The Baby-friendly Hospital Initiative for neonatal wards and the World Health Organization recommend that stable preterm infants initiate breastfeeding regardless of gestational age, postmenstrual age (PMA), or weight. Documented practice, however, is limited. We aimed to describe PMA at first breastfeeding attempt of stable preterm infants, to analyse delaying factors, to detect differences in breastfeeding performance across gestational age groups and use of nasal-CPAP. This Danish multicentre cohort study was based on questionnaires answered by mothers of 992 preterm infants gestational age 23-36 weeks. Differences in PMA between gestational age groups at first breastfeeding attempt were analysed by One-way ANOVA, and associations between PMA and selected factors by linear regression models. The lowest PMA at first breastfeeding attempt was 27.57 weeks. Of the extremely and very preterm infants, 61% and 46%, respectively, had the first breastfeeding attempt before PMA 32 weeks. Mechanical ventilation significantly delayed first breastfeeding attempt by seven days (p < 0.0001). Performance at the preterm infants' first breastfeeding attempt were predominantly without swallowing (78%). During first attempt, 29% were at breast with nasal-CPAP. Performance was in general not affected by nasal-CPAP treatment. In this cohort of preterm infants, we conclude that early initiation of breastfeeding is possible, also at low PMA and while maintained on nasal-CPAP. Hence, nasal-CPAP should not be a barrier for breastfeeding initiation. At first breastfeeding, even preterm infants before PMA 32 weeks demonstrated breastfeeding behaviours, although the majority did not swallow. Preterm infants need time to familiarize with the breast.

Background The number of people living with chronic conditions is increasing worldwide, and with that, the need for multiple long-term complex care across care settings. Undergoing transitions across healthcare settings is both challenging and perilous for patients. Nevertheless, knowledge of what facilitates quality during transitions in healthcare settings from the lifeworld perspective of patients is still lacking. Therefore, we aimed to explore the lived experience in healthcare quality for Danish adult patients during healthcare pathways including transitions across settings. Methods Within a hermeneutic-phenomenological approach, interviews were conducted with three women and five men with various diagnoses and care paths between 30 and 75 years of age. Data underwent a three phased thematic analysis leading to three themes. Results Patients with various illnesses’ experiences of quality of care is described in the themes being powerless in the face of illness; burdensome access and navigation; and being in need of mercy and striving for kindness . This highlights that patients’ experiences of quality in healthcare pathways across settings interweaves with an overall understanding of being powerless at the initial encounter. Access and navigation are burdensome, and system inflexibility adds to the burden and enhances powerlessness. However, caring care provided through the kindness of healthcare professionals supports patients in regaining control of their condition. Conclusions This hermeneutical-phenomenological study sheds light on the lived experiences of people who are at various stages in their care paths with transitions across healthcare settings. Although our findings are based on the lived experiences of 8 people in a Danish context, in light of the discussion with nursing theory and other research, the results can be reflected in two main aspects: I) kind and merciful professional relationships and II) system flexibility including access and navigation, were essential for their experiences of care quality during healthcare transitions. This is important knowledge when striving to provide patients with a clear voice regarding quality in care pathways stretching across settings.

Background The quality of care pathways that include transitions between healthcare settings may be increased by improving patients’ experiences of their care journey. Patients’ experiences can be explored through in-depth interviews, but valid and reliable patient-reported experience measures (PREMs) can be a useful and more cost-effective way of assessing patient-experienced quality. The aim of this study was to develop a valid, generic measure for assessment of PAtient-experience of Transitions in Healthcare settings, PATH. We evaluated the structural validity, internal consistency, and test-retest reliability of the PATH questionnaire in a Danish patient population with a range of diagnoses, comorbidities and diversity in age. Methods The PATH questionnaire was developed and tested through an iterative 3-step pilot-test and a comprehensive field-test. Results We found an 18-item version of PATH to be content valid and to have internal consistency and structural validity for a 2-factor solution with a single item scored separately. We found satisfactory test-retest reliability. Conclusions PATH is a generic, content valid, and reliable patient-reported experience measure for the assessment of patient-experienced quality in healthcare transitions. The PATH questionnaire is available for use in quality monitoring and quality improvement research, but we recommend further testing of its measurement properties alongside its practical application.

No reviews so far have been conducted to define the constructs of patient-experienced quality in healthcare transitions or to identify existing generic measures of patients’ experience of the quality within healthcare transitions. Our aim was to identify domains relevant for people experiencing healthcare transitions when evaluating the quality of care they have received, map the comprehensiveness of existing patient-reported experience measures (PREM), and evaluate the PREMs’ content validity. The method was guided by the Joanna Briggs Institutes’ guidance for scoping reviews. The search was performed on 07 December 2021 and updated 27 May 2024, in the electronic databases Medline (Ovid), Embase (Ovid), and Cinahl (EBSCO). The search identified 20,422 publications, and 190 studies were included for review. We identified 30 PREMs assessing at least one aspect of adults’ experience of transitions in healthcare. Summarising the content, we consider a model with two domains, organisational and human-relational, likely to be adequate. However, a more comprehensive analysis and adequate definition of the construct is needed. None of the PREMs were considered content valid.

BackgroundTransitions in healthcare settings can be a challenge for patients and they express a need for guidance and support to cope with these transitions. The aim of this scoping review was to investigate if interventions can improve patients' experiences when transitioning between healthcare settings.MethodsThis review was conducted following the Johanna Briggs Institute's methods and reported according to the PRISMA-ScR Checklist. Included articles were published and peer-reviewed, and reported qualitative and quantitative findings on patient experiences with interventions when transitioning between healthcare settings. The search was conducted in May 2024 in Medline Ovid, Embase Ovid, and Cinahl.ResultsTwenty-three studies were included. Factors extracted from the studies were: author(s), year of publication, country of origin, study design, theoretical methods, population description, intervention, phenomena of interest(s), and key findings. There has been an increase in published studies on the subject in the last few years, and most of the included studies originated from Western countries. Most studies were quantitative, primarily RCTs, and the theoretical methods were thus mainly statistical analysis. The study populations were found to be heterogeneous. The interventions were categorized: care coordinator, program, integrated care, online communication platform, coaching, discharge care plan, and miscellaneous interventions.ConclusionsOverall, interventions were found to improve the patient experience. Centralization of healthcare has increased the number of transitions, and patients express that the coordination of healthcare transitions can be improved. This review's findings should be used alongside other research on interventions' effect on factors like hospital readmissions and mortality to determine the optimal intervention to implement.

Further evaluation of the Patient Assessment of Transitions in Healthcare settings (PATH) questionnaire measurement properties is needed to ensure high-quality measurement of patients' experiences of healthcare provision which includes transitions across settings. The aim of this study was to determine structural validity and reliability for measurement of patient-experienced quality in healthcare transitions across hospital, GP, municipal rehabilitation, and/or home care settings for the PATH questionnaire through Rasch analysis. This study supports that PATH is a structurally valid measure for use in hospital, GP, and municipal home care. However, use of PATH for evaluation of municipal rehabilitation is not currently recommended. We find that PATH discriminates adequately between poor, moderate, and good patient-experienced quality of healthcare transitions without systematic differential item functioning. In conclusion, PATH enables valid and reliable planning and evaluation of initiatives to improve pathways which include transitions across healthcare settings.

Background Patient complaints and compensation cases are analysed individually and do not allow for organisational learning. Systematic information on complaint patterns needs evidence-based measures. The Healthcare Complaints Analysis Tool (HCAT) can systematically code and analyse complaints and compensation claims, but whether this information is useful for quality improvement is underexplored. We aim to explore if and how HCAT information is perceived useful to inform healthcare quality gaps. Methods To explore the HCAT’s usefulness for quality improvement purposes, we used an iterative process. We accessed all complaints relating to a large university hospital. Trained HCAT raters systematically coded all cases, using the Danish version of HCAT. Intervention The intervention had four phases: (1) coding of cases, (2) education, (3) selection of HCAT analyses for dissemination, (4) ‘dashboard’ development and delivery of targeted HCAT reports. To study the interventions and phases, we used quantitative and qualitative approaches. The coding patterns were descriptively displayed on department and hospital level. The educational programme was monitored using passing rates, coding reliability checks and rater feedback. Online interviews recorded dissemination feedback. We used a phenomenological approach with thematised quotations from the interviews to analyse the usefulness of the information from cases coded. Results We coded 5217 complaint cases (11 056 complaint points). The average case coding time was 8.5 min (95% CI 8.2 to 8.7). All four raters passed the online test with >80% correct answers. Using rater feedback, we handled 25 cases of doubt. None affected the HCAT structure or categories. Interviews verified the usefulness of analyses after expert group dissemination. Three themes were important: ‘overview of complaints’, ‘learning from complaints’ and ‘listening to the patients’. Stakeholders perceived the ‘dashboard’ development as highly relevant. Conclusion Through the development process with several adjustments, stakeholders found the systematic approach useful for quality improvement. The hospital management evaluated the approach as promising and decided to test the approach in clinical practice.

Introduction Staff shortages and quality in obstetric care is a concern in most healthcare systems and a hot topic in the public debate that has centred on complaints about deficient care. However there has been a lack of empirical data to back the debate. The aim of this study was to analyse and describe complaints in obstetric care. Further, to compare the obstetric complaint pattern to complaints from women about other hospital services. Materials and methods We used the Healthcare Complaints Analysis Tool to code, analyse and extract contents of obstetric complaint cases in a region of Denmark between 2016 and 2021. We compared the obstetric complaint pattern to all other hospital complaint cases in the same period regarding female patients at a large University Hospital in a cross-sectional study. Results Complaints regarding obstetric care differed from women’s complaints regarding other healthcare services. Women from obstetric care raised more problems per complaint, and tended to complain more about relational issues indicated by odds for complaints about staff shortage four times higher in the obstetric care group. Women from obstetric care had a lower proportion of compensation claims. Conclusion Systematic complaint analysis acknowledged women’s experience in obstetric care and may point to areas that potentially need further attention. Complaints from obstetric care show that women experience deficiencies related to relational problems like recognition and individualized support compared to complaints from women receiving other hospital healthcare services.

Purpose: The effects of physical activity on health are well-established for chronic diseases such as multiple sclerosis (MS), Alzheimer's disease (AD), and ischaemic heart disease (IHD). However, sustaining physical activity in everyday life is difficult. Lifeworld knowledge can help qualify interventions aimed at resolving this public health issue, but there is a gap in regard to synthesized research on peoples' experiences with integrating and sustaining physical activity. Hence, the purpose of this review is to explore and present the available evidence on experiences with integrating and sustaining physical activity in a lived life with MS, AD, and IHD. Methods: We conducted a scoping review with qualitative analysis and narrative syntheses in accordance with PRISMA-ScR. Based on SPIDER we ran a systematic search in Cinahl, Embase, Medline, and PsychInfo for primary qualitative research papers published until December 2022. Results: 43 papers were included. A thematic content analysis found that individuals who have MS, AD or IHD find integrating and sustaining physical activity in everyday life meaningful on several levels: Physical activity can facilitate meaningful movement with outcomes of physical, psychosocial, and existential importance. Conclusion: The research literature presents a meaning to physical activity that extends the idea of physical fitness to one of existential movement and personal growth. In addition, our review finds that people are more likely to integrate and sustain physical activity if they feel acknowledged, supported and believe that physical activity has a meaningful purpose reflecting their sense of self. Taking a more person-centred approach in rehabilitative care might help qualify the content of physical activity in terms of integration into everyday life, but more research is needed on how to implement a person-centred approach in practice.

BACKGROUND:The Healthcare Complaints Analysis Tool (HCAT) offers a validated way of systematically extracting content from patient complaints for further analysis of complaint hot spots with harm or near misses, and blind spots with, for example, systemic problems or quality problems arising during discharge. This study analyzed a Danish national sample of compensations claims about emergency care using the HCAT. METHODS:Through use of the HCAT, compensation claims about Danish emergency care from 2013 to 2017 (N = 712) were coded and then grouped to identify and highlight hot spot problem areas (harm and near misses) and blind spot problem areas (admission/discharge, systemic problems, errors of omission). Two assessors coded the compensation claims by entering data into a database. RESULTS:The HCAT analyses of the sample resulted in coding of 1,305 problems. Most problems concerned quality and safety issues at the examination/diagnosis stage of care (63.9%). In 91.2% of the cases, the level of harm was moderate or major. Harm hot spots most often involved diagnostic errors (189 problems). Eighty-nine problems related to errors of omission, all causing moderate or major harm. For systemic blind spots, patient harm significantly increased in cases of multiple problem types in the compensation claim (odds ratio = 1.6, 95% confidence interval = 1.3-2.0). CONCLUSION:Systematic coding and analytic approach to the HCAT can highlight potential quality problems in emergency care and point to areas for further consideration. From the perspective of future health care harm prevention, there seems to be a strong incentive for further analysis of the amount, nature, and prevention of diagnostic errors in emergency care.

ObjectiveTo determine levels of objectively measured physical activity (PA) and the proportion of adults with multimorbidity that adheres to PA guidelines.MethodsAll studies, where PA was measured at baseline using an activity monitor in an adult (≥18 years) multimorbid (≥80% of the population had ≥2 chronic conditions) population. A systematic literature search was performed in Medline, EMBASE, CINAHL, CENTRAL, ClinicalTrials.gov, opengrey.eu and google.com from inception up until 18th of January 2022. Risk of bias was assessed with a modified version of the Quality Assessment Tool for Quantitative Studies. A random-effects meta-analyses was performed to estimate daily minutes of sedentary behavior (SB), light PA (LPA), moderate PA (MPA), moderate to vigorous PA (MVPA) and steps. Proportions adhering to PA guidelines was narratively synthesized. Certainty of evidence was determined using The Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach.ResultsFifteen studies (2,172 participants) were included. The most frequent combination of conditions were type 2 diabetes and hypertension (six studies). Participants spent a daily average of 500.5 (95% CI: 407.1 to 593.9) minutes in SB, 325.6 (95% CI: 246.4 to 404.7 minutes in LPA and 32.7 (95% CI: 20.2 to 45.3) minutes in MVPA. The mean daily number of steps was 5,145 (95% CI: 4264 to 6026) for people in free-living conditions. The proportion adhering to PA guidelines ranged widely (7.4% to 43%). All studies were rated as at high risk of bias and the certainty of evidence was very low.ConclusionsPA levels and adherence varied from low to above guideline recommended levels for adults with chronic conditions, depending on PA intensity. The very low certainty of evidence calls for high quality studies focusing on detailed descriptions of PA behavior in people with multimorbidity.Prospero registration numberCRD42020172456.

Purpose The study aimed to translate and cross-culturally adapt the English version of the HCAT to produce a Danish HCAT version and to test the Danish version’s reliability. Methods We used best-practice guidelines for linguistic translations and cultural adaptations. For cross-cultural adaptation, we conducted forward and back translation followed by expert committee review. Subsequently, two researchers assessed 140 complaint cases to test intra- and inter-rater reliability of the Danish HCAT version. We used descriptive statistics for distributions and tested for differences between English and Danish editions Intra- and inter-rater reliability used Gwet’s AC1 statistics, applying quadratic weights to assign more weight to large discrepancies. Results The back translations showed both semantic and conceptual differences, and the expert committee thus discussed the meaning of the wording in the HCAT guide and coding form to ensure that the Danish version would be conceptually similar to the English version but also culturally appropriate for Danish settings. There was discussion about how to use the coding form to graduate problem severity, and this led to some altered wording. Pilot testing revealed the need for two new categories of “hospital-acquired infection” and “involvement of patients’ relatives”. The problem categories of the HCAT-DK showed “substantial” intra- and inter-rater reliability (0.79, and 0.79 to 0.85). In addition, there was a “substantial” agreement (0.70 to 0.73) between the original HCAT and the HCAT-DK version. Conclusion The study translated and cross-culturally adapted the English HCAT version to produce a Danish HCAT version. Cultural and conceptual differences led to adjustments and to addition of two extra items in the HCAT-DK. The Danish version showed “substantial” intra- and inter-rater reliability and is considered suitable for coding complaint and compensation cases in Danish health care.

BACKGROUND:Early breast milk expression, prolonged skin-to-skin contact, rooming-in, use of test-weighing and minimizing use of pacifiers are positively associated with exclusive breastfeeding of preterm infants, whereas use of nipple shields is negatively associated.AIM:To test whether a training program for neonatal nurses with a focus on these six breastfeeding-supportive clinical practices affects the rate of preterm infants exclusively breastfed at discharge to home, the postmenstrual age at establishment of exclusive breastfeeding, and maternal self-reported use of the practice in the neonatal intensive care unit, the.METHODS:A quasi-experimental multi-centre intervention study from 2016-2019 including a control group of 420 preterm mother-infant dyads, an intervention with a training program for neonatal nurses and implementation of weekly breastfeeding meetings for neonatal nurses, and an intervention group of 494 preterm mother-infant dyads.RESULTS:Significantly more preterm infants in the intervention group were exclusively breastfed at discharge to home (66.6%) than in the control group (58.1%) p = 0.008. There was no significant difference in postmenstrual age at establishment of exclusive breastfeeding between control and intervention group (37.5 vs.37.8 weeks, p = 0.073). Compared to the control group the number of infants continuing daily skin-to-skin contact after incubator care increased (83.2% vs. 88.3%, p = 0.035), infants using a nipple shield decreased (61.8% vs. 54.2%, p = 0.029), and the number of mothers initiating breast milk expression before six hours post-partum increased (32.6% vs. 42.4%, p = 0.007). There was a significant correlation between percentage of neonatal nurses participating in the breastfeeding training program and changes in exclusive breastfeeding rates (Pearson Correlation 0.638, p = 0.047).CONCLUSION:Exclusive breastfeeding rates in preterm infants and maternal self-reported use of breastfeeding-supportive practices increased by training neonatal nurses in the six clinical practices. It is important to include all nurses in the breastfeeding training program to ensure positive effect on exclusive breastfeeding rates.