BACKGROUND: Planned home birth is an option for healthy women with low-risk pregnancies and is attended by midwives in the home setting. While well established in several countries, planned home birth remains uncommon in Sweden. Available evidence suggests that, for selected women, home birth can be as safe as hospital birth and may be associated with greater autonomy, control, and more positive birth experiences. However, women's experiences of planned home birth in Sweden remain underexplored.

OBJECTIVES: To explore women's experiences of planned home birth attended by midwives in Sweden.

DESIGN: Qualitative study using a netnographic design.

METHODS: Twelve publicly available online narratives were collected from blogs, discussion forums, and Instagram posts in which women described their experiences of planned home birth supported by a midwife. Data were analysed using Kozinets' netnographic analysis framework.

RESULTS: Two themes and four categories were identified: Experiencing safety in the home environment and The importance of a supportive team. Women described the home as a calm and secure environment that promoted confidence, autonomy, and trust in the birth process. Freedom to manage labour according to individual needs and support from a known midwife, partners, and family members contributed to positive birth experiences.

CONCLUSION: Planned home birth was experienced as safe, positive, and empowering. Choice, informed decision-making, and individualised care emerged as key factors influencing positive birth experiences. Providing alternatives to hospital birth may support women's autonomy within an equitable and person-centred maternity care system.

The global population is ageing, and chronic kidney disease is becoming more common. As a result, increasing numbers of older adults with multimorbidity and frailty are progressing to kidney failure. This requires all healthcare professionals involved in the care of people with kidney failure to be able to provide careful guidance with regards to available treatment options. Choosing a treatment pathway for frail patients may be challenging, particularly for those considered ineligible for kidney transplantation. For such individuals, the remaining options are dialysis and conservative kidney management (CKM). However, these treatments have not been compared in randomized trials, which often makes it difficult to determine which treatment best aligns with the needs and preferences of people living with kidney failure. In this narrative review, we discuss CKM as a valuable treatment approach for old and frail people with kidney failure, and those considered ineligible for kidney transplantation. We compare clinical outcomes between CKM and dialysis, such as health-related quality of life and survival. We guide the identification of people who may benefit from CKM and when discussions on CKM should be initiated. We discuss shared decision-making and consider the perspectives of patients, caregivers, and clinicians. Lastly, we embed CKM within the broader context of kidney supportive care, a palliative approach that includes advance care planning, symptom management, and lifestyle modifications that can be considered irrespective of treatment modality. Regardless of whether CKM or dialysis is chosen in the end, careful consideration of treatment options can help to ensure that people with kidney failure receive care that aligns with their values, preferences, and goals.

OBJECTS: The effective treatment of acute stroke requires a series of events, including the recognition of stroke symptoms, following known action plans, and the rapid transfer to a hospital with sufficient medical competence. This is challenging in rural areas with long distances between hospitals with emergency departments. We studied the availability and effectiveness of acute stroke treatment in the most rural parts of northern Sweden. Some of the population in the study area belong to the Sámi, Sweden's indigenous people. Our aim was to study the yearly incidence of ischemic stroke, time window from start of symptoms to arrival at first hospital, and rate of revascularization treatment in the study population and compare to the rest of Sweden.

METHODS: Statistics Sweden defined the study group which was 142,127 individuals registered as living in the study area sometimes during 2019-2021. We used data from the National Board of Health and Welfare (NBHWF) regarding incidence and from the Swedish Stroke Register (Riksstroke, RS), for time windows and treatments. The study area was compared with the Swedish national data. Transfer times between municipalities, first hospitals, and thrombectomy centers were assessed using open data.

RESULTS: The incidence of ischemic stroke in the study group was 280/100.000/year which was significantly higher than national data for the same age group. 1,153 stroke incidents were registered in RS. In the study group 21.1% arrived at the first hospital >24 h from start of symptoms compared to 4.5% in national data. Three percent were treated with thrombectomy and 11.1% with thrombolysis. The numbers were small but those with the lowest percentage of arrival < 3 h, and of reperfusion treatment, all had the longest distances to the first hospital. 26.1 and 17.9% in two municipalities had an unknown time window from start of symptoms. A majority of the population would have shorter distances to thrombectomy centers outside Sweden.

CONCLUSION: Our data shows a higher incidence of ischemic stroke in the study area in the rural northern Sweden. Persons with stroke in this area are unlikely to receive acute care in accordance with the Swedish national stroke guidelines.

OBJECTIVES: This study aimed to evaluate the feasibility and fidelity of a multiprofessional intervention for intensive care survivors at increased risk of physical and/or psychological problems.

METHODS: The study was conducted in two ICUs, with a single-arm interventional design. Adult patients (≥18 years) with an ICU length of stay of>12 hours were assessed using a combined validated screening instrument to estimate the risk of physical and/or psychological morbidity. The intervention consisted of 1) in-hospital follow-up comprising several components, a first ward visit by a case manager within 1-5 days after ICU discharge and establishment and follow-up of an individual rehabilitation plan; 2) out-of-hospital telephone follow-up for 12 weeks. Data on process feasibility (recruitment, retention, and assessment completion) and intervention fidelity (adherence and experiences of intervention delivery) were collected. Intervention acceptability was assessed through interviews with participants and family members, while the in-hospital follow-up programme was evaluated using a questionnaire completed by healthcare professionals and patient-reported outcomes three months after ICU discharge.

RESULTS: Of 155 patients screened for increased risk of long-term sequelae at ICU discharge, 57 were identified as high risk, and 41 consented to participate in the study. The intervention was feasible (retention rate 90%), and acceptable from the perspectives of the participants, family members and healthcare professionals. Fidelity of the intervention components varied, with high adherence to the initial ward visit, development of a rehabilitation plan and involvement of multiple healthcare professionals based on individual needs.

CONCLUSIONS: A multiprofessional follow-up programme for high-risk ICU patients is feasible. Feedback informed logistical adjustments while preserving core principles. The findings support a future effectiveness trial, with refinements to improve screening and assessment completion.

IMPLICATIONS FOR CLINICAL PRACTICE: Early multiprofessional follow-up after intensive care appears to be feasible and appreciated by patients at risk of physical and/or psychological problems after ICU stay.

Introduction/Objectives: Hazardous alcohol use is a modifiable risk factor for hypertension, yet it is often underrecognized in primary care, and the role of Phosphatidylethanol (PEth) testing in documenting alcohol use remains unclear. This study assessed alcohol use documentation using PEth and alcohol history in relation to blood pressure (BP) control and patient characteristics, and examined hazardous alcohol use by both methods in relation to BP control.

Methods: All patients with hypertension from a Swedish primary care centre, routinely using PEth, were included in a cross-sectional study based on electronic medical records. Patients were categorized as having controlled (&lt;140/90 mmHg), uncontrolled (≥140/90 mmHg), or apparent treatment-resistant hypertension (aTRH) (≥140/90 mmHg despite ≥3 antihypertensive drugs). Alcohol documentation and hazardous use were analyzed using PEth 16:0/18:1 values and alcohol history (free-text entries or AUDIT). Group differences were examined using chi-square and one-way ANOVA.

Results: A total of 1,826 patients were included (mean age 71 years; 51.5% women); 35% had controlled hypertension, 50% uncontrolled hypertension, and 16% aTRH. Documentation patterns differed by BP control, sex, age, and comorbidities. PEth was documented more often than alcohol history (56.0% vs. 39.9%, respectively). Women, older individuals, and patients with diabetes more frequently lacked documentation. Hazardous alcohol use was identified in 18.4% using PEth and 7.1% using alcohol history, with no differences across BP control groups. Hazardous use was higher in men by PEth, not alcohol history.

Conclusion: PEth testing can complement alcohol history in hypertension management, providing clinically relevant information, although its impact on detecting hazardous drinking or improving BP control remains uncertain.

Introduction: Nurses play a crucial role in promoting health and well-being by advocating for, developing, and implementing policies that impact population health at both global and local scales. Achieving sustainable improvements in healthcare requires nurses to possess both professional competence and knowledge of quality improvement methodologies. Quality improvement education, coupled with hands-on proposals, is invaluable for nursing students as it enables them to rhetorically describe evaluation ideas and utilize their experiences as learning tools. Therefore, the aim of this study was to explore how nursing students conceptualized perceived educational needs and how these needs were articulated in hypothetical written curriculum proposals produced within a course-based pedagogical writing assignment.

Materials and methods: A qualitative design was employed to explore the student-authored curriculum proposals developed within an educational proposal assignment. The study included six nursing student–authored curriculum proposals. A document analysis inspired by Bowen was conducted.

Results: The analysis revealed four key themes: constructing educational needs through student experience; articulating curriculum proposals using academic conventions; using evaluation-oriented language to establish credibility; making curriculum proposals institutionally legible. The student-authored curriculum proposals developed within an educational proposal assignment offered a diverse array of suggestions for enhancing the nursing education program. Proposed new courses covered topics such as leadership, disaster management, sexuality and sexual health, and knowledge regarding different skin colours.

Conclusions: Engaging in student-authored curriculum proposals developed within an educational proposal assignment during undergraduate nursing education may support the development of discursive and conceptual competencies relevant to engaging with improvement-related language in professional contexts. While patient outcomes were not examined, the findings suggest that such proposals may contribute to students’ preparedness to interpret, critique, and communicate improvement- and evaluation-oriented proposals in institutional settings in their professional roles.

Perinatal psykisk ohälsa utgör ett omfattande och växande folkhälsoproblem som kan påverka kvinnans psykiska och fysiska hälsa samt relationen mellan mor och barn. Den perinatala perioden präglas av betydande biologiska, psykologiska och sociala förändringar vilket kan medföra en ökad sårbarhet för psykisk ohälsa. Barnmorskan har en central roll i att identifiera, stödja och bemöta kvinnor med psykisk ohälsa under graviditet och postpartumperioden. Tidigare forskning har samtidigt visat att barnmorskans möjlighet att uppmärksamma och bemöta psykisk ohälsa kan påverkas av flera professionella, organisatoriska och relationella aspekter. Trots detta kvarstår kunskapsluckor rörande integrerad kunskap om det studerade problemområdet.  

Syftet var att beskriva aspekter som kan påverka barnmorskors bemötande av kvinnor med perinatal psykisk ohälsa. En litteraturöversikt med systematisk sökmetod utfördes. Datainsamlingen genomfördes i databaserna CINAHL, PubMed och PsycInfo, vilket resulterade i att 16 vetenskapliga originalartiklar med kvantitativ och kvalitativ ansats inkluderades. Det insamlade materialet sammanställdes och analyserades genom en integrerad analys. 

Resultatet visar att barnmorskans bemötande av kvinnor med perinatal psykisk ohälsa påverkas av flera samverkande aspekter. Bristfällig kunskap, otillräcklig utbildning och kompetens samt begränsad erfarenhet inom problemområdet bidrog till en osäkerhet i vårdmötet. Detta orsakade svårigheter att identifiera psykiska symtom och initiera stödjande insatser. Organisatoriska förutsättningar såsom tidsbrist, hög arbetsbelastning och avsaknad av tydliga riktlinjer och vårdstrukturer försvårade även möjligheten att erbjuda kontinuitet och personcentrerat stöd. Samtidigt framkom att emotionell kompetens, erfarenhet och förmågan att etablera en tillitsfull vårdrelation kunde främja kvinnors möjlighet att uttrycka psykiskt lidande och ta emot stöd.

Barnmorskans bemötande av kvinnor med perinatal psykisk ohälsa påverkas av ett komplext samspel mellan kunskapsmässiga, organisatoriska och relationella aspekter. För att stärka vården och främja ett personcentrerat bemötande krävs ökad kunskap, förbättrade organisatoriska förutsättningar och tydligare strukturer för stöd och uppföljning inom den perinatala vården.