Hälsosamtalet: Skolbarns självrapporterade hälsa i ett svenskt kontext.

The overall aim of this thesis was to explore and describe schoolchildren's selfreported-health based on the Health Dialogue concept as well as to identify healthindicators and their possible associations in the perspective of 6 to 16 year-olds,and to provide an analysis of school nurses´ experiences of using the HealthDialogue concept, in the County of Västernorrland. The thesis was based on fourstudies (I-IV). Study I was qualitative using a descriptive design, based onindividual interviews with school nurses who had working experience of using theHealth Dialogue concept. Studies II-IV were quantitative with cross sectional andlongitudinal design based on statistical data from the Health Dialogue concept, apopulation survey among schoolchildren. The data were analyzed usingqualitative content analysis (I) and regression analyses (II-IV).Study I showed that the school nurses had developed their own commonapproach, a health promotion model derived from experiences of working with theHealth Dialogue concept. Study II showed that the most important health variablesinfluencing pre-schoolchildren´s positive self-reported-health were experience ofcomfort in preschool, good sleep, absence of headaches, being physicalactive/playing daily, and not being a victim for bullying. Both boys and girlsneeded to experience comfort, being physical active, and not being bullied. Forgirls, positive self-reported-health seemed to be more dependent on comfort, beingphysical active/playing, and not being bullied, whereas boy’s health was moredependent on eating school lunch daily and not experiencing headaches.Study III revealed that in 10-year-old children´s positive self-reported-health,comfort in school, normal iso- body mass index and absence of headaches wereshown to be significantly important health indicators. Normal iso- body massindex (girls) and absence of headaches (boys) were shown to have a potentiallycausal effect on 10-year-old children's positive self-reported-health. Study IVrevealed several significantly important health indicators in schoolchildren´shealth during three school transitions in the Swedish Education system (betweenthe ages of 6-10, 10-13 and 13-16); not experiencing being sad/depressed,afraid/worried, experiencing the school environment positively (schoolyard andivrestrooms), not being bullied, having good sleep, daily physical activity/play andability to concentrate. Gender and age differences were also identified. The HealthDialogue concept, contributes increased knowledge and a new cross sectional andlongitudinal perspective to individual, school, community and organization’sperception of schoolchildren´s self-reported-health. Furthermore, these resultsdemonstrate the importance and validity of children´s experiences in the context ofhealth and should contribute to future health promotion activities and schoolbasedinterventions.Key words: Health promotion, health dialogue, longitudinal design, school nurses,schoolchildren, self-reported-health.Det övergripande syftet med avhandlingen var att undersöka och beskrivaskolbarns självrapporterade hälsa baserat på Hälsosamtals konceptet, attidentifiera hälsoindikatorer och deras möjliga samband för skolbarn självskattadehälsa i ett 6 till 16- års perspektiv, och att analysera skolsköterskornas erfarenheterav att använda Hälsosamtals konceptet i Västernorrlands län. Avhandlingenbygger på fyra studier (I-IV). Studie I var kvalitativ med en deskriptiv design,baserad på individuella intervjuer med skolsköterskor med arbetserfarenhet frånHälsosamtals konceptet. Studie II-IV var kvantitativ med tvärsnitt ochlongitudinell design baserat på statistisk data på länsnivå från Hälsosamtalskonceptet bland skolbarn i ålder 6-16 år. Data analyserades med kvalitativinnehållsanalys (I) och regressions analys (II-IV). Studie 1 visade attskolsköterskorna i länet hade utvecklat en egen gemensam strategi och modell förhälsofrämjande arbete. Studie II visade att de viktigaste hälso- indikatorer för barni förskoleklass avseende positivt självrapporterade hälsa var trivsel, god sömn,frånvaro av svår huvudvärk, vara fysiskt aktiv/leka varje dag, samt att inte varautsatt för mobbning. Både pojkar och flickor behövde trivas, vara fysisktaktiva/leka, och inte vara utsatta för mobbning. Flickorna visade sig vara merberoende av trivsel, vara fysiskt aktiva/leka, och inte vara utsatta för mobbning föratt rapportera sin hälsa positivt medan pojkarnas positivt självrapporterande hälsavisade sig bero på daglig skollunch och att inte ha huvudvärk. Studie III visade attför 10-åriga barns positivt självrapporterade hälsa var, trivsel i skolan, normalt iso-BMI och frånvaro av huvudvärk viktiga hälsoindikatorer. Normal iso-BMI visadeett potentiellt kausalt samband för 10-åriga flickors, och frånvaro av huvudvärkvisade ett potentiellt kausalt samband för 10-åriga pojkars positivtsjälvrapporterad hälsa. Studie IV visade flera signifikant viktiga hälsoindikatorer iskolbarns (6-16 år) positivt självrapporterade hälsa, under tre skolövergångar i detsvenska utbildningssystemet (6-10, 10-13, 13-16 år). Att inte känna sigledsen/deprimerad, rädd/orolig, uppleva skolmiljön positivt (skolgården ochtoaletter), inte vara mobbad, sova gott, vara dagligt fysiskt aktiv/leka och att kunnakoncentrera sig visade sig vara viktiga hälsoindikatorer. Dessa hälsoindikatorerviskilde sig avseende på ålder och kön. Denna avhandling bidrar med ökad kunskapom skolbarns självrapporterade hälsa grundat på Hälsosamtals konceptet.Hälsosamtals konceptet tillför nya perspektiv avseende barns hälsa på individ,skola, samhälls/organisations nivå i ett tvärsnitts och longitudinellt perspektiv.Hälsofrämjande arbete i skolan och samhället bör ta barns upplevelser,erfarenheter och synpunkter i beaktande och som giltiga. Resultatet i dennaavhandling hoppas kunna bidra till framtida hälsofrämjande arbete och insatser iskolan

Students’ experience of Uncertain times: Learning and well-being in Swedish upper secondary schools during the pandemic

This study aims to explore how students in upper secondary schools in Sweden perceived changes to their pre-pandemic study habits and well-being that took place during the pandemic. Because our study is based on theoretical perspectives relevant to learning and well-being, our framing loosely follows concepts from the work of Antonovsky. For this purpose, we have analyzed the responses of 209 students who completed a web survey. The study adopts mixed methods, combining analyses of data gathered via the Holistic Student Assessment (HSA), questionnaire surveys, and open-ended questions focusing on students' perceptions of learning and well-being during and before the pandemic. Results show that most students perceived significant differences between their situations before and during the pandemic, which in turn significantly affected their school performance and well-being. Although many of the students described poorer management of their studies and deterioration of their study strategies, no difference was shown in self-regulated learning. From this, it can be concluded that the students previously had a low awareness of self-regulated learning. The study's contribution is that the results are based on students' perceptions during the pandemic which preventing an ex post facto design. Implications of this study both for practice and policy is to address a salutogenic process and curricula to strengthen academic performance and health and give young people readiness for action for unexpected situations and for coping with life

Nurses’ experiences from a flexible online course in a higher education learning initiative

Remote healthcare is developing at a rapid pace to create high-quality, efficient, and financially sustainable care. The article aims to describe and explore nurses’ experiences of networked learning before and after participation in a higher education lifelong learning initiative. The study was conducted in primary healthcare and hospital units in Sweden with ten nurses (eight women and two men), where the participants answered a web-based questionnaire before and after participating in an online course, Digital Competence in Care. The data were analysed with descriptive statistics and qualitative content analysis. The results show increased development of nurses’ competence and learning. The mean of digital competence among all participants increased from 4.4 to 8.9 on a scale of 0-10 and the mean of expectations for learning among all participants increased from 7.1 to 9.2 on a scale of 0-10. Furthermore, two themes were identified: Lifelong learning important and urgent for nurses and Networked learning a flexible way to strengthen learning and think outside the box. The content and design of DCC were experienced as relevant for the participants, and networked learning was perceived as a way of developing and strengthening learning and competence. The participants indicated that sharing experiences and networking with others supported them in solving problems in their daily work, “thinking outside their own box,” and putting ideas into action together to support a critical and responsible attitude. The use of authentic work-related problems in the course assignments was experienced as a good thing, as it supported the nurses in their everyday work. Finally, the participants described how they became more courageous and confident in their ability to communicate and work securely digitally, and also that their new knowledge and competence were relevant to the continued development of digitalisation in healthcare settings and medical care, as colleges and leaders turned to them for support and advice

Networked Learning for Life-Long Learning in Swedish Health Care. A Pilot Study

A healthy work environment in health care requires that staff feel in control and are provided with self-development opportunities, information and adequate resources, all of which lead to job satisfaction. Lifelong learning for health care staff has received increasing attention as a step towards an attractive workplace and safer care. However, people in working life demand conditions that enable them to participate in educational activities. The aim of this paper is to describe experiences of creating and distributing short, flexible and networked courses in higher education, for health care personnel’s lifelong learning. Following research questions are included: what challenges have been identified by higher education staff when creating flexible courses for lifelong learning based on networked learning? and what, in the course design, was essential for the students networked learning? The project was built on the assumption that knowledge is empowering for staff and patients, and that organizational learning and behaviour is central for quality. The sociocultural theory of learning, which claims that all humans are willing and able to learn, and that people learn when they realize that the knowledge is relevant and important to them, has inspired. One pilot course was developed, and this paper focuses on the preliminary findings for the course “Peer learning”. E-mail, memos and notes were used as data and examined with thematic analysis. The findings showed four themes that answered the aim: identifying courses in collaboration; recruiting and maintaining the participants; learning activities in the course design and improving the course. It was important to have flexibility along with some structure in the course. The three components in networked learning contributed to learning and motivation during the course: relationship between educators, gatekeepers and students, the technology in the digital classroom, and a collaborative engagement. It seems successful working together and networking between the two organizations (university and health care) for a common purpose. The conclusion focuses further on the importance of building a robust network as well as bringing new ideas and needs for lifelong learning from the health care to the university. Further data collection is needed to get additional and deeper insights of health care managers along with workforce experiences and wishes for lifelong learning

The lived experiences of young people living with type 1 diabetes : A hermeneutic study

Aims: The aim of this hermeneutic study was to explore and elucidate the lived experiences of young people living with type 1 diabetes in terms of their everyday life and school in Sweden. Design: A qualitative interview study with a hermeneutic approach inspired by Gadamer's thinking. Methods: Interviews were conducted with a purposive sample of seven girls and three boys with type 1 diabetes between January and September 2017 and analysed with a hermeneutic method. Results: Young peoples' everyday lives were transformed and re-organized by their illness and they parodically live a double-edged everyday life. To support young people's healthcare personnel, headmasters and teachers must understand this double-edged situation.

Nurses’ experiences from a flexible online course in a higher education learning initiative

Remote healthcare is developing at a rapid pace to create high-quality, efficient, and financially sustainable care. The article aims to describe and explore nurses’ experiences of networked learning before and after participation in a higher education lifelong learning initiative. The study was conducted in primary healthcare and hospital units in Sweden with ten nurses (eight women and two men), where the participants answered a web-based questionnaire before and after participating in an online course, Digital Competence in Care. The data were analysed with descriptive statistics and qualitative content analysis. The results show increased development of nurses’ competence and learning. The mean of digital competence among all participants increased from 4.4 to 8.9 on a scale of 0-10 and the mean of expectations for learning among all participants increased from 7.1 to 9.2 on a scale of 0-10. Furthermore, two themes were identified: Lifelong learning important and urgent for nurses and Networked learning a flexible way to strengthen learning and think outside the box. The content and design of DCC were experienced as relevant for the participants, and networked learning was perceived as a way of developing and strengthening learning and competence. The participants indicated that sharing experiences and networking with others supported them in solving problems in their daily work, “thinking outside their own box,” and putting ideas into action together to support a critical and responsible attitude. The use of authentic work-related problems in the course assignments was experienced as a good thing, as it supported the nurses in their everyday work. Finally, the participants described how they became more courageous and confident in their ability to communicate and work securely digitally, and also that their new knowledge and competence were relevant to the continued development of digitalisation in healthcare settings and medical care, as colleges and leaders turned to them for support and advice

Networked Learning for Life-Long Learning in Swedish Health Care. A Pilot Study

A healthy work environment in health care requires that staff feel in control and are provided with self-development opportunities, information and adequate resources, all of which lead to job satisfaction. Lifelong learning for health care staff has received increasing attention as a step towards an attractive workplace and safer care. However, people in working life demand conditions that enable them to participate in educational activities. The aim of this paper is to describe experiences of creating and distributing short, flexible and networked courses in higher education, for health care personnel’s lifelong learning. Following research questions are included: what challenges have been identified by higher education staff when creating flexible courses for lifelong learning based on networked learning? and what, in the course design, was essential for the students networked learning? The project was built on the assumption that knowledge is empowering for staff and patients, and that organizational learning and behaviour is central for quality. The sociocultural theory of learning, which claims that all humans are willing and able to learn, and that people learn when they realize that the knowledge is relevant and important to them, has inspired. One pilot course was developed, and this paper focuses on the preliminary findings for the course “Peer learning”. E-mail, memos and notes were used as data and examined with thematic analysis. The findings showed four themes that answered the aim: identifying courses in collaboration; recruiting and maintaining the participants; learning activities in the course design and improving the course. It was important to have flexibility along with some structure in the course. The three components in networked learning contributed to learning and motivation during the course: relationship between educators, gatekeepers and students, the technology in the digital classroom, and a collaborative engagement. It seems successful working together and networking between the two organizations (university and health care) for a common purpose. The conclusion focuses further on the importance of building a robust network as well as bringing new ideas and needs for lifelong learning from the health care to the university. Further data collection is needed to get additional and deeper insights of health care managers along with workforce experiences and wishes for lifelong learning

Establishing Patient Safety in Intensive Care -A Grounded Theory. : Building Trust-Important for Patient Safety

Background: The modern intensive care unit (ICU) is a complex and high-risk environment, and even small adverse events and changes may deteriorate the patient’s conditions and eventually cause harm. Many factors can potentially be associated within an increased amount of errors, leading to adverse events. Nurses, nurse managers, and other leaders all play important roles in establishing patient safety. Aim: This study aimed to obtain a deeper understanding of leaders’ and nurses’ main concerns in establishing patient safety in Swedish intensive care units. Method: A grounded theory methodology was used. Data from 15 interviews with leaders and nurses involved in critical care in Sweden were collected, analysed and constant compared. Findings: The main concern in establishing patient safety was promoting quality of care, work engagement, and staffs well-being in strained ICUs. The core category building trust explained how the leaders’ and nurses’ strove for quality of care and wished a healthy, safe work environment. This is further explained in the categories “Being an accessible and able leader”, “Creating knowledge and understanding”, and “Establishing collaborative practice”. Conclusion: Establishing patient safety in the ICU requires that staffs enjoy going to work, have good work relations, are committed and want to stay at the unit. A healthy, salutogenetic unit with a work environment marked by trust provides a better opportunity to establish patient safety, and various leaders have potential to achieve this

Experiences from Parents to Children with Diabetes Type 1.

Introduction: When a child is diagnosed with a long-term illness such as diabetes type 1(DT1) parents often find it stressful to give optimum support to the child and to manage the situation especially when the child is in school. Parents experience that the stress to manage life with Diabetes Type 1, means to constant monitor blood glucose, to assist with insulin injections, food intake and physical activity, in order to optimum disease management. Aim: To explore how parents’ of children with Diabetes Type 1 experienced their role as a parent. Material and method: A qualitative design was used and individual interviews were conducted with a purposive sample of 13 parents (10 mothers and 3 fathers) of children with Diabetes Type 1. The interviews were analyzes using qualitative content analysis. Results and conclusions: The analysis resulted in one theme A life change revealing new needs with four subthemes; Struggling with fear and searching for explanations, Learning to manage and getting control of a lifelong illness, Collaboration with school as an important support and Managing the illness influenced work and family finances. Parents in this study struggled for their children at all times, to be the child’s caregiver and to take care of the child’s life in the best possible way. They asked for flexible and continue diabetes education for themselves and for school staff efficient communication and cooperation between parents/families, healthcare and school