Högskolan i Skövde

Introduction: Oral health is multi-faceted and influences a person’s daily life, and numerous potential barriers and factors can challenge and pose barriers to good oral health. Shortages of healthcare professionals or incorrect care practices can be barriers to performing good oral healthcare. A knowledge gap has been identified in qualitative research on description of healthcare professionals’ experiences of oral healthcare among older adults in municipal healthcare.

Aim: To describe healthcare professionals’ experiences of oral healthcare among older adults in Swedish municipal healthcare.

Design and methods: The study employed a qualitative design guided by a secondary qualitative analysis method comprising inductive qualitative content analysis. Data were collected through semi-structured individual interviews with healthcare professionals.

Results: Good relationships and mutual trust create the conditions for delivering good oral healthcare. Knowledge provides confidence and trust in performing oral healthcare, experiences and strategies influence the individual adaptation of oral healthcare, and priorities and collaboration influence oral healthcare provision.

Conclusion and implications: The performance of oral healthcare is complex and cannot be achieved without establishing a relationship with the older adult who needs care. Oral healthcare includes prerequisites such as routines, sufficient time, work-time planning, and collaboration between healthcare professionals. Registered nurses positively experience opportunities to collaborate with other healthcare professionals regarding oral healthcare and are seen as leaders in the Fundamentals of Care and are sharing good examples of oral healthcare in palliative care.

Background: Community-based nursing today faces significant challenges regarding the future supply of healthcare professionals such as registered nurses. This may be due to numerous challenges, such as registered nurses being principally responsible for coordinating care and aligning with the transition to integrated person-centred care, which affects the work environment in community-based nursing. The work environment also affects career advancement prospects, personal motivations, and the desire to make a meaningful contribution to the quality of care. It is, therefore, essential to shed light on registered nurses’ experiences of their working situation within community-based nursing to identify factors that can create a better working situation.

Aim: To describe registered nurses’ experiences of the work situation in Swedish community-based nursing.

Method: The study employed a mixed-methods design. Data were collected through (a) a quantitative sample and (b) a qualitative sample of free-text answers to open-ended questions in the questionnaire. The quantitative material was analysed through descriptive statistics, and the qualitative material was analysed with deductive direct content analysis based on the Fundamental of Care framework’s three dimensions.

Results: The overall experience in community-based nursing was that the registered nurse’s work situation within community-based nursing is influenced by factors such as lack of time and understaffing. Lack of time and understaffing affect the possibilities of creating a caring relationship, the integration of care and the context of care.

Conclusion: Registered nurses’ work situation within community-based nursing is influenced by factors such as lack of time and understaffing. Lack of time and understaffing affect the possibilities of creating a caring relationship with both the person being cared for and their next of kin. In comparison with continuity, good personal knowledge and presence are promoting factors to good caring relationships. The establishment of a care relationship, satisfying basic care and creating organisational conditions take place in collaboration and are the foundations for being able to work person-centred, which also are elements described in the Fundamental of Care framework.

Introduction: In ambulance services, personnel often work together in teams. There are two personnel in ambulances, at least one of whom is a registered nurse. Besides leading nursing work, the registered nurse should be able to lead and work in teams. The registered nurse develops an intuitive approach through work experience, enabling them to act without analysing their actions.

Aim: This study illuminates registered nurses’ perceptions of factors affecting teamwork and solo work in ambulance care.

Method: The sample consisted of ten registered nurses from ambulance stations in western Sweden. Semi-structured individual interviews were analysed using qualitative content analysis, according to Graneheim and Lundman (2004).

Results: Ambulance healthcare nurses emphasise continuous teamwork, where clear roles and effective communication are key. Team continuity fosters trust among colleagues for a safer work environment. Striking a balance between new and experienced staff is crucial. Experience and reflection are vital for building professional knowledge, instilling confidence, and fostering an intuitive approach.

Conclusion: Secure teamwork and solo work require experience, continuity, distinct roles, communication, and reflection.

Oral health care is essential, and digital training may influence healthcare professionals’ attitudes to and knowledge of oral health. The aim, therefore, was to evaluate the impact on attitudes to and knowledge of oral health after using a digital training module among Swedish healthcare professionals working within a municipality-run healthcare service for older adults. A secondary aim was to explore the healthcare professionals’ experiences of using the digital module. The study comprised a survey of healthcare professionals (registered nurses (RNs), assistant nurses, and care assistants) caring for older adults in a municipality in Sweden. Pre-post-tests were conducted to evaluate the outcomes for attitudes to and knowledge of oral health and of their experiences of completing the digital training module in oral health. These were statistically explored by comparing differences between the pre-post-tests, while the open-ended questions were analysed with qualitative content analysis. The findings of this study indicate that healthcare professionals had similar perceptions of their attitudes to and knowledge of oral health both before and after the digital training module in oral health. The study also indicates that healthcare professionals experienced that it is easier to perform practical oral health care after completing the digital training. The results also show that healthcare professionals value oral health knowledge and that the digital training module was easy to use and to disseminate knowledge throughout the municipality. The findings have implications for developing, implementing, and promoting healthcare professionals’ attitudes to and knowledge of oral health and in using a digital training module in combination with practical exercises in oral health in municipality health care.

Bakgrund: Det är känt att äldre personer har bättre munhälsa i dag och fler kvarvarande tänder än tidigare generationer. Det är en komplex uppgift att utföra munvård för att förebygga nedsatt munhälsa på någon annan. Nedsatt munhälsa kan påverka allmänhälsan på olika sätt, till exempel genom smärta och nedsatt aptit. Nedsatt munhälsa kan också vara en bidragande orsak till infektioner lokalt i munnen, men även i andra delar av kroppen. Det har dock visat sig att vårdpersonal (sjuksköterskor, undersköterskor och vårdbiträden) inom kommunal äldreomsorg försummar utförandet av munvård hos äldre personer av olika skäl, däribland tidsbrist, okunskap och bristande rutiner. Vårdpersonal värdesätter kunskap om munhälsa och efterfrågar utbildning om munhälsa och munvård. Kompetensutveckling för vårdpersonal tar tid samtidigt som den digitala utvecklingen och tillgången till digitala tjänster ökar. Digital utbildning kan vara en lösning till att sprida kunskap i en hel arbetsgrupp. Studier har visat på stort värde av möjligheten till interaktivitet, repetition och feedback som tydligt förknippas med ett ökat lärande vid användande av digitala utbildningar. Studier visar även att vårdpersonal som kompetensutvecklas genom utbildning om munhälsa tillhandahåller bättre munvård till äldre personer efter utbildning.

Syfte: Det övergripande syftet var att studera äldre personers uppfattning om munhälsa och vårdpersonals attityder till och kunskaper om omvårdnad relaterat till munhälsa. Ytterligare ett syfte var att beskriva vårdpersonals attityder och kunskaper före och efter en digital utbildning i munhälsa och användbarheten av denna.

Metod: Avhandlingen inkluderar fyra delstudier varav två har en kvalitativ design, delstudie I och IV, en med kvantitativ design, delstudie II och en med mixad metod, delstudie III. Delstudie I inkluderar äldre personer och delstudie II-IV inkluderar vårdpersonal. Data har samlats in med hjälp av frågeformulär, individuella intervjuer och fokusgruppsintervjuer. Kvalitativ analys genomfördes med hjälp av kvalitativ innehållsanalys i delstudie I och IV. Kvantitativa analyser genomfördes med Psykometrisk utvärdering med klassisk testteori (CTT) kompletterad med Item Response Theory (IRT) i delstudie II och beskrivande statistik och Wilcoxon signed-rank test i delstudie III.

Resultat: Resultaten visar att det är komplext att utföra munvård på någon annan och kräver att tid ges till att bygga personkännedom mellan vårdpersonalen och den äldre personen som får hjälp med munvård. Personkännedom beskrivs av vårdpersonal främja och ge trygghet i utförandet av munvård. Äldre personer beskriver att de är experter på sina egna upplevelser av munhälsan och att denna kunskap behöver delas med vårdpersonalen. Personkännedom etableras och uppnås genom att vårdpersonalen skapar förtroende, är närvarande, förutser behov, är pålästa och genom att reflektera över vården. Det är ett förtroende att utföra munvård på någon annan, vilket underlättas av personkännedom. Det ger vårdpersonalen information och bättre förutsättningarna att utföra god munvård och att synliggöra hinder som tids-, personal- och kunskapsbrist. Äldre personer värdesätter en god munhälsa och vårdpersonalen värdesätter kunskap relaterad till munhälsa. Ett sätt att sprida kunskap om munhälsa bland vårdpersonalen är genom digitala utbildningsinterventioner. Kombinationen av teoretisk kunskap med hjälp av digital utbildning och praktiska övningar beskrivs av vårdpersonalen som ett sätt att ge både teoretisk och praktisk kunskap. Att arbeta tillsammans över professionsgränser i omvårdnad kring munvården beskrivs ofta brista inom kommunal äldreomsorg. Arbetet tillsammans upplevs dock fungera bra vid palliativ omvårdnad. Äldre personer beskriver en önskan om hjälp med sin munhälsa när behov uppstår.

Slutsatser: Äldre personer värdesätter en god munhälsa och vårdpersonalen värdesätter kunskap relaterad till munhälsa. Munvård är komplex och förutsätter att vårdpersonalen erhåller kunskap, rutiner, tid och samarbetar för att utföra den med god personkännedom om den äldre person. Digital utbildning är ett sätt att öka kunskapen om munhälsa bland vårdpersonalen. En kombination av teori med hjälp av digital utbildning och praktiska övningar bidrar till både teoretisk och praktisk kunskap. Samarbetet kring munvård mellan sjuksköterskor, undersköterskor och vårdbiträden fungerade inte alltid optimalt, däremot fungerade samarbetet bra vid palliativ omvårdnad. Samarbete, tid och kunskap samt reflektion anses vara viktiga faktorer för vårdverksamheter att beakta i framtiden för att god munvård ska kunna utföras inom kommunal äldreomsorg.

The increasing proportion of older adults (persons aged 65 years or older) in society who have their own teeth and advanced dental restorations contributes to new challenges for healthcare professionals in municipality healthcare, such as registered nurses, assistant nurses and care assistants. It has been shown that oral health care is often overlooked when the need for care and nursing increases. Good oral health is a fundamental human right, and poor oral health is not part of normal ageing but is an effect of several factors, such as impaired motor skills, changes in diet, disease, medical treatments, drugs, or reduced saliva secretion. Traditionally, oral health has been defined as the absence of disease and has not taken into consideration a person’s own values, perceptions and disabilities. The World Dental Federation (FDI) has developed a definition of oral health to create a broader understanding of what oral health includes. The FDI definition of oral health includes physical and mental aspects and objective and subjective experiences of oral health. The FDI defines oral health as being: “multi-faceted and includes the ability to speak, smile, smell, taste, touch, chew, swallow and convey emotions through facial expressions with confidence and without pain, discomfort and facial disease”.

The Fundamentals of Care (FoC) framework is defined as care actions performed by healthcare professionals that respect and focus on a person’s basic needs to ensure their physical and psychosocial well-being, regardless of illness, disease or the environment in which the healthcare is provided. These needs, such as oral health care, are met by developing a positive and trusting relationship with the person being cared for and their family/carers. The care relationship is a dynamic process that includes good knowledge of interpersonal communication among health professionals. The care relationship and the holistic approach to healthcare are central to FoC.

The framework includes three dimensions: (1) Relationship, which includes establishing a relationship; (2) Integration of care, where the basic physical, psychosocial, and relational care needs are identified and met and where a continued care relationship is central; and (3) the context of care, which includes the organisation and policies that include laws, regulations, human resources, and cultural and economic conditions to provide person-centred care. Healthcare related to oral health is included under the physical dimension, which encompasses nursing needs, personal hygiene and dressing. Performing FoC related to oral health on someone else is not an easy task, as it can be perceived as a violation of privacy. Studies show that healthcare professionals neglect oral health and oral care in older people for various reasons, such as lack of time, knowledge, procedures and responsibility, as oral care is perceived as unpleasant to perform and shown to be of low priority. However, healthcare professionals are eager to develop this knowledge and training in their practices of oral healthcare. Skills development for healthcare professionals can be challenging to implement, and often only a few are trained in oral health care, and it can be challenging to disseminate such knowledge throughout a workgroup. Rapid technological development in society stimulates an increased implementation of digitalisation and the use of digital forms of education. Digital training can be easily accessible and flexible in terms of time and place. Interactivity, practical exercises, repetition and feedback are associated with increased learning in digital education. Hence, there is a need to study oral health and oral healthcare in Swedish municipality care for older adults based on the experiences of older adults and healthcare professionals.

The overall aim was to study older adults’ perceptions of oral health and healthcare professionals’ attitudes towards and knowledge of FoC related to oral health. Another aim was to describe the attitudes and knowledge of the healthcare professionals’ before and after digital training modules in oral health and the usefulness of this.

The thesis includes four sub-studies, two of which adopted a qualitative design (I and IV), one sub-study adopted a quantitative design (II), and one sub-study used a mixed method design (III). The data were collected using questionnaires as well as individual and focus group interviews. Qualitative analysis was conducted using qualitative content analysis (I, III and IV). Quantitative analyses were performed using psychometric evaluation with classical test theory (CTT) supplemented with item response theory (IRT) (II), descriptive statistics, and Wilcoxon signed-rank test (III).

The findings highlight the importance of nursing care related to oral health, how it promotes general health and how it can lead to more independent living for older adults. The results also highlight the importance of healthcare professionals’ attitudes to and knowledge of oral health and its role in achieving good oral health for older adults. The main results from the studies highlight an often forgotten but essential aspect of municipal health care related to oral health. The results describe oral healthcare and how it must be emphasised, visible, and perceived as complex healthcare.

Healthcare professionals describe obstacles to oral healthcare, such as time and staff shortages and lack of knowledge. Healthcare professionals, however, experienced fewer obstacles to performing oral care after a digital training module in oral health. Older adults also describe the importance of receiving help and support with oral healthcare when the need for help arises. Having personal knowledge of the older adult and establishing a good relationship between healthcare professionals and older adults presents opportunities for providing good oral healthcare. Older adults and healthcare professionals describe that having personal knowledge promotes and gives confidence in the performance of oral health care. Older adults describe that they are experts in their experience and that this knowledge needs to be shared with the healthcare professional. Care relationships are established and achieved by healthcare professionals by creating trust, being present, anticipating needs, being informed and reflecting/evaluating healthcare. Healthcare professionals describe that performing oral healthcare on someone else is a trust facilitated by personal knowledge about the older adult. Getting to know someone can take time, but this creates a sense of security for the older adult and the health care professional. Older adults also describe the importance of healthcare professionals’ knowledge when performing oral healthcare. After a digital training module, the healthcare professionals felt less nervous about performing oral healthcare. Previous research has also described that providing oral health training or education can significantly improve oral health among older adults, including a lack of visible plaque and no detectable denture stomatitis.

Older adults and healthcare professionals describe the importance of receiving/performing oral healthcare to prevent oral health problems. Healthcare professionals highly value knowledge about oral health and see rinsing the mouth as part of performing oral healthcare. Older adults and health professionals describe oral health, general health, and well-being as being connected. By evaluating healthcare professionals’ attitudes to and knowledge of oral health, healthcare’s physical, psychosocial and relational aspects can be integrated. A supportive care context, including organisational culture, resources and evaluation of the care provided, such as nursing care related to oral health, can be facilitated by meeting educational needs, establishing routines, appropriate work scheduling and registered nurse interaction in the team to develop and promote safe healthcare.

Conclusions can be drawn that oral healthcare is complex and requires, knowledge, personal knowledge, and sufficient time to be performed. Older adults value good oral health and oral healthcare. Healthcare professionals value knowledge related to oral health and oral healthcare. One way to increase knowledge about oral health among healthcare professionals is through a digital training module. Combining theory with the help of digital training and practical exercises contributes to theoretical and practical knowledge of oral health care. Good examples of collaboration and organisation around oral health and oral healthcare are seen in palliative care, which should be broadened and applied to other healthcare areas.

People with impaired hearing or deafness often perceive communication barriers when and participating in their daily lives, such as when contacting primary healthcare, leading to a risk of them using emergency services for less urgent conditions. Therefore, the aim of the present study was to describe the perceptions of individuals with hearing impairments and deafness in relation to the treatment and communication they received from primary healthcare professionals. The study employed a mixed-methods design, and the data comprised questionnaire responses from 101 individuals with hearing impairments or deafness, including 11 open-ended questions, analyzed with conventional content analysis. The study was evaluated using the COREQ checklist and the GRAMMS guidelines to further improve the transparency of the research. The results indicate that healthcare professionals who are responsive, considerate, and respectful regarding communication were perceived among people with hearing impairments or deafness to be professionals. The ideal healthcare encounter for people with hearing impairments or deafness would be where the healthcare professionals could perform sign language, which would allow the healthcare professional to communicate freely. Healthcare professionals need more knowledge about how they can best meet, care for, and communicate with individuals with hearing impairments or deafness.

Oral health is a complex issue associated with social and behavioral factors and general health. Therefore, this study aims to explore Swedish older adults’ perceptions of oral health and its influence on general health, based on the World Dental Federation's (FDI) definition and framework of oral health. The study adopted a descriptive qualitative design. Data were collected from semi-structured individual and focus group interviews with older adults (n = 23) and were analyzed with deductive direct content analysis. The study was evaluated using the COnsolidated criteria for REporting Qualitative research (COREQ) checklist. The older adults described the importance of good oral health in the physical, social, emotional, and mental aspects of their daily lives. The findings also indicate that older adults described oral health as multifaceted and agreed with the FDI's definition and framework of oral health. Therefore, the study findings might provide healthcare professionals with new knowledge and further insight into older adults’ perceptions of oral health and its influence on their well-being and general health. 

BackgroundHealthcare professionals’ attitudes to and knowledge of oral health are fundamental to providing good oral health care to older adults. One instrument that assesses healthcare professionals’ attitudes to and knowledge of oral health in a Swedish context is the “Attitudes to and Knowledge of Oral health” (AKO) questionnaire. Two of the three item-groups of the AKO have previously been validated in a Swedish context. However, it is crucial that all three item-groups are validated, and beneficial to design a shorter, easy-to-use questionnaire for healthcare professionals while maintaining adequate integrity of its reliability and validity. Therefore, the present study aims to develop a short-form version of AKO and to secure its psychometric properties.

MethodsPsychometric evaluation with Classical Test Theory and Item Response Theory to validate and shorten AKO with 611 healthcare professionals from a population of 1159 working in a municipality in an urban area in western Sweden.

ResultsOf the original 16 items in the AKO, 13 were shown to warrant retention in the abbreviated/shortened form. These showed acceptable validity and reliability for assessing healthcare professionals’ attitudes to and knowledge of oral health.

ConclusionThis validated short-form version of AKO shows acceptable validity and reliability after being reduced to 13 items, structured in a 3-part scale. The items are consistent with the total scale, indicating that the internal consistency is acceptable. Future studies should be performed to evaluate AKO in other groups of healthcare professionals, across cultures, languages, and so on, to investigate its use and strengthen its validity and reliability.

The aim of the study is to describe disability among younger stroke patients by analyzing activity and participation and the environmental aspect as well as to compare assessed and self-perceived problems after stroke. International Classification of Functioning and Health (ICF) is a tool that provides a scientific basis for understanding and studying health and health-related states. ICF core sets have been developed to increase the usefulness of ICF in everyday practice and were gathered for 71 younger persons with stroke by interviews. Self-perceived problems were assessed with the Stroke Impact Scale. The data are presented by their most common categories in activity and participation and environmental factors. The ICF core sets and the SIS identified different things as being the most difficult. The problems that are most obvious in an assessment are activity and participation and the environmental factors are more difficult to assess. The study shows that there are broad spectra of problems among younger stroke patients mainly identified in the area of activity and participation. Assessed and perceived problems are not always the same, which is of clinical importance.