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Stakeholder perspectives on needs and priorities in home-based stroke rehabilitation : A concept mapping study
No full textDespite growing emphasis on home-based rehabilitation following stroke, there remains limited understanding of how to effectively tailor services to individual needs. This study employed concept mapping to explore diverse stakeholder perspectives on adapting home-based rehabilitation to better support the recovery process after stroke. Through this mixed-methods participatory approach, we engaged 89 stakeholders, including stroke survivors, significant others, healthcare professionals, managers, and architects. Participants generated, sorted, and rated statements about what matters most in home-based stroke rehabilitation. A hierarchical cluster analysis was conducted to organize the data into concepts. Five clusters were identified: 1) social support at home and beyond; 2) professional competence; 3) supportive home environment; 4) teamwork and resources; and 5) patient involvement. Patient involvement was rated highest for importance and feasibility, followed by professional competence. Specifically, stakeholders emphasized that rehabilitation should feel meaningful and be tailored to the patient's needs. No generated ideas from the cluster “supportive home environment” were found in the go-zone, and adapting rehabilitation to diverse home environments was recognized as crucial but hard to implement. The findings underscore the need for individualized, context-sensitive approaches and suggest that strengthening professional competence, particularly in navigating diverse environments and engaging support networks, will be essential to translating person-centered principles into everyday rehabilitation practice
Nurse staffing skill mix and acuity-adjusted provision ratios in Swedish neonatal care : A cohort benchmark study
No full textBackground The development of neonatal intensive care has substantially reduced infant mortality, still, infants remain at high risk for adverse outcomes. Safe care relies on adequate nurse staffing and an appropriate skill mix, which is especially important in neonatal intensive care as infants are extremely vulnerable to harm when quality lapses occur. Although international guidelines recommend optimal nurse-to-patient ratios for neonatal care, these standards have not been fully implemented, leaving it unclear whether current staffing levels align with recommendations for safe staffing. Objective To benchmark the acuity-adjusted registered nurse staffing provision ratio in neonatal intensive care and determine the skill mix distribution and variation of nursing staff across shifts. Method This retrospective cohort study included infant data from a 16-week period in 2022 in three neonatal intensive care units with a common administration at a university hospital. Data were obtained from the hospital’s data repository and the Swedish Neonatal Quality Register, including 609 neonatal admissions and 345 nursing staff members working 1008 shifts. Infants’ daily acuity levels were assessed using an adapted version of the British Association of Perinatal Medicine’s guideline, classifying infants into three levels: intensive care, high dependency care, and special care. Staffing provision was measured as the number of worked hours per shift, staff category, and unit. The registered nurse provision ratio was defined as the number of registered nurse hours provided divided by the recommended hours. A ratio below 1.0 indicates understaffing. Results The population’s total in-hospital days were 4674, and the mean birth weight was 2843 g (SD 1029), with 57.0 % being boys. The proportion of registered nurses relative to nursing assistants ranged from 22.2 % to 85.7 %, with a median of 46.5 %. Registered nurses with specialist education accounted for a median of 73.0 % of total registered nurse hours. Within each unit, the mean acuity-adjusted number of registered nurses recommended by the British Association of Perinatal Medicine’s standard was relatively consistent across shift types and between weekdays and weekends. However, the required number of registered nurses between individual shifts showed considerable variation, ranging from 2.5 to 10.3. During the inclusion period, 81.2 % of the shifts had a registered nurse provision ratio below 1.0, suggesting that most shifts did not meet the recommendations for staffing levels. Conclusions This study highlights a shortfall in registered nurse staffing relative to recommended levels. Ensuring adequate registered nurse staffing levels is crucial for maintaining high-quality neonatal care and improving infant outcomes
Nurses' attitudes towards patients with substance use disorder : A literature review
No full textBakgrund Substansbrukssyndrom är ett växande samhällsproblem som påverkar både individen och vårdsystemet. Personer med substansbrukssyndrom riskerar att bli stigmatiserade och etiketterade, vilket kan skapa hinder för att söka vård och få adekvat vård. Brist på kunskap och negativa föreställningar kan förstärka stigma och begränsa patientens tillgång till vård. Syfte Syftet med denna litteraturöversikt var att belysa faktorer som påverkar sjuksköterskors attityder till att vårda patienter med substansbrukssyndrom inom somatisk vård. Metod Denna litteraturöversikt utfördes med en kvalitativ ansats där 14 artiklar inkluderades och analyserades enligt Fribergs femstegsmodell. Resultat Resultatet genererade tre teman; Organisatoriska och professionella förutsättningar, Motstånd i vårdmötet samt Kliniska och etiska utmaningar med tillhörande subteman. Dessa teman beskriver faktorer som påverkar sjuksköterskors attityder till att vårda patienter med substansbrukssyndrom. Slutsats Sjuksköterskors attityder till patienter med substansbrukssyndrom formas av flertalet faktorer såsom, organisatoriska strukturer, etiska ställningstaganden och klinisk komplexitet. Detta understryker att attityder inte är statiska utan kan påverkas genom både individuella och strukturella insatser. Sjuksköterskors attityder till att vårda patienter med substansbrukssyndrom kan påverkas positivt med hjälp av faktorer som ökad kunskap, tydliga riktlinjer och goda organisatoriska förutsättningar.Background Substance use disorder is a growing social problem that affects both individuals and the healthcare system. People with substance use disorder risk being stigmatised and labelled, which can create barriers to seeking care and receiving adequate healthcare. Lack of knowledge and negative perceptions can reinforce stigma and limit patients' access to care. Aim The aim of this literature review was to highlight factors that affect nurses' attitudes towards caring for people with substance use disorder in somatic care. Method This literature review was conducted using a qualitative approach, in which 14 articles were included and analysed according to Friberg's five-step model. Results The results generated three themes: Organisational and professional conditions, Resistance in healthcare encounters, and Clinical and ethical challenges, with associated sub-themes. These themes describe factors that influence nurses' attitudes towards caring for patients with substance use disorders. Conclusions Nurses' attitudes towards patients with substance use disorders are shaped by a number of factors, such as organisational structures, ethical positions and clinical complexity. This emphasises that attitudes are not static but can be influenced by both individual and structural interventions. Nurses' attitudes towards caring for patients with substance use disorders can be positively influenced by factors such as increased knowledge, clear guidelines and good organisational conditions
Registered nurses' Experiences Relating to Challenges in Encountering Patients with Self-Harm Behavior in Somatic Emergency Departments : A literature review
No full textBakgrund Självskadebeteende är en följd av psykisk ohälsa och är ett allvarligt folkhälsoproblem globalt. Personer med denna problematik söker ofta vård vid somatiska akutmottagningar till följd av de fysiska skador som deras handlingar har medfört. Sjuksköterskor utgör vanligen den första vårdkontakten och kan uppleva olika utmaningar i mötet med denna särskilt utsatta patientgrupp. Syfte Att sammanställa kunskap om sjuksköterskors upplevelser av utmaningar med att möta patienter med självskadebeteende på somatisk akutmottagning. Metod En strukturerad litteraturöversikt med inslag av den metodologi som används vid systematiska översikter, utgör litteraturöversiktens design. Datasökningen utfördes i databaserna PubMed, CINAHL och PsycInfo. Tolv vetenskapliga artiklar ligger till grund för att besvara litteraturöversiktens syfte. Artiklarna har granskats med stöd av granskningsmallar för kvalitativa respektive kvantitativa studier och analyserades enligt Fribergs femstegsmodell. Resultat Resultatet av litteraturöversikten sammanställdes i två huvudkategorier: Osäkerhet i mötet med patienter med självskadebeteende och bristande organisatoriska förutsättningar, med tillhörande underkategorier. Resultatet visade att sjuksköterskor saknar tillräcklig kompetens i att möta patienter med självskadebeteende och önskar ett tydligare samarbete med psykiatrin och riktad utbildning. Slutsats Resultatet visar att sjuksköterskor på somatiska akutmottagningar upplever osäkerhet i mötet med patienter som söker vård för skador till följd av självskadebeteende, ofta på grund av bristande erfarenhet och utbildning och begränsat samarbete med psykiatrin.Background Self-harm behavior is often the result of mental illness and a serious public health issue globally. Patients combined with self-harming behavior often seek medical care in the Somatic Emergency Department, due to injuries related to the mental illness. Registered Nurses (RNs) are often the first healthcare professionals that the patient comes in contact with. RNs experience difficulties in the care of this specific and vulnerable patient group. Aim The aim of this study is to summarize knowledge about RNs experiences and challenges when caring for patients with self-harm behavior in the Somatic Emergency Department. Method A structured literature review with elements of the methodology used in systematic reviews which constitutes the design of the literature review. The literature review is based on twelve scientic articles identified through searches in PubMed, CINAHL and PsycInfo. The articles where reviewed using appraisal templates for qualitative and quantitative studies and analysis was carried out according to Friberg’s five-step model. Results The results of the literature review were compiled into two main categories: Uncertainty when encountering patients with self-harming behavior and Lack of organizational resources, with associated subcategories. The results showed that nurses lack sufficient competence in meeting patients with self-harming behaviour and wish for clearer collaboration with psychiatric services and targeted education. Conclusions The result shows that RNs at Somatic Emergency Departments often feel uncertainty when caring for patients seeking care for self-harming injuries. This is often due to a lack of experience, knowledge and education as well as the limited collaboration with the psychiatric services, which affects the ability to provide safe and personalized care
Rally and recover : Physiological demands between tennis drills
No full textThis study examined physiological recovery between repeated tennis drills in elite adolescent tennis players. Ten tennis players (5 males, 5 females; age 17 ± 2 years) underwent treadmill testing to establish maximal physiological characteristics. Several days later participants completed three standardized on-court tennis drills with fixed rest intervals, during which physiological parameters were monitored. A one-way repeated-measures ANOVA was used to compare physiological responses across the three drills. [Formula: see text] utilization stayed above 75% in all drills, peaking during the first drill (p = 0.003). During recovery, [Formula: see text] utilization decreased from 58 ± 8% in the first recovery to 50 ± 9% (p = 0.018) and 47 ± 12% (p = 0.022) in the second and third recovery, respectively. The respiratory exchange ratio (RER) stayed below 1.0 during drills, while increasing during recovery periods, (1.07 ± 0.08, 1.00 ± 0.01, 1.04 ± 0.05; p = 0.014). Ventilatory equivalents for oxygen ([Formula: see text]) were stable (p = 0.054), while those for carbon dioxide ([Formula: see text]) increased progressively for each recovery period (29.5 ± 3.6, 31.5 ± 3.8, 32.3 ± 4.3; p < 0.001). Blood lactate concentration differed significantly across recovery periods (p = 0.035) with the lowest value in recovery period two (5.9 ± 2.0, 4.9 ± 1.9 and 5.6 ± 2.0 mmol·l-1). These findings highlight a sustained metabolic demand extending into the recovery phase during standardized tennis drills, characterized by substantial [Formula: see text] utilization and elevated respiratory compensation. This suggests a significant anaerobic contribution and underscores the intensity of the physiological load imposed even after exercise cessation
Nurses' experiences of pain management in persons with dementia : A literature review
No full textBakgrund Demens är ett samlingsnamn för ett flertal sjukdomar som orsakar nedbrytning av hjärnceller. Kommunikationssvårigheter förekommer hos personer med demens och det är vanligt att drabbade har nedsatta kommunikationsförmågor. Globalt upplever sjuksköterskor svårigheter i att bedöma smärta hos personer med demens, oavsett vårdform och verksamhet. Det finns flera sätt att behandla smärta vid demens, dock kommer varje behandlingsmetod med egna utmaningar som försvårar hanteringen av smärta hos personer med demens. Syfte Syftet med denna litteraturstudie var att beskriva sjuksköterskors erfarenheter av smärthantering för personer med demens. Metod Arbetet genomfördes som en strukturerad litteraturstudie med inslag av den metodologi som används vid systematiska översikter. Databaserna som använts i denna litteraturstudie är PubMed och CINAHL. Efter urvalet inkluderades 13 kvalitativa artiklar. Dataanalysen utfördes i enlighet med Graneheim & Lundmans kvalitativa analysmetod. Resultat Litteraturstudien resulterade i två kategorier och sex underkategorier. Sjuksköterskor upplevde hanteringen av smärta hos personer med demens vara utmanande. Inre och yttre faktorer påverkade sjuksköterskors hantering av smärta. Det var grundläggande att skapa en relation med personen med demens för att kunna bedöma och i förlängningen behandla smärta, samtidigt skapade kommunikationsproblem flera utmaningar i bedömning, behandling och i relationsskapandet vilket försvårade smärthanteringen. Slutsats Hanteringen av smärta hos personer med demens är komplex och upplevs utmanande av sjuksköterskor. Relationer beskrevs vara centrala för god smärthantering, därmed kan ett personcentrerat arbetssätt vara värdefullt för sjuksköterskors hantering av smärta.Background Dementia is a collective name for several diseases where brain cell death occurs as a result of various disease processes. Communication difficulties occur in people with dementia, and it is common for those affected to have an impaired ability to communicate. Globally, nurses experience difficulties in assessing pain in people with dementia, regardless of the context they work in. There are several ways to treat pain in dementia, however, each method comes with its own challenges that make it difficult to manage pain in people with dementia. Aim The aim of this study was to describe nurses' experiences of pain management in people with dementia. Method This study was conducted as a structured literature review with elements of the methodology used in systematic reviews. The databases used in the study are PubMed and CINAHL. Thirteen qualitative articles were included after the selection process. Data analysis was performed in accordance with Graneheim & Lundman's qualitative analysis method. Results The analysis resulted in two categories and six subcategories. Nurses described pain management in people with dementia as challenging. Internal and external factors influenced nurses' management of pain in people with dementia. It was essential to create a relationship with the person in order to be able to assess and ultimately treat pain, at the same time communication problems created challenges in assessment, treatment and in relationship building, which complicated pain management. Conclusions The management of pain in people with dementia is complex and is perceived as challenging by nurses. Relationships were described as essential to good pain management, thus a person-centered approach can be valuable for nurses' management of pain in people with dementia
Patients' experience of living with type 2 diabetes : A Literature Review
No full textBackground Type 2 diabetes is a growing public health problem. For the patient the disease entails lifelong changes with lifestyle adjustments and self-care, that affect the individual’s lifestyle and quality of life. Nurses play an important role in supporting and motivating lifestyle changes. By understanding the patient's experience of the disease, nurses can adapt their support and promote lifestyle changes. Aim The aim is to describe patients’ experiences of living with type 2 diabetes. What challenges do patients experience in their daily lives? Method A structured literature review based on 13 scientific articles:10 qualitative, one quantitative and one mixed-method article. The articles were published between 2015-2025 and identified in the databases CINAHL and PubMed. The articles were analysed according to Friberg’s analysis method. Results Two main categories were identified: complex experiences in everyday life, and positive experiences and strategies in lifestyle changes. Patients with type 2 diabetes experience routine-based, social, emotional and knowledge-related difficulties. Factors such as social support, assistive devices, well-established routines and access to knowledge can facilitate self-care. Conclusions Patients with type 2 diabetes face a complex combination of challenges that affect their ability to perform self-care. Personalized support from healthcare professionals is therefore crucial for enabling individuals to manage their disease in daily life, and achieve sustainable lifestyle, long-term lifestyle changes.Bakgrund Diabetes-typ 2 är ett växande folkhälsoproblem. För patienten innebär sjukdomen livslånga förändringar med livsstilsanpassningar och egenvård som påverkar individens livsstil och livskvalitet. Sjuksköterskor spelar en viktig roll i att stödja och motivera till livsstilsförändringar. Genom att förstå patientens upplevelse av sjukdomen kan sjuksköterskor anpassa sitt stöd och främja livsstilsförändringar. Syfte Syftet är att beskriva patienters upplevelse av att leva med typ 2 diabetes Vilka utmaningar upplever patienter i sitt dagliga liv? Metod En strukturerad litteraturstudie baserat på 13 vetenskapliga artiklar: 11 kvalitativa, en kvantitativ samt en mixed-method artikel. Artiklarna är publicerade mellan 2015–2025 och identifierades i databaserna CINAHL och PubMed. Artiklarna analyserades enligt Fribergs metod. Resultat Två huvudkategorier identifierades: komplexa upplevelser i vardagen samt positiva upplevelser och strategier i livsstilsförändringar. Patienter med typ 2-diabetes upplever rutinmässiga, sociala, emotionella och kunskapsrelaterade svårigheter. Faktorer som socialt stöd, hjälpmedel, väletablerade rutiner och tillgång till kunskap kan underlätta egenvården. Slutsats Patienter med diabetes-typ 2 möter en komplex kombination av utmaningar som påverkar deras möjlighet att utföra egenvård. Individanpassat stöd från hälso- och sjukvården är därför avgörande för att patienter ska kunna hantera sin sjukdom i vardagen, och nå hållbara, långsiktiga livsstilsförändringar
The Impact of Digital Games on Vocabulary Learning and Retention in Spanish as a Foreign Language (SFL) : A Quasi-Experimental Study with Seventh-Grade Students Using the Gimkit Platform
No full textThis study explores the impact of digital games on the learning and retention of both active and passive vocabulary among seventh-grade students of Spanish as a foreign language (ELE). Using a quasi-experimental design, two approaches were compared: the digital platform Gimkit and traditional analog activities. A total of 61 students participated, divided into two groups. Data collection included a diagnostic test, a final evaluation, a long-term retention minitest, and a perception survey. Both the minitest and the survey were completed by 47 students. The results show that both approaches supported vocabulary learning, but in different ways: analog activities led to faster and more balanced consolidation, while Gimkit sparked high levels of motivation, although with more uneven performance across students. In the discussion, these findings are connected with the theories of Piaget, Vygotsky, and Vivanco, highlighting the value of play as a learning resource, the role of social interaction, and the teacher's key function as a mediator in vocabulary development.Este estudio explora como los juegos digitales pueden influir en el aprendizaje y la retencion del vocabulario – tanto activo como pasivo – en estudiantes de septimo grado que aprenden espanol como lengua extranjera (ELE). A traves de un diseno cuasiexperimental, se compararon dos formas de trabajo: por un lado, la Plataforma digital Gimkit y, por otro, actividades analogicas tradicionales. En total participaron 61 estudiantes, distribuidos en dos grupos. La recogida de datos incluyo una prueba diagnostica, una evaluacion final, un minitest de retencion a largo plazo y una encuesta de percepcion. Tanto el minitest como la encuesta fueron respondidos por 47 estudiantes. Los resultados muestran que ambos metodos ayudaron al aprendizaje del vocabulario, aunque de maneras diferentes: las actividades analogicas facilitaron una consolidacion mas rapida y equilibrada, mientras que Gimkit desperto un alto nivel de motivacion, aunque con rendimientos mas desiguales entre los alumnos. En la discusion, estos hallazgos se relacionan con las aportaciones de Piaget, Vygotsky y Vivanco, lo que permite destacar el valor del juego como recurso de aprendizaje, la importancia de la interaccion social y el papel clave del docente como mediador en el desarrollo del vocabulario
Tense and Aspect in Multilingual Romance Language Education
No full textThis book brings together multilingualism, tense and aspect, and Romance language education. The chapters present theoretical and empirical research on the teaching and learning of French, Spanish, Italian, and Catalan in different educational contexts with data collected in Europe, the Americas, and Asia from learners with various linguistic backgrounds. With its clearly delineated sections on learning, teaching, and sociolinguistic variation, the volume makes an important contribution to the rich field of inquiry of second and third languages that is of significance to researchers, teachers, and learners alike
