Stenfors (2019) Qualitative identification and characterisation of self-reported symptoms arising in humans during experimental exposure to cold air,

The aim was to investigate the knowledge and the attitude regarding recovery among practitioners working in the Swedish mental health system, Personligt Ombud (PO), Supported Housing Team (SHT) and Psychiatric Out Patient Service (POPS), to determine whether and how knowledge and attitude regarding recovery differ between the three services. A web-based questionnaire based on the Recovery Knowledge Inventory was sent to the participants. Participant selection ensured that different parts of Sweden were represented. A multiple linear regression was used to examine the result under control of Sex, Age, Educational Level, Further Education, Relevant Work Experience and Training in Recovery. The result of the regression showed that POs had higher scores than both SHT and POPS on the subscales, even under control of other variables. The SHT differed significantly from POs on two of the subscales and POPS differed significantly from POs on all subscales. Personnel with university education, more work experience or specific training in recovery also had a higher mean score. Swedish practitioners need to learn more about certain aspects of the recovery process. The differences between the services may possibly be due to the services' organization, assignment and role. Other important aspects were the level of education and having specific training in recovery; the combination of these elements could facilitate the development of a recovery-oriented mental health system.

The Swedish state uses a case management function known as Personligt Ombud (PO). The role as PO differs from the traditional professional roles. It has a freestanding position in the welfare system. The aim of this study was to investigate POs' experiences of working from a freestanding position when supporting clients. Telephone interviews were conducted with 22 POs across Sweden. The interviews were recorded, transcribed, and analyzed by latent qualitative content analysis. The findings were reflected in three categories - freedom-promoted flexibility, surfing through a complex welfare system, and working for legitimacy. POs developed a holistic view to both the client as well as to the welfare system. POs experienced solely representing the client, which is a positive feature because part of the POs' role is advocating for the clients rights. The PO service differs from the PO service from other existing case management models and may need to develop strategies for decision-making and support in their own role. For example, they may use group supervision teams or 'reflective teams'. The freestanding position may also entail problems in terms of lack of legitimacy. It is important for POs to develop good platforms with the surrounding actors among others things to improve the co-ordination process. It could be interesting if the PO model would be tested in other countries that have a fragmented welfare system. The PO model may also be useful to other 'target groups' who are in need of co-ordinated rehabilitation services.

Personligt ombud (PO) is a Swedish version of case management that aims to support individuals with psychiatric disabilities. Guidelines to the PO service emphasize the different role that the PO plays with respect to the relationship with clients. The aim of this study was to investigate the components that POs found to be important in the relationship with clients. Telephone interviews with 22 POs across Sweden were carried out. The interviews were recorded, transcribed, and analyzed using qualitative content analysis. The relationship with each client was described as the foundation of the POs' work; it was the only 'tool' they had. The findings were reflected in a main theme, which showed the importance of creating personal working alliances with each client where POs put the client at the center of the work and adjusted their support according to the client's needs at the time. Important components were that the PO and the client trusted each other, that the power between the PO and the client was balanced, and to be a personal support. Many of the components that POs found to be important are shown as essential in recovery-oriented services. POs followed the client in the process and remained as long as necessary and this is one way of bringing hope to the client's recovery process. However, the personal tone can be fraught with difficulties and to maintain professionalism, it is necessary to reflect, through discussions with colleagues, with the leader and in supervision.

Introduction: Personligt Ombud (PO) is a Swedish version of case management (CM) which was established with the Swedish Mental Health Reform in 1995. The main purpose of POs is to ensure that people with psychiatric disabilities receive the services needed to live an independent life in the community and to coordinate these services. Studies have shown that POs provide more support than this and it was interesting to investigate this further. Aim: The aim of the study was to explore what supportive strategies Personligt Ombuds (POs) use in their work with the clients who have PO support. Method: To obtain extensive descriptions of strategies that POs use in work, POs from different parts of Sweden were chosen and asked to participate in the study and 22 POs agreed to participate. The interviews were conducted over the telephone. The interviews were transcribed and analyzed using qualitative content analysis. Findings: The findings of the study were reflected in a main category where PO could be described as a facilitator of an active changing process, where the clients make their personal changes in life, based on personal active choices. POs used several strategies, such as defining goals, acting to push the client forward, acting as mentors, strengthening the client and mobilizing external resources. Conclusion: Many of the strategies POs used are similar to strategies in recovery-oriented services and, in particular, in Strengths Model Case Management. However, there are strategies that POs could develop to be even more recovery-oriented. There is a lack of systematic review of the strengths of a client, and this could be solved by using an already existing assessment instrument like the one in the Strengths Model Case Management.

Purpose This study explores the organisational dynamics in a change process across work units in a Swedish municipality. The purpose of this study is to understand how and why co-creation unfolds during efforts to bring different units into one united work unit. Design/methodology/approach A qualitative longitudinal study was designed using data triangulation for eight months, comprising written reflection texts, meeting protocols and interviews. This study is based on a back-and-forth inductive and abductive grounded theory analysis. Findings The main results of this study indicate that there was friction in the co-creation process between units, between the members of the change group and supervisors, as well as friction within the change group. Further, the results indicate that communications, relations, supervisor support and governing strategies clashed with work routines and methods, work cultures, roles and responsibilities and that the units had differing views of the needs of the intended target group. This thereby challenged the propensity for change which, in turn, may have limited developmental learning at a workplace and organisational level. Originality/value Working across units to find common and new paths and work methods for labour market inclusion proved to be challenging because of contextual circumstances. Crossing and merging organisational boundaries through co-creation processes was demanding because of new expectations from the organisation, as it shifted towards trust-based governance in conjunction with working during a pandemic when social interactions were restricted to digital communication channels.

Background: Until recently, clinical ultrasound technology was limited to the hospital-based disciplines, and few studies assessed training in focused cardiac ultrasound (FCU) in primary care. We designed an interview study among general practitioner (GP) registrars taking part in an FCU training program and discussed their experiences compared to their documented skills.Methods: This qualitative content analysis used an inductive approach. Five GP registrars and their tutor participated in semi-structured individual interviews during April–July 2017. Participants were interviewed after they each had conducted 20 supervised and 7–10 independent examinations and were encouraged to complete self-directed study using video tutorials on web-based platforms. FCU examinations of study patients recruited from primary care clinics were conducted with a hand-held device (Vscan 1.2) at the Centre of Clinical Research, Östersund Hospital, Sweden. Results: We identified two categories of information: the prerequisites of learning FCU and the acquisition of skills for professional development. Combining theoretical education with hands-on tutorials was an essential part of FCU learning. However, participants suggested that the training program should include group tutorials to give a deeper understanding of scanning positions and a reference standard for evaluating the FCU recordings. In skill acquisition, participants experienced more confidence in performing the technical aspects of FCU than in interpreting the images to evaluate cardiac function. The participants saw several possibilities for applying FCU in primary care, including as a screening tool in rural clinics or to support referrals to specialized care.Conclusions: After completing 20 supervised FCU training sessions, previously inexperienced examiners felt that assessment of cardiac function was more difficult than acquiring adequate ultrasound images. To gain confidence in assessment of cardiac function, respondents suggested personal feedback and group tutorials with discussion of clinical examples in smaller groups for improvement of learning. Demographic differences between patients seen in hospital wards and primary care clinics should also be considered in the design of FCU training programs. Trial registration: NTC02939157, ClinicalTrials.gov.