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Background: Communication is a cornerstone in nursing. Research on nurse-patient communication faces well-known challenges, as encounters are dynamic, context-dependent, and shaped by subtle verbal and non-verbal cues. Capturing this complexity requires rigorous observational approaches, of which audio and video recordings are key methods, enabling documentation of communication as it unfolds in practice. However, collecting such data in clinical settings involves significant methodological and ethical considerations. Objective: The aim of this paper is to provide guidance for methodological rigor in data collection using audio or video recordings when observing clinical communication in patient encounters. Information sources: This discussion paper draws on theory and previous empirical research on communication in clinical patient encounters using data collected with audio and video recordings. Results: The practical guidance is structured into five key areas spanning the data collection process: (1) planning and preparation, (2) audio versus video recordings, (3) ethical and legal concerns, (4) information and recruitment, and (5) procedures for collecting recordings. Each area includes methodological considerations related to the design and conduct of data collection, as well as recommendations for transparent reporting to support rigor. Conclusions: This guidance supports researchers in addressing key methodological challenges in data collection using audio and video recordings in studies of clinical communication. It highlights considerations relevant to the design and conduct of the research process, including issues of ecological validity and generalizability, and emphasizes the importance of transparent reporting of methodological decisions. In light of previous inconsistencies in reporting, such guidance is essential to strengthen methodological rigor.

Background Primary care includes preventive and acute care, and management of long-term conditions. In Sweden, approximately 40 million annual visits are made to primary care, of which more than 12 million are registered nurse consultations. Registered nurses are often responsible for initial assessments, including triage and prioritization. Timely and accurate assessments are essential, as inappropriate decisions may adversely affect both care quality and patient outcomes. However, demographic changes, rising chronic disease prevalence, and growing expectations for accessible and efficient services continue to strain primary care capacity. Therefore, this study aims to explore registered nurses' experiences of goal conflicts in decision-making during primary care consultations for acute illnesses, with a focus on clinical assessment, prioritization, and their perceived consequences. Methods A qualitative study using semi-structured focus group discussions was conducted to explore registered nurses' experiences and perspectives. Seven focus group discussions with 27 registered nurses in Sweden were conducted between April and May 2025. A thematic analysis was conducted. Results The results present one overarching theme, Juggling conflicting demands of optimal and timely care with limited resources, and four interrelated themes illustrating these goal conflicts: organizational demands versus quality of care, accessibility versus risk of crowding out, expectations versus adequate resources, and teamwork versus professional autonomy. The findings highlight conflicting organizational, professional, and patient-driven goals that result in ethical dilemmas and ambivalence among registered nurses. Conclusions This study indicates that goal conflicts in primary care arise from extensive assessment responsibilities placed on registered nurses without adequate alignment with education, competence, and organizational support. Despite extensive responsibilities for clinical assessment, decision-making, and prioritization, registered nurses have limited influence over organizational conditions, creating an asymmetry between responsibility and authority. These findings suggest a need for improved alignment between roles, competence, and organizational support.

Background Enhancing communication in everyday nursing conversations is essential for promoting person-centred care and preserving the dignity of older persons. This qualitative study was performed to gain an in-depth understanding of the nursing assistants’ person-centred communication skills and their communication style. The aim was to explore the communication styles of nursing assistants during home care visits to older persons.

Methods This deductive qualitative study was based on observational data gathered with audio recordings of naturally occurring communication between nursing assistants and older persons during home care visits. Data collection was part of an educational intervention study for in-home nursing assistants and took place from March to December 2022. Data were analysed with a method for deductive qualitative content analysis. The deductive analysis was guided by the framework developed by Bottorff and Morse, and the communication styles identified in the current study, doing more, doing with, doing for, and doing tasks.

FindingsA total of 70 audio recording home care visits, including 39 nursing assistants and 37 older persons were included. Based on conversations during these visits, four distinct communication styles employed by NAs in their everyday interactions with older persons were described in depth with focus on communication patterns observed. The different styles included nuances of communication ranging from being more relational and collaborative to more task-oriented interactions. A pattern of doing too much was also observed.

Conclusions The communication styles used influenced the degree of person-centredness. Nurse assistants’ communication styles can vary during conversations and appear to reflect individual traits. The emotional demands of home care work may require more recognition and support from policymakers and managers. Strengthening person-centred communication and care for older persons requires both training and organizational support.

OBJECTIVES: To explore how patients in digital rehabilitation for knee osteoarthritis understand the regulation of physical activity. DESIGN: A qualitative, exploratory study with a phenomenographic approach. SETTING: A digital rehabilitation programme for knee osteoarthritis in Sweden. PARTICIPANTS: 20 adults with knee osteoarthritis were recruited using purposive sampling to maximise variation in sex, pain intensity, body mass index and fear avoidance. RESULTS: Five qualitatively different ways of understanding the regulation of physical activity were identified, represented by: avoidance of physical activity, need for expert guidance, navigating symptoms and daily activity, adaptation to remain active and development through physical activity. The descriptive categories were related through shared dimensions concerning perceptions of physical activity, interpretation of pain, purpose of regulation and perception of the body. The categories differed in aspects considered important when regulating physical activity and in the range of actions perceived as possible. CONCLUSIONS: Different ways of understanding the regulation of physical activity shape the range of possible actions among patients in digital rehabilitation for knee osteoarthritis. Some ways of understanding appear to constrain regulatory options, whereas others support a wider range of strategies to remain physically active. These findings contribute to the understanding of why similar health information and recommendations may be interpreted differently and could lead to varying approaches to physical activity. TRIAL REGISTRATION NUMBER: https://doi.org/10.17605/OSF.IO/N3UBQ. © Author(s) (or their employer(s)) 2026. Re-use permitted under CC BY. Published by BMJ Group

BackgroundCaesarean section on maternal request (CSMR) raises ethical and clinical challenges despite Sweden’s low overall caesarean section (CS) rate. National written recommendations are restrictive, yet regional differences suggest unequal care. While previous research has focused on women and healthcare professionals, little is known about the views on CSMR of policymakers and other key stakeholders. The aim of this study was to investigate how stakeholders in the Swedish healthcare system view CSMR in relation to medical considerations, individual autonomy and societal values.

MethodsA qualitative study with an inductive approach was conducted using reflexive thematic analysis of semi-structured interviews. Sixteen stakeholders were recruited, including regional politicians, policymakers, national authority representatives, and members from organisations and associations with relevant interest and expertise in the field.

ResultsFive themes were generated: (1) Caesarean section is a valid way of giving birth for some; (2) The right to choose and the decision process are complex issues; (3) Individual options for childbirth are desirable; (4) There is a lack of trust in maternity care; (5) Economic and ethical challenges in maternity care exist. The participants viewed CSMR as a legitimate option for some women, despite the increased medical risks, which were considered concerning but not disqualifying. Support and guidance in decision-making were considered essential by the participants. They valued continuity in care and emotional support highly. The participants expressed the views that distrust in Swedish maternity care was linked to media portrayals and inconsistent handling of CSMR. Economic and ethical concerns included questions of resource allocation and the scope of public healthcare responsibilities. The option to pay privately for a planned CS was broadly rejected by the participants.

ConclusionsThis study highlights the complexity of CSMR and its varied perspectives. While individual risks may be low, population-level risks could rise with increased prevalence, and the perception of risk varies depending on perspective. Both medical and psychological risks should inform decisions, with counselling seen as crucial by the participants. Continuity of midwife care models may offer an alternative to CSMR for some. Stakeholders are key to ensuring clear guidelines, equal care, and trust in the system.

Background At emergency medical dispatch centres (EMDCs) telephone triage takes place in three steps: identifying the event, assessing the callers' need for support, and prioritizing the response. Some calls are considered to be more difficult to handle than others, and decision support systems may in these situations be of limited help. The aim of this study was to describe and characterize difficult calls to EMDCs. Methods Retrospective call data from 2022 to 2023 was extracted for Registered Nurse (RN) dispatchers at three EMDCs in Sweden agreeing to participate in this mixed-method study. Categories of difficult calls were identified based on prior research and operationalized as key-word searches in the free text call notes or as indicators based on structured data. A purposeful selection of calls meeting these criteria were extracted, anonymized, and data regarding categories and the phase on the call in which they occurred then coded. A descriptive quantitative analysis was performed, and logistic regression was used to estimate the association between demographics and the likelihood of high-priority ambulance dispatch. Results Over the two-year study period, 14 included RNs handled 27,805 calls. Of these, 4888 calls (17.6%) were identified as potentially difficult calls based on free-text notes and structured data, from which 123 calls were selected for further analysis. The median age of callers were 49 years, and 49% were female. Median call duration was 5.6 min, compared to 5.1 min in the full dataset, and 39.5% of calls resulted in a lights and sirens response.Vague or unclear symptoms and psychiatric problems were the most common difficulties. These could occur in all three phases of the calls and in several of the phases in one single call, with a combination of "assessing and prioritizing" being the most common. Male sex was found to be associated with a higher likelihood of receiving an ambulance with high priority. Conclusions Difficult calls, mainly with vague or unclear symptoms and psychiatric problems, are common at EMDCs. The reason for the tendency to prioritize young males higher are seen in other contexts but not in truly high priority cases at dispatch and needs further investigation.

Purpose

To explore how stroke survivors experience and prefer to participate in clinical reasoning processes in the subacute phase of stroke rehabilitation.

Methods

An explorative qualitative design was used. Individual interviews were conducted with 10 stroke survivors (4 women and 6 men, mean age 68 years) 4 weeks after their stroke, and follow-up interviews were conducted with 6 of them after 10 weeks. The interview settings were the patient’s home during their home rehabilitation, an inpatient and an outpatient rehabilitation unit. A reflexive thematic analysis was performed.

Results

Four themes were identified: discharge as a critical point for participation, describing a stressful time with varying involvement; supportive actions and context as crucial for participation, describing collaboration with the stroke team, the team’s consideration of the stroke survivor’s resources and needs, and a supportive home environment; the importance of goals and follow-up, describing goals as motivational and an unstructured use of goals; and difficulties in participation, describing a lack of dialogue with the stroke team and undetected resources and needs.

Conclusions

The stroke survivors experienced changes in their participation in the clinical reasoning process as their rehabilitation progressed. They moved from perceiving themselves as passengers at the time of their hospital discharge to gradually seeing themselves as the driver of their rehabilitation process. Some person-centered attributes, such as respectful relationships and a health focus, were incorporated into the clinical reasoning, while others, such as a holistic view and shared goal-setting, required further emphasis for improved person-centeredness in stroke rehabilitation.

Aim: This paper examines a theory and practice developed framework aimed at guiding person‐centred communication in registered nurse–patient encounters. The primary objective is to refine and present a data‐ and theory‐driven framework tailored to the demands of nursing practice and those receiving care. To achieve this, the COMCARE model is introduced, providing practical guidance for understanding and implementing strategies for nurses' communication and caring behaviours.

Design: This theoretical paper addresses theory and research on communication strategies during registered nurse–patient encounters based on the principles of caring and person‐centredness.

Results: The COMCARE model outlines communication strategies to guide registered nurses to ensure caring and supportive interactions, aligning with the principles of person‐centred care. COMCARE builds on the necessary communication skills for person‐centred registered nurses–patient encounters and clarifies key components of such communication, with related goals. The key components proposed are related to empathic listening and asking questions, responding and acknowledging, guiding and using clear communication, supportive communication, and appraising and confirming communication. Person‐centred communication requires a broad repertoire of skills to be applied and tailored to individuals in various situations and practices.

Conclusion: The COMCARE model provides an overview of the communication skills essential for person‐centred care, emphasising guidance for nursing practice to support patients' optimal well‐being and health. This framework highlights the importance of communication skills in shaping patient experiences and outcomes and underscores the need for their application and implementation in caring and nursing practice. Effective communication by registered nurses and other healthcare professionals is vital for delivering high‐quality care. The COMCARE framework offers practical guidance and serves as a foundation for future training and education for nursing students, as well as informing policy and research in this area. Further research is needed to test and validate the COMCARE model in clinical settings.