Hälsosamtal som metod att främja barns och ungdomars hälsa : en utmanande uppgift

The overall aim of this thesis was to explore and describe health dialogues from pupils’ and nurses’ perspectives as well as the verbal interaction between them, in the context of a structured health and lifestyle tool. Seventy-four pupils and 23 school nurses participated in focus group interviews, and further 14 nurses participated in individual interviews. To explore the verbal interaction, 24 health dialogues with pupils and school nurses were recorded using a video camera. The data from the interviews were subjected to qualitative content analysis and the verbal interactions were analysed using the paediatric version of the Roter Interaction Analysis System. Health dialogues based on the pupil’s own situation were described as a process that provided them opportunities to influence their own health. Prerequisites for a pupil-centered health dialogue were that the pupils were prepared, felt respected and like active participants, and that their own experiences were in focus. How the nurses acted was crucial to the pupils’ experience of and possibility to benefit from of the health dialogue based on their own needs and wishes. A health and lifestyle tool could support the dialogue by constituting a structure, open up for discussion and contribute to an understanding of the individual’s situation. The tool could also facilitate the transmittal of health information on an individual as well as a group level. In terms of utterances in the dialogues, the school nurses were the ones who talked the most. The pupils most frequently gave information about their lifestyle and agreed with the nurses. The nurses asked questions and provided information about lifestyle, and checked that they had understood the pupils. Just over a third of the nurses’ verbal interaction approaches were aimed to make the pupil more active and participatory in the dialogues. In conclusion, the health dialogues were described as an opportunity to gain knowledge about and insight into health and lifestyle, but a pupil-centered dialogue was considered crucial. The challenge is to adapt the health dialogue based on each pupil’s needs and wishes, and a health and lifestyle tool could contribute structure and support the dialogue.

Contributing to making the school a safe place for the child : School nurses’ perceptions of their assignment when caring for children having parents with serious physical illness

Aim: To explore how school nurses perceive their assignment when caring for children having parents with serious physical illness. Design: An explorative inductive qualitative design. Method: The study is based on interviews with 16 school nurses. The interviews were subjected to qualitative content analysis. Results: The main category, “Contribute in making the school a safe place for the child”, reveals how the school nurses try to contribute to making the school a safe place for a child when his/her parent has a serious physical illness. They support children through individual support, as well as at an overall level in the school health team to make the school, as an organization, a safe place. Routines and collaboration to recognize the child when his/her parent has become ill is described as crucial to accomplishing this assignmen

Special Support for Behavior Difficulties and Engagement in Swedish Preschools

The Swedish preschool curriculum stipulates that all children independent of support needs should attend mainstream preschool groups, with equal opportunities for learning and engagement. Preschool teachers are responsible for paying attention to children in need of special support to achieve this. How support is provided for children in need of special support due to behavior difficulties in Swedish preschools varies, however. Some children, often formally identified as in need of special support, are supported by preschool staff supervised by external services. Other children receive support initiated and implemented by preschool staff, without supervision from external services. A further number of children receive no support for behavior difficulties, on top of what is provided to all children. This study investigated associations between support format (i.e., supervised support, staff-initiated support, or no additional support), support content (i.e., implementation of support), behavior difficulties, socio-demographics and engagement. A mixed methods approach was used with a sample of 232 preschool children 15–71 months with assessed behavior difficulties. Preschool staff reported on the children's engagement, behavior difficulties, socio-demographics, and support provision. Logistic regression models were used to analyze the probability of children receiving either support format. Content analysis was used to categorize the support content, reported by preschool staff through open-ended questions. Point-biserial correlations were used to test associations between support content, behavior, socio-demographics and engagement. All children receiving supervised support for behavior difficulties were formally identified by external services as in need of special support. Supervised support was also more common if children disturbed the free play in the preschool group, with the most frequent support being collaboration with external teams. Staff-initiated support was most commonly given to children with high engagement, and for children who are not early second language learners. These children were most frequently supported by staff paying attention to negative behavior. Children who were not perceived as a burden to the group were less likely to receive any form of additional support. Ways of managing the preschool group seem to guide support strategies for children with behavior difficulties, rather than child-focused strategies emphasizing engagement in everyday activities

Children's experiences of information, advice and support from healthcare professionals when their parent has a cancer disease : experiences from an oncological outpatient department

Purpose This study was carried out in order to evaluate children's experiences after taking part in the pilot clinical intervention “See Me” aimed at supporting children as relatives. Method A qualitative explorative design with interviews was chosen, with analyses using an inductive approach. Interviews were conducted with 19 children (9 aged 7–12 years and 10 aged 13–18 years). The younger children were asked to draw a picture of a person in hospital, using the Child Drawing: hospital (CD:H) instrument to measure the child's level of anxiety. The older children completed the Caring Professional Scale (CPS) as a measure of the caring approach in their encounter with the nurse. Results The interviews with the children show that: they felt expected and welcomed at the hospital; they needed knowledge about their parent's situation; they needed information and participation based on their individual situation; and they needed the nurse to offer them information and support. The results from the pictures showed that one child had above-average levels of anxiety. The older children reported that the nurses were Competent Practitioners, but to a lesser degree that they were Compassionate Healers. Conclusions The results of this pilot study indicate that the structure of “See Me” could be used as a starting point to ensure that children as relatives receive information, advice, and support. Further the results indicate that both CD:H and CPS could be used to evaluated children's experiences of support when a parent has a long-term illness

Trends in prevalence of thinness, overweight and obesity among Swedish children and adolescents between 2004 and 2015.

AIM: This study explored weight trends among children aged 4, 7, 11, 14 and 17 years in Jönköping County Sweden, from 2004 to 2015. METHODS: The study had a repeated cross-sectional design, and body mass index (BMI) was calculated based on height and weight measurements collected from child health and school health records. The prevalence of thinness, overweight and obesity was estimated with international cut-offs, with linear trends calculated separately for boys and girls. RESULTS: There were 190 965 measurements of BMI and these covered 82-97% of the younger children and 55-69% of the older children during the study period. The prevalence of thinness varied between 0.2% and 2.2% across time and age groups and did not change over the study period. There was a small decrease in overweight among both girls and boys aged four years. There were increasing trends in overweight and obesity in both girls and boys aged 11 and 14 years of age and a sharp increase among 17-year-old boys, with 7.3% obese in 2014/2015 and 3.6% in 2004/2005. CONCLUSION: The prevalence of obesity decreased from 2004 to 2015 or was stable in younger Swedish children, but increased among older children, with a large increase in adolescent boys

Parents Thoughts Regarding Their Normal-Weight Childrens Food and Physical Activity as Expressed During Health Conversations With the School Nurse : A Qualitative Analysis Informing Health-Promoting Practices

Parents are key to promoting childrens healthy growth and development. However, school nurses need knowledge about how to best support parents health-promoting activities. This study aimed to explore parents thoughts regarding their normal-weight 6-year-old childrens food and physical activity behaviors as expressed during health conversations with the school nurse. Qualitative content analysis of audio-recorded conversations (n = 30) showed that parents think of their childrens behaviors in terms of: (a) childrens personality in relation to food and physical activity; (b) recognizing childrens food and physical activity behaviors; (c) parenting in relation to food and physical activity; (d) interaction with children in situations around food and physical activity; and (e) contextual circumstances to promote childrens healthy food and physical activity behaviors. The study contributes with novel knowledge regarding clinical work in health promotion, with suggestions for how school nurses can engage parents in promoting and sustaining healthy food and physical activity behaviors.Funding Agencies|Familjen Kamprads Stiftelse; Kamprad Foundation; Swedish Research Council for Health, Working Life and WelfareSwedish Research CouncilSwedish Research Council for Health Working Life &amp; Welfare (Forte)</p

The meaning of being a visiting child of a seriously ill parent receiving care at the ICU

Purpose: Children's visits to the ICU are still restricted, and more focus on the child's own needs and experiences are needed. The aim of this study is to illustrate the meaning of being a visiting child of a seriously ill parent receiving care at the ICU. Method: A qualitative descriptive design was used, with open-ended interviews with seven children (6-18 years) performed and analysed using a phenomenological research approach. Findings: Being a visiting child of a seriously ill parent receiving care at the ICU is described as a life situation taking place in an unfamiliar environment, characterized by a heartfelt, genuine desire to be there, in an interdependence entailing offering a loved one the help they need while at the same time being seen in a compassionate way and being able to share, revealing a sudden awakening of an inner truth of reality and a sense of a healing wisdom of understanding. Conclusions: The children felt good when they visited their ill parent, but at the same time not fully involved, and desired a more compassionate, caring approach by the nurses. Improvements are needed in how to approach visiting children in a more individual and caring way

General practitioners’ accounts of how to facilitate consultations with toddlers : An interview study

Objective: To describe general practitioners’ (GPs’) accounts of how to facilitate consultations with children aged 1–2 years. Design: A qualitative study based on focus group interviews. Setting and subjects: Five focus group interviews were conducted with a total of 25 GPs at Swedish primary health care (PHC) centres. The GPs regularly invited toddlers to consultations. Result: The GPs’ accounts of how to facilitate consultations with toddlers revealed descriptions of making efforts to instil confidence in the situation to enable the consultation. Toddlers in need of health care always visit the GP with adults such as their parents, guardians or other relatives. Therefore, the GP directs efforts towards the adults and the child more or less simultaneously, as they both need to rely on the GP. The GPs describe how they instil confidence in the adults by establishing a mutual understanding that the consultation is necessary to secure the child’s health. Regarding the child, the GP instils confidence by establishing a relationship in order to approach the child and accomplish bodily examinations. Conclusion: The result shows that GPs’ encounters with children in consultations are two-sided. The GP needs to conduct bodily examinations to secure the child’s health and development, but to do so he/she needs to establish purposeful relationships with the adults and the child by instilling confidence. This indicates that establishing relationships in the consultation is significant, and a way to achieve a child-centred consultation. KEY POINTS Research regarding GPs’ encounters with toddlers in consultation is limited, even though toddlers frequently visit PHC. GPs make efforts to instil confidence by establishing mutual understanding with parents and a relationship with the child. Establishing purposeful relationships with both the child and parent is significant in enabling the consultation. Establishing a relationship with the child overrides conducting the bodily examination, t opromote the child’s feeling of ease and allow a child-centred consultation