Introduction: Needs within healthcare are changing and nurses require new skills and knowledge in global nursing. Student exchange programs in global contexts provide an opportunity to develop the necessary skills.ObjectiveThe aim of this study was to describe Tanzanian nursing students’ experiences of student exchange in Sweden.

Methods: A qualitative design was used for this empirical study. Semistructured interviews were conducted with six Tanzanian nursing students who had participated in student exchange in Sweden. The participants were recruited by purposeful sampling. Inductive reasoning and qualitative content analysis were applied.

Results: Four main themes were formed; new roles, experience a new culture, establish new competencies, and global work ambitions. The findings revealed that the students experienced new approaches in Sweden, giving them new competencies and understanding. Furthermore, they increased their global perspectives on nursing and interest in working with global health issues, but they also experienced challenges in the new environment.

Conclusion: The present study showed that Tanzanian nursing students benefitted from their student exchange, both personally, as well as for their future careers as nurses. More research is needed in examining nursing students from low-income countries participating in student exchange in high-income countries.

Background: Meeting with health care gets short before and after the operation. The difficulty at the day surgery is that preparation and information take place in close proximity to the operation. Health professionals must not only take care of the child during the medical visit, but also of the accompanying parent, too. Parents’ participation in the perioperative care, sometimes unable to attend.

Aim: This study aims to investigate how parental involvement in the perioperative a process can be facilitated.

Method: A qualitative design based on observations and interviews with semi structured questions with open answers. Results: The results conveyed involvement in the child’s perioperative process in diverse ways and to a different depth. This is highlighted in the theme Allowed with the under themes Security and Being accepted. However, the theme Exclusion with the under-theme Rejection revealed a non-caring approach where no caring relation could be established. Quotes from the transcribed material are used to highlight the results.

Conclusion: The study’s findings confirm earlier studies in the perspective that information is of central importance in enabling parents to be involved in the perioperative process. The results showed that parents’ involvement in the perioperative process is a prerequisite for creating safety in the child and reducing concerns in connection with the operation. Parental involvement may be hindered by a conventional approach that does not include the child’s perspective.

Aims: In general, COVID-19 symptoms are milder in children than inadults, but the experience of the pandemic could increase anxiety andsignificantly affect the life situation of children and adolescents. Itcould also lead to a long-term negative effect on their health. To studyhow the corona pandemic affected the life situation of children andadolescents in Sweden. Methods: A self-reported online survey wasperformed July–November 2020. Cross-sectional data were collectedusing non-probability and convenience sampling methods. The sample consisted of children 6–14 years and their guardians, and adolescents 15–19 years. The questionnaire covered items regarding the life situation including demographics, school situation, social isolation, and an open-ended question to provide a subjective expression of the living situation. A standardized measurement of anxiety was collected using the Children’s Anxiety Questionnaire (CAQ) (scores range 4–12) and the Numeric Rating Scale (NRS)(scores range 0–10). Data were analyzed by descriptive statistics andwith qualitative manifest content analysis. Results: In total, 1487 participants, 768 children with guardians and 719 adolescents participated. Most of the participants, 754 children (97.2%) and 634 adolescents (89.2%) attended school where a mixture of physical attendance and distance learning was reported by 79 children (10.2%)and 261 adolescents (36.7%). Two children (0.3%) and 298 adolescents (41.9%) reported only having distance learning. A larger proportion of children (n = 339, 43.9%) and adolescents (n = 420,59.2%) reported abstaining from leisure activities, while a minority ofchildren (n = 103, 13%) and adolescent (n = 135, 19%) reportedexperiencing a feeling of ‘social isolation’. These experiences ofchanges in daily routine were prominent in the qualitative result. Social restrictions and loss of contact with older relatives led to fear and anxiety. However, for young children, their lives continued torevolve around the everyday things in life rather than the coronapandemic, for the adolescents; however, their life situation was negatively affected by isolation from peer groups and the loss ofschool routine. Conclusion: The experiences by children due toCOVID-19 in Sweden highlight the importance that children continue living their lives as unchanged as possible and that particularly adolescents need receiving greater support with the maintenance of an educational routine.

The aim of this study was to examine aspects of children's health literacy; the information sources they were accessing, their information preferences, their perceived understanding of and their reported information needs in relation to COVID-19. An online survey for children aged 7-12 years of age and parent/caregivers from the UK, Sweden, Brazil, Spain, Canada and Australia was conducted between 6th of April and the 1st of June 2020. The surveys included demographic questions and both closed and open questions focussing on access to and understanding of COVID-19 information. Descriptive statistics and qualitative content analysis procedures were conducted. The findings show that parents are the main source of information for children during the pandemic in most countries (89%, n = 347), except in Sweden where school was the main source of information. However, in many cases parents chose to shield, filter or adapt their child's access to information about COVID-19, especially in relation to the death rates within each country. Despite this, children in this study reported knowing that COVID-19 was deadly and spreads quickly. This paper argues for a community rather than individual approach to addressing children's health literacy needs during a pandemic.

Background: Authors commonly agree that the clinical learning environment significantly affects student learning. Studies of how operating room nurses perceive the clinical learning environment during their specialist studies are sparse. 

Method: This study aimed to examine newly graduated operating room nurses’ perceptions of the clinical learning environment during their specialist education. Fifty newly graduated operating room nurses answered a questionnaire gaging their perceptions of clinical education. 

Results: Most participants perceived the clinical learning environment as good and highly associated with the supervisor’s ability to supervise, enjoy supervision, and show interest in the participants’ degree project. The management at the clinical setting, which was perceived to emphasize the importance of supervision, time allocated especially for supervision, and perceived cooperation between the University and hospital, also had an impact. 

Conclusion: Social interactions and structures within the operating room affect how the clinical learning environment is perceived. 

Background: The organ donor process is challenging, not at least for intensive care nurses. The situation changes radically, from intensively working to save the patient’s life to instead caring for the donor patient’s organs so that those, in turn, can save another patient’s life. The donation process challenges nurses’ view on what dignified caring at end-of-life entails. The inner core of caring comprises love, mercy and compassion. Dignified caring is related to treating the patient as a unique human being and respecting human value, rooted in the theory of caritative caring that is the framework for this study.   

Aim: The aim was to illuminate intensive care nurses’ experiences of caring during the organ donor process, from a caring science perspective.

Methodology: A descriptive research design including inductive qualitative content analysis of interviews with twelve intensive care nurses in Sweden about their experiences of caring during the donor process.

Results: The theme The complexity of caring during the organ donor process with two categories and five subcategories was generated. Intensive care nurses experienced caring during the donor process as being complex in relation to the potential donor patient and patient’s family as well as communication, teamwork and organization. Caring affects not only the patient and families, but also the nurses and receivers of the donated organs. Intensive care nurses perceive the other’s life situation as if it were their own and recognize the importance of shared humanity.

Background: Internationally, there are very few guidelines regarding how near relations can be taken care of on a children’s intensive care unit. Despite knowledge about the positive effects of parental presence, staff frequently reject parents out of insecurity. This study aimed to investigate health professionals’ understanding of letting parents be present throughout critical situations. A qualitative method with semi-structured interviews was used to answer the aim of his study. Nine persons participated in the study, both physicians and nurses. The result showed that health professionals’ main view is that parents’ presence is positive. However, their presence often has lower priority than the medical focus of the child and the health professionals’ concern of failure. Conclusion: Health professionals have the power to decide if parents can be present in critical situations. Only when a parent demands to be present does that demand beat the decisions made by health professionals. Lack of resources within the team and fear of parents becoming a disturbance or a distraction are cited as the primary reasons not to let parents be present.

Aims: During the COVID-19 pandemic, Sweden was one of the few countries that rejected lockdowns in favour of recommendations for restrictions, including careful hand hygiene and social distancing. Preschools and primary schools remained open. Several studies have shown negative impacts of the pandemic on children, particularly high levels of anxiety. The study aim was to explore how Swedish school-aged children aged 6–14 years, experienced the COVID-19 pandemic and their perceived anxiety.

Methods: In total, 774 children aged 6–14 years and their guardians answered an online questionnaire containing 24 questions, along with two instruments measuring anxiety: the Children’s Anxiety Questionnaire and the Numerical Rating Scale. A convergent parallel mixed-methods design was used for analysing the quantitative and qualitative data. Each data source was first analysed separately, followed by a merged interpretative analysis.

Results: The results showed generally low levels of anxiety, with no significant sex differences. Children who refrained from normal social activities or group activities (n=377) had significantly higher levels of anxiety. Most of the children were able to appreciate the bright side of life, despite the social distancing and refraining from activities, which prevented them from meeting and hugging their loved ones.

Conclusions: These Swedish children generally experienced low levels of anxiety, except those who refrained from social activities. Life was nonetheless mostly experienced as normal, largely because schools remained open. Keeping life as normal as possible could be one important factor in preventing higher anxiety and depression levels in children during a pandemic.

The aim of this study was to explore ways clinical supervisors facilitate the learning of the affective elements of professional competence in a clinical palliative care environment. The secondary aim was to advocate for and raise awareness of the importance of the affective domain in medical education.

A clinical palliative care learning environment has been reported to be emotionally challenging. The affective and transformative learning processes taking place requires special support. However, little is known about how clinical supervisors facilitate this learning processes. A qualitative, explorative study was designed to capture supervisors' perceptions of their supervision using semi-structured interviews. Six experienced clinical supervisors working within a palliative care context were recruited using convenience sampling. Data were analyzed using inductive content analysis. The affective elements were viewed as essential for learning, clinical supervision, and professional competency. Supervisors use a variety of different ways of facilitation. Four main themes were identified; building a relationship, creating space for learning, creating a pedagogical environment, and Mirroring.

Background: Today mobil phones has been incorporated in our daily lives to such an extent that they are used in the operating theater for both professional and private matters. The advantages and disadvantages associated with the use of mobile phones in the healthcare sector are described in studies.

Aim: To describe healthcare professionals use and managing of professional phones and private mobile phones in the operating theater.

Method: The design is a descriptive cross-sectional study with 40 structured observations in the operating theater and a questionnaire survey. The study was conducted in three surgical departments at a Swedish children's hospital. The participants were anesthetic nurses, physicians, operating theater nurses and assistant nurses. Data was analyzed descriptively in SPSS.

Result: The observations showed that of 477 phone uses, 287 (60.2%) were private mobile phones and 190 (39.8%)professional phones. The adherence to basal hygiene guidelines before and after telephone use, n = 477, was 93 (19.4%) and 103 (21.5%), respectively. The questionnaire showed that 9 (27.2%) of the participants experienced daily that the use of private mobile phones disturbed team members in the operating theater. Eight (24, 2%) of participants experienced daily, 7 (21.7%) weekly, employees became less concentrated due to the use of private mobile phones.

Conclusion: Increased compliance with basic hand hygiene guidelines, designing policies regarding the use of private mobile phones in the operating theater and a discussion concerning what is ethically correct in relation to the patients can be considered essential. Further studies are needed for continued exploration of the use and managing of mobile phones in the operating theater.

Objective: The psychiatric mental status examination is a fundamental aspect of the psychiatric clinical interview. However, despite its importance, little emphasis has been given to evidence-based instructional design. Therefore, this review summarizes the literature from an instructional design perspective with the aim of uncovering design strategies that have been used for teaching the psychiatric interview and mental status examination to health professionals.

Methods: The authors conducted a scoping review. Multiple databases, reference lists, and the gray literature were searched forrelevant publications across educational levels and professions. A cognitive task analysis and an instructional design framework was used to summarize and chart the findings.

Results: A total of 61 articles from 17 countries in six disciplines and three educational levels were identified for data extractionand analysis. Most studies were from the USA, presented as educational case reports, and carried out in undergraduate education in the field of psychiatry. Few articles described the instructional rationale for their curriculum. None of the studies compared the effectiveness of different instructional design components. Reported learning activities for each task domain (knowledge, skills,and attitudes) and for each step of an instructional design process were charted. Most articles reported the use of introductory seminars or lectures in combination with digital learning material (videos and virtual patients in more recent publications) and role-play exercises.

Conclusions: Educators in psychiatry should consider all task domains of the psychiatric interview and mental status examination. Currently, there is a lack of empirical research on expertise acquisition and use of instructional design frameworks in this context

Introduction: The field of geriatric psychiatry has in recent decades developed into an independent discipline, incorporating elements of psychiatry, neurology and internal medicine. In view of demographic changes, this field is becoming increasingly relevant for primary care and undergraduate medical training. So far, however, there is little educational guidance for instructional design of geriatric psychiatry in undergraduate medical education.

Project description: A narrative literature review of medical education studies in the field of geriatric psychiatry was conducted. Student evaluations of a geriatric psychiatry clerkship seminar were analyzed, followed by a target group analysis. Results informed the iterative development of new clerkship seminar content and structure. This was implemented and evaluated over several academic cycles. Learning material was made available via the open-source learning management system “ILIAS”.

Results: A total of 29 medical education articles were identified and evaluated. The previous seminar in geriatric psychiatry at our university hospital was rated below average (Likert item overall rating of 4.3/6 compared to other seminars with an average overall rating of 5.2, p<0.001). An evidence-oriented revision of the content and instructional design was implemented. Activation of learners, self-reference effect, and audience questioning were used during the lecture. Additionally, two geriatric psychiatry case scenarios were adapted for discussion. We saw continuous improvement of student evaluations of the revised course, reaching a rating improvement of 5.3 out of 6 (p<0.01, U=135.5 Cohen’s d=1.28).

Conclusion: A systematic approach was used to develop a geriatric psychiatry clerkship seminar, based on medical education evidence, for undergraduate medical students, resulting in better student evaluations. The teaching materials can be adapted for local implementation at other teaching hospitals. Future studies should also explore effects regarding higher learning outcomes.

Background: Adolescent pregnancy is a global health problem. In Uganda, the rate of teenage pregnancies is approximately 25% and these are associated with both poor maternal- and perinatal health outcome.

Objective: This qualitative case study aimed to examine health workers’ experiences of promoting sustainable health and well-being for pregnant adolescent girls in Uganda.

Method: A qualitative study design was used. Data was collected through semi-structured interviews of four health workers working for a Non-Government Organization (NGO) based in Uganda. Data was inductively analyzed by content analysis.

Result: Three categories emerged: social structure, organization’s work – rehabilitation and therapy, and outcome. Healthcare workers worked with health promotion using a person-centered approach, emphasizing therapies and empowerment strategies and an overall faith-based approach. Furthermore, the result showed that girls were abandoned by their families when entering the center, but with help from the NGO they increased their understanding of the girls situation, due to resettlement of plan and follow up made by the health workers.

Conclusion: Health workers can promote health and well-being among pregnant adolescent by applying person-centered care, including therapies and empowerment strategies by a faith-based approach. Social structures and families should be encouraged to provide support to pregnant adolescent girls.

Background

Caring for dying children is complex and requires coordination of all resources.In PICU the main objective is to save lives and ensure vital functions in critically ill children. However due to the child’s critical and life threatening condition, there is always the possibility the child will not survive. The acuity and technical nature of the intensive care context can provide an obstacle in the transition to palliative care and furthermore conflict with the affected families’ needs.

Objectives

The study aim was to enlightening caring as it is represented in caring situations of dying children at PICU.

Methods

An Interpretative Phenomenological design was applied. The data collection was performed at three PICU in Sweden at 2011 and 2016. Caring situations of a total of 18 children were observed, six cases were estimated as end of life care or life threatening conditions. Nurses and parents were interviewed in direct connection to the observation.

Conclusions/Results

Preliminary findings showed that for nurses, it was a challenge to change perspective from curative to palliative care. Medical examinations and treatment was experienced to disturb the dying child thus causing unnecessary suffering. Parents found it difficult to leave their dying children even just for a moment and the space in PICU did not support closeness and parenting but rather separated the dying child from her/his family.In conclusion, these findings illuminates the importance of guidelines and training in palliative care in PICU. Children and their family ought to have the best care possibly when affected by life-limiting or life-threatening illness.

BACKGROUND: The preparation to become a critical-care nurse in Sweden consists of a college program. The programs need to meet a set of widely defined goals developed by the Board of Higher Education, but can differ in content and lay-out depending on the college curriculum. There is subsequently no pre-defined standards for the knowledge, competencies and capabilities a critical-care nurse should possess. This presents a problem for both employers, educators, nurses and students and can ultimately compromise patient safety.AIM: Our aim was to develop a final examination that would reflect theoretical knowledge, as well as practical skills and competencies for an entry-level critical care nurse.

METHOD: The content of the final examination was based on a previously developed assessment tool used for clinical rotations at our college. This assessment tool reflected the competencies stated by the national association of critical care nurses in Sweden (AnIva) as well as the goals required by the Board of Higher Education in Sweden. After development of the exam, which comprises a two-step assessment where the students´ skills and capabilities are assessed, and a theoretical part where the students´ nursing-care knowledge is assessed by explicit pre-determined standards, the exam was tested and then revised in several steps after several focus-group discussions with content-experts and students.

RESULT: The content-experts reported they were helped by having a set of explicit pre-determined standards to guide them. The students expressed similar sentiments as well as satisfaction from receiving “proof” of having reached an entry-level critical-care nurse level.IMPACT FOR PRACTICE: A set benchmark where knowledge-level and competency requirements are clarified for critical care nursing-practice aids students, educators and employers in setting goals for, and evaluating individuals working towards becoming a critical care nurse. This ultimately strengthens the profession and promotes patient safety.

Relatives to patients that has been undergoing resuscitation attempts, where no family members have been allowed to stay in the room, describe their greatest fear as being separated from the patient if he or she did not survive [1]. From the child’s perspective when hospitalized in a Pediatric Intensive Care Unit (PICU), collaboration between healthcare professionals, parents and the child, if possible, is a prerequisite for god nursing care. The child is also entitled to have a parent or other relative with them 24 hours a day [2]. From the parent’s perspective many situations in the PICU feels chaotic and unreal, the worst situations are when they are not given the opportunity to be close to their child and being involved in the care [3,4]. Observing the healthcare staff working intensively is perceived as very stressful and the parents are filled with much fear [4]. 

Background: Children who are critically ill are vulnerable and the nurse has a responsibility to meet the child`s needs in a pediatric intensive care unit (PICU). Objectives: The aim was to explore the vulnerable child's participation and how it can be understood through the nurses’ perspective in the situated nursing care intervention. By exploring ways clinical supervisors facilitate the learning of the participation from critically ill children in a clinical environment  Method: The study design was an exploratory inductive qualitative approach.  Data collection was done through observations and interviews. The data from the observations were analyzed through interpretive phenomenology. Findings: The affective elements were viewed as essential for learning to understand how children participate in the PICU and to develop professional competency. Three themes emerged through the analysis: Mediated participation, Bodily participation and Participation by proxy. They all highlight different aspect of the vulnerable child's way of participating in the nursing care given, through nurses awareness and situated salience. Conclusion: The concept participation should be redefined and broadened; as participation can present itself through the child’s body in diverse ways. considerations: Confidentiality procedures were followed, ethical permission was given from the ethical komitee at KI, and all informants participated on an informed, independent and voluntary basis. The informants that chose to participate were informed that they could cease participation at any time.

 Audience take away: 1.    The concept participation should be redefined and broadened; it should be understood and interpreted in a new way within the PICU.2.     Participation can present itself through the child’s body in diverse ways, and every person working with children needs to act accordingly. Children has a right to be involved in their care and treated as the first person the PICU nurses first responsibility lies with the child, to address their needs and their rights.   3.    We call for an awareness and a strategy on how participation can be established and strengthened in various ages at the PICU. Through the awareness of the Childs body and the technical devices the Childs needs can be interpreted and meet

• The audience will get examples of how nurses can “listen” with their nursingcare interventions and meet the subtle signs of the childs will.  
• It will give them evidence to be in harmony with the convention of childrens right as well as strengthen the child as a person.Practical tips on how to expand the well being of the whole family in the PICU. It also relates to the caring culture which can be studied. 

In the Pediatric Intensive Care Unit (PICU) family- and childcentered care does not have the same prepared tools to relay on as, for example, neonatal care. In neonatal care the parents are quickly involved in the child's care. The caring philosophy NIDCAP (Newborn individualized Developmental Care and Assessment Program) and SFS-Situation adapted family co-operation, are both adapted for the child and for the parents. Both these "utensils" are based on individualizing the nursing care from a family-centered perspective. However, the same prepared tools or tools are not available from a child-centered care perspective, which gives the child a disadvantage and every act of involvement rests upon the nurse’s knowledge and ability to vindicate such child centered care in the caring situation [1]. According to the United Nations Convention on Children's Rights [2], the child´s best interest needs to be put firsthand when health and medical care is given to children. The idea is that the child should be in the center. The focus is thus moved from a family-centered perspective, to a child-centered perspective.

Sometimes children get so sick that they rapidly become omitted to the most advanced level of pediatric care, the Pediatric Intensive Care Unit (PICU). This is a strange place where noise and scent as well as the touch feels different [1] to all other experiences the child might have had prior to the omittance. Research have shown that the parents perspective for the future is only a few hours [2] when their child are at the PICU. They all, in their own ways, balance between life and death. There is a real threat that the care in a PICU might end in the death of the child. In this context the PICU nurse works, learns and balances here nursing care interventions to support the child, the parents as well as being a team member with exceptional skills [3]. 

Bellerarn som läggs in på sjukhus har i många fall akuta akutiserade kroniska sjukdomar. Infektioner och inflammationer minskar önskan att äta, vilket försämrar möjligheten att inta, digerera och absorbera tillräckligt med föda.

Ökade förluster i samband med kräkningar och/eller diarré kan bidra till försämrat näringsläge. Med ett par enkla frågor och vikt/längd mätning kan man gruppera barn som läggs in på avdelningarna beträffande risknivå för malnutrition. Med denna riskbedömning kan man sedan gå vidare för att förebygga eller behandla malnutrition hos dessa barn, på sjukhus eller i öppenvården.

Studier har visat att 8-26% av barn vårdade på sjukhus har låg vikt i förhållande till ålder eller längd. Malnutrition påverkar muskelmassa, försämrar hjärt-lungfunktionen, ger sämre sårläkning, sämre immunförsvar, ökar risken för sekundära infektioner och påverkar det psykiska välbefinnandet negativt.

Sjuksköterskor på Sachsska Barnsjukhuset har en nyckelroll i upptäckten av dessa missförhållanden. Till sin hjälp har de STAMP (Screening tool for the Assessment of Malnutrition in Paediatrics) vilket är ett enkelt verktyg för att poängsätta risk för malnutrition hos sjuka barn. Genom att kontrollera nutritionsstatus på alla barn som läggs in på Sachsska barnsjukhuset upptäcks och korrigeras malnutrition av olika genes i ett tidigt skede. Målet är att  nutritionsscreena alla barn som läggs in på Sachsska Barnsjukhuset. 

Som analysunderlag användes STAMP, en validerad näringsscreeningmetod för barn i åldern 2-16 år. STAMP är ett enkelt 5-stegs verktyg som utvecklats av ett team från Royal Manchester barnsjukhus och University of Ulster.

En pilotstudie på 20 barn genomfördes under januari/februari 2011. Resultatet visade att barn med risk för malnutrition fångades upp och övervakades under vårdtiden för att sedan skrivas ut med god nutritionsstatus.

Genom att screena barnen för malnutrition kan vi tidigt skilja ut de barn som riskerar malnutrition av något slag och ge dem individuellt anpassad omvårdnad. Detta minskar risken för bestående malnutrition,                                                        ökar deras välbefinnande samt kvaliteten i omvårdnaden av nutritionen under sjukhusvistelsen. 

Background: Children who are critically ill are vulnerable and the nurse has a responsibility to meet the child`s needs in a pediatric intensive care unit (PICU).

Objectives: The aim was to explore the vulnerable child's participation and how it can be understood through the nurses’ perspective in the situated nursing care intervention. By exploring ways clinical supervisors facilitate the learning of the participation from critically ill children in a clinical environment  

Method: The study design was an exploratory inductive qualitative approach.  Data collection was done through observations and interviews. The data from the observations were analyzed through interpretive phenomenology. 

Findings: The affective elements were viewed as essential for learning to understand how children participate in the PICU and to develop professional competency. Three themes emerged through the analysis: Mediated participation, Bodily participation and Participation by proxy. They all highlight different aspect of the vulnerable child's way of participating in the nursing care given, through nurses awareness and situated salience.

Conclusion: The concept participation should be redefined and broadened; as participation can present itself through the child’s body in diverse ways.

Considerations: Confidentiality procedures were followed, ethical permission was given from the ethical komitee at KI, and all informants participated on an informed, independent and voluntary basis. The informants that chose to participate were informed that they could cease participation at any time.

We all know that the digitalization is here to stay, so also in the children’s operating theater. We also know that effective teamwork is crucial for safe surgery. Changes in demographic trends and new surgical and technological innovations require close collaboration with other disciplines for a number of reasons [1]. Despite the advances in technology, making healthcare safer depends, not on minimizing the human contribution but on understanding how people, look ahead, overcome hazards and, in effect, create safety [2]. This is very true in a high technological environment that has become utterly specialized and digitalized during the last decade. As the technical devices becomes more and more complex we require another approach for interprofessional collaboration in the operating theater to keep the child safe during the operation. Especially a breakdown in communication, poor teamwork, lack of leadership and poor decision making by individuals and teams have all been shown to be major contributors to adverse events [3].