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  • 1.
    De Lima, Sara
    et al.
    St. Erik Eye Hospital, Karolinska Institutet, Stockholm, Sverige.
    Kugelberg, Maria
    St. Erik Eye Hospital, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.
    Jirwe, Maria
    The Swedish Red Cross University College, Department of Health Sciences.
    Swedish parents' experiences and their need for support when having a child with congenital cataract: A qualitative study2021In: Journal of Pediatric Nursing: Nursing Care of Children and Families, ISSN 0882-5963, E-ISSN 1532-8449, Vol. 60, p. 109-115Article in journal (Refereed)
    Abstract [en]

    PURPOSE: To explore parents' experiences of living with a child with congenital cataract, with the intention of identifying how to improve the parental support.

    DESIGN AND METHOD: A qualitative descriptive design using semi-structured interviews. The parents were interviewed when the children were aged 12-24 months. All children were operated on for congenital cataract before three months of age. The interviews were transcribed and analysed using qualitative content analysis with an inductive approach. Findings were reported following the Standard for Reporting Qualitative Research (SRQR) checklist.

    RESULTS: Three categories emerged from the data: trying to survive during a chaotic time; adapting to a different normal; being in need of support. When receiving the preliminary diagnosis, most of the parents were upset but managed well once the initial shock had subsided. However, some described feelings of despair, difficulties in accepting the situation and in connecting with the child. All parents stated that, to be valuable, a counsellor needed to have insights in how the eye works and the function of visual development.

    CONCLUSION: The parents' need for psychosocial support in the early post-diagnostic stage varied greatly. Early identification of those in need of specialized counselling is therefore of importance, preferably at the maternity ward or by the regional ophthalmologist when the referral is made.

    CLINICAL IMPLICATIONS: The study provides understanding of the importance to take the parents' well-being beyond the medical issues into consideration. This knowledge can be used to provide support at an earlier stage in the treatment programme than is currently the case.

  • 2.
    Englid, Marianne Birke
    et al.
    Karolinska University Hospital, Sweden.
    Jirwe, Maria
    Swedish Red Cross University, Department of Health Sciences. Karolinska Institutet, Sweden.
    Conte, Helen
    Karolinska Institutet, Sweden.
    Perioperative Comfort and Discomfort: Transitioning From Epidural to Oral Pain Treatment After Pancreas Surgery2023In: Journal of Perianesthesia Nursing, ISSN 1089-9472, E-ISSN 1532-8473, Vol. 38, no 3, p. 414-420.e1, article id S1089-9472(22)00259-3Article in journal (Refereed)
    Abstract [en]

    PURPOSE: To explore patients' experiences of pain treatment in the perioperative period after surgery for pancreatic cancer.

    DESIGN: A qualitative descriptive design using semi-structured interviews.

    METHODS: This study was a qualitative study based on 12 interviews. Participants were patients that had undergone surgery for pancreatic cancer. The interviews were conducted 1 to 2 days after the epidural was turned off, in a surgical department in Sweden. The interviews were analysed with qualitative content analysis. The Standard for Reporting Qualitative Research checklist was used for reporting the qualitative research study.

    FINDINGS: The analysis of the transcribed interviews, generated one theme: Maintaining a sense of control in the perioperative phase, and two subthemes: (i) Sense of vulnerability and safety, and (ii) Sense of comfort and discomfort, were found.

    CONCLUSIONS: The participants experienced comfort after pancreas surgery if they maintained a sense of control in the perioperative phase and when the epidural pain treatment provided pain relief without any side effects. The transition from epidural pain treatment to oral pain treatment with opioid tablets was experienced individually, from an almost unnoticed transition to the experience of severe pain, nausea, and fatigue. The sense of vulnerability and safety among the participants were affected by nursing care relationship and the environment on the ward.

  • 3.
    Gottvall, Maria
    et al.
    Swedish Red Cross University, Department of Health Sciences. Uppsala University, Sweden.
    Brunell, Calle
    Swedish Red Cross University, Department of Health Sciences.
    Eldebo, Anna
    Swedish Red Cross University, Department of Health Sciences.
    Johansson Metso, Frida
    Swedish Red Cross University, Department of Health Sciences.
    Jirwe, Maria
    Swedish Red Cross University, Department of Health Sciences. Karolinska Institutet, Sweden.
    Carlsson, Tommy
    Swedish Red Cross University, Department of Health Sciences. Uppsala University, Sweden.
    Post‐migration psychosocial experiences and challenges amongst LGBTQ + forced migrants: A meta‐synthesis of qualitative reports2023In: Journal of Advanced Nursing, ISSN 0309-2402, E-ISSN 1365-2648, Vol. 79, no 1, p. 358-371Article in journal (Refereed)
    Abstract [en]

    Aims: Synthesize qualitative research to illuminate the post-migration psychosocial experiences amongst LGBTQ+ forced migrants.

    Design: Meta-synthesis of qualitative reports.

    Data sources: Systematic searches in seven databases and manual screenings were performed in July 2021 (21,049 entries screened in total). The final sample included 29 English-language reports containing empirical qualitative findings about post-migration experiences and published 10 years prior to the searches, based on migrants as the primary source.

    Review Methods: Methodological quality was appraised using the CASP and JBI checklists. Through a collaborative process involving nurse-midwife researchers and experienced clinical professionals, reports were analysed with a two-stage qualitative meta-synthesis including an inductive qualitative content analysis.

    Results: The methodological quality was high and the reports included 636 participants in total. Two themes were identified through the meta-synthesis. The first theme illustrates the psychological distress and numerous challenges and stressors forced migrants face after arrival, including challenges encountered as an LGBTQ+ forced migrant, psychological reactions and manifestations, and practical issues related to resettlement and living conditions. The second theme highlights the resilience and strength they find through various internal processes and external resources, including resilience and strengthening resources, identity formation and establishing and maintaining social relationships.

    Conclusion: After arrival in the host country, forced migrants identifying as LGBTQ+ face numerous societal and personal challenges whilst being at risk of experiencing significant psychological distress. These migrants utilize a wide range of resources that may strengthen their resilience. Peer support stands out as a highly appreciated and promising resource that needs further attention in experimental research.

    Impact: Forced migrants identifying as LGBTQ+ need access to adequate and sufficient support. The findings emphasize several strength-building resources that may inform nurses, midwives, researchers and other professionals when providing psychosocial support for these persons.

    Patient or Public Contribution: No patient or public contribution.

  • 4.
    Gottvall, Maria
    et al.
    Swedish Red Cross University, Department of Health Sciences. Uppsala University, Sweden.
    Brunell, Calle
    Swedish Red Cross University, Department of Health Sciences.
    Eldebo, Anna
    Swedish Red Cross University, Department of Health Sciences.
    Kissiti, Rogers
    Swedish Red Cross University, Department of Health Sciences.
    Mattsson, Elisabet
    Uppsala University, Sweden; Marie Cederschiöld University, Sweden.
    Jirwe, Maria
    Swedish Red Cross University, Department of Health Sciences. Karolinska Institutet, Sweden.
    Carlsson, Tommy
    Swedish Red Cross University, Department of Health Sciences. Uppsala University, Sweden.
    Nurse education about forced migrants with diverse sexual orientations, gender identities, and gender expressions: An exploratory focus group study2023In: Nurse Education Today, ISSN 0260-6917, E-ISSN 1532-2793, Vol. 128, p. 105880-, article id 105880Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: In many countries, forced migrants can seek asylum based on persecution and danger related to self-identifying as having diverse sexual orientations, gender identities, and gender expressions; herein defined as lesbian, gay, bisexual, transgender, queer, or other non-heterosexual orientations, non-cisgender identities, gender expressions and/or reproductive development considered beyond cultural, societal or physiological norms. Nurse education has a significant role in promoting cultural competence among future health professionals.

    OBJECTIVES: To explore the experiences and views regarding education about forced migrants with diverse sexual orientations, gender identities, and gender expressions, among students and lecturers in nurse education.

    DESIGN: Explorative qualitative study with focus group discussions.

    SETTINGS: Swedish nursing programs.

    PARTICIPANTS: Final-year nursing students and lecturers (n = 25 participants) at nursing programs were recruited with convenience and snowball sampling.

    METHODS: Semi-structured digital focus group discussions (n = 9) were audio recorded and transcribed verbatim. Data were analyzed with inductive qualitative content analysis.

    RESULTS: Promoting a broader understanding regarding societal structures and preparing students to provide culturally sensitive care were considered as essential components in nurse education. Challenges and problems involved a need for increased awareness, the associated topics and target populations seldom being addressed, and a need for improvements within clinical placements. Participants suggested the utilization of external resources, presented a range of different specific learning activities that would promote in-depth understanding, and articulated a need for overarching decisions and guidelines regarding mandatory inclusion in nurse education.

    CONCLUSIONS: Students and lecturers describe several challenges and problems that need to be addressed in regard to forced migration, sexual health, and inclusion health. There seems to be a need for utilization of external competence in learning activities as well as establishing clearer guidelines, which may increase the quality of education and better prepare future nurses to support patients with diverse backgrounds and identities.

  • 5.
    Gottvall, Maria
    et al.
    Swedish Red Cross University, Department of Health Sciences. Uppsala University, Sweden.
    Kissiti, Rogers
    Swedish Red Cross University, Department of Health Sciences.
    Ainembabazi, Ronah
    Swedish Red Cross University, Department of Health Sciences.
    Bergman, Hannah
    Swedish Red Cross University, Department of Health Sciences.
    Eldebo, Anna
    Swedish Red Cross University, Department of Health Sciences.
    Isaac, Rummage
    Swedish Red Cross University, Department of Health Sciences.
    Yasin, Sumera
    Swedish Red Cross University, Department of Health Sciences.
    Jirwe, Maria
    Swedish Red Cross University, Department of Health Sciences. Karolinska Institute, Sweden.
    Carlsson, Tommy
    Swedish Red Cross University, Department of Health Sciences. Uppsala University, Sweden.
    Mental health and societal challenges among forced migrants of diverse sexual orientations, gender identities and gender expressions: health professionals’ descriptions and interpretations2024In: Culture, Health and Sexuality, ISSN 1369-1058, E-ISSN 1464-5351Article in journal (Refereed)
    Abstract [sv]

    The aim of this study was to explore health professionals’ descriptions and interpretations of post-migration mental health and societal challenges among forced migrants with diverse sexual orientations, gender identities and gender expressions. Participants representing seven professions were recruited by a combination of convenience, purposive and snowball sampling. Data were collected through focus groups and individual interviews, analysed with systematic text condensation in a collaborative process involving researchers, clinicians and migrants with lived experiences. Participants described a challenging trajectory for migrants, as migrants venture through an uncertain and demanding journey impacting their mental health. Needing to deal with legal requirements, stressful circumstances and normative expectations during the asylum process were highlighted as major challenges, along with exposure to discrimination, violence, abuse and lack of psychosocial safety. Participants described significant psychological distress among migrants, including loneliness and shame. Challenges were also recognised related to exploring, accepting and expressing sexuality and gender. Loneliness and shame are major challenges in need of further attention in research, which could be addressed through the development and evaluation of actions, programmes and interventions to provide peer support.

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  • 6.
    Gour, Priyanka
    et al.
    R D Gardi Medical College.
    Choudhary, Anita
    R D Gardi Medical College.
    Sahoo, Krushna Chandra
    ICMR-Regional Medical Research Centre.
    Jirwe, Maria
    The Swedish Red Cross University College, Department of Health Sciences. Karolinska Institutet.
    Hallgren, Mats
    Karolinska Institutet.
    Diwan, Vinod Kumar
    Karolinska Institutet.
    Mahadik, Vijay K
    R D Gardi Medical College.
    Diwan, Vishal
    ICMR-National Institute for Research.
    Experience of Elderly People Regarding the Effect of Yoga/Light Exercise on Sedentary Behavior: A Longitudinal Qualitative Study in Madhya Pradesh, India2020In: Geriatrics, ISSN 2308-3417, Vol. 5, no 4, article id E103Article in journal (Refereed)
    Abstract [en]

    This study is set on the background of a randomized control trial (RCT) in which intervention was carried to observe the effects of yoga/light exercise on the improvement in health and well-being among the elderly population. A longitudinal qualitative study was conducted as part of RCT interventions to explore the experience of the elderly practicing yoga/light exercise in relation to sedentary behavior in the Ujjain district of Madhya Pradesh, India. Participants of the RCT were selected for this study. Eighteen focus group discussions were conducted-six during each phase of RCT interventions (before, during, and after). The findings regarding motivating and demotivating factors in various phases of intervention were presented in three categories: experience and perception of the effects of yoga/light exercise on sedentary behavior (1) before, (2) during, and (3) after intervention. This study explores the positive effect of yoga/light exercise on sedentary behavior and subjective well-being on the elderly population. They were recognized to have undergone changes in their physical and emotional well-being by consistently practicing yoga/light exercise. The main driving factors were periodic health check-ups and the encouragement of qualified trainers without any cost. This study concludes with the notion that these interventions should be encouraged in the community to use physical exercise as a method to better control the physical and social effects of aging.

  • 7.
    Gunillasdotter, Victoria
    et al.
    Karolinska Institutet, Sweden; Centre for Psychiatry Research, Stockholm Health Services, Sweden.
    Andreasson, Sven
    Karolinska Institutet, Sweden; Centre for Psychiatry Research, Stockholm Health Services, Sweden.
    Jirwe, Maria
    Swedish Red Cross University, Department of Health Sciences. Karolinska Institutet, Sweden.
    Ekblom, Örjan
    The Swedish School of Sport and Health Sciences, Sweden.
    Hallgren, Mats
    Karolinska Institutet, Sweden.
    Getting fit for change: exercise as treatment for alcohol use disorder2023In: Addiction science & clinical practice, ISSN 1940-0632, E-ISSN 1940-0640, Vol. 18, no SUPPL 1, article id P21Article in journal (Other academic)
  • 8.
    Gunillasdotter, Victoria
    et al.
    Karolinska Institutet, Sweden; Stockholm Health Services, Sweden.
    Andréasson, Sven
    Karolinska Institutet, Sweden; Stockholm Health Services, Sweden.
    Hallgren, Mats
    Karolinska Institutet, Sweden.
    Jirwe, Maria
    Swedish Red Cross University, Department of Health Sciences. Karolinska Institutet, Sweden.
    Exercise as treatment for alcohol use disorder: A qualitative study2022In: Drug and Alcohol Review, ISSN 0959-5236, E-ISSN 1465-3362, Vol. 41, no 7, p. 1642-1652Article in journal (Refereed)
    Abstract [en]

    Introduction: Exercise is a promising treatment option for individuals with alcohol use disorder, but qualitative studies are lacking. Our aim was to explore experiences of yoga and aerobic exercise among non-treatment-seeking adults with alcohol use disorder.

    Methods: Semi-structured qualitative interviews (face-to-face or telephone) with 12 participants from a randomised controlled trial. Qualitative content analysis was used to analyse data.

    Results: One main category was identified, motivating and maintaining a lifestyle change, including four generic categories: (i) Initiating factors for lifestyle change, which describes how the concept of a lifestyle change initiated participants change; (ii) Influencing lifestyle change, explains how mood-enhancing effects from exercise influence exercise behaviours; (iii) Influencing physical and mental health, which describes how improvements in physical and mental health influence self-confidence and self-esteem; and (iv) Influencing alcohol consumption, which describes how exercise reduced alcohol cravings and that success in changing exercise behaviours made participants take healthier decisions regarding their alcohol intake.

    Discussion and Conclusions: Exercise may help reduce alcohol intake, especially when presented in the context of a lifestyle change. Being able to self-select the type of exercise may increase compliance and optimise these benefits. Intentional planning and positive results from exercise may strengthen the individual's self-efficacy and increase the motivation to change behaviours associated with alcohol consumption.

  • 9.
    Gunillasdotter, Victoria
    et al.
    Department of Public Health Sciences, Karolinska Institutet; Department of Clinical Neuroscience, Karolinska Institutet.
    Andréasson, Sven
    Department of Public Health Sciences, Karolinska Institutet; Department of Clinical Neuroscience, Karolinska Institutet.
    Jirwe, Maria
    Swedish Red Cross University, Department of Health Sciences. Department of Neurobiology, Care Sciences and Society, Karolinska Institutet.
    Ekblom, Örjan
    Swedish School of Sport and Health Science (GIH).
    Hallgren, Mats
    Department of Public Health Sciences, Karolinska Institutet.
    Effects of exercise in non-treatment seeking adults with alcohol use disorder: A three-armed randomized controlled trial (FitForChange)2022In: Drug And Alcohol Dependence, ISSN 0376-8716, E-ISSN 1879-0046, Vol. 232, article id 109266Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Most individuals with alcohol use disorder (AUD) do not seek treatment. Stigma and the desire to self-manage the problem are likely explanations. Exercise is an emerging treatment option but studies in non-treatment seeking individuals are lacking. We compared the effects of aerobic exercise, yoga, and treatment as usual (phone-based support) on alcohol consumption in non-treatment seeking adults with AUD.

    METHODS: Three-group parallel, single blind, randomized controlled trial. 140 physically inactive adults aged 18-75 diagnosed with AUD were included in this community-based trial. Participants were randomized to either aerobic exercise (n = 49), yoga (n = 46) or treatment as usual (n = 45) for 12-weeks. The primary study outcome was weekly alcohol consumption at week 13 (Timeline Follow-back).

    RESULTS: A significant decrease in weekly alcohol consumption was seen in all three groups: aerobic exercise (mean ∆ = - 5.0, 95% C = - 10.3, - 3.5), yoga group (mean ∆ = - 6.9, 95% CI = - 10.3, - 3.5) and TAU (mean ∆ = - 6.6, 95% CI = - 8.8, - 4.4). The between group changes were not statistically significant at follow-up. Per-protocol analyzes showed that the mean number of drinks per week reduced more in both TAU (mean ∆ = - 7.1, 95% CI = - 10.6, - 3.7) and yoga (mean ∆ = - 8.7, 95% CI = - 13.2, - 4.1) compared to aerobic exercise (mean ∆ = - 1.7, 95% CI = - 4.4, 1. 0), [F(2, 55) = 4.9, p = 0.011].

    CONCLUSIONS: Participation in a 12-week stand-alone exercise program was associated with clinically meaningful reductions in alcohol consumption comparable to usual care (phone counseling) by an alcohol treatment specialist.

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  • 10.
    Heldring, Sara
    et al.
    Sophiahemmet University, Sweden; Falck Ambulance Sweden, Sweden.
    Jirwe, Maria
    Swedish Red Cross University, Department of Health Sciences.
    Wihlborg, Jonas
    Dalarna University, Sweden.
    Berg, Lukas
    Samariten Ambulance, Sweden.
    Lindström, Veronica
    Sophiahemmet University, Sweden; Samariten Ambulance, Sweden; Umeå University, Sweden.
    Using High-Fidelity Virtual Reality for Mass-Casualty Incident Training by First Responders: A Systematic Review of the Literature2024In: Prehospital and Disaster Medicine, ISSN 1049-023X, E-ISSN 1945-1938, Vol. 39, no 1, p. 94-105Article, review/survey (Refereed)
    Abstract [en]

    Introduction: First responders’ training and learning regarding how to handle a mass-casualty incident (MCI) is traditionally based on reading and/or training through computer-based scenarios, or sometimes through live simulations with actors. First responders should practice in realistic environments to narrow the theory-practice gap, and the possibility of repeating the training is important for learning. High-fidelity virtual reality (VR) is a promising tool to use for realistic and repeatable simulation training, but it needs to be further evaluated. The aim of this literature review was to provide a comprehensive description of the use of high-fidelity VR for MCI training by first responders.

    Methods: A systematic integrative literature review was used according to Whittemore and Knafl’s descriptions. Databases investigated were PubMed, CINAHL Complete, Academic Search Ultimate, Web of Science, and ERIC to find papers addressing the targeted outcome. The electronic search strategy identified 797 potential studies. Seventeen studies were deemed eligible for final inclusion.

    Results: Training with VR enables repetition in a way not possible with live simulation, and the realism is similar, yet not as stressful. Virtual reality offers a cost-effective and safe learning environment. The usability of VR depends on the level of immersion, the technology being error-free, and the ease of use.

    Conclusions: This integrative review shows that high-fidelity VR training should not rule out live simulation, but rather serve as a complement. First responders became more confident and prepared for real-life MCIs after training with high-fidelity VR, but efforts should be made to solve the technical issues found in this review to further improve the usability.

  • 11.
    Hyland, Karin
    et al.
    Karolinska Institutet, Sweden; Stockholm County Council, Sweden.
    Hammarberg, Anders
    Karolinska Institutet, Sweden; Stockholm County Council, Sweden.
    Andreasson, Sven
    Stockholm County Council, Sweden; Karolinska Institutet, Sweden.
    Jirwe, Maria
    The Swedish Red Cross University College, Department of Health Sciences.
    Treatment of alcohol dependence in Swedish primary care: perceptions among general practitioners2021In: Scandinavian Journal of Primary Health Care, ISSN 0281-3432, E-ISSN 1502-7724, Vol. 39, no 2, p. 247-256Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: To describe general practitioners' (GPs) attitudes to the management of patients with alcohol dependence in primary care and current treatment routines and their view on a new treatment approach; internet-based Cognitive Behavioral Therapy (iCBT).

    DESIGN: A qualitative interview study with ten GPs participating in a randomized controlled trial. The interviews were analyzed using qualitative content analysis.

    SETTING: The participating GPs were recruited via purposeful sampling from primary care clinics in Stockholm.

    SUBJECTS: The GPs were participants in an RCT investigating if iCBT when added to treatment as usual (TAU) was more effective than TAU only when treating alcohol dependence in primary care.

    RESULTS: The GPs found alcohol important to discuss in many consultations and perceived most patients open to discuss their alcohol habits. Lack of training and treatment options were expressed as limiting factors when working with alcohol dependence. According to the respondents, routines for treating alcohol dependence were rare.

    CONCLUSION: GPs believed that iCBT might facilitate raising questions about alcohol use and thought iCBT may serve as an attractive treatment option to some patients. The iCBT program did not require GPs to acquire skills in behavioral treatment, which could make implementation more feasible.KEY POINTSAlcohol dependence is highly prevalent, has a large treatment gap and is relevant to discuss with patients in many consultations in primary care.This study is based on interviews with 10 GPs participating in a randomized controlled trial comparing internet-based Cognitive Behavioral Therapy (iCBT) for alcohol-dependent patients to treatment as usual.GPs viewed alcohol habits as important to discuss and they perceived most patients are open to discuss this.The access to iCBT seemed to increase GPs' willingness to ask questions about alcohol and was viewed as an attractive treatment for some patients.The iCBT program did not require GPs to acquire skills in behavioral treatment, which might be timesaving and make implementation more feasible.

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  • 12.
    Kokkonen Nassef, Sari
    et al.
    Karolinska Institutet, Sweden.
    Blennow Bohlin, Mats
    Karolinska institutet, Sweden; Karolinska University Hospital, Sweden.
    Jirwe, Maria
    Swedish Red Cross University, Department of Health Sciences. Karolinska Institutet, Sweden.
    Experiences of parents whose school-aged children were treated with therapeutic hypothermia as newborns: A focus group study2023In: Nursing Open, E-ISSN 2054-1058, Vol. 10, no 11, p. 7411-7421Article in journal (Refereed)
    Abstract [en]

    Aim: To describe parents' past and present experiences of their newborn infant's therapeutic hypothermia (TH) treatment after perinatal asphyxia 10-13 years after the event.

    Background: Newborn infants are treated with TH following perinatal asphyxia to improve neurodevelopmental outcomes.

    Design: A qualitative descriptive design using focus groups (FGs).

    Methods: Twenty one parents to 15 newborn infants treated with TH between 2007 and 2009 participated in five FGs. The FGs were transcribed verbatim and analysed using framework approach. The SRQR checklist was followed for study reporting.

    Results: Two main categories were identified: hardships and reliefs during TH treatment and struggles of everyday life. Both categories include three subcategories, the first: (1) concern and gratitude for the unrecognized treatment, (2) insufficiency of information and proposed participation and (3) NICU nurses instilled security and hope. The second with subcategories: (1) unprocessed experiences of the TH treatment, (2) later challenges at school and (3) existential and psychological challenges in everyday life.

    Conclusion: TH of their newborns affected the parents psychologically not only during the treatment, but lasted months and years later. Information and communication with health care professionals and school management were inefficient and inadequate. The parents' concerns could be prevented by an improved identification and understanding of the problems and the needs of the infants and their families before discharge.

    Relevance for Clinical Practice: Through more personalized and efficient preparation and communication by the nursing staff before discharge, many of the parents' worries and problems could be reduced. Check-up of parents' needs of psychosocial support before and after discharge and offering counselling should become routine. Also, nurses at Well-Baby Clinics and in school health care should receive knowledge about TH treatment and the challenges the children and the parents experience.

    Patient or Public Contribution: Participation of parents was limited to the data provided through interviews.

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  • 13.
    Murphy, Jason P.
    et al.
    Karolinska Institutet, Sweden; Sophiahemmet University, Sweden.
    Hörberg, Anna
    Dalarna University, Sweden.
    Rådestad, Monica
    Karolinska Institutet, Sweden.
    Kurland, Lisa
    Karolinska Institutet, Sweden; Örebro University, Sweden.
    Rüter, Anders
    Karolinska Institutet, Sweden; Sophiahemmet University, Sweden.
    Jirwe, Maria
    Swedish Red Cross University, Department of Health Sciences.
    Registered nurses' experience as disaster preparedness coordinators during a major incident: A qualitative study2022In: Nursing Open, E-ISSN 2054-1058, Vol. 9, no 1, p. 329-338Article in journal (Refereed)
    Abstract [en]

    AIMS: To explore registered nurses' experiences as disaster preparedness coordinators of hospital incident command groups' during a major incident.

    DESIGN: A qualitative descriptive design using semi-structured interview.

    METHODS: This was a qualitative study based on one focus group discussion and six individual follow-up interviews. Participants were registered nurses in their capacity as disaster preparedness coordinators with experience from Major Incident simulations and a real-life Major Incident. The interviews were transcribed verbatim and analysed using content analysis. The COREQ checklist was used for reporting the findings.

    RESULTS: The analysis of data generated the main category: Expectations, previous experience and uncertainty affect hospital incident command group response during a Major Incident and three categories, (I) Gaining situational awareness (containing two subcategories), (II) Transitioning to management (containing three subcategories) and (III) Actions taken during uncertainty (containing two subcategories).

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  • 14.
    Olt, Helen
    et al.
    Department of Neurobiology Care Sciences and Society, Division of Nursing, Karolinska Institutet.
    Jirwe, Maria
    Department of Neurobiology Care Sciences and Society, Division of Nursing, Karolinska Institutet.
    Saboonchi, Fredrik
    The Swedish Red Cross University College.
    Gerrish, Kate
    Department Nursing Research, School of Nursing and Midwifery, University of Sheffield.
    Emami, Azita
    University of Washington, School of Nursing and Biobehavioral Nursing and Health Systems, School of Nursing, Seattle; Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet.
    Communication and equality in elderly care settings: Perceptions of first- and secondgeneration immigrant and native Swedish healthcare workers2014In: Diversity and equality in health and care, ISSN 2049-5471, E-ISSN 2049-548X, Vol. 11, no 2, p. 99-111Article in journal (Refereed)
    Abstract [en]

    An ethnically diverse healthcare workforce is considered beneficial to meeting the needs of an ethnically diverse population. In the UK and the USA, lack of equality and difficulties in communication between co-workers and patients from different ethnic backgrounds is problematic. Little is known about the ethnically diverse healthcare workforce in elderly care settings in Sweden. This paper compares native Swedish and first- and secondgeneration immigrant healthcare workers' perceptions of diversity in relation to equality and communication in elderly care settings. The study used a cross-sectional design with a survey administered by self-completed questionnaire. The Assess Awareness and Acceptance of Diversity in Healthcare Organizations questionnaire was distributed to healthcare workers in elderly care settings in one municipality in Sweden. Responses from 643 healthcare workers were analysed. A factor analysis was performed on 26 items in the questionnaire. Reliability analysis on the subscales was conducted using Cronbach's alpha. Differences between native and first- and second-generation immigrants were analysed using ANOVA followed by post-hoc tests. The results showed that first-generation immigrant and native Swedish healthcare workers had different views on equality and communication in four of the five subscales, namely care of elderly patients from different backgrounds, equality in the workplace, communication with diverse co-workers, and treatment by family and significant others from a different ethnic background. Second-generation immigrants held similar views to native Swedish healthcare workers on two factors, namely equality in the workplace and communication between co-workers from different backgrounds. There were no differences between the groups with regard to their views on self-awareness in collaboration with co-workers. Differences in the experiences of first- and secondgeneration healthcare workers should be acknowledged, rather than assuming that they share similar experiences as immigrants. Managers need to promote equality and effective communication among an ethnically diverse workforce.

  • 15.
    Pettersson, Sara
    et al.
    Linköping University, Sweden.
    Holstein, Jane
    Linköping University, Sweden.
    Jirwe, Maria
    Swedish Red Cross University, Department of Health Sciences.
    Jaarsma, Tiny
    Linköping University, Sweden.
    Klompstra, Leonie
    Linköping University, Sweden.
    Cultural competence in healthcare professionals, specialised in diabetes, working in primary healthcare — A descriptive study2022In: Health & Social Care in the Community, ISSN 0966-0410, E-ISSN 1365-2524, Vol. 30, no 3, p. e717-e726Article in journal (Refereed)
    Abstract [en]

    Self-care is the most important cornerstone of diabetes treatment. As self-care is affected by cultural beliefs, it is important for healthcare professionals to be able to adapt their educational approach and to be culturally competent. The aim of this study was to describe the cultural competence in Swedish healthcare professionals, specialised in diabetes care and to examine related factors for cultural competence. The healthcare professionals' perceived level of cultural competence was measured across three domains-Openness and awareness, Workplace support and Interaction skills-in 279 Swedish healthcare professionals from all 21 regions of Sweden, using the Cultural Competence Assessment Instrument (Swedish version-CCAI-S). Descriptive statistics were used to describe cultural competence in healthcare professionals, and linear regression was conducted to examine factors related to cultural competence. Of the healthcare professionals studied, 58% perceived that they had a high level of Openness and awareness, 35% perceived that they had a high level of Interaction skills and 6% perceived that they had a high level of Workplace support. Two factors were found to be related to cultural competence, namely, high percentage of migrant clients at the healthcare clinic and whether the healthcare professionals previously had developed cultural competence through practical experience, education and/or by themselves. In conclusion, most healthcare professionals perceived that they had cultural openness and awareness but need more support from their workplace to improve their interaction skills. Cultural competence-related education could support the healthcare professionals to develop interaction skills.

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  • 16.
    Pettersson, Sara
    et al.
    Linköping University, Sweden.
    Klompstra, Leonie
    Linköping University, Sweden.
    Jirwe, Maria
    Swedish Red Cross University, Department of Health Sciences.
    Jaarsma, Tiny
    Linköping University, Sweden.
    Developing a Culturally Appropriate Tool to Support Self-Care in Migrants with Type 2 Diabetes: A Co-Design Study2023In: Patient Preference and Adherence, E-ISSN 1177-889X, Vol. 17, p. 2557-2567Article in journal (Refereed)
    Abstract [en]

    INTRODUCTION: Migrants, especially from the Middle East, experience poorer health outcomes and face greater difficulties in accessing healthcare compared to native populations and there is a need for culturally appropriate education for this vulnerable group. The purpose of this study is to describe the process of developing a culturally appropriate tool to support self-care in migrants with type 2 diabetes.

    METHODS: In this Co-design study, a tool for supporting self-care in migrants with type 2 diabetes was developed. Migrant patients with type 2 diabetes, healthcare providers and researchers participated in the process, which was based on six elements; engage, plan, explore, develop, decide and change. From February 2021 to December 2022, idea groups were conducted, and a tool was developed through brainstorming, prioritizing and prototyping.

    RESULTS: In total, 14 migrant patients, ten health care providers and four researchers participated in the Co-design process. The patients wished to receive information about type 2 diabetes self-care behaviour in their own languages. The healthcare providers asked for clear instructions on where to guide their patients regarding reliable information about diabetes in the patient's own language. All participants agreed that information can be presented in different formats, either: text (paper or online), audio-visual via recorded videos and/or lectures and pictures.

    DISCUSSION: The Co-design process led to several important insights and experiences related to the importance of diverse cultural backgrounds. When conducting a Co-design study with end-users as stakeholders, it is significant that the stakeholders have a diverse background in experiences, both as patients as well as those who deliver or implement the health service. In this study it was of great importance to include patients with diverse backgrounds regarding; gender, age, health literacy, occupation, years living in Sweden and duration of diabetes.

  • 17.
    Schell, Carl Otto
    et al.
    Karolinska Institutet, Sweden; Uppsala University, Sweden; Nyköping Hospital, Sweden .
    Khalid, Karima
    Muhimbili University of Health and Allied Sciences, United Republic of Tanzania; Ifakara Health Institute, United Republic of Tanzania.
    Wharton-Smith, Alexandra
    London School of Hygiene & Tropical Medicine, UK.
    Oliwa, Jacquie
    KEMRI-Wellcome Trust Research Programme Nairobi, Kenya; University of Nairobi, Kenya.
    Sawe, Hendry R
    Muhimbili University of Health and Allied Sciences, United Republic of Tanzania.
    Roy, Nobhojit
    Karolinska Institutet, Sweden; The George Institute for Global Health India, India; WHO Collaborating Centre for Research in Surgical Care Delivery in LMICs, BARC Hospital, India.
    Sanga, Alex
    Ministry of Health, Community Development, Gender, Elderly and Children, United Republic of Tanzania.
    Marshall, John C
    University of Toronto, Canada.
    Rylance, Jamie
    Malawi-Liverpool-Wellcome Trust Clinical Research Programme, Malawi.
    Hanson, Claudia
    Karolinska Institutet, Sweden; London School of Hygiene & Tropical Medicine, UK.
    Kayambankadzanja, Raphael K
    Queen Elizabeth Central Hospital, Malawi; College of Medicine, Malawi.
    Wallis, Lee A
    University of Cape Town, South Africa.
    Jirwe, Maria
    The Swedish Red Cross University College, Department of Health Sciences.
    Baker, Tim
    Karolinska Institutet, Sweden; Ifakara Health Institute, United Republic of Tanzania; London School of Hygiene & Tropical Medicine, UK.
    Essential Emergency and Critical Care: a consensus among global clinical experts.2021In: BMJ Global Health, E-ISSN 2059-7908, Vol. 6, no 9, article id e006585Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Globally, critical illness results in millions of deaths every year. Although many of these deaths are potentially preventable, the basic, life-saving care of critically ill patients are often overlooked in health systems. Essential Emergency and Critical Care (EECC) has been devised as the care that should be provided to all critically ill patients in all hospitals in the world. EECC includes the effective care of low cost and low complexity for the identification and treatment of critically ill patients across all medical specialties. This study aimed to specify the content of EECC and additionally, given the surge of critical illness in the ongoing pandemic, the essential diagnosis-specific care for critically ill patients with COVID-19.

    METHODS: In a Delphi process, consensus (>90% agreement) was sought from a diverse panel of global clinical experts. The panel iteratively rated proposed treatments and actions based on previous guidelines and the WHO/ICRC's Basic Emergency Care. The output from the Delphi was adapted iteratively with specialist reviewers into a coherent and feasible package of clinical processes plus a list of hospital readiness requirements.

    RESULTS: The 269 experts in the Delphi panel had clinical experience in different acute medical specialties from 59 countries and from all resource settings. The agreed EECC package contains 40 clinical processes and 67 requirements, plus additions specific for COVID-19.

    CONCLUSION: The study has specified the content of care that should be provided to all critically ill patients. Implementing EECC could be an effective strategy for policy makers to reduce preventable deaths worldwide.

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  • 18.
    Wallhed Finn, Sara
    et al.
    Karolinska institutet, Sweden.
    Hammarberg, Anders
    Karolinska institutet, Sweden.
    Andreasson, Sven
    Karolinska institutet, Sweden.
    Jirwe, Maria
    The Swedish Red Cross University College, Department of Health Sciences.
    Treating alcohol use disorders in primary care - a qualitative evaluation of a new innovation: the 15-method2021In: Scandinavian Journal of Primary Health Care, ISSN 0281-3432, E-ISSN 1502-7724, Vol. 39, no 1, p. 51-59Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: This study aims to explore how the characteristics of an innovation, the 15-method, a stepped care model for treatment of alcohol use disorders in primary care was perceived.

    METHODS/DESIGN/SETTING/SUBJECT: General practitioners and heads of primary care units (n = 10) that delivered the 15-method in a randomized controlled trial participated in individual interviews at two occasions in Stockholm, Sweden. Data were analyzed with theoretical thematic analysis, using Diffusion of Innovation Theory.

    RESULTS: The participants described that offering the 15-method met a need among their patients. Participants were positive towards the training and the manual for the method. They mentioned a previous lack of routines to work with alcohol use disorders. The 15-method was described as easy to use. It would however be more feasible to implement in a team of different professions, rather than among general practitioners only. Priorities made by regional health care managers were described as important for the implementation, as well as financial incentives. A barrier to implementation was that alcohol screening was perceived as difficult. While the 15-method was perceived as effective in reducing the patients' alcohol use and cost effective, participants expressed uncertainty about the long-term effects.

    CONCLUSIONS: The 15-method provides structure for treatment of alcohol use disorders and is described by general practitioners and heads as a promising approach. Being able to offer treatment for alcohol dependence may increase the uptake of alcohol interventions in primary care.

    KEY POINTS Little attention has been given to develop treatment models for alcohol use disorders that are adapted to primary care settings. This study describes how an innovation, the 15-method, a stepped care model for treatment of alcohol use disorders in primary care was perceived. The 15-method provides structure for treatment of alcohol use disorders in primary care and is described by general practitioners and heads as a promising approach. Being able to offer treatment for alcohol dependence may increase the uptake of alcohol interventions in primary care.

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  • 19.
    Östh, J
    et al.
    Karolinska Institutet, Sweden.
    Danielsson, A K
    Karolinska Institutet, Sweden.
    Lundin, A
    Karolinska Institutet, Sweden.
    Wennberg, P
    Karolinska Institutet, Sweden; Stockholm University, Sweden; Inland Norway University of Applied Sciences, Norway.
    Andréasson, S
    Karolinska Institutet, Sweden.
    Jirwe, Maria
    Swedish Red Cross University, Department of Health Sciences. Karolinska Institutet, Sweden.
    Keeping Track of My Drinking: Patient Perceptions of Using Smartphone Applications as a Treatment Complement for Alcohol Dependence2024In: Substance Use & Misuse, ISSN 1082-6084, E-ISSN 1532-2491, Vol. 59, no 2, p. 291-299Article in journal (Refereed)
    Abstract [en]

    Background: Alcohol dependence is common, yet highly undertreated. Smartphone applications (apps) have potential to enhance treatment accessibility and effectiveness, however evidence is limited, especially studies focussing on user experiences. The aim was to describe patient perceptions on the usability and acceptability of self-monitoring apps provided as treatment complement for alcohol dependence.

    Methods: Individual semi-structured interviews were conducted through video or phone calls with 21 participants, recruited from a randomized controlled trial at a dependency clinic in Stockholm. The participants had used two specific apps for self-monitoring consumption ("Glasklart" and "iBAC") during 12 wk prior to the interviews. Data was analyzed using Qualitative Content Analysis.

    Results: Two domains were identified: 1) Smartphone applications as facilitators to treatment, and 2) Barriers to smartphone application use. Using apps within the treatment context was believed to increase the accuracy of the reported consumption. Participants became more aware of their alcohol problem and described the apps as reinforcers that could increase both the motivation to change and the focus on the problem and commitment to treatment. The apps were further described as helpful to control alcohol consumption. However, app usage was constrained by technical problems, unfit app-specific features and procedures, and alcohol-related shame and stigma.

    Discussion and Conclusions: Self-monitoring alcohol apps have several beneficial features that can help assess, track, and control alcohol consumption, and improve communication with clinicians. The results indicate they can be useful complements to treatment for patients with alcohol dependence, but their use can be limited by different, foremost technical, issues. Smartphone applications for self-monitoring of alcohol consumption may help provide accurate data, increase consumption awareness, focus, motivation, and perceived control; Smartphone applications for self-monitoring of alcohol consumption are considered helpful complements to alcohol treatment; The use of smartphone applications for self-monitoring of alcohol consumption can be constrained by technical problems, and unfit app-specific features and procedures.

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