Objectives: To investigate the construct validity and psychometric properties of the Swedish version of the Moral Distress Scale–Revised and to describe moral distress in an intensive care context. Research Methodology/Design: The Italian Moral Distress Scale–Revised was translated and semantically adjusted to the Swedish intensive care context. A web survey with 14 moral distress items, as well as three additional and eight background questions was answered by critical care nurses (N = 71) working in intensive care units during the second year of the coronavirus disease pandemic. Inferential and descriptive statistics were used to investigate the Italian four-factor model and to examine critical care nurses’ moral distress. Results: The result shows a factor model of four components differing from the previous model. Critical care nurses demonstrated significant differences in moral distress regarding priorities compared to before the pandemic, type of household; experience as critical care nurses and whether they had supervised students during the pandemic. Conclusion: The component structure might have originated from the specific situation critical care nurses perceived during the pandemic. The health care organisations’ role in preventing and healing the effects of moral distress is important for managers to understand. Implications for clinical practice: Moral distress is common in intensive care and it is necessary to use valid instrument when measuring it. A psychometrical investigation of the Swedish version of the Moral Distress Scale–Revised, adapted for intensive care shows need for further semantic and cultural adaptation. Perceived priorities during the pandemic, household type, supervising during the pandemic and working experience were related to critical care nurses’ experience of moral distress and managers need to be aware of conditions that may trigger such a response.

Objectives: This study explored postgraduate critical care nursing students' experiences of learning in the ICU during the COVID-19 pandemic and to understand these experiences in relation to self-directed learning and professional development. Methods: An explorative qualitative design was used. Eight postgraduate critical care nursing students from two different universities were interviewed. Questions focused on learning, supervision, ethically difficult situations, issues regarding communication, as well as the impact of the pandemic on students' health. Interviews thematically analyzed, and further analyzed using a theoretical framework focusing self-directed learning and professional development containing the concepts of autonomy, authenticity, and attachment. Results: The result consists of three themes: 1) Attachment with subthemes Attachment to the patient, Attachment to family and friends, Attachment to the ICU-context, and Attachment to the clinical supervisor.  2) Authenticity with subthemes Experiencing a varying degree of authenticity, Clinical reasoning about how to prioritize care. 3) Autonomy with subthemes Being just a student - with limited responsibility, taking responsibility, and having worries regarding one's professional development. Conclusion: Findings show the need for participation in the ICU community of practice without the demands and responsibility of full participation. Students need to be given the opportunity to form a relationship with practice. For attachment, participation, and consequently professional development to take place, there is need for inviting students to be a part of the team even during such straining circumstances as an ongoing pandemic. These findings can advance the understanding of how to organize clinical education during future crisis such as a new pandemic.

Background: Individually designed interventions delivered through mobile health applications (mHealth apps)may be able to effectively support diabetes self-care. Our aim was to review and synthesize available evidence in theliterature regarding perception of adults with type 1 diabetes on the features of mHealth apps that help promote dia-betes self-care, as well as facilitators and barriers to their use. An additional aim was to review literature on changes inpatient reported outcome measures (PROMs) in the same population while using mHealth apps for diabetes self-care.Methods: Quantitative and qualitative studies focusing on adults aged 18 years and over with type 1 diabetes in anycontext were included. A systematic literature search using selected databases was conducted. Data was synthesisedusing narrative synthesis.Results: We found that features of mHealth apps designed to help promote and maintain diabetes self-care could becategorized into self-care data monitoring, app display, feedback & reminders, data entry, data sharing, and additionalfeatures. Factors affecting the use of mHealth apps reported in the literature were personal factors, app design orusability factors, privacy and safety factors, or socioeconomic factors. Quality of life and diabetes distress were themost commonly reported PROMs in the included studies.Conclusion: We are unable to reach a conclusive result due to the heterogeneity of the included studies as well asthe limited number of studies reporting on these areas among adults with type 1 diabetes. We therefore recommendfurther large-scale studies looking into these areas that can ultimately improve mHealth app use in type 1 diabetesself-care.

Introduction: Oral care to older people in short-term care units is a complex and challenging everyday practice for nursing staff. Oral care research and knowledge about prerequisites and obstacles is extensive. However, there is a lack of knowledge about how nursing staff in short-term care units describe their satisfaction about provided oral care in order to maintain older people's oral health. Objective: The purpose of this study was to describe how nursing staff perceive their satisfaction of oral care provided for older people in short-term care units and to identify oral care improvements. Methods: This study reports on the results of two open-ended questions that were part of a larger study. Informants (n = 54) were nursing staff working in the involved short-term care units in municipalities from both densely and sparsely populated regions in central and northern Sweden. The answers to the open-ended questions were analyzed using content analysis. Results: The analysis yielded one main category; "Working together to improve satisfaction with older people's oral care" and four subcategories: "Older people's oral health," " Consideration and respect for the older person's autonomy," "Having access to adequate products," and "Working together in the same direction." Conclusion: Identification of older people's oral health problems together with adequate nursing intervention will increase older people's health outcomes and quality of life. However, regardless of work role, the nursing staff might have difficulty changing their behavior or transforming intentions into actions. Oral care is a complicated and proactive practice that requires nursing staff's attention as well as both educational and organizational initiatives. Working in a supportive and collaborative relationship provides prerequisites for optimal oral care in short-term care units.

Aim (a) To describe and compare perceptions of humanity aspects of oral care quality in relation to nursing staff in short-term care units and intensive care units and older people in short-term care units and their person-related conditions; and (b) to compare humanity aspects of oral care quality perceptions between nursing staff and older people in short-term care units. Design Cross-sectional study. Self-reported questionnaire and clinical assessments. Methods Nursing staff (N = 417) and older people (N = 74) completed the modified Quality of Care from a Patient Perspective instrument and person-related items. Older people's oral health status was clinically assessed using the Revised Oral Assessment Guide. Data were analysed using descriptive and analytic statistics. The data were collected from 2013-2016. Results Nursing staff's perceptions of humanity aspects of oral care quality were related to gender, work role and care environment. Older people's perceptions of humanity aspects of oral care quality were related to self-reported physical health. Nursing staff in short-term care units perceived the subjective importance of humanity aspects of oral care quality higher compared with older people in short-term care units.

Objectives: To identify intensive care nurses’ perceptions of oral care according to Coker et al.'s (2013) conceptual framework and to contribute to the knowledge base of oral care in intensive care. Design/methods: This was a concurrent embedded mixed-methods design, with more weight given to the quantitative part. Participants responded to the Nursing Care related to Oral Health questionnaire, including perceptions of oral care antecedents (18 items), defining attributes (17 items), and consequences (6 items) and two open-ended questions. The data were analysed with descriptive and correlation statistics and qualitative content analysis. Setting: Intensive care nurses (n = 88) in six general intensive care units. Results: Intensive care nurses perceived that an important part of nursing care was oral care, especially to intubated patients. They perceived that the nursing staff was competent in oral care skills and had access to different kinds of equipment and supplies to provide oral care. The oral cavity was inspected on a daily basis, mostly without the use of any assessment instruments. Oral care seemed to be task-oriented, and documentation of the patients’ experiences of the oral care process was rare. Conclusions: The antecedents, knowledge and skills are available to provide quality oral care, but intensive care nurses seem to have difficulties translating these components into practice. Thus they might have to shift their task-oriented approach towards oral care to a more person-centred approach in order to be able to meet patients’ needs. © 2018 Elsevier Ltd

Purpose: To describe and compare nurses' and healthcare assistants' oral care qualityperceptions, including perceived reality and subjective importance, to identify improvementareas in intensive care and short-term care, and to explore potential nursing satisfactionpredictors regarding oral care.Design/methodology/approach: Swedish staff, 154 within intensive care and 278 withinshort-term care responded to a modified Quality of Care from a Patient Perspectivequestionnaire. Descriptive and analytical statistics were used.Findings: Staff scored oral care quality both high and low in relation to perceived reality andsubjective importance. Improvement areas were identified, despite high satisfaction valuesregarding oral care. Setting, subjective importance, and perceived reality explained 51.5% ofthe variance in staff satisfaction regarding oral care quality.Practical implications: Quality improvements could guide oral care development.Originality/value: This study describes oral care by comparing nurse perceptions of howimportant they perceive different oral care aspects and to what extent these oral care aspectsare performed.