Högskolan i Skövde

Background: A woman's pain during labour plays a dominant role in childbirth. The midwife's role is to assess the degree of pain experienced during labour. When professionals respond to labour pain with acknowledgement and understanding, the woman's sense of control and empowerment is increased, which could contribute to a positive experience of childbirth. The aim of this study is to describe how labour pain in Swedish delivery wards is assessed and documented. Methods: This quantitative descriptive study was designed as a national survey performed through telephone interviews with the representatives of 34 delivery wards in Sweden. Results and conclusion: The majority of the participating delivery wards assessed and documented women's labour pain, but in an unstructured manner. The wards differed in how the assessments and documentation were performed. In addition, almost all the delivery wards that participated in the survey lacked guidelines for the assessment and documentation of the degree of pain during labour. The findings also showed that the issue of labour pain was sometimes discussed in the delivery wards, but not in a structured or consistent way. (C) 2015 Australian College of Midwives. Published by Elsevier Australia (a division of Reed International Books Australia Pty Ltd). All rights reserved.

Background: The World Health Organization recommends promoting exclusive breastfeeding for six months. Women much too often end breastfeeding earlier than they planned, but women who continue to breastfeed despite problems more often experience good support and counselling from health professionals. The aim in this study was to evaluate the effects of a process-oriented training in breastfeeding support counselling for midwives and child health nurses, in relation to women’s satisfaction with breastfeeding counselling, problems with insufficient breast milk, pain or nipple sores in relation to exclusive breastfeeding shorter or longer than 3 months.

Methods: An intervention through process-oriented training for health professionals regarding support in childbearing and breastfeeding took part in the south west of Sweden. The present study was performed in Sweden, in 2000- 2003. Ten municipalities were paired, and within each pair, one was randomly assigned to the group of five intervention (IG) municipalities and one to the group of five control municipalities. Primiparas (n=540) were asked to participate in a longitudinal study to evaluate the care they received. A survey was distributed at 3 days, 3 months and 9 months postpartum. Data collection for control group A (n=162) started before the intervention was initiated. Data for control group B (n=172) were collected simultaneously with the intervention group (IG) (n=206).Women were also divided into two groups depending on whether they exclusive breastfed < 3 months or ≥ 3 months.

Results: Women in IG were more satisfied with the breastfeeding counselling (p=0.008) and felt the breastfeeding counselling was more coherent (p=0.002) compared with control groups, when the exclusively breastfeeding was < 3 months. In addition fewer women in the IG, among the group exclusively breastfeeding < 3 months, had problems with insufficient breast milk compared to the control groups (p=0.01).

Conclusion: A process-oriented training for health professionals in support influenced women's ability to solve breastfeeding problems such as the experience of insufficient breast milk production. Women with exclusive breastfeeding lasting ≥ 3 months more often had breastfeeding duration in conformity with their planned breastfeeding duration, compared with women who had breastfeeding duration < 3 months.

Trial registration: ACTRN12611000354987

Background: Midwives’ support of breastfeeding in maternity wards has been proven to provide an impact on women’s breastfeeding experiences. In previous studies women describe professional support unfavourably, with an emphasis on time pressures, lack of availability or guidance, promotion of unhelpful practices, and conflicting advice. Thus, the present study aims to investigate women’s experiences and reflections of receiving breastfeeding support and midwives’ experiences and reflections of giving breastfeeding support. Methods: This study was carried out in a county in southwestern Sweden during 2003-2004. A qualitative method, content analysis, was chosen for the study. The data came from interviews with women as well as interviews with midwives who were experienced in breastfeeding support. Results:  The women’s and midwives’ experiences and reflections of receiving and giving breastfeeding support were conceptualized as one main theme: “Individualized breastfeeding support increases confidence and satisfaction.” This theme contained three categories: “The unique woman,” ”The sensitive confirming process,” and “Consistency of ongoing support.” In order to feel confident in their new motherhood role, the women wanted more confirmation as unique individuals and as breastfeeding women; they wanted to be listened to; and they wanted more time, understanding, and follow-up from health professionals. In contrast, the midwives described themselves as encouraging and confirming of the women’s needs.  Conclusions:  If health care professionals responded to the woman’s unique needs, the woman felt that the breastfeeding support was good and was based on her as an individual, otherwise a feeling of uncertainty emerged. The midwives, however, expressed that they gave the women individual support, but they also expressed that the support came from different points of view, because the midwives interpreted women’s signals differently. 

The over all objectives of this thesis was to map factors of importance for breastfeeding such as maternal background factors, maternal perception of breastfeeding support, confidence, caring routines, breastfeeding attitudes of health care professionals, and to investigate whether a training intervention within the care team of

the antenatal (ANC) and child health centres (CHC) would improve maternal perception of support and strengthen maternal feelings for the baby.

Material and method: A questionnaire was sent to mothers when their babies were 9-12 months old (n=540). The questionnaire embraced questions regarding maternal background, caring routines, perception of support and duration of breastfeeding (I-II). Thereafter an attitudinal instrument was developed to measure breastfeeding attitudes in health care professionals (n=168). Four attitude dimensions were identified by factor analysis (III). Ten municipalities in a county of south west Sweden was paired and randomized to intervention or control (IV). Thus, all midwives and postnatal nurses working at the ANC or CHC in a randomised municipality were asked to participate in the study (n=81). Health professionals in the intervention group had a process-oriented training in breastfeeding counselling including planned continuity in family education and development of a common breastfeeding policy within the caring team. Changes in attitude were measured by the instrument developed in study III. For study V, mothers were recruited from the maternity and were allocated to intervention- or control group according to the randomization of municipalities in study IV (n=565). Questionnaires were sent out at three days, 3 and 9 months post partum to investigate how the care and counselling skills acquired by the health care professionals would be reflected in maternal perception of breastfeeding support and maternal feelings for and relation to the baby.

Results: Early initiation of suckling, late discharge from hospital (more than 72 hours) and perceived good support contributed positively to the duration of exclusive breastfeeding. Supplementation the first days after birth for other than medical reasons shortened the duration of breastfeeding. For primiparas, the partner’s presence after childbirth contributed positively to the duration of exclusive breastfeeding. Multiparas who were aware of their mothers breastfeeding history had a longer breastfeeding period than those who did not know of their mother’s breastfeeding history. Mothers were more satisfied with the breastfeeding information they had received at maternity than the breastfeeding information they got from the ANC and CHC (I-II). This induced the idea to develop an attitude instrument and start a training intervention for the care team at ANC and CHC. The attitudinal dimensions identified by the factor analysis were: The regulating factor comprising statements scheduling breastfeeding; the facilitating factor comprising statements showing confidence in the ability of the mother-infant dyad to breastfeed on their own; the disempowering factor comprising statements that objectified the woman and ascribed her no ability to breastfeed without guidance of the health care professional and the breastfeeding antipathy factor comprising statements that showed unwillingness and failing knowledge about breastfeeding (III). After training the health care professionals became less regulating and more facilitating (IV). Family classes provided the intervention mothers with better breastfeeding information, more knowledge about their social rights, the needs of the baby and a stronger social network than the control mothers (V). The postnatal nurse gave a better over all support, was a better listener, showed more understanding and provided the mother with better information about breastfeeding and the needs of the baby. Mothers in the intervention group reported that they interacted more with their baby. They had also more positive views on their baby and felt more confident and close with the baby than mothers in the control groups (V).

Conclusion: This study showed that it is important to adopt caring routines, which will facilitate breastfeeding. The health care professional needs to find out the background of the mother to be able to provide her with adequate breastfeeding counselling. Caring routines should include early suckling. Supplementation of the baby the first week after birth should only be given on medical grounds. This study showed that a processoriented training in breastfeeding counselling alters attitudes of health care professionals in a positive way. The trained health care professionals organized continuity of family classes and developed a common breastfeeding policy and were more supportive in their encounters with the mothers. These behaviors strengthen the mother’s feelings for her baby and brought about a richer interaction with her baby. A model to provide continuity of family classes, conducted by trained antenatal midwives and postnatal nurses should thus be practiced within the caring team around first time parents.

Aim: This study investigated if a process-oriented training for health professionals will influence women's use and reasons for using a nipple shield, the baby's weight, and the duration of breastfeeding.

Materials and Methods: An intervention was performed for health professionals that included a process-oriented training program on breastfeeding support. Primiparas living in either the intervention municipality or in a control municipality were asked to participate in a longitudinal study to evaluate the care given. Data collection for control group A (CGA) (n=162) started before the intervention was initiated. Data for control group B (CGB) (n=172) were collected simultaneously with those for the intervention group (IG) (n=206). The mothers responded to questionnaires at 3 days, at 3 months, and at 9 months postpartum.

Results: The mothers' use of nipple shields related to the finding that if the women had a higher body mass index in the beginning of the pregnancy, the babies had difficulty in grasping over the nipple, and the mothers had pain or wound on the nipple. For the mothers in the IG group, there was no significant difference if they had used nipple shields or not in relation to breastfeeding duration. In contrast, the mothers in the control groups had a significant shorter breastfeeding duration if they had used nipple shields. In the IG, there were no significant difference between the use of nipple shields and the babies' weights at 3 or 9 months. The babies of women in the CGB who used nipple shields had a significantly lower weight at 3 months than the babies of those who did not use nipple shields (p=0.02).

Conclusions: A process-oriented training in breastfeeding counseling prolongs the duration of breastfeeding for women with breastfeeding problems, where the problems are remedied by the use of nipple shields.

Background: Fathers feel excluded and insecure during childbirth and professional support for fathers can be inadequate. Therefore it is important to further understand fathers experience in order to develop professional support and to create a positive childbirth experience for both fathers and their partners.

Aim: The aim of this study was to explore fathers’ feelings and experiences during pregnancy and childbirth.

Materials and Methods: A qualitative method was used, with written interviews which were analyzed using a qualitative content analysis. Participants were eight fathers who wrote answers to two open questions.

Results: The theme “Fathers have strong, mixed feeling while striving to become prepared and to participate during pregnancy and childbirth” crossed over into all the four categories: Being prepared gave security, Feeling needed, Feeling strong, mixed feelings during pregnancy, and Feeling strong, mixed feelings during childbirth. Fathers’ previous experiences from childbirth facilitated being prepared and increased sense of security.

Conclusion: It was important for fathers to be prepared and to feel needed and to witness the birth of their baby was fantastic. Overall, the fathers were faced with handling their strong but mixed feelings while striving to prepare for and participate in pregnancy and childbirth.

Implications: Healthcare professionals need to acknowledge that fathers have needs of their own during pregnancy and childbirth. Fathers also worry about the woman and the baby so they need explanations about normal changes as well as possible complications.

Background: The approach to nursing should be characterized by a holistic view of the human being which includes sexual health. From a nursing perspective, it is therefore of most importance to have a dialogue about factors associated with sexual health also among hospitalized patients. However, to our knowledge there is a lack of qualitative studies regarding nurses attitudes about dialogue with patients about sexual health.

Objective: To investigate nurses attitudes towards dialogue with hospitalized patients about sexual health.

Methods: A qualitative method was used and interviews were conducted which then were analyzed using a qualitative content analysis. Eleven registered nurses were included, the inclusion criteria was: at least one year of experience as a nurse and working on a medical or surgical ward in a hospital in the southwest of Sweden. The participants were in the ages 25-65 and had worked as nurses between 2 and 30 years. Nine of the participants were women. The data were collected during 2011.

Results: The nurses experiences of and reflections on dialogue with patients about sexual health were presented as a single main theme: Nurses challenges to support hospitalized patients with sexual health issues. This theme had three categories: Feeling uncomfortable, Feeling inadequate and Task-oriented care with related subcategories respectively.

Conclusions: Nurses attitudes towards their dialogues about sexual health with hospitalized patients were less challenging if they were initiated by the patients or if the patients were men with medical causes related to sexual health. Lack of knowledge and support from colleagues became reasons why nurses felt inadequate about discussing sexual health with their patients.

Professional support is important for women during pregnancy, but more research is needed to provide a better understanding of how this support affects the mother's experience of support and breastfeeding behavior the first days after birth and its relation to the duration of breastfeeding. This study aims to evaluate the effects of a professional support during pregnancy in relation to mothers’ perceived support at delivery and maternity ward, and on the number of breastfeeding sessions during the first three days after birth. These factors would be subsequently considered in relation to the duration of breastfeeding. Mothers in the Intervention group (IG) and Control group B (CGB) (November 2000 to April 2002) perceived significant better overall support, breastfeeding information and preparation for parenting from the professionals in the delivery and maternity wards compared with the Control group A (CGA) (April to October 2000), (p<0.001), (n = 540). The IG showed a higher frequency of breastfeeding sessions in the first 24 h compared with the mothers in the CGB (p<0.008) and a positive correlation between preparation for the parental role and duration of exclusive breastfeeding (p = 0.006).

Introduction: The impact of giving an infant food other than breast milk depends on several factors. Evidence to date supports the recommendation for exclusive breastfeeding for six months.

The aim of the this study was to evaluate the effect of a process-oriented training in support during childbirth and breastfeeding for midwives and postnatal nurses in relation to  the time of initial breastfeeding session, introduction of breast milk substitute and solids effects on  the duration of breastfeeding.

Materials and methods: Ten municipalities in Sweden were randomized to either intervention (IG) or control groups (CGA and CGB). The intervention included a process-oriented training program* for midwives and postnatal nurses in the intervention municipalities. Primiparas (n=540) who were living at either site were asked to respond to questionnaires at three days, three and nine months postpartum. Data collection for mothers in CGA (n=162) started before effects of the intervention could be studied, CGB (n=172) was collected simultaneously with the IG (n=206).

Results: Preliminary results showed that fewer infants in the IG received breast milk substitute (the first week of life) without medical reasons (p=0.01) and were older (3.8 months) when breast milk substitute was introduced after discharge compared with the infants in the control groups (CGA 2.3 months p= 0.01 and CGB 2.5 months p= 0.03).

Discussion and Conclusion: A process-oriented training program for midwives and postnatal nurses (by changed attitudes among health staff and changing mothers self imaging) reduced the number of infants who got breastmilk substitute during the first week without medical reasons and delayed the introduction of breast milk substitute after the first week.

Abstract Aim: The aim of the study was to evaluate the effects of process-oriented training in supportive breastfeeding counseling for midwives and postnatal nurses on the time lapse between the initial breastfeeding session, introduction of breastmilk substitutes and solids, and the duration of breastfeeding. Materials and Methods: Ten municipalities in Sweden were randomized to either the intervention or control groups. The intervention included a process-oriented training program for midwives and postnatal nurses in the intervention municipalities. Primiparas (n=540) living in either an intervention or control municipality were asked to participate in a longitudinal study to evaluate the care given. Data collection for control group A (CGA) (n=162) started before the intervention was initiated. Data for control group B (CGB) (n=172) were collected simultaneously with the intervention group (IG) (n=206). The mothers responded to questionnaires at 3 days, 3 months, and 9 months postpartum. Results: As a result of the process-oriented training program for midwives and postnatal nurses, the IG mothers had a significantly longer duration of exclusive breastfeeding, even if the initial breastfeeding session did not occur within 2 hours after birth, than the corresponding group of CGA mothers (p=0.01). Fewer infants in the IG received breastmilk substitutes (in the first week of life) without medical reasons compared with the control groups (p=0.01). The IG infants were significantly older (3.8 months) when breastmilk substitutes were introduced (after discharge from the hospital) compared with the infants in the control groups (CGA, 2.3 months, p=0.01; CGB, 2.5 months, p=0.03). Conclusion: A process-oriented training program for midwives and postnatal nurses was associated with a reduced number of infants being given breastmilk substitutes during the 1st week without medical reasons and delayed the introduction of breastmilk substitutes after discharge from the hospital.

Aim: The aim of the study was to develop an instrument that can be used for accurate assessment of nurses' and midwives' attitudes toward breastfeeding in a group of midwives, maternity-nursing staff and postnatal nurses experienced in breastfeeding counselling. Method: An instrument based on WHO standards was developed to measure breastfeeding attitudes. In all, 168 healthcare professionals filled in the instrument. A factor analysis using maximum likelihood and varimax rotation was performed. Spearman's correlation was used to correlate factorial dimensions and self-described interest in breastfeeding. Results: By means of factor analysis four factors were identified: the "regulating" factor focused on regulating the mothers' breastfeeding management, the "facilitating" factor focused on making it easy for mothers to manage their breastfeeding, the "disempowering" factor focused on giving advice, disregarding the needs of the mother being counselled, and the "breastfeeding antipathy" factor focused on insufficient, basic, breastfeeding knowledge and aversive reactions to breastfeeding. Midwives rated higher on the facilitating factor and breastfeeding antipathy factor and lower on the regulating factor than postnatal nurses. Breastfeeding interest was positively correlated with the facilitating factor, and negatively with the disempowering factor and the breastfeeding antipathy factor. Conclusion: This instrument provides a picture of health professionals' attitudes towards breastfeeding. Four factors were identified in order of importance: regulating, facilitating, disempowering, and breastfeeding antipathy factors. Harmful attitudes were identified and suggested a need for educational programmes to help health professionals to reconcile damaging values, in order to improve breastfeeding counselling

OBJECTIVE. Continuous support during the childbirth process ultimately may strengthen the mother's self-esteem and her capacity to interact with and nurture her infant and also may improve paternal involvement in general. In the present study, we investigated whether mothers, who were attended by midwives and nurses who had had a process-oriented training program in breastfeeding counseling, perceived stronger maternal feelings for their infant than mothers who had received only routine care.

METHODS. In a previous study, an intervention that included a process-oriented program on breastfeeding counseling for health professionals and continuity in family classes through childbirth was conducted. The 10 largest municipalities were classified in pairs that were similar in size and had similar figures of breastfeeding duration. The municipalities were randomized pairwise to either an intervention or a control group. The present study is a follow-up study on women's feelings for their infants in relation to the kind of care that they had had and was undertaken between April 2000 and January 2003. The sampling frame was based on women who were cared for at either the intervention clinic or control clinics. The mothers at the control clinics had received standard routine care and had attended family classes through the point of birth. Data collection for control group A started before effects of the intervention could be studied. Data for control group B were collected simultaneously with data collection for the intervention group (n = 540). The mothers responded to 3 questionnaires at 3 days and at 3 and 9 months postpartum. Background data of the mothers were collected. The perception of support that was provided by the health professionals and the perception of mother–infant relationship and feelings for the infant were rated on Likert scales.

RESULTS. At 3 days postpartum, both the intervention group and control group B versus the control group A thought that their understanding of the infant was better, they perceived more strongly that the infant as their own, and they enjoyed more breastfeeding and resting with the infant. Although there was no significant difference between the intervention group and control group B at 3 days and 3 months observation, mothers in the intervention group talked more to their infant, perceived their infant to be more beautiful than other infants, and perceived more strongly that the infant was their own than did the mothers in control group B at 9 months observation. In addition, the mothers in the intervention group felt significantly more confident with the infant and felt the infant to be closer than did the mothers in control group B.

CONCLUSION. A process-oriented breastfeeding training program for antenatal midwives and postnatal nurses that included an intervention that guaranteed continuity of care strengthened the maternal relationship with the infant and the feelings for the infant.

Background: Becoming parents for the first time is challenging. Mothers need both social and professional support to handle these challenges. Professionals’ attitudes affect quality of care and support. So to improve professional support, an intervention consisting of a process-oriented training was performed. Due to the positive results of the intervention there is a need to illuminate the methodological approach further. The overall aim was therefore to describe a methodological approach to improve and evaluate health care professionals’ attitudes toward breastfeeding and parental support in order to improve quality of care in childbearing.

Methods: This study was a longitudinal randomized control intervention study, in which groups of mothers received care in childbearing from midwives and child health nurses. These health professionals had gone through a process-oriented training, or not. In order to improve attitudes of health professionals the training was based on evidence, practical skills and reflective processes (both private and professional experiences) in relation to breastfeeding and parental support. Included in the longitudinal study were health professionals from five intervention municipalities n = 36 and health professionals from five control municipalities n = 45. All mothers who fulfilled the inclusion criteria were consecutively identified from the hospital register and asked to participate in the study. Mothers who accepted to participate were included in the interventions group (n = 206) or control groups (n = 162, n = 172 respectively) based on which municipality they belonged to.

Results: The results of the process-oriented training improved the professionals’ attitudes toward breastfeeding and parental support. These improved attitudes in health professionals increased intervention-group mother’s satisfaction with professional and social support. Intervention-group mother’s relation to and feelings for their baby as well as breastfeeding was also improved.

Conclusion: These results stress the importance of professionals’ attitude in quality of care during childbearing, as well as pointing to the possibility to improve professionals’ attitudes with a process-oriented training.

Trial registration: Australian New Zealand Clinical Trials Registry (ANZCTR), trial registration:ACTRN12611000354987.

Background: Support from the mother’s network of relatives, friends, and professional caregivers during childbirth is likely to be important for breastfeeding success. Few studies have been conducted to examine mothers’ perceptions of breastfeeding support. The objective of this study was to describe breastfeeding support and feelings of confidence of primiparas and multiparas in relation to duration of breastfeeding. Methods: Mothers who

delivered vaginally were eligible for inclusion. After receiving a questionnaire when their children were 9 to 12 months of age, 194 primiparas and 294 multiparas responded to questions on

breastfeeding history and on perceived and overall breastfeeding support and feelings of confidence. Results: Feelings of overall breastfeeding support were correlated with duration of

exclusive breastfeeding in both primiparas (p < 0.001) and multiparas (p < 0.001). Multiparas who knew how long they were breastfed as a child showed a longer duration of exclusive

(p ¼ 0.006) and total (p ¼ 0.007) breastfeeding than multiparas who did not know. The time during which the partner was present after labor was correlated with the duration of exclusive

(p < 0.001) and total breastfeeding (p ¼ 0.002) in primiparas. Feelings of confidence when the baby was 6 to12 months old, as retrospectively rated on a visual analog scale, was correlated

with feelings of confidence in the partner during childbirth in both primiparas (p < 0.001) and multiparas (p < 0.001) and the experience of overall breastfeeding support (primiparas,

p ¼ 0.002; multiparas, p < 0.001). Both groups were more content with breastfeeding information they received from midwives in the maternity wards, compared with that from antenatal midwives and postnatal nurses (p < 0.001). Conclusions: A helpful support strategy for mothers with respect to breastfeeding outcome is for health professionals to discuss the grandmother’s perception of breastfeeding with the mother. It is important for perinatal

caregivers to provide an environment that enables the family to stay together after delivery. A helpful support strategy for health professionals might be to mobilize grandmothers with positive breastfeeding perception to provide support for their daughters’ breastfeeding. (BIRTH 30:4 December 2003)

Background:Social support has been shown to be greatly important for breastfeeding success. The objective of this study was to investigate if mothers who were attended by midwives and nurses specially trained in breastfeeding counseling perceived better continuity of care and emotional and informative breastfeeding support than mothers who received only routine care. Method:Ten municipalities, each with an antenatal center and child health center, in southwest Sweden were randomized either to intervention or control municipalities. The intervention included a process-oriented training in breastfeeding counseling and continuity of care at the antenatal and child health centers. Primiparas were asked to evaluate the care given, and those living in the control municipalities were divided into control groups A and B. Data collection took place at different points in time for the two control groups. The 540 mothers responded to 3 questionnaires at 3 days and at 3 and 9 months postpartum. The perception of support provided by the health professionals and from the family classes was rated on Likert scales. Results:Intervention group mothers rated the breastfeeding information given during the family class as significantly better during pregnancy than both control groups, and better than control group B mothers at 3 months postpartum; compared with both control groups, intervention group mothers perceived that they received significantly better overall support and that postnatal nurses provided better information about breastfeeding and the baby's needs. At 9 months, intervention group mothers were more satisfied with knowledge about social rights, information about the baby's needs, and their social network than control group B mothers. Both intervention group and control group B mothers perceived better overall support than control group A during pregnancy. At 3 and 9 months, intervention group mothers perceived that postnatal nurses were more sensitive and understanding compared with both control groups. Conclusions:After implementation of a process-oriented breastfeeding training program for antenatal midwives and postnatal nurses that included an intervention guaranteeing continuity of care, the mothers were more satisfied with emotional and informative support during the first 9 months postpartum. The results lend support to family classes incorporating continuity of care. (BIRTH 33:2 June 2006)

The aim of this study was to describe the effects of sociodemographicfactors and maternity ward practices on the duration of breastfeedingin Swedish primiparas (n = 194) and multiparas (n = 294), consecutivelyselected from hospital birth files for 3 months, who respondedto a questionnaire 9 to 12 months after childbirth. The impactof sociodemographic data and maternity ward practices on exclusiveand any breastfeeding were examined. Smoking and supplementationwithout medical reasons influenced the duration of both exclusiveand any breastfeeding negatively, whereas early first breastfeedinginfluenced the duration of both exclusive and any breastfeedingpositively, and parity had no significant influence. Late hospitaldischarge influenced the duration of exclusive breastfeedingpositively, and higher maternal age influenced the durationof any breastfeeding positively. These variables altogetherexplained 11.4% (P <.001) of the variance in the durationof exclusive breastfeeding and 8.2% (P <.001) of the durationof any breastfeeding

Aim: The purpose of the study was to measure the attitudes of antenatal midwives and postnatal nurses to breastfeeding before and after common, process-oriented breastfeeding training. Method: Antenatal centres and child-health centres in 10 municipalities were randomized to either an intervention or a control group. The antenatal midwives and postnatal nurses in the intervention group were together given process-oriented breastfeeding training and were, in addition, asked to develop a common breastfeeding policy. A previously developed instrument was used to measure the effects of a training programme on breastfeeding attitudes among midwives and postnatal nurses. It consisted of four scales measuring a person's attitudes toward breastfeeding in four dimensions: regulating, facilitating, disempowering, and breastfeeding-antipathy attitudes. A mean score was calculated for each individual on these four dimensional scales. The higher the score, the stronger the attitude. Results: After one year, the intervention group reduced their scores on the regulating scale when compared with the control group (p<0.001). The intervention group decreased their scores on the regulating scale and increased their scores on the facilitating scale over the first year after training. The control group also significantly increased their scores on the facilitating scale. When the results were analysed profession-wise, the postnatal nurses in the intervention group decreased their scores on the regulating and disempowering scales and increased their scores on the facilitating scale. In contrast, the midwives in the intervention group decreased their scores only on the breastfeeding antipathy scale. The control group midwives decreased their scores on the disempowering scale. No differences were found among the postnatal nurses in the control group. Conclusion: Process-oriented breastfeeding training made both antenatal midwives and postnatal nurses better disposed to breastfeeding; postnatal nurses in particular improved their attitudes. Attitudes to breastfeeding tended to be stable over time, but process-oriented training lowered the scores a little on the regulating scale, suggesting that after this kind of training counsellors would find it less necessary to schedule and control the mothers' breastfeeding behaviour.

Background: Professional support in childbearing has beneficial effects on childbirth experience, interactions within the family, breastfeeding and medical outcomes. However, more knowledge is needed about prerequisites for professional support to be valuable and satisfactory during childbearing. Aim: The aim of this discourse paper is to describe and explore prerequisites for professional support that are of value for women and their families during childbearing as well as how healthcare organizations can be formed to facilitate these prerequisites. Design: Discourse paper. Methods: This discourse paper is based on our own experiences and is supported by literature and theory. Results: Well-functioning structures and processes facilitate professional support that leads to safe, secure, calm and prepared parents with the ability to handle the challenges of childbearing and parenting. When organizing care in childbearing, prerequisites for support needs must also be considered. 

Background: Wellness is a holistic, multidimensional, and process-oriented property on a continuum. It has been used interchangeably with and is undifferentiated from concepts such as health and well-being without an in-depth clarification of its theoretical foundations and a reflection on its meaning. The concept of wellness is frequently used, but its definition remains unclear. Aim: To conceptually and theoretically explore the concept of wellness to contribute to a deeper understanding in caring science. Method: Rodgers' evolutionary concept analysis was applied to the theoretical investigation of data from publications of international origins. The focus was on antecedents, attributes, consequences, surrogate and related terms, and contextual references. A literature search was performed through a manual review of reference lists and an online search in CINAHL and PubMed via EBSCO, and in ProQuest. Abstracts were examined to identify relevant studies for further review. The inclusion criteria were peer-reviewed papers in English; papers published in scientific journals using the surrogate terms ‘wellness’, ‘health’, ‘health care’, and ‘health care and wellness’; and papers discussing and/or defining the concept of wellness. Twenty-six studies met the inclusion criteria. Results: Based on the findings from this concept analysis, a definition of wellness was developed: ‘a holistic and multidimensional concept represented on a continuum of being well that goes beyond health’. Implications for nursing practice were correspondingly presented. Conclusion: Wellness is defined as a holistic and comprehensive multidimensional concept represented on a continuum of being well, that goes beyond health. It calls attention by applying the salutogenic perspective to health promotion in caring science. It is strongly related to individual lifestyle and health behaviour and is frequently used interchangeably with health and well-being without an in-depth clarification of its theoretical foundation.

Background: When designing, implementing, and evaluating a work site health promotion program, it is necessary to ensure that the program is evidence based. The present article aims to present in-depth information on the design of a longitudinal randomized controlled complementary intervention pilot study that follows the Consort recommendations to evaluate possible effects of a health promotive intervention in healthy workers.

Methods: Employees from four different workplaces were randomly assigned to one of the following groups: i) Massage and mental training (sitting in the armchair and receiving mechanical massage while listening to mental training programs, n=19), ii) Massage (sitting in the armchair and receiving mechanical massage only, n=19), iii) Mental training (sitting in the armchair and listening to mental training programs only, n=19), iv) Pause (sitting in the armchair but not receiving mechanical massage or listening to mental training programs, n=19), v) Control (not sitting in the armchair at all, n=17). The study lasted for eight weeks. Immediately before the randomization, after four weeks and after eight weeks the participants responded to statements from the Swedish Scale of Personality and had their heart rate, blood pressure and fingertip temperature measured.

Results: Receiving mechanical massage and listening to mental training programs, either separately or in combination, during working hours had some positive effects on the employees’ own evaluation of their health, as well as their heart rate, blood pressure and fingertip temperature. However, the intervention need to be evaluated further.

Conclusion: The approach described makes it possible to design, implement and evaluate a work site health promotion program, also on pilot-study level and these results should be seen as a first step towards larger randomized studies. This types of studies need to focus on healthy participants and special care should be taken to guarantee adequately powered study groups and their homogeneity.

Nowadays, in Sweden, fathers are expected to be active in their father role and to share caring responsibilities for their children equally with mothers. This active role of a father in a family can be challenging, especially for the first-time fathers. Child health nurses’ support is an important factor for fathers to become confident caregivers. The Father Perceived Professional Support scale (FaPPS scale) can be used in nursing practice for better understanding father’s needs of professional support.

The aim of this study was to describe first-time fathers’ experiences of the professional support received from child health nurses and to validate the instrument: ‘FaPPS scale’. A qualitative design, with inductive and deductive approaches, was used in this study.

Twelve first-time fathers participated in the semi-structured interviews, thereafter grading the FaPPS scale items and commenting on them. The fathers experienced nurses’ support positively when nurses provided practical information and stimulated them to be involved in care of their children. In contrast, the support was experienced negatively because of nurses’ lack of commitment, availability and adaptation to the fathers’ individual needs. The fathers also felt inequality between the support received by fathers and by mothers. Although some fathers perceived it as negative, others considered it fair, believing that mothers needed more support. In addition, fathers expect nurses to actively offer support to them and supervise them in childcare. The fathers also needed meeting other parents, for example in parental groups.This study also indicates that FaPPS scale can be used both in research and clinical practice, though still needing further development.

Background: Research shows that first-time fathers want to take part in preparation for birth and parenthood but they describe being excluded by health professionals. Aim: The aim of this study was to illustrate first-time fathers’ experiences of support from midwives in maternity clinics as a step in the validation of “The Father Perceived-Professional-Support” (The FaPPS) scale. Methods: A qualitative content analysis with an inductive and deductive approach was used; seven first-time fathers were strategically selected and interviewed. In the inductive part the following open question was asked: “How did you perceive the support from the antenatal midwife/midwives?” In the deductive part, the fathers were asked to respond to the FaPPS scale, in order to receive their thoughts and understanding of the scale, inspired by the “Think-aloud” method. Findings. The inductive results showed two main categories: Experience of not knowing what support they needed and Experience of being excluded. The fathers found support from other fathers in parental education classes, but they lack time to discuss. Overall it seems as if the fathers answered both from their own perspective and from the mothers’ perspective. This was not evident in the deductive results. The FaPPs scale should therefore include professionals’ ability to strengthen social support from other first-time fathers and professionals’ ability to offer support to the mother. Conclusion and Clinical Implications. The fathers experienced exclusion both by themselves and also by midwives. Midwives should offer both parents the opportunity to pose questions. It is important for expectant fathers that time for discussion is planned in parental education classes. The FaPPS scale is useful but needs further development. Parts of our result are in line with earlier research, for decades; therefore it is necessary to focus more on support for fathers.

Little is known about prenatal breastfeeding confidence, although such knowledge is necessary for developing the content of counseling and tailoring it for individuals. The purpose of this study was to describe women’s prenatal breastfeeding confidence and how their sociodemographic characteristics, breastfeeding knowledge, and attitudes relate to it. The electronic confidence scale was used in data collection, and 123 Finnish women filled in the questionnaire. The mean confidence score was 83.88 when the maximum possible score was 120. Confidence scores varied when parity, breastfeeding knowledge, and attitudes were involved. Variables regarding breastfeeding as difficult, regarding breastfeeding as exhausting, and parity explained 38.1% of the variation of the breastfeeding confidence scores. Pregnant women need information about managing potential breastfeeding problems and the physiology of breastfeeding. Interventions designed to promote breastfeeding confidence need to be focused on primiparas and women with a lack of breastfeeding knowledge.

Background: Breastfeeding attitudes are known to influence infant feeding but little information exists on the prenatal breastfeeding attitudes of parents. The purpose of this study was to describe Finnish parents’ prenatal breastfeeding attitudes and their relationships with demographic characteristics.  Methods: The electronic Breastfeeding Knowledge, Attitude and Confidence scale was developed and 172 people (123 mothers, 49 fathers) completed the study. The data were analysed using factor analysis and nonparametric methods.  Results: Breastfeeding was regarded as important, but 54% of the respondents wanted both parents to feed the newborn. The mean rank values of breastfeeding attitudes differed significantly when parity, gender, education, age, breastfeeding history and level of breastfeeding knowledge were considered. The respondents who were expecting their first child, were 18–26 years old or had vocational qualifications or moderate breastfeeding knowledge had more negative feelings and were more worried about breastfeeding than respondents who had at least one child, had a higher vocational diploma or academic degree or had high levels of breastfeeding knowledge. Respondents with high levels of breastfeeding knowledge did not appear concerned about equality in feeding.  Conclusions: Both mothers and fathers found breastfeeding important. A father’s eagerness to participate in their newborn's life should be included in prenatal breastfeeding counselling and ways in which to support breastfeeding discussed. Relevant information about breastfeeding should focus on the parents who are expecting their first child, those who are young, those with low levels of education or those who have gaps in breastfeeding knowledge, so that fears and negative views can be resolved.

Introduction A positive childbirth experience promotes women’s health, both during and beyond the perinatal period. Understanding what constitutes a positive childbirth experience is thus critical to providing high-quality maternity care. Currently, there is no clear, inclusive, woman-centered definition of a positive childbirth experience to guide practice, education, and research.

Aim To formulate an inclusive woman-centered definition of a positive childbirth experience.

Methods A six-step process was undertaken: (a) Key concepts associated with a positive childbirth were derived from a rapid literature review; (b) The key concepts were used by interdisciplinary experts in the author group to create a draft definition; (c) The draft definition was presented to clinicians and researchers during a European research meeting on perinatal mental health; (d) The authors integrated the expert feedback to refine the working definition; (e) A revised definition was shared with women from consumer groups in six countries to confirm its face validity; and (f) A final definition was formulated based on the women’s feedback (n = 42).

Results The following definition was formulated: “A positive childbirth experience refers to a woman’s experience of interactions and events directly related to childbirth that made her feel supported, in control, safe, and respected; a positive childbirth can make women feel joy, confident, and/or accomplished and may have short and/or long-term positive impacts on a woman’s psychosocial well-being.”

Conclusions This inclusive, woman-centered definition highlights the importance of provider interactions for facilitating a positive childbirth experience. Feeling supported and having a sense of control, safety, and respect are central tenets. This definition could help to identify and validate positive childbirth experience(s), and to inform practice, education, research, advocacy, and policy-making.

Introduction: Inability to relax and recover is suggested to be a key factor for stress-related health problems. This study aimed to investigate possible effects of mechanical massage and mental training, used either separately or in combination during working hours. Methods: Employees were randomly assigned to one of the following groups: i) Mechanical massage combined with mental training (n = 19), ii) Mechanical massage (n = 19), iii) Mental training (n = 19), iv) Pause (n = 19), v) Control (n = 17). The study lasted for eight weeks. Heart rate, blood pressure and fingertip temperature were measured at start, after four and after eight weeks. Results: Between-group analysis showed that heart rate differed significantly between the groups after 4 weeks (p = 0.020) and tended to differ after eight weeks (p = 0.072), with lowest levels displayed in the massage group and the control group. Blood pressure and fingertip temperature did not differ between the groups. Within-group analysis showed that mechanical massage decreased heart rate (p = 0.038) and blood pressure (systolic p = 0.019, diastolic p = 0.026) and increased fingertip temperature (p = 0.035). Mental training programs reduced heart rate (p = 0.036). Combining the two methods increased diastolic blood pressure (p = 0.028) and decreased fingertip temperature (p = 0.031). The control group had a significant decrease in systolic blood pressure during the first four weeks of the study (p = 0.038) Conclusion: Receiving mechanical massage and listening to mental training programs, either separately or in combination, during working hours had some positive effects on the employees’ heart rate, blood pressure and fingertip temperature. The effects were especially strong for employees who received mechanical massage only.

BACKGROUND:

Working people's reduced ability to recover has been proposed as a key factor behind the increase in stress-related health problems. One not yet evidence-based preventive method designed to help employees keep healthy and be less stressed is an armchair with built-in mechanical massage and mental training programmes, This study aimed to evaluate possible effects on employees' experience of levels of "Anxiety", "Stress Susceptibility", "Detachment" and "Social Desirability" when using mechanical massage and mental training programmes, both separately and in combination, during working hours.

METHODS:

Employees from four different workplaces were randomly assigned to one of the following groups: i) Massage and mental training (sitting in the armchair and receiving mechanical massage while listening to the mental training programmes, n=19), ii) Massage (sitting in the armchair and receiving mechanical massage only, n=19), iii) Mental training (sitting in the armchair and listening to the mental training programmes only, n=19), iv) Pause (sitting in the armchair but not receiving mechanical massage or listening to the mental training programmes, n=19), v) Control (not sitting in the armchair at all, n=17). In order to discover how the employees felt about their own health they were asked to respond to statements from the "Swedish Scale of Personality" (SSP), immediately before the randomisation, after four weeks and after eight weeks (end-of-study).

RESULTS:

There were no significant differences between the five study groups for any of the traits studied ("Somatic Trait Anxiety", "Psychic Trait Anxiety", "Stress Susceptibility", "Detachment" and "Social Desirability") at any of the occasions. However, the massage group showed a significant decrease in the subscale "Somatic Trait Anxiety" (p=0.032), during the entire study period. Significant decreases in the same subscale were also observed in the pause group between start and week eight (p=0.040) as well as between week four and week eight (p=0.049) and also in the control group between the second and third data collection (p=0.014). The massage and mental training group showed a significant decrease in "Stress Susceptibility" between week four and week eight (p=0.022). The pause group showed a significant increase in the subscale "Detachment" (p=0.044).

CONCLUSIONS:

There were no significant differences between the five study groups for any of the traits studied. However, when looking at each individual group separately, positive effects in their levels of "Anxiety", "Stress Susceptibility" and "Detachment" could be seen. Although the results from this pilot study indicate some positive effects, mechanical chair massage and mental training programmes used in order to increase employee's ability to recover, needs to be evaluated further as tools to increase the employees ability to recover.

Background: The Visual Analogue Scale (VAS) is one of the most widely used pain assessment scales in clinical practice and research. However, the VAS is used less frequently in midwifery than in other clinical contexts. The issue of how people interpret the meaning of the VAS endpoints (i.e. no pain and worst imaginable pain) has been discussed. The aim of this study was to explore midwifery students' conceptions of 'worst imaginable pain'. Methods: A sample of 230 midwifery students at seven universities in Sweden responded to an open-ended question: 'What is the worst imaginable pain for you?' This open-ended question is a part of a larger study. Their responses underwent manifest content analysis. Results: Analysis of the midwifery students' responses to the open-ended question revealed five categories with 24 sub-categories. The categories were Overwhelming pain, Condition-related pain, Accidents, Inflicted pain and Psychological suffering. Conclusions: The midwifery students' conceptions of 'worst imaginable pain' are complex, elusive and diverse. © 2014 Australian College of Midwives.

Objectives. The objective of this study was to describe first-time mothers’ experiences and reflections of their first birth. Study Design. This study is a part of a larger study which was carried out in southwestern Sweden in 2008. A qualitative method with content analysis was chosen for this study. The unit of data was 14 written narratives from the first-time mothers. Results. The theme “To be empowered increases first-time mothers’ chances for a positive birth experience” crossed over into all the three categories: “To trust the body and to face the pain,” “Interaction between body and mind in giving birth,” and “Consistency of support.” Conclusion. In order to feel confident in their first childbirth, the women wanted to be confirmed and seen as unique individuals by the professionals and their partner. If professionals responded to the individual woman’s needs of support, the woman more often had a positive birth experience, even if the birth was protracted or with medical complications.

Background: Further research is needed about the women’s experience of support during labor in order for health professionals to respond to a woman’s unique needs.

Aim: To explore first time mothers experience of giving birth as well as professional and social support during labor.

Method: This study was carried out in southwestern Sweden in 2008. A qualitative method with content analysis was chosen for the study. The unit of data is from 14 women’s written narratives.

Results: Results show that the women’s experiences of being involved in decisions and the relationship to professional and social support during their first labor can be conceptualized as one main theme: "Most important for first time mothers’ during labor is to be respected for their needs, to feel involved in the care, and support from their partner". This theme contained three categories: "To be respected for their needs", "To be involved in the care" and "Support from the partner". A safe and calm environment positively influenced the women’s sense of support, and the ability to have her partner physically present positively influenced the sense of support.

Conclusion: When healthcare professionals responded to a woman’s unique needs during labor, the woman felt that the support was based on her as an individual and possibility to being involved in decisions; otherwise a feeling of uncertainty emerged. If the woman’s partner was able to offer support, then it was essential that he was physically present in the room throughout the birth.

Background. Although the World Health Organization recommends exclusive breastfeeding for six months, the rate of breastfeeding has decreased worldwide. Breastfeeding is the natural way of feeding a baby, but it is a process that has to be learnt. It is not unusual for problems to occur and hence support for breastfeeding is vital. The aim of this study was to explore first-time mothers' experiences of the breastfeeding support offered by pediatric nurses, as well as to develop and evaluate the Mother Perceived Support from Professionals (MoPPS) scale. Methods. A qualitative design involving both inductive and deductive approaches was chosen. Nine first-time mothers were interviewed regarding their experiences of the breastfeeding support offered by pediatric nurses. Semistructured interviews were conducted. The mothers were also asked to grade their experiences of breastfeeding support on the MoPPS scale. A qualitative content analysis was applied when analyzing the data obtained using both the inductive (interviews) and deductive (MoPPS scale) approaches. Results. The results revealed that the mothers felt the desire to breastfeed, although they all experienced some difficulties. They wanted the pediatric nurses to be perceptive and provide professional support based on their own experiences. When the pediatric nurses took time and booked extra appointments, the mothers felt supported. The inductive analysis resulted in one theme: When wanting to breastfeed, mothers have a desire to be offered professional breastfeeding support. Two main categories were identified, namely Mothers wanted but lacked breastfeeding support and Mothers received professional support. The deductive analysis of the MoPPS scale showed similar results, and the questions were perceived as relevant to the aim. The mothers considered it important that the pediatric nurses had sufficient knowledge about breastfeeding. It was also considered important that the pediatric nurses involved the mothers' partners in the breastfeeding support. Therefore, we suggest that these areas should be included in the MoPPS scale for pediatric nurses. Conclusions. The MoPPS scale can be a useful tool for helping pediatric nurses to offer mothers professional breastfeeding support. Indeed, when offering breastfeeding support, pediatric nurses can use the items included on the MoPPS scale as guidance.

Background: Nursing as a profession exhibits high levels of work-related stress and psychosocial disorders. Daily, nurses face job-related ethical challenges, high job stress and risk of burnout. Emotional distress, lack of support from the employer, bad working and employment conditions contribute to illness and sickness. To retain nurses and to reduce negative trends of stress-related psychosocial disorders, it is important to explore nurses’ experiences on work-related health.

Purpose of study: To explore nurses’ experiences of work-related health in Swedish context.

Methods/Theory: A qualitative study design. 13 in-depth interviews with nurses were analyzed with qualitative content analysis applying an inductive approach.

Findings: As the main category, we identified “Nurses’ health and job satisfaction are affected by the quality of organizational and collegial support and the opportunities that facilitate recovery, health and the care”. Four generic categories were found; 1) “Work environment and organizational support as reasons for reduced recovery”; 2) “Competence opportunities, supervision and time for reflection for health and job satisfaction”; 3) “Work variation, collegial support, and feedback from patients for better health and care”; and 4) “Social network and physical activities for better recovery”.

Registered nurses and midwives are in short supply and have among the highest rates of sick leave in the global workforce. The aim of this study was therefore to explore and gain a deeper understanding of how nurses and midwives experience their everyday work, with a view toward promoting and sustaining their work-related health. Nine registered nurses and four registered midwives working in hospitals and community healthcare facilities in Sweden were interviewed. The interviews were analyzed using content analysis. This study is reported in accordance with COREQ. One main category emerged: ‘Quality of organizational and collegial support and opportunities to facilitate recovery, health, and patient care’. From this category, four generic categories describing the overall experiences of registered nurses and midwives could be discerned. Based on these results, it is recommended that employers adopt a systematic health-promotive approach to foster and maintain the workplace health of registered nurses and midwives.

Background

Sense of coherence (SOC) is a core concept of salutogenesis which relates to individuals’ overall life orientation. Stronger SOC associates with better coping strategies, better health, and better quality of life. Although the SOC-questionnaire is validated in many cultures and languages, it has not, to date, been applied in Nepal.

Objective

To determine and evaluate women’s SOC before and after a health education intervention.

Method

This study was conducted as a part of the Heart-health Associated Research, Dissemination, and Intervention in the Community in the semi-urban Jhaukhel-Duwakot Health Demographic Surveillance Site in Nepal. Jhaukhel and Duwakot were selected as the control and intervention areas, respectively. Participants were women with children aged 1-7 years. Eight hundred and fifty-seven women before and 1,268 women after the health education intervention participated in the study. The statistical analysis was carried out with chi-square tests and one-way uni-variate ANOVA.

Result

Women’s total SOC mean values at baseline were 51.1-57.4 and at follow up 54.4-54.9 in the intervention and control area, respectively. At baseline, SOC was significantly weaker in the intervention area compared to the control area (p < 0.001). At follow-up three months later, SOC was significantly stronger in the intervention area than in the control area (p < 0.001).

Conclusion

Nepalese women had weaker SOC than women in high-income countries, but comparable to neighboring country India with similar cultural features. Empowerment of women through community participation and health education strengthened SOC. The SOC-13-questionnaire in its Nepali version is recommended to be further evaluated.

Background

Sense of coherence (SOC) is a core concept of salutogenesis which relates to individuals’ overall life orientation. Stronger SOC associates with better coping strategies, better health, and better quality of life. Although the SOC-questionnaire is validated in many cultures and languages, it has not, to date, been applied in Nepal.

Objective 

To determine and evaluate women’s SOC before and after a health education intervention. 

Method

This study was conducted as a part of the Heart-health Associated Research, Dissemination, and Intervention in the Community in the semi-urban Jhaukhel-Duwakot Health Demographic Surveillance Site in Nepal. Jhaukhel and Duwakot were selected as the control and intervention areas, respectively. Participants were women with children aged 1–7 years. 857 women before and 1,268 women after the health education intervention participated in the study. The statistical analysis was carried out with chi-square tests and one-way uni-variate ANOVA.

Results

Women’s total SOC mean values at baseline were 51.1-57.4 and at follow up 54.4-54.9 in the intervention and control area, respectively. At baseline, SOC was significantly weaker in the intervention area compared to the control area (p < 0.001). At follow-up three months later, SOC was significantly stronger in the intervention area than in the control area (p < 0.001).

Conclusion

Nepalese women had weaker SOC than women in high-income countries, but comparable to neighboring country India with similar cultural features. Empowerment of women through community participation and health education strengthened SOC. The SOC-13-questionnaire in its Nepali version is recommended to be further evaluated.

Biography: I am a Registered Nurse (RN) and Public Health Nurse in Sweden. My research interest started during my nursing studies and it became reality when I got enrolled as a PhD-student since the end of 2016 at Jönköping University, Skövde. I am part-time lecturer in the University of Skövde, Sweden and teach mostly nursing students. My research is about health resources and job-demands in women-dominated work, presented as examples from two cultural context from Nepal and Sweden. This research is a part of my doctoral studies where four research will be included.

Background

Nursing professionals exhibit high prevalence of stress-related health problems. Job demands and job resources are parallel drivers of health and well-being among employees. Better job resources associate with better job satisfaction, job motivation and engagement even when job demands are high. To date, there is limited research which explores the association between job demands, job resources and health outcomes among nursing professionals in the Swedish context. The aim of this study was therefore to investigate Swedish nursing professionals’ job demands and job resources in relation to health outcomes, with comparisons between the private and public healthcare sectors. The specific research questions were as follows: (1) Are there differences between private and public healthcare regarding job demands, job resources, and health outcomes? and (2) Are there prospective associations between job demands and job resources in relation to health outcomes?

Methods

Data were drawn from the Swedish Longitudinal Occupational Survey of Health (SLOSH) 2016 and 2018, including 520 nurses and 544 assistant nurses working in the private and public healthcare sectors from 2016 (baseline). Data were analyzed using binary logistic regression.

Results

Nursing professionals reported higher threats, lower bullying, lower control, lower social support, and lower cohesion in the public healthcare units compared to the private healthcare units. The prospective analyses showed that job resources in terms of social support and rewards were associated with higher self-rated health and lower burnout. Cohesion was associated with higher self-rated health. Job demands in terms of psychological demands and job efforts were associated with lower self-rated health, higher burnout, and higher sickness absence, while emotional demands were associated with higher burnout.

Conclusions

Nursing professionals’ job resources are deficient in public healthcare units. Job resources are associated with positive health outcomes, whereas job demands are associated with negative health outcomes, among nursing professionals. Strengthening job resources among nursing professionals in the private and public healthcare sectors can promote and sustain their work-related health.

Background

Sense of Coherence (SOC) relates to an individual’s overall life orientation, and stronger SOC is associated with better health, quality of life, and coping strategies. When our research group used the SOC-13 questionnaire for the first time in Nepal, we identified difficulties in response patterns. The findings necessitated further evaluation of the Nepali version of the SOC-13 questionnaire.

Objective

To qualitatively evaluate the SOC-13 questionnaire in Nepali for cross-cultural adaptation.

Method

Nineteen nurses were interviewed. We used the methodological approach of “think aloud” to obtain a deeper understanding of the interferences of the scales. Transcribed materials were analyzed using a deductive approach through qualitative content analysis. The original translated version of the SOC-13 questionnaire in Nepali was modified by replacing words that were easier to understand.

Result

Participants found the questionnaire content general and non-specific but easy to complete. The nurses experienced that the meanings and sentences in some of the items and response alternatives were difficult to understand. However, the overall comprehensiveness of most items and response alternatives was perceived as good. Nurses’ interpretation of the SOC-items in the translated version of the SOC-13 questionnaire in Nepali matched the original English version. Items that were experienced as difficult in the Nepali language were modified to increase their comprehensiveness. Modified items and response alternatives had the same content as before, but some words and meanings were substituted with easier language.

Conclusion

The current revised version of SOC-13 in Nepali is valid and useful to explore individuals’ overall life orientation and their abilities to deal and cope with various life events in the Nepalese context.

Background

Work-related health problems, such as work stress, fatigue, and burnout constitute a global challenge within the nursing profession. Work-related health among nurses is not yet a prioritized phenomenon in Nepal. Health-promoting approaches to maintaining and sustaining nurses’ health are therefore essential. The aim of this study was to explore and thereby gain a deeper understanding of how nurses in Nepal’s hospitals experience their everyday work, with a focus on promoting and sustaining their work-related health.

Methods

A qualitative design with semi-structured individual interviews were used. Nineteen registered nurses working at hospitals in Kathmandu Valley, Nepal, were individually interviewed between October 6 and December 5, 2018. Transcribed interviews were analyzed through thematic analysis.

Results

Four main themes with belonging eight subthemes were constructed from the analysis: (1) “Sense of meaningfulness and belongingness in work culture” with subthemes; “Open environment” and “Sharing attitude and cooperating for the entire team” (2) “Support and rewards from the management team” with subthemes; “Lacking managerial support” and “Fair evaluation and job promotion opportunities”(3) “Workload and protection against work-related hazards” with subthemes; “Stressful and multitasking in workload” and “Lacking equipment for own health and caring”, and (4) “Motivation through opportunities and activities” with subthemes; “Employment benefits that motivate work”, and “Activities outside of work needed to recover”. These main themes and subthemes described nurses’ facilitators for and barriers to their work environment and health.

Conclusion

Our study highlighted nurses’ experiences with facilitators and barriers to their work-related health. Nurses’ work-related health was positively affected by support from colleagues, managers, and the organization. Conversely, less support from managers, lack of equipment, and unfair judgment were barriers to nurses’ work-related health. This study adds new knowledge about nurses’ work-related health from the context of Nepal. Hospital organizations and nursing managers in similar cultural and healthcare settings can apply the results of our study to develop strategies to promote and sustain nurses’ health and prevent work-related illness.

Background

Stronger Sense of Coherence (SOC) associates with better health, quality of life, and coping strategies. We translated and applied the SOC-13 questionnaire for the first time in Nepal. In this process we identified difficulties in response patterns. The findings necessitated further evaluation of the Nepali version of the questionnaire.

Purpose of the study

To qualitatively evaluate the SOC-13 questionnaire in Nepali for cross-cultural adaptation.

Methods and Theory

Nineteen registered nurses from Nepal were asked to respond to the SOC-13 questionnaire in Nepalese, in order to receive their thoughts and understanding of SOC-13, inspired by the “think-aloud” method. Transcribed materials were analyzed using a deductive approach through qualitative content analysis.

Findings

Participants described the questionnaire content as general and non-specific but easy to complete. The overall comprehensiveness and response alternatives were perceived as good, even if there were some items and response alternatives that were difficult to understand according to the nurses. Nurses’ interpretation of the SOC items in the translated version of the SOC-13 questionnaire in Nepali matched the original English version. Items that were experienced as difficult in the Nepali language were modified to increase their comprehensiveness by substituting with easier language.

Conclusion

The current revised version of the SOC-13 questionnaire in Nepali is valid and useful to explore individuals’ overall life orientation and their abilities to deal with and cope with various life events in the Nepalese context.