This study aims to explore experiences of healthcare professionals, including midwives, obstetricians, and assistant nurses, after a perinatal death. A qualitative study design was used, and 20 participants were interviewed. Data were analyzed using content analysis. Three categories emerged from the data: (i) external responses, (ii) internal responses, and (iii) personal responses. Generally, there was a “culture of blame” in response to the perinatal death among the professionals. The lack of opportunity to deal with perinatal death and having an inappropriate way to handle feelings and experiences are the important findings of this study. If not well supported, the concerned healthcare professionals may face serious health challenges in the long term. Hence, supportive interventions need to be designed and evaluated to provide adequate support to the concerned professionals.

AIMPerinatal death is often regarded as a critical incident for the healthcare personnel involved. How healthcare personnel respond to traumatic events in their work is a function of their level of awareness or exposure to the incident, as well as their genuine expectations, support, and trust. The aim of this study was to explore coping strategies of Norwegian healthcare professionals including midwifes, obstetricians, and assistant nurses when faced with perinatal death in a clinical setting.METHODMidwives, obstetricians, and assistant nurses in two public hospitals in Norway participated in an in-depth and semi-structured interview. The data was analyzed using Kvale's approach, which involves condensing and thematic analysis.FINDINGSThe results are divided into three categories with eight subcategories. Having the support of one's colleagues was described as an important factor for coping with these situations. Both immediate support in the situation and talking about their feelings later with colleagues were found to be important. Discussing and sharing responsibility were also mentioned.CONCLUSIONInformants in this study stated that talking with one another about the challenges they faced in these situations was important. Appropriate education and training programs, together with healthy coping and debriefing strategies must be implemented in maternity units.

Kristen Ringdal1, Gerd Inger Ringdal2, Helene Kristin Olsen3, Asgeir Mamen3, Per Morten Fredriksen3 1 Department of Sociology and Political Science, Norwegian University of Science and Technology (NTNU), Trondheim, Norway 2 Department of Psychology, Norwegian University of Science and Technology (NTNU), Trondheim, Norway 3 Kristiania University College Department of Health Sciences, Oslo, Norway.

Aims: An increasing number of people in Europe are living with cancer, either as an active disease or as a past experience. Depressive symptoms may impair quality of life in cancer patients and may constitute increased risks for disability, as well as being a risk factor for increased mortality. Our study compared self-reported symptoms of depression in people who currently or previously have experienced cancer with self-reported symptoms of depression in the general population. Methods: Our study was based on data from the European Social Survey 2014, with representative samples from 19 countries. Depression was measured by an eight-item CES-D Scale, with a cut-point of a mean score of 2 to indicate depression. Multilevel modelling was used to examine the relationship between cancer status and depression. Results: Respondents who at the time of the interview reported to have cancer were more likely to report symptoms above the cut-point on the depression scale than people who never had experienced cancer (unadjusted odds ratio (ORunadjusted)=2.59; 95% confidence interval (CI) 2.20–3.06; and ORadjusted=2.00; 95% CI 1.70–2.36). The difference was smaller comparing people who previously had experienced cancer to people who never had experienced cancer (ORunadjusted=1.46; 95% CI 1.19–1.79; and ORadjusted=1.28; 95% CI 1.05–1.55). The differences in depression by cancer status did not vary among the welfare state regimes. Conclusions: Respondents with a cancer disease showed a substantial elevated risk of depression after adjusting for a range of potential confounders. Respondents who had recovered also showed significantly higher adjusted risk of depression than respondents who had never experienced cancer.

Background An increasing number of people in Europe are living with cancer, either as an active disease or as a past experience. The experience with a life threatening disease may be expected to have a deteriorating effect on mental health and well-being. Our study compared self-reported symptoms of depression in people who currently or previously have experienced cancer with self-reported symptoms of …

Background: Health care personnel's experiences of grief and painful emotional involvements in situations facing perinatal death has attracted woefully little research and attention. In order to provide high standards of care for patients and their families, health care personnel needs to express their emotions in these situations in an adequate way. Aim: The main aim was to explore how midwives, obstetricians and nurses experience perinatal death and what characterize these experiences. Methods: This review study was designed through systematic examination methods to detect articles in English and Scandinavian language that describe midwifes', obstetricians' and nurses' experiences with perinatal death and factors that characterize these experiences. Only ten articles met these inclusion criteria. A qualitative method was used to describe and comprehend the phenomena. Results: The following categories emerged from the data: (1) emotional implications, (2) change in culture, (3) education and training, (4) hierarchical issues, (5) support and learning from others. Emotional implications when facing perinatal death were reported in all the ten articles. Conclusions: This study revealed that withdrawal from the situation and denial were common reactions to perinatal death among health care personnel. These reactions may lead to a lower quality of care for the bereaved parents. Findings in this study indicate that the problem is related to culture and to accept this as a problem and challenge. Emotional reactions among health care personnel to perinatal death must be fully acknowledged and normalized.

Objective: The aim of the study is to explore what characterizes the work culture in Norwegian nursing homes and what promotes the positive aspects in the work culture. Methods: Research design: Multimethod research. Two surveys (N = 105) and interviews with 11 informants at three Norwegian nursing homes were conducted. We included the questionnaires: The Systematizing Person-Group Relations, that seek to explore which aspects dominate the particular work environment identifying challenges, limitations and opportunities and The Sense of Coherence (SoC) that was used as an indicator for overall quality of working life with a salutogenic orientation. The data were analyzed using independent samples student’s t-test and factor analyses, the material from the interviews was systemized and worked through using well known analytical methods. Results: The results showed that the informants feel more meaning, manageability and comprehensibility in their work environment, when they are engaged and focused on goal orientation. In the interviews the informants expressed engagement related to their work environment and to patients and colleagues. They mentioned that being a team and working together was positive for their perception of their work environment. A positive work culture was characterized by solution orientation and the experiences of better opportunity to “attend to the patients in a good way”. Conclusions: It seems like healthcare workers as individuals has both a positive attitude and ways to express this in the work culture, such as humor and positive thinking. But the work culture itself seems to create some negative issues.

Background:This study is a comparison of quality of life (QOL) of current and previous cancer victims with people who never had experienced cancer in samples from the general population from the 19 countries in the European Social Survey (ESS) 2014.Methods:The study was based on the ESS 2014 with representative samples from 19 countries. QOL was measured by combining two questions on happiness and life satisfaction into a QOL scale. Multilevel modelling was used to examine whether the relationship between cancer status and QOL varies between countries in general and by welfare state regimes in particular.Results:People with cancer at the time of the interview, showed lower general QOL than both people who previously have had cancer and people who never have experienced cancer. The unadjusted and the adjusted odds ratios (ORs) for poor QOL were respectively, OR = 2.38, (2.07, 2.74) and OR = 1.98, (1.71, 2.30). The difference between the ‘Never’ and the ‘Previously’ groups was minor but statistical significant. The welfare state classification was a strong predictor of country differences in QOL, but there was no significant statistical interaction effect between cancer status and the welfare state classification. The study also replicated well-documented findings on differences in QOL by education and social support.Conclusion:The QOL of people with a cancer disease is significantly impaired. People who previously have had cancer, scored only slightly lower on the QOL scale than people who never had experienced cancer. We found evidence indicating that these differences may vary between the countries, but this variation cannot be explained by the welfare state classification.

War experiences may have an extensive impact on the health status of the exposed populations. This population-based study aimed to examine the relationship between war experiences and self-reported general health in representative sample surveys from Bosnia-Herzegovina (n = 3,313) and Kosovo (n = 1,000). Data were collected with face-to-face interviews fielded in the winter of 2003-2004. Logistic regression analysis was used to compute unadjusted and adjusted odds ratios (ORs). The adjusted effects of the extensiveness of war experiences on poor health were positive in both countries, but they were statistically significant only for Bosnia-Herzegovina: OR = 1.04, 95% CI [1.00, 1.08] for Bosnia-Herzegovina and OR = 1.03, 95% CI [0.98, 1.09] for Kosovo. The strongest observed effect was found for Kosovo only: The extensiveness of war experiences was relatively strongly related to longstanding health problems, OR = 1.09, 95% CI [1.03, 1.15]. We found that war experiences may contribute to increased poorer health in the exposed populations; however, the effects 4-9 years after the war ended were modest. Hence, war experiences seemed to be more strongly related to war-related distress and posttraumatic stress disorder than to self-reported general health.

Aim: The main aim of this review study was to identify which factors that characterise the relationship between work culture and quality of care in nursing homes.Method: This review study was structured through systematic search methods to identify articles that describe the relationship between work culture and quality of care in nursing homes. The database search yielded 14510 hits. Closer examination showed that 10401 of these hits were duplicates. Of the remaining 4109 articles, only 10 were related to our aim for the study. A qualitative method were used to explain and understand phenomena of work culture and quality if care in nursing homes.Findings: Nine out of 10 articles in this review study emphasise the importance of leadership style and supportive management to increase quality of care in nursing homes. Increased empowerment, participation and influence were important factors for improving quality of care. Significant associations between work culture and quality of care and between empowerment and quality of care were reported.Conclusion: Nursing management and leaders must take in consideration that work culture is crucial for improving quality of care in nursing homes, and this study can be used to increase the focus on the work culture among healthcare personnel in nursing homes. Changes are necessary to increase healthcare personnel's job satisfaction, empowerment, autonomy and influence in nursing homes. Giving empowerment to the healthcare personnel working in nursing homes is both an organisational and an interpersonal issue. Being given empowerment and influence over their own work situation, the healthcare workers can be more committed and involved in the goal of obtaining best possible care to the residents.

Introduction: Exploring the work culture of health care personnel is important in order to understand the challenges they face and the issues they experience. Believing in and shaping their futures indicates a working culture influenced by promoting factors. The aims of this study were to explore how health care workers at a Palliative Medicine Unit perceive their future work culture would be and whether they perceive that their expectations and desires will be fulfilled. Design: A correlational study. Methods: Health care personnel, physicians, nurses, physiotherapists, and others (N = 26) at a PMU in Norway completed a questionnaire according to the two perspectives, expectations (future) and desire (wish). The findings in these two perspectives were compared. The method seeks to explore what aspects dominate the particular work culture and identifying challenges, limitations, and opportunities. The findings were also compared with a reference group of 347 ratings of well-functioning Norwegian organizations, named the “Norwegian Norm”. Results: The findings for the wish perspective showed significant (p<0.05; p<0.01) higher rates for nurturing and synergy dimensions and significant lower rates (p>0.05; p>0.05) for opposition and control dimensions than the findings for the future perspective. Conclusions: It appears that the health care personnel wish for changes that they don’t believe they will achieve. The changes the respondents wish for are fewer negative work culture qualities, such as assertiveness and resignation, and more positive work culture qualities, such as engagement and empathy. Changes must be made to give the health care personnel improved working conditions and empowerment in order to change their situations to reflect what they wish for. The present findings can give an indication as to the direction that research ought to follow in subsequent studies.

Abstract Objective: Understanding and assessing health care personnel's work culture in palliative care is important, as a conflict between “high tech” and “high touch” is present. Implementing necessary changes in behavior and procedures may imply a profound challenge, because of this conflict. The aim of this study was to explore the work culture at a palliative medicine unit (PMU). Method: Healthcare personnel (N = 26) at a PMU in Norway comprising physicians, nurses, physiotherapists, and others filled in a questionnaire about their perception of the work culture at the unit. The Systematizing Person-Group Relations (SPGR) method was used for gathering data and for the analyses. This method applies six different dimensions representing different aspects of a work culture (Synergy, Withdrawal, Opposition, Dependence, Control, and Nurture) and each dimension has two vectors applied. The method seeks to explore which aspects dominate the particular work culture, identifying challenges, limitations, and opportunities. The findings were compared with a reference group of 347 ratings of well-functioning Norwegian organizations, named the “Norwegian Norm.” Results: The healthcare personnel working at the PMU had significantly higher scores than the “Norwegian Norm” in both vectors in the “Withdrawal” dimension and significant lower scores in both vectors in the “Synergy,” “Control,” and “Dependence” dimensions. Significance of results: Healthcare personnel at the PMU have a significantly different perception of their work culture than do staff in “well-functioning organizations” in several dimensions. The low score in the “Synergy” and “Control” dimensions indicate lack of engagement and constructive goal orientation behavior, and not being in a position to change their behavior. The conflict between “high tech” and “high touch” at a PMU seems to be an obstacle when implementing new procedures and alternative courses of action.

Background: The main aim of this paper was to examine the usefulness of the Mini-Mental State Examination (MMSE) for screening delirium in elderly patients with hip fracture. Methods: The sample included 364 elderly patients with hip fracture admitted to two hospitals in Oslo. Delirium was assessed by the Confusion Assessment Method (CAM) as an approximation of the gold standard, DSM-IV. To evaluate the psychometric properties of the MMSE scale, we used the Mokken nonparametric latent trait model for unidimensional scaling. Results: In total, 76 (21%) patients were diagnosed with delirium based on the CAM, and 141 (43%) had preexisting cognitive impairment. As a screening tool, the recommended MMSE cut-point of 24 showed an acceptable sensitivity of 88% with a specificity of 54%. The prediction of delirium, based on logistic regression on the MMSE total score and on the 5 items selected by the stepwise logistic regression procedure, gave clearly less acceptable results. Conclusions: Our study indicates that the MMSE may be useful in screening for delirium, but the high percentage of false positives shows that it does not have diagnostic potential in patients with hip fracture.