BackgroundBecause health professionals can end up being first responders to a mass casualty incident, they must train to improve preparedness and increase the preconditions of victim outcomes. Training and learning on how to handle a mass casualty incident is traditionally based on reading, lectures, training through computer-based scenarios, or sometimes through live simulations. Professionals should practice in realistic environments to narrow the theory-practice gap, and the possibility of repeating the training is important for learning. Virtual reality is a promising tool for realistic and repeatable simulation training, but it needs further evaluation. This study aimed to describe the acceptability and applicability of using VR for training in mass casualty incidents.MethodsA mixed-methods evaluation design was used, where the qualitative and quantitative findings were embedded into the discussion with a realist inquiry approach. A virtual reality simulation with mass casualty incident scenarios, named GoSaveThem (www.crash.nu), was used, and the participants were directed to perform triage. After the simulation, the participants filled in a questionnaire with open-ended questions and ratings on technical aspects, learning experiences, and improvement of preparedness. Eleven of the participants underwent interviews. The qualitative data was analyzed either summarily or with a conventional content analysis. Data were extracted from computer recordings of how long it took for each participant to triage the first 10 victims and to what extent the triage for the first 10 victims was correct. Descriptive statistical analyses were done, and a comparison was made to see if there were any differences between age, sex, educational background, and previous experiences that affected the outcome of triaging.ResultsTraining with virtual reality enables repeatable and realistic simulation training of mass casualty incidents. The participants expressed motivation to repeat the training and experience expanded virtual reality scenarios. This study shows that the acceptability and applicability of using VR for training MCIs were high overall in all examined dimensions for most users, with some exceptions.

The health of underserved populations, including sexual and gender minority forced migrants, is a pressing global concern. Public contribution in research has the potential to enhance prioritisation and aid in intervention development, but has been criticised due to a lack of sufficient diversity and engagement with underserved populations.

The core research team conducted eight workshops together with eight experts by lived experience to prioritise and guide future peer support intervention research. Activities included brainstorming, pathway mappings, ranking procedures, storytelling exercises, photovoice sessions and individual open-ended writing sessions. Open-ended reflective meetings and manifest content analysis of material, as well as documentation, guided the progress towards final results.

Peer support was identified as an intervention with the potential to reduce mental health burdens, enhance the capacity to integrate into society and provide access to basic needs. Peer support interventions aiming to reduce health inequities by promoting language proficiency and employment attainment were identified as prioritised areas. A range of considerations and barriers regarding the modality of interventions, the training of peer supporters and recruitment strategies needs further examination in research.

Our findings illustrate the importance of public contribution when planning research addressing support for underserved and marginalised populations. Public contribution efforts targeting underserved populations such as ours will help researchers gain an in-depth understanding of prioritised research questions and pragmatic study procedures. In regard to research for sexual and gender minority forced migrants, we recommend prioritisation of intervention development that promotes mental health and reduces loneliness through support from peers in group settings and from peer mentors, informational support and capacity-building.Patient or Public ContributionRepresentatives acting as experts by lived experience contributed as research partners throughout the procedures and workshops.

Aim: This study explores HICGs’ experience of disaster response during a terrorist-induced major incident major incident.

Design: A qualitative descriptive design with individual semi-structured interviews was used.

Methods: This was a qualitative study based on seven individual interviews. Participants were members of hospital incident command groups during a terror attack. The interviews were transcribed verbatim and analyzed using deductive content analysis. The SRQR checklist was used to report the findings.

Results: The data created from the interviews identified barriers and facilitators for hospital response as well as aligned with previously established categories: Expectations, prior 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) Experiences of hospital incident command group response (containing two subcategories). In addition, the results suggest that an exaggerated response may have led to unanticipated adverse events.

Clinical trial number: Not applicable.

Aim: To explore the correlation between motor performance, health-related quality of life (HRQOL) and self-esteem in early adolescents treated with therapeutic hypothermia (TH) following neonatal hypoxic-ischaemic encephalopathy (HIE).

Method: This cross-sectional study included 45 children (mean age 11 years) with a neonatal TH-treated HIE between 2007 and 2009 in Stockholm. Motor performance was assessed with Movement Assessment Battery for Children-2 (MABC-2), HRQOL by Paediatric Quality of Life Inventory (PedsQL 4.0) and self-esteem with 'I Think I Am -2'. Nonparametric statistical methods were applied.

Results: Significant positive correlations were found between MABC-2 scores and all PedsQL 4.0 dimensions in parents' reports (p < 0.001-0.029). Parents reported lower PedsQL 4.0 Total scores for children below the 15th percentile on MABC-2 (p = 0.004), while the self-reports of the same children were not significant (p = 0.098). Motor performance did not affect children's self-esteem; no difference was found between the group above or the group below the 15th percentile (p = 0.881).

Conclusion: Differences between parent and child-reported outcomes suggest the need for continued follow-up of children treated with TH into adolescence, including HRQOL and self-esteem. Long-term assessment is necessary to identify challenges not captured in early childhood or by self-reports alone.

PURPOSE: Nurses are expected to provide appropriate care for children from diverse cultural backgrounds to achieve the aims of current legislation on good care and to ensure equal terms for the entire population. This study aim was to describe nurses' experiences of cross-cultural care encounters when interacting with children and families with a Culturally and Linguistically Diverse background in Swedish pediatric hospital care.

DESIGN AND METHODS: A descriptive qualitative study was conducted. Individual semi-structured online interviews were performed with 21 nurses in pediatric care from six university hospitals.

RESULTS: Two themes were identified, (I) the importance of culturally competent care, with two sub-themes, (i) the significance of open-mindedness and cultural understanding, (ii) the significance of organizational support, and (II) the importance of effective communication, with three sub-themes, (i) the influence of language barriers, (ii) the importance of using communication tools and strategies and (iii) the influence of socio-cultural differences.

CONCLUSIONS: The findings provide further insight into the facilitators and barriers of cross-cultural care encounters in pediatric hospital care. Interactions with families from culturally and linguistically diverse backgrounds offer opportunities to enhance understanding of cultural differences and promote cultural awareness. Facilitating cross-cultural care encounters in pediatric hospital care requires cultural competence, mutual respect, and sufficient organizational support.

IMPLICATIONS FOR PRACTICE: The findings have implications for nursing practice, particularly in improving nurses' understanding of the diverse opportunities and challenges related to cultural and linguistic diversity in pediatric care, and in improving family-centered care.

Aim: To identify, define and achieve consensus on perioperative patient safety indicators within a Swedish context.DesignA modified Delphi method.

Methods: A purposeful sample of 22 experts, all experienced operating room nurse specialists, was recruited for this study. A questionnaire was constructed incorporating statements derived from a preceding study. The experts were asked to rate the importance of each statement concerning patient safety during the perioperative phase. The data collection occurred through an online survey platform between November 2022 and April 2023. The CREDES checklist guided the reporting of this study.

Results: The three-round Delphi study resulted in consensus on 73 statements out of 103, encompassing 74% process indicators and 26% structure indicators. Key areas of consensus included the use of the Surgical Safety Checklist and optimizing the operating room environment.

Conclusion: Consensus was reached on perioperative safety indicators, underscoring the intricate challenges involved in ensuring patient safety in the operating room. It emphasizes the important integration of both structure and process indicators for comprehensive safety assessment during surgical procedures. Recognizing the difficulty in measuring factors like teamwork and communication, essential for patient safety, the study offers practical guidance. It underlines a balanced approach and specific consensus areas applicable in clinical practice to enhance perioperative patient safety.

Implications for the profession and patient care: This study provides concrete practice guidance and establishes a structured framework for evaluating perioperative care processes. It emphasizes the critical role of professionals having the necessary skills and being present during surgical procedures. Additionally, the study underscores the paramount importance of effective communication and teamwork within the operating room team, substantively contributing to overall patient safety enhancement.

Impact: The study focused on addressing the challenge of ensuring patient safety in operating rooms, acknowledging the persistent complications related to surgery despite global efforts to eliminate avoidable harm in healthcare. Consensus was reached on 73 crucial indicators for perioperative patient safety, emphasizing a balanced approach integrating both process and structure indicators for a comprehensive assessment of safety during surgical procedures. The study has a broad impact on professionals and healthcare systems, providing concrete guidance for practice and offering a structured process for evaluating perioperative care.

Reporting Method: The study is reported informed by 'Guidance on Conducting and REporting DElphi Studies (CREDES) in palliative care: Recommendations derived from a methodological systematic review'.

Patient or Public Contribution: No patient or public contribution.

Introduction In Sweden, alcohol consumption has increased among people aged 65 years and older. Among older adults, 2.7% of men and 1.6% of women fulfill criteria for alcohol dependence. The large majority do not seek treatment. Little is known about treatment seeking among older adults with alcohol dependence.

Aim The aim of this study was to describe elderly's views on alcohol dependence, treatment seeking, and treatment preferences. Possible gender differences will also be explored.

Methods Between December 2017 and March 2018, two focus group interviews and 10 individual interviews were conducted, using semistructured interviews. In total, 13 elderly participated. Data were analyzed using the framework approach.

Results Two themes and five subthemes were identified: (a) "regret and feelings of shame when losing control" consisting of two subthemes, namely, (1) loss of control over your alcohol consumption and (2) regret and feelings of shame, and (b) "taking back control over your life" consisting of three subthemes, namely, (1) becoming aware that you have problematic alcohol use, (2) to seek help for alcohol dependence, and (3) views on treatment options and treatment settings.

Conclusions Increased alcohol use was attributed to a decrease in responsibility and belonging. Alcohol dependence was associated with shame and stigma, which was especially strong for women. Preferred treatments were tailored for the individual, rather than to general factors such as age or gender. Moreover, important components of treatment were to be met with respect, continuity, and controlled drinking as a treatment goal. Future research should focus on interventions to reduce stigma and the development of patient-centered treatments.

BackgroundHow ambulance clinicians (ACs) handle a mass casualty incident (MCI) is essential for the suffered, but the training and learning for the ACs are sparse and they don't have the possibility to learn without realistic simulation training. In addition, it is unclear what type of dilemmas ACs process in their clinical reasoning during an MCI. With virtual reality (VR) simulation, the ACs clinical reasoning can be explored in a systematic way. Therefore, the objective was to explore ambulance clinicians' clinical reasoning when simulating a mass casualty incident using virtual reality.MethodsThis study was conducted as an explorative interview study design using chart- stimulated recall technique for data collection. A qualitative content analysis was done, using the clinical reasoning cycle as a deductive matrix. A high-fidelity VR simulation with MCI scenarios was used and participants eligible for inclusion were 11 senior ACs.Results/conclusionAll phases of the clinical reasoning cycle were found to be reflected upon by the participants during the interviews, however with a varying richness of analytic reflectivity. Non-analytic reasoning predominated when work tasks followed specific clinical guidelines, but analytical reasoning appeared when the guidelines were unclear or non-existent. Using VR simulation led to training and reflection on action in a safe and systematic way and increased self-awareness amongst the ACs regarding their preparedness for MCIs. This study increases knowledge both regarding ACs clinical reasoning in MCIs, and insights regarding the use of VR for simulation training.

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.

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.