Samsjuklighet bland personer med missbruk och/eller beroende är vanligt förekommande. Exempelvis är psykiska sjukdomar tre gånger så vanligt hos de som missbrukar alkohol, jämfört med hos personer som inte gör det. Särskilt vanligt förekommande är samsjuklighet av missbruk och psykiska sjukdomar bland klienter som befinner sig i missbruksvårdens sammanhang. Tidigare forskning har visat att behandling av missbruk och beroende med psykiatrisk samsjuklighet är mest effektiv när insatserna integreras. Trots detta saknas sådan behandling på bred basis. Syftet med föreliggande projekt var att pilottesta integrerad behandling i LVM-vårdens kontext, med huvudfokus på genomförbarhet och hållbarhet. Ett underordnat syfte var att beskriva effekterna av sådan behandling. Två behandlingsmodeller pilottestades vid tre SiS-institutioner. Den ena modellen, Integrating Combined Therapies (ICT), pilottestades vid två institutioner och den andra modellen, Enhanced Illness Management and Recovery (E-IMR), testades vid en institution. Totalt ingick 70 klienter i ICT-behandlingsgruppen, och elva klienter i E-IMR-gruppen. Utöver detta intervjuades 14 anställda vid de tre olika institutionerna. Implementeringen av E-IMR tog inte fäste, huvudsakligen på grund av yttre organisatoriska omständigheter. Vad gäller ICT, tyder resultaten på att modellen är genomförbar inom LVM-vården. Likaså föreligger goda tecken på hållbarhet. Det är dock viktigt att beakta att denna pilotimplementering är en relativt liten studie där det inte funnits någon kontrollgrupp. Utifrån designen på forskningsprojektet går det därför inte att dra säkra slutsatser om de positiva effekter av ICT som observera

Aim: The purpose of this article was to explore workplace routines and strategies for preventing and managing bullying in the context of health and elderly care. Background: Bullying is a serious problem in workplaces with consequences for the individual, the organisation and the quality of care. Method: Open-ended interviews were conducted with 12 participants, including managers and specialists within one hospital and three municipalities. The interviews were analysed with qualitative content analysis. Results: Bullying was often concealed, due to avoidance, unclear definition and lack of direct strategies against bullying. No preventative work focusing on bullying existed. Psychosocial issues were not prioritized at workplace meetings. The supervisor had the formal responsibility to identify, manage and solve the bullying problem. The most common decision to solve the problem was to split the group. Conclusions: The findings showed that bullying was a concealed problem and was first acknowledged when the problem was acute. Implications for Nursing Management: Crucial strategies to prevent and combat bullying consist of acknowledgement of the problem, transformational leadership, prioritization of psycho-social issues, support of a humanistic value system and work through bullying problems to achieve long-term changes. © 2018 John Wiley & Sons Ltd

Workplace bullying is a taboo event which occurs worldwide, although the prevalence varies significantly between and within countries. Nurses have been regarded an occupational risk group for bullying at the work place. Bullying in health and social care contexts is sometimes reported as frequent and, other times, as not occurring, which sparked our interest in mapping the occurrence of bullying in the health and social care system in Sweden. Thus, the purpose of the study was to examine the prevalence of bullying, and to discuss cultural traditions and environmental factors that affect bullying in workplaces. The sample (n = 2810) consisted of employees at inpatient wards at four hospitals, and employees at municipal eldercare wards in Sweden. A questionnaire including NAQ‐22 R was distributed and subsequently analysed with descriptive statistics using SPSS. The youngest group of respondents scored higher than the older groups. Using contrasting estimates of bullying, the prevalence varied between 4.1 and 18.5%, with the lowest prevalence in regards to self‐reported exposure. According to the cut‐off scores, NAQ‐22 R, 8.6% of the respondents were occasionally exposed to bullying while 2.3% were considered to be victims of severe bullying. Work‐related negative acts were more common than personal negative acts. The variations in prevalence of bullying as a result of contrasting estimation strategies are discussed from perspective of the 'law of Jante', the 'tall poppy syndrome' and shame. Bullying deteriorates the working conditions which may have an impact on quality of patient care.

Introduction. We focus on trauma care conducted in the context of a simulated traumatic event. This is in this study defined as a four-meter fall onto a hard surface, resulting in severe injuries to extremities in the form of bilateral open femur fractures, an open tibia fracture, and a closed pelvic fracture, all fractures bleeding extensively. Methods. The simulated trauma care competence of 63 ambulance nurses in prehospital emergency care was quantitatively evaluated along with their perception of their sufficiency. Data was collected by means of simulated trauma care and a questionnaire. Results. Life-saving interventions were not consistently performed. Time to perform interventions could be considered long due to the life-threatening situation. In comparison, the ambulance nurses' perception of the sufficiency of their theoretical and practical knowledge and skills for trauma care scored high. In contrast, the perception of having sufficient ethical training for trauma care scored low. Discussion. This study suggests there is no guarantee that the ambulance nurses' perception of theoretical and practical knowledge and skill level corresponds with their performed knowledge and skill. The ambulance nurses rated themselves having sufficient theoretical and practical knowledge and skills while the score of trauma care can be considered quite low.

Simulation provides the opportunity to learn how to care for patients in complexsituations, such as when patients are exposed to high-energy trauma such as motor vehicle accidents.The aim of the study was to describe nurses’ perceptions of high-energy trauma care through simulationin prehospital emergency care. The study had a qualitative design. Interviews were conductedwith 20 nurses after performing a simulated training series. Data were analyzed using a phenomenographicmethod. The result indicates that simulation establishes, corrects, and confirms knowledge andskills related to trauma care in prehosp ital emergency settings. Trauma knowledge is readily availablein memory and can be quickly retrieved in a future trauma situation.

Nursing students need an understanding of how nurses care for people’s health from a global perspective. The aim of this studywas to explore how nurses can contribute to health from the perspectives of first-year nursing students in Scandinavia (Sweden,Norway) and Indonesia. Data were collected using an open-ended question about nurses’ contribution to health, and analysedusing qualitative content analysis. Three common categories emerged: ‘Promoting health and preventing disease’, ‘Performingcare and treatment’, ‘Establishing a relationship with patients and being compassionate’. ‘Possessing and implementing knowledgeand skills’ was common to Norway and Indonesia. ‘Being a team member’ was emphasised by the Indonesian participants.The Norwegian participants focused on health promotion, whereas those from Indonesia prioritised disease prevention. TheScandinavian participants emphasised individuality, while those from Indonesia focused on the community. The findings indicatethat nursing education should take account of different cultures and include student exchange programmes.

Background: Simulation participants are not dependent on learning during an actual clinical situation. This allows for a learning environment that can be constructed to meet the knowledge and experience needs of the participant. Simulations in a prehospital emergency are an ideal way to address these needs without risking patient safety. Method: Nurses in prehospital emergency care (n = 63) participated in simulation interventions. During the simulation, the performed trauma care was assessed in two groups of participants with different frequency of simulation. Results: Several statistically significant differences and clinical improvements were found within and between the groups. Differences were noted in specific assessments, examinations, care actions, and time from assessment to action. Conclusion: The result suggested that repeated simulation may contribute to a clinical improvement in trauma care, and more frequent simulation may led to even greater improvements. (c) 2017 International Nursing Association for Clinical Simulation and Learning. Published by Elsevier Inc.

Background:Little is known about the combination of person- and organization- related conditions and the relationshipswith patients'perspectives of care quality. Such a combination could contribute knowledge reflecting the complexity ofclinical practice, and enhance individualized care. The aim wasto investigate the relationships between the combination ofperson- and organization-related conditions and patients'perceptions of palliative care quality.Methods:A cross-sectional study, including 191 patients in the latepalliative phase (73% response rate) admitted to hospiceinpatient care (n= 72), hospice day care (n= 51), palliative units in nursing homes (n= 30) and home care (n=38),wasconducted between November 2013 and December 2014, using the instrument Quality from the Patients'Perspectivespecific to palliative care (QPP-PC). Data were analysed, using analysis of covariance, to explore the amount of the variancein the dependent variables (QPP-PC) that could be explained by combination of the independent variables–Person- andorganization-related conditions,−while controlling for differences in covariates.Results:Patients scored the care received and the subjective importance as moderate to high. The combination of person-and organization - related conditions revealed that patients with a high sense of coherence, lower age (person–relatedconditions) and being in a ward with access to and availabilityof physicians (organization-related condition) might beassociated with significantly higher scores for the quality ofcare received. Gender (women), daily contact with family andfriends, and low health-related qualityof life (person-related conditions) might be associated with higher scores forsubjective importance of the aspects of care quality.Conclusion:Healthcare personnel, leaders and policy makers need to pay attention to person- and organization-relatedconditions in order to provide person-centered palliative care ofhigh quality. Further studies from palliative care contexts areneeded to confirm the findings and to investigate additional organizational factors that might influence patients'perceptions of care quality.

The purpose of this exploratory study was to investigate how nursing students in Indonesia and Scandinavia characterize a healthy person. Two hundred thirty-two nursing students from Indonesia, 50 students from Sweden, and 119 students from Norway participated by answering an open-ended question. Qualitative content analysis was used to identify patterns of health in a cultural and national context. The characteristics of a healthy person were summarized in the theme “external and inner balance,” which are intertwined because of the wholeness of self-image and appearance. The subcategories were having a strong and positive body image, feeling well and having inner harmony, following the rules of life, coping with challenges, and acting in unison with the environment. There were more similarities than differences between the Indonesian and Scandinavian nursing students’ understanding of being a healthy person. The difference is that the Scandinavian students mentioned individuality, whereas the Indonesian students referred to collective values.

BACKGROUND: Acquiring knowledge and experience on high-energy trauma is often difficult due to infrequent exposure. This creates a need for training which is specifically tailored for complex prehospital conditions. Simulation provides an opportunity for ambulance nurses to focus on the actual problems in clinical practice and to develop knowledge regarding trauma care. The aim of this study was to describe what ambulance nurses and paramedics in prehospital emergency care perceive as important for learning when participating in simulation exercises.

METHODS: An integrative literature review was carried out. Criteria for inclusion were primary qualitative and quantitative studies, where research participants were ambulance nurses or paramedics, working within prehospital care settings, and where the research interventions involved simulation.

RESULTS: It was perceived important for the ambulance nurses' learning that scenarios were advanced and possible to simulate repeatedly. The repetitions contributed to increase the level of experience, which in turn improved the patients care. Moreover, realism in the simulation and being able to interact and communicate with the patient were perceived as important aspects, as was debriefing, which enabled the enhancement of knowledge and skills. The result is presented in the following categories: To gain experience, To gain practice and To be strengthened by others.

CONCLUSION: Learning through simulation does not require years of exposure to accident scenes. The simulated learning is enhanced by realistic, stressful scenarios where ambulance nurses interact with the patients. In this study, being able to communicate with the patient was highlighted as a positive contribution to learning. However, this has seldom been mentioned in a previous research on simulation. Debriefing is important for learning as it enables scrutiny of one's actions and thereby the possibility to improve and adjust one's caring. The effect of simulation exercises is important on patient outcome.