‘First line healthcare’ is offered via telephone in many Western countries. The overall aim of this thesis is to describe Telephone Nursing (TN) from three viewpoints: telenurses, parents calling for their children, and operation managers. Four empirical studies were conducted. Telenurses described their work in five different ways: ‘Assess, refer and give advice to the caller’, ‘Support the caller’, ‘Strengthen the caller’, ‘Teach the caller’ and ‘Facilitate the caller’s learning’, which all constitute a TN ‘work map’. Authentic paediatric calls between parents and telenurses revealed that 73% of callers were mothers and children were aged between 5 days and 14.5 years. The top three contact reasons were ear and skin problems, and fever, with a median call length of 4.4 minutes. More than half of the calls resulted in referrals and 48% received self-care advice. The likelihood of fathers being given referrals as a result of their call was almost twice as high as that for mothers, while mothers were almost twice as likely to receive self-care advice as fathers. Parents described their degree of worry and trust that influenced their decisions whether to contact SHD or not. Their calls were carefully prepared, and the parent calling often depended on family routine. Parents reported to follow recommendations. Most relied upon their own intuition if further worried, but some indicated they would never seek healthcare unless it was recommended. Operation managers described four main goals of TN work: ‘create feelings of trust’, ‘achieve patient safety’, ‘assess, refer and give advice’, and ‘teach the caller’. Equitable healthcare was regarded as important, whereas health promotion was not considered as part of the goals. Conclusion: The studied TN viewpoints present concordance and discrepancies. Paediatric health calls appear mostly to be a woman-to-woman activity. Telenurses’ increased gender competence might increase TN safety. For that matter, telenurses’ collaboration with parents and making parents aware of holding the ultimate responsibility for their child’s condition is important. Goals of TN work and their relationship with healthcare obligations such as equitable healthcare and health promotion need further clarification. The viewpoints described in this thesis may contribute to the development of TN.

Bakgrund: Ett för tidigt fött barns tarmar och matsmältningsapparat är inte färdigutvecklade och de kan drabbas i större utsträckning av mag-tarmproblem. Att vårdpersonal har kunskap om upplevelser och stöd kring för tidigt födda barns magbesvär är viktigt. Syfte: Att beskriva för tidigt födda barns mag-tarmbesvär ur föräldrarnas perspektiv samt beskriva vilket stöd som gavs av vårdgivaren. Metod: Denna studie genomfördes med en kvalitativ innehållsanalys med deskriptiv ansats. Data analyserades med en tematisk nätverksanalys. Data bestod av loggboksblad samt skriftliga kommentarer från mödrar. Totalt antal mödrar som inkluderades i denna studie var 148, totalt antal loggboksblad var 133 och 56 skriftliga kommentarer. Resultat: Ett globalt tema, två organisationsteman samt åtta basteman identifierades. De två organisationsteman som framkom var: föräldrarnas upplevelser kring sitt för tidigt födda barn med magbesvär samt Vårdgivarens stöd och föräldrarnas upplevelse och effekt av detta stöd. Det globala temat som framkom var: Vikten av att bli lyssnad på, få stöd, och rätt information i en utsatt situation. Slutsats: Det finns ett behov av individuellt anpassat stöd hos föräldrar till för tidigt födda barn med magbesvär. Trygghet skapades då det upplevdes att vårdgivarna hade god tillgänglighet, var kunniga inom området och gav adekvata rekommendationer. Den stress och oro hos föräldrarna som barnets magbesvär medförde kunde minskas med hjälp av att bli lyssnad på, få individuellt stöd och rätt information. / Background: A prematurely born infant’s intestines and digestive system is not fully developed and may suffer of gastrointestinal problems. It is important that health care staff have knowledge of experiences and support regarding premature born infants. Purpose: To describe preterm infant’s gastrointestinal problems from a parents perspective as well as the type of support provided by medical provider. Method: The study was carried out with a qualitative/descriptive analysis of collected data. Data comprised of 133 logbook notes as well as 56 written comments from the mothers. In total 148 mothers were included in the study. Result: One global theme, two organisational themes and eight base themes were identified. The two organisational themes emerged: Parents experience of their prematurely born infant’s stomach problems and Medical providers support and parents experience and the effect of that support. The global theme emerged: The importance of being listened to, receive support and the correct information in a compromised situation. Conclusion: There is a need for individually tailored support for parents of premature infants with stomach problems. Security was created when parents experienced that the medical providers provided good accessibility, were knowledgeable in the area and made adequate recommendations. The stress and anxiety of the parents caused by the infants stomach problems could be alleviated by being listened to, receive individual support and correct information.

Within the last decade, the influence of focus of attention (FOA) instruction on postural control has been an increased interest among researchers (Yeh et al., 2016; McNevin et al., 2013). The general agreement when it comes to the role of FOA has been that adopting an external (EXT) FOA enhances the efficiency of motor programming by strengthening the relationship between movement planning and outcome, when compared to an internal (INT) FOA (see Wulf, 2013). However, increasing evidence suggests that the benefits from an EXT FOA can be mitigated by certain factors (e.g., age, skill level, novelty of the task and task complexity; Becker & Smith, 2013; Emanuel et al., 2008). As such, questions remain as to what form of FOA instruction is best suited for young learners, as FOA research has been criticized for being studied almost exclusively among adults (Agar et al., 2016). Research in this area is particularly sparse as it pertains to FOA in combination with postural control among this younger age group. This is particularly problematic as significant changes in postural control, stability and balance occur during one’s first decade in life (Haas, et al., 1989; Hay & Redon, 1999; Barela et al., 2003). Moreover, there exists some methodological concerns with regard to the lack of consistency of FOA instructions being used during experimentation. This directly influences where participants are guiding their attention and their interpretation of FOA cues (Davids, 2007; Petranek, et al., 2019). Further, the lack of replicability of traditional FOA studies and the increasing number of non-statistically significant findings in this research, calls into question the overall validity, both internal and external, regarding FOA instruction (Becker & Smith, 2013; Lawrence et al., 2011). Therefore, as a series of four complementary studies, the overall aim of this thesis is to further investigate these theoretical as well as procedural gaps. The first study examines which type of FOA instruction is best suited for two groups of young learners (typically developing children between 4-6 and 7-10 years of age) performing a postural control task. Participants will be randomized into either an INT, EXT or CTRL condition, where they will perform a postural control task with different respective visual displays. A force platform will be used to assess participants’ mediolateral centre of pressure (COP) performance, and electromyography (EMG) will be used to assess muscular activation of the participants’ major ankle stabilizers. The primary goal of study one is to investigate the influence of FOA in children by following the most common and traditional of FOA instruction. The second study serves as an extension for the first study. The aim of this study is to specifically investigate the validity and reliability of using FOA instructions, and whether or not the different attentional cues can drive their intended mental focus states. The method of this study is identical to those is Study 1 with a few major exceptions. In this case, two manipulation checks will be added to the procedure in order to assess how participants perceived, comprehended, and acted to their assigned FOA instructional condition. The first manipulation check is embedded in the structure of the trial itself: the comparison of postural control performance with and without visual information, modeled after the technique used in Yeh and colleagues (2016). The second manipulation check will be a retrospective verbal interview inspired by Perreault & French (2016). Finally, the third and fourth studies look to expand the research question from study one and two to different populations of atypically developing young learners who are known to struggle with both attention and postural control. Individuals with ADHD and individuals with DCD have been shown to interpret attentional and postural information differently when compared to age-matched controls. Therefore, the aim of these studies is to compare the differing effects of FOA across neurodiverse populations. Specifically, study three will use a group of young learners (from 4 – 10 years of age) with ADHD and study four will use a group of young learners (from 4 – 10 years of age) with DCD. The only differences in these studies compared to study one will be the lack of an age split and the use of EMG assessment. / Thesis / Master of Science in Kinesiology