resources and competence, and a more holistic approach to new arrivals’ existential situationare key areas to address to move towards successful integration.

Good health is a prerequisite for individuals to function in everyday life. The same applies to newly arrived immigrants, where good health is crucial for successful establishment. The aim of this study was to describe stakeholders’ experiences of how newly arrived immigrants’ health affects their opportunities to establish themselves in society. The study had a qualitative design where open-ended questions were analysed following Braun and Clarke’s guidelines for conducting a qualitative thematic analysis. The results consist of three themes: Mental health problems, disabilities, and tormenting concerns about absent family members; A precarious life situation related to housing, education, and income; and Deficiencies in responding to health challenges in organisations and in society. Stakeholders face health problems among newly arrived immigrants that they do not have the right skills to deal with. We argue for the presence of nurses in organisations working with newly arrived immigrants, and that nurses’ competence is necessary to capture their needs.

The ability to appropriately attend to refugee health needs in the countries that are receiving them is an enormous institutional challenge. The varying practicalities of administering refugee health services can affect a refugee’s mental health outcome during the adjustment period to their new home country. This is a report on a study undertaken to overview Delphi method approaches used to investigate the consensus by experts on the issue of refugees’ social participation in health services. The review was conducted from March to December 2018 by two evaluators utilizing a systematic search strategy in presently available electronic databases. Only Delphi studies concerning forced adult refugee’s social participation in health services were included, while studies that focused on children, minorities, immigrants, migrants, asylum seekers, etc., as well as studies that did not utilize the Delphi technique, were excluded. Ten peer-reviewed articles were included in the final charting of the data. The results show that Delphi approaches regarding refugee social participation have focused on important factors important for providing quality health care, health care priorities, barriers preventing social participation, and research priorities. The experts make clear that bureaucratic procedures, cross-cultural communication and empowerment, be taken into consideration when creating policies, in practice and in research. The conclusion is that by emphasizing the tacit knowledge of experts, the Delphi method can contribute to a deeper understanding of policy priorities and responsive health services.

Primary health prevention regarding social participation for newly arrived immigrants is needed to address challenges when responding to the needs of such immigrants in their new and vulnerable situation. The aim of this study was to describe social participation as reported by civil servants and volunteers working with newly arrived immigrants in Sweden. Open-ended data collected in a Delphi project targeting civil servants and volunteers working within the policy establishment programme was used. Qualitative content analysis was conducted. The findings show that several interacting factors contribute to resources that create perquisites for “going native in the community” and “being part of everyday life” as points of perquisites for how civil servants and volunteers elaborate on social participation for newly arrived immigrants. A focus on the “here and now” and avoiding measures that “put life on hold” are two points of aspects that generate possibilities for promoting social participation in health services.

De senaste decennierna har sjuksköterskeutbildningen i Sverige gått från en praktisk utbildning till en professionsutbildning. Professionsperspektivet har inneburit ett ökat fokus på studenternas utveckling av academic literacies (Lea & Street, 2006). I denna presentation redovisas ett högskolepedagogiskt projekt om litteracitetsutveckling på Röda Korsets Högskola (RKH). Det har involverat både studenter och lärare inom sjuksköterskeutbildningen.

Under samma period som utbildningen har professionaliserats har rekryteringen till högskolan breddats vilket lett till en förändrad studentgrupp inom sjuksköterskeutbildningen (Borglin & Fagerström, 2012). Studenter överlag upplever en svårighet med att utveckla en akademisk litteracitet (Ask, 2007). Svårigheterna kan bland annat kopplas till att studenterna har svårt att förstå vad som förväntas av dem i deras akademiska texter. Men inte bara studenterna ser det akademiska skrivandet som svårt. Många lärare som arbetar på RKH uttrycker att det är svårt att veta vad som är bra arbetssätt för att stödja studenternas litteracitetsutveckling.

I samband med RKH:s flytt till Campus Flemingsberg startade RKH 2018 ett samarbete med Södertörns högskolas högskolepedagogiska enhet, studieverkstad och bibliotek om en introduktion till akademiskt skrivande. På Södertörns högskola pågår sedan några år en satsning på ämnesintegrerat akademiskt skrivande som omfattar arbete med att söka, värdera, läsa och skriva akademiska texter.

Syftet med momentet akademiskt skrivande inom RKH har varit att under första terminen och samtidigt med examinationen av ämnesinnehållet, introducera studenterna till det akademiska skrivandet. Olika aktiviteter som formativ respons har använts för att stimulera studenternas lärande och lägga en grund för deras fortsatta utveckling av akademisk och professionell litteracitet. Flertalet studenter säger att det varit givande att tidigt i utbildningen få starta lärprocessen gällande ett vetenskapligt förhållningssätt, även om många studenter uttrycker att det akademiska skrivandet är svårt.

En viktig del av samarbetet mellan högskolorna har varit att skapa förutsättningar för hållbarhet även vad gäller ämneslärarnas kunskaper om litteracitetsutveckling. Bland annat har workshoppar hållits med hela lärarkollegiet, inte bara med de lärare som arbetar på den aktuella kursen. Lärarna, som ofta implicit har lärt sig det akademiska skrivandet, har fått bekanta sig med verktyg och nyckelbegrepp för att diskutera text med studenter, och har funnit arbetssättet stimulerande. För hållbarheten i utbildningen gäller att alla lärare kan fortsätta att ge stöd i utvecklingen av studenternas litteracitet. Precis som studenterna har konstaterat i sina utvärderingar lär sig ingen ett väl utvecklat akademiskt och professionellt skrivande på första terminen.

Referenser

Ask, S. (2007). Vägar till ett akademiskt skriftspråk [Roads to academic written language] In Swedish. Växjö University, Växjö University Press. (No 115/2007)

Borglin, G., & Fagerström, C. (2012). Nursing students' understanding och critical thinking and appraisal and academic writing: A descriptive, qualitative study. Nurse Education in Practice, 12, 356-360. doi:10.1016/j.nepr.2012.04.009

Lea, M. R., & Street, B. V. (2006). The "Academic Literacies Model: Theory and Application. Theory Into Practice, 45, 368-377. doi:10.1207/s15430421tip4504_11

Introduction: In a global context of an increasing and aging population, along with environmental changes, nurses play an important role in relieving suffering among vulnerable people and groups in society. Sustainability in nursing contributes to sustainable development through providing an environment that is not detrimental to/protects present and future generations′ opportunities for good health. There is a global shortage of nurses, and it has been shown that, locally, every fifth newly graduated nurse considers leaving their new profession five years after graduation. The aim was to describe how nursing students’ thought about a sustainable professional life as nurses before their graduation.

Materials and Methods: A qualitative design with a written data set was used, and a thematic analysis was performed. One hundred five students (80 women and 25 men) in semester six out of six of the nursing education program participated.

Results: The analysis resulted in three themes: 1) to have an ethical foundation that guides the individual nurse in protecting the nursing care and developing the nursing care for their patients; 2) to be in a listening, reflexive and supportive workplace enabling a professional nurse to continuously grow and learn and 3) to be a proud professional nurse with integrity, not risking with their own health or personal professional development.

Conclusion: The nursing students describe their thoughts on the requirements for having a sustainable professional life as nurses as having a strong inner ethical compass to help guide, protect and develop the nursing care for the patients. In addition, it requires a workplace with a reflexive and supporting culture. However, the nursing students also put their own health and the opportunities for professional growth at the top of their priorities, and if these conditions are lacking, they will switch to another workplace.

The aim of this study was to describe family members' life situation and experiences of care in two different care settings, the patient's home or in hospital during the acute post-transplantation phase after allogeneic haematopoietic stem cell transplantation (HSCT). Data were collected through semi-structured interviews with 14 family members (seven women and seven men). An inductive qualitative content analysis was used to analyse the data. The majority of the family members' (n = 10) had experiences from home care. The findings show the family members' voice of the uncertainty in different ways, related with the unknown prognosis of the HSCT, presented as Being me being us in an uncertain time. The data are classified into; To meet a caring organisation, To be in different care settings, To be a family member and To have a caring relationship. Positive experiences such as freedom and security from home care were identified. The competence and support from the healthcare professionals was profound. Different strategies such as adjusting, having hope and live in the present used to balance to live in an uncertain time. The healthcare professionals need to identify psychosocial problems, and integrate the psychosocial support for the family to alleviate or decrease anxiety during HSCT, regardless of the care setting.

Over the past 20 years, considerable healthcare resources have shifted from an inpatient to an outpatient setting. To be in an outpatient setting or at home after allogeneic haematopoietic stem cell transplantation (allo-HSCT) has been shown to be medically safe and beneficial to the patient. In this study we describe patients' experiences of different care settings (hospital or home) and a new life situation during the acute post-transplant phase after HSCT. Semi-structured interviews were conducted with 15 patients (six women and nine men) 29-120 days after HSCT. An inductive qualitative content analysis was performed to analyse the data. The analysis resulted in four categories: To be in a safe place, To have a supportive network, My way of taking control, and My uncertain return to normality. The findings showed that patients undergoing HSCT felt medically safe regardless of the care setting. The importance of a supportive network (i.e. the healthcare team, family and friends) was evident for all patients. Both emotional and problem-focused strategies were used to cope with an uncertain future. Being at home had some positive advantages, including freedom, having the potential for more physical activity, and being with family members. The study highlights some key areas thought to provide more personalised care after HSCT.

Background: The Delphi method developed in the 1950s in the US-Army as a way to forecast the probability of nuclear weapons usage in war by consulting "experts". From this origin the Delphi method successfully spread in dierent academic disciplines during the late 1900 to become one important method for access "expert consensus" in situations where no other evidence exist and furthermore to provide a valuable tool in the investigation of "expert opinion" and may thereby help to guide future policy directives in an era such as nursing. Objective: The aim of this presentation is to describe the possibilities of using this approach to explore under-researched areas in nursing using conclusion drawn from a scoping review of Delphi studies on refugee's health and social participation. Method: Scoping review Results: The ndings show that health workers; nurse’s, physicians, civil servants have a tremendous impact on health outcomes that occur for refugees during their adjustment to a new life and that their interpretation and implementing policies is important to consider when elaborating on health and resources of health. Conclusion and implication for practice: To conclude, emphasizing the tacit knowledge of experts the ndings show that this type of approaches can serve as a method to both investigate and establish a consensus among nurses or in areas of nursing research where evidence is lacking. Delphi method is a tool that can provide valuable insight regarding nursing knowledge that is not possible to monitor in any other way and can become more important in nursing research in the future.

PURPOSE: Earlier studies have shown that home care during the neutropenic phase after allogeneic hematopoietic stem cell transplantation (allo-HSCT) is medically safe, with positive outcomes. However, there have been few results on long-term outcomes after home care. The aims of this study were to compare general health, symptom occurrence, and self-efficacy in adult survivors who received either home care or hospital care during the early neutropenic phase after allo-HSCT and to investigate whether demographic or medical variables were associated with general health or symptom occurrence in this patient population.

METHODS: In a cross-sectional survey, 117 patients (hospital care: n = 78; home care: n = 39) rated their general health (SF-36), symptom occurrence (SFID-SCT, HADS), and self-efficacy (GSE) at a median of 5 (1-11) years post-HSCT.

RESULTS: No differences were found regarding general health, symptom occurrence, or self-efficacy between groups. The majority of patients in both hospital care (77 %) and home care (78 %) rated their general health as "good" with a median of 14 (0-36) current symptoms. Symptoms of fatigue and sexual problems were among the most common. Poor general health was associated with acute graft-versus-host disease (GVHD), low self-efficacy, and cord blood stem cells. A high symptom occurrence was associated with female gender, acute GVHD, and low self-efficacy.

CONCLUSIONS: No long-term differences in general health and symptom occurrence were observed between home care and hospital care. Thus, home care is an alternative treatment method for patients who for various reasons prefer this treatment option. We therefore encourage other centers to offer home care to patients.

Purpose: Treatment at home during the pancytopenic phase after allogeneic hematopoietic stem cell transplantation (HSCT) has been an option for patients at our center since 1998. Earlier studies have shown that home care is safe and has medical advantages. In this study, we present patients’ experiences of care and support while being treated in hospital or at home during the acute post-transplantation phase.

Method: Patients (n ¼ 41, 22 in hospital care and 19 in home care) answered the SAUC questionnaire at discharge (when home, or from hospital). Both statistical analysis and deductive content analysis were used.

Results: The patients were highly satisfied with the care and support during the acute posttransplantation phase. Patients in home care were found to be more satisfied with care in general than patients in hospital care. The importance of safety, empathy, and encouragement from healthcare staff were expressed regardless of where care was given. Patients also felt that receipt of continuous, updated information during treatment was important and they had a strong belief in HSCT but were uncertain of the future regarding recovery.

Conclusions: The main findings of this study were that in comparison to hospital care, home care does not appear to have a significant negative effect on patients’ experiences of care and support during the acute post-transplantation phase. In addition patients in home care felt safe, seen as a person and encouragement seem to empower the patients at home. Thus, this study may encourage other transplantation centers to provide home care if the patients want it.

Purpose

Approximately 10% of all patients is in some way harmed by the health care system. Risk factors have been identified and patients with cancer are at high risk due to the seriousness of the disease, co-morbidity, often old age, high risk treatments such as chemo and radiotherapy. Therefore, a closer look on safety for patients undergoing chemotherapy is needed. The aim of this study was to identify and evaluate interventions for improved patientsafety in chemotherapy care.

Method

We undertook a review of the available evidence regarding interventions to improve patientsafety in relation to chemotherapy care.

Results

We found 12 studies describing the following interventions; 1) Computerized Prescription Order Entry (CPOE), 2) Failure Mode and Effect Analysis (FMEA) and Lean Sigma, 3) Error reporting and surveillance systems, 4) Administration Checklist and 5) Education for nurses. Even if all five interventions showed positive effects in patientsafety, the evidence level is rather weak due to design, sample size and the difficulties involved measuring patient safety issues.

Conclusions

Three studies with fairly high evidence level showed that computerized chemotherapy prescriptions were significantly safer than manual prescriptions and could therefore be recommended. For the other remaining interventions, more research is needed to assess the effect on improved patient safety in chemotherapy care. There is a need for more rigorous studies with sophisticated design for generating evidence in the field.

Purpose: Patient participation in goal setting and decision making is a core component of the rehabilitation process, but there is little information on what patients want to achieve after allogeneic stem cell transplantation (allo-SCT). The aim of this study was to describe adult patients' perceptions of goals related to health and function, as well as self-perceived limitations and facilitating strategies in the first 13 months after allo-SCT. Methods: Fifteen patients with a median age of 44 years (range, 22-65 years) were interviewed on one occasion during the first year after allo-SCT. Data were analysed using qualitative content analysis. Results: Results showed that patients felt that time after allo-SCT largely concerned: "to be healthy" and "to participate in a normal life". Some patients felt it was easy to set goals while others found it difficult. Most described goals had a long-term character. Patients were faced with a wide variety of limitations of which a few did not link to a described goal. Several facilitating strategies were described that either had or could help patients to reach their goals. Conclusions: Our results indicate that assistance with setting achievable goals, including individualised strategies and support from health care professionals to realise the goals, may assist in the rehabilitation to restore health and function after allo-SCT.

Aims: To describe functional status (FS), general health (GH) and symptom distress (SD) from admission to 1 year post-SCT and to identify medical, demographic, and/or patient-reported outcome variables associated with patient-perceived GH. Material and Methods: Forty-one patients (27 women) with a median age of 44 (18-65) years answered three questionnaires (SIP, SWED-QUAL, and SFID-SCT) from admission to 1 year post-SCT. Results: At discharge, 59% of the patients reported poor FS and GH, and 24% reported > 10 simultaneous symptoms. After 1 year post-SCT, 22% still reported poor FS, 32% poor GH, and 12% > 10 simultaneous symptoms. Compared with admission, significantly larger proportions of the patients reported poor GH at discharge (20 vs 59%, p = .001), poor FS at 6 months (24 vs 59%, p = .004), and poor GH [The number of symptoms was found to be significantly associated with poor GH at discharge (OR 1.330, p = .009) and at 1 year post-SCT (OR 2.000, p = .010)]. Patients reporting "poor GH" at discharge and at 1 year post-SCT reported a median of 7 and 10 symptoms, respectively. Patients with "good GH" reported a median of three symptoms both at T1 and T4. "Tiredness", "anxiety", "mouth dryness", "loss of appetite", and "diarrhoea" were reported by a larger proportion of the patients reporting "poor GH". Conclusions: The results confirm that some patients who have undergone a SCT have a negatively affected life situation. The study indicates that actively asking for symptoms and applying the best treatment for symptom alleviation are among the most important measures that SCT teams can take to help the patients perceive better general health and an improved life situation.

Stem-cell transplantation (SCT) is one therapy alternative in cases of malignant diseases. The SCT process begins with a course of high-dose chemotherapy with or without irradiation, which results in side-effects that can range from minimal to life-threatening. The symptoms occurring from the conditioning regimen are well known, but the patients' experiences of them have been only minimally studied. The overall aim of this thesis was to ask for and describe the symptoms adult patients' undergoing SCT experience and how intense and distressing these symptoms are perceived before, during and after SCT. Furthermore the aim was also to describe functional status (FS), health-related quality of life (HRQOL) and general health (GH) from admission to one year post-SCT and to identify medical, demographic and/or patient reported outcome variables associated with patient-perceived GH. A total of 51 patients was consecutively recruited from the department of haematology at Huddinge University Hospital. The majority of the patients suffered from acute or chronic leukaemia, multiple myeloma and breast cancer. Three questionnaires were used to collect data: the Symptom, Frequency, Intensity and Distress Questionnaire for SCT (SFID-SCT), the Sickness Impact Profile (SIP) and the Swedish Healthrelated Quality of Life Questionnaire (SWED-QUAL). The patients answered the questionnaires at nine time-points, from admission to one year post-SCT. A majority of the patients (92%) reported one or more ongoing symptoms already on admission and at this timepoint the symptom manifestation was related to the malignancy the patient was suffering from. From the day of the stem-cell infusion and up to approximately 10 days after the transplantation, between 33% and 54% of the patients reported >10 simultaneous symptoms. Tiredness (81-91%), loss of appetite (88-93%) and mouth dryness (70-83%) were the most frequently reported symptoms during this period. Also nausea, sleeping problems, diarrhoea and changes of taste were reported by >50% of the patients during the protectivecare period. Vomiting, reduced mobility and fever are examples of symptoms that, once they occurred, were perceived as distressing. Overall, during the hospital stay, the patients reported the occurring symptoms as quite or very intense at 1,036/2,251 (46%) occasions. The corresponding figure for symptom distress (quite or very distressing) was 51% (916/1,813 occasions). The patients reported that the occurring symptoms led to a worse I HRQOL and that they especially had an impact on physical performances. Patients who on admission reported anxiety experienced less symptom distress at the end of the protective-care period and at discharge, as compared with patients reporting no anxiety on admission. The patients' FS and GH improved over time from discharge to one year post-SCT. About one-third of the patients suffered from reduced FS, poor GH and a number of simultaneously occurring symptoms to handle on a daily basis one year post-SCT. The regression analyses identified 'number of simultaneously occurring symptoms' as associated with poor GH at discharge from the hospital and at one year post-SCT. To actively and systematically measure, follow and document patients' self-reported symptoms, FS, 1 HRQOL and GH and to encourage and facilitate evidence based strategies for alleviation and management of symptoms are some of the most important tasks for the nurse and the other members of the SCT-team in order to alleviate distressing symptoms and contribute to a better health and life situation for individuals undergoing SCT.

The main aim of this study was to investigate the patients' self-reported symptom occurrence, symptom intensity (SI), and symptom distress (SD) from admission for stem-cell transplantation (SCT) until discharge from the ward. Forty-three patients participated and data were collected at 7 different time-points by using the self-administered Symptom Frequency, Intensity, and Distress questionnaire for SCT (SFID-SCT). The results showed that symptom occurrence followed a curve on which the highest frequencies of symptoms were reported from the day of the SCT (T2) until the end of the protective care period (T5). The mean SI and SD scores became higher when the number of reported symptoms increased. Between T2 and T5, 33% to 54% of the patients reported >10 simultaneous symptoms. Symptoms reported by more than 50% of the patients during T2-T5 were tiredness, loss of appetite, mouth dryness, nausea, sleeping disturbances, diarrhea, and changes of taste. Loss of appetite, tiredness, and mouth dryness were, in descending order, the 3 symptoms reported as most intense and distressing. A statistically significantly higher SD-score was found for the patients undergoing allogeneic SCT on the day before start of the conditioning regimen, as compared to the patients undergoing autologous SCT. Patients reporting no anxiety on admission were found to have higher, mean SD-scores at the end of the hospital stay than anxious patients. The SFID-SCT questionnaire was found to give useful information not only about symptom occurrence but also about SI and SD. To use an instrument that distinguishes between these aspects of the symptom experience may help health care professionals to support the patients through the SCT-process.

The aims of this study were to describe how a group of patients with different malignant diseases perceived symptom distress (SD), functional status (FS) and health-related quality of life (HRQOL) on admission to the hospital for stem-cell transplantation (SCT), to compare the obtained data regarding FS and HRQOL with similar data from two general-population groups, and to relate the results to disease- and treatment-specific data. Fifty-one patients participated in the study. Three instruments were used to collect data: SFID-SCT, SIP and SWED-QUAL. The majority of the patients (92%) reported ongoing symptoms even before the SCT with tiredness (67%) and anxiety (53%) as the two most commonly reported symptoms. Although tiredness and anxiety were reported to be the most frequently occurring symptoms, these symptoms were not considered to cause that much distress. Instead, vomiting, reduced mobility and fever, although less commonly occurring, were reported as highly distressing when present. Compared with the general-population groups, the patients reported significantly poorer FS and HRQOL but no statistically significant correlations were found between SD, FS or HRQOL and the time since the last chemotherapy cycle or cycles respectively. Patients with advanced disease and patients with multiple myeloma were found to report more SD and poorer FS and HRQOL.

This is the first Swedish study to evaluate the health-related quality of life and sense of coherence in adult survivors of allogeneic, haematopoietic stem cell transplantation (HSCT). Twenty-five recipients completed three questionnaires 2-4 years after the transplantation. The questionnaires used were the Sickness Impact Profile (SIP), the Symptom Frequency Intensity and Distress (SFID-BMT) scale and the Sense of Coherence (SOC) scale measuring subjective functional status, symptom distress and coping ability. Impairments in functional status were found, as compared with a population norm. The most common impairments were found in the areas of social interaction and sleep and rest. Eye problems, dry mouth, cough, sexual problems, tiredness, anxiety and changes of taste were symptoms reported by more than half of the patients. Despite impaired functioning and a high incidence of symptoms, the general health was described as quite good or excellent by 80% (n = 20) of the patients. The majority (20/22) had also been able to return to work or to attend school. No difference in the sense of coherence was seen, as compared with the population norm. Functional impairments were significantly correlated to a lower degree of sense of coherence.

The functional capacity and the health-related quality of life were investigated in nine women (ages 23-58 years) undergoing high-dose chemotherapy with autologous stem-cell transplantation (ASCT). Data were obtained by using two questionnaires: the Sickness Impact Profile (SIP) and the Swedish Health-Related Quality of Life Questionnaire (SWED-QUAL). The patients answered the questionnaires on three occasions: on admission to the transplant unit, at discharge from the unit, and 7-15 weeks after ASCT. It was found that the women were affected by the treatment in various dimensions of daily life. The transplantation primarily affected their self-rated physical health and functions. Their physical-health status was poorest at the time of discharge. The women's emotional status was found to be poor during the whole study period. The results of the present study indicate that professional nursing is essential for breast cancer patients undergoing ASCT.