Abstract
In 2016, Denmark's nurse education eliminated diagnoses, age and care settings from the curriculum. How students are trained for homecare is unknown. This article illuminates how students of non-Danish origin were socialised into homecare practice during nurse education in Denmark. Semi-structured interviews with eight students and a theoretical inspired latent thematic analysis of data were conducted. The SRQR checklist was used. The results are presented under three themes: Unprepared students stepped out from university college, Clinical supervisors as instructive and questioned role models, and Patients and relatives acted as co-supervisors. Theoretical highlights on homecare nursing were scarce from students’ perspectives. Clinical supervisors and encounters with patients and relatives in their homes socialised students into professional roles within homecare. The organisation of education in homecare pointed to a clinical, professional socialisation of nursing students in patients’ homes rather than a theoretical socialisation with an inherent formation at university college.
Introduction
This article focuses on socialisation of nursing students into homecare practice based on the nurse education in Denmark, which has radically changed its organisation and teaching content in recent years. From a historical perspective, there has been an explicit focus on specific areas of nursing, such as homecare, 1 which are no longer to be found in the current executive order of nursing education in Denmark. 2 Instead, it is constructed by descriptions of learning objectives in relation to knowledge, skills and competencies, in a unified healthcare system.2,3 The changes stemmed from years of criticism from clinical practice, which pinpointed that newly qualified nurses did not possess the required practical skills, and lacked clinical leadership and the ability to make decisions in clinical situations.4,5 The current bachelor's degree programme, implemented in 2016 at university colleges, consists of a two-year national identical and common part and an 18-month institution-specific part, structured into seven semesters. 2 The programme differs from previous national programmes by being organised into themes focusing on the complexity of nursing in patient cases, where diagnoses, age groups and care settings are eliminated from the curriculum. The national part consists of four themes: ‘Observation and assessment of patient and citizens' health challenges and disease correlations’, ‘Clinical decision-making in stable and complex care and treatment pathways’, ‘Situation-specific communication in interaction with patients and citizens, relatives and professionals in and across sectors’, and ‘Clinical management of patient and citizen care pathways’. The three institution-specific themes differ. What motivates this structure are ambitions to successfully address future care challenges with increased complexities of diseases, demographic growth of the elderly population, 4 lack of professionals, and movement of care and treatment from hospital to outpatient treatment and homecare. 6 However, how educators highlight homecare as a teaching area within Danish nurse education, and what implications this has for nursing students, are unexplored areas.
Homecare practice refers to nursing provided to patients of all ages, living in their own homes including nursing homes, in cases of acute or chronic illness that require nurses’ contributions. 7 There are many factors at stake when professional competencies are developed and deployed in homecare practice. This applies to subject-relevant knowledge, skills, an overview of complex situations and self-insight. The development of professional competencies becomes possible in the interplay between all these elements, when this interplay is integrated into an inner, personal acquisition and processing process together with previous life experiences.8,9 This means that students' preferential general, theoretical knowledge of nursing must be put into play with the elements, including the history and the social context in which practice takes place. The theoretical part of nursing education contributes with theories of and for practice, which help students acquire theoretical awareness as a basis for professionalism and reflection in clinical practice. 10 Trends are seen towards stronger focus on student-centred learning rather than teacher-centred approaches to promote critical thinking, analysis, and problem-solving skills, taking into account the learner, instructors and systems, including cultural diversity in students. 11 Clinical practice and placements are essential components of nurse education programmes and a frontstage for socialisation into the nursing profession, contributing to the students’ learning experiences. 12 For their socialisation into clinical environments, students depend on clinical practice competency, i.e. their ability to integrate and apply skills, knowledge, and judgement to clinical practice. 13 Supportive environments, 9 role models, educator preceptorship, and appropriate feedback12,14 can promote learning and competency enhancement. The students’ personal dispositions and levels of confidence can enhance the socialisation process and how the students will ‘fit in’ with their working environments. 12 Understanding barriers and facilitators to students’ learning processes and socialisation into the nursing profession is hence of importance to promote their entry into and retainment in the nursing profession.
Considering nurses’ global migration15,16 and the cultural diversity among nursing students,17–19 it is of interest to understand whether and how students' cultural upbringings and backgrounds affect their understanding of homecare encounters. While several studies focus on encounters between healthcare professionals and patients with different cultural backgrounds in homecare,20–22 there are fewer studies focusing on professionals with different cultural backgrounds from the patients. Both appreciative23,24 and discriminative22,25 relationships are seen between patients and nurses with immigrant backgrounds, and studies show that nursing students display positive attitudes towards immigrant patients.17,18,26 Nurses’ training and socialisation throughout nurse education ought to facilitate patient encounters and accommodation of cultural diversity. This study aims to illuminate how nursing students with an ethnic background other than Danish were socialised into homecare practice during their nurse education in Denmark.
Method
This study was based on a Braun and Clarke 27 and Berger and Luckmann-inspired 28 latent thematic analysis of empirical data from a qualitative interview study, 29 consisting of eight individual interviews with nursing students with a self-appointed background of origin other than Danish. The current study is part of a larger project exploring nursing students’ understanding of ‘a home’ and how it influences professional meetings in homecare. The current article, however, focuses the nursing students’ socialisation into homecare practice. To enhance the quality and transparency of the study, the Standards for Reporting Qualitative Research (SRQR) checklist was used. 30
Theoretical framework
The socialisation of nursing students into the field of nursing is coherent with their learning of and in the profession. This motivates the choice of a theoretical perspective regarding socialisation to understand what is at stake when learning homecare nursing. According to Berger and Luckmann, 28 ‘society’ is understood as an ongoing dialectical process composed of the moments of externalisation, objectivation and internalisation. A key concept in the current study is socialisation of nursing students into homecare, with socialisation referring to the comprehensive and sustained governance that leads individuals into a sub-world in society. Primary socialisation occurs through the individuals’ growth, while secondary socialisation refers to the internalisation of institutional or institutional-based sub-worlds, such as nursing schools at university colleges/universities, experienced as an objective reality. Such sub-worlds are determined by the division of labour and social distribution of knowledge. Individuals are confronted with undeniable facts that are external to the individual and persistent in their reality. Institutions require legitimations, which permit individuals to interpret the institutions’ reality. New generations learn these legitimations through socialisation, through which institutionally related knowledge supplies institutionally appropriate rules of conduct. These motivate the dynamics of institutionalised conduct and roles to be played. 28 Individuals externalise their own being into the social world and internalise it as an objective reality. Further, the individuals’ specific societal context influences their understandings of ‘reality’ and ‘knowledge’, which also applies to nursing students in their understanding of homecare. The current study took place in the sub-world of nursing education, focusing on homecare settings.
Recruitment of participants
A purposive, convenience sample was selected for this study.
31
The participants were recruited among undergraduate nursing students from a university college in Denmark, based on the following inclusion criteria:
Identify themselves as belonging to an ethnic culture other than Danish. Having been raised in a home with a non-Danish cultural background. Being a nursing student having completed at least one year's nursing studies. Having spent a clinical training period in community preventive child healthcare, homecare or nursing homes.
An invitation to participate in the study was sent to all nursing students after study year 1 through their student email accounts. Interested students contacted the project manager for enrolment in the study. Eight students participated. The interviewer and interviewees did not know each other at a personal level.
Interviewing process
Data were collected using a semi-structured interview guide constructed specifically for this study by the authors. The themes in the interview guide focused on the informants’ self-presentations and reflections about the meaning of a home, their experiences of being nursing students, of being supervised in others’ homes, and of the nursing programme's theoretical education about homecare. The interviewer (JWJ) conducted a pilot interview, which was then discussed amongst the researchers regarding the content of the interview guide. It spawned no changes in the interview guide. All interviews were conducted by JWJ and recorded using the digital Zoom application. They lasted between 43 and 73 minutes (average 55 min). All interviews were transcribed verbatim for analysis.
Ethical considerations
The study was carried out in line with the principles of the Helsinki Declaration. 32 The study was registered, and data stored at VIA University College according to National Data Protection legislation. 33 Participation was voluntary. All participants signed an informed consent prior to the interviews after receiving verbal and written information about the study. All data were anonymised and stored securely. Data that may have compromised the participants’ anonymity were removed.
Analytical strategy
The latent, thematic analysis was inspired by Braun and Clarke
27
and Berger and Luckmann's theory of socialisation.
28
First, all empirical material was read and re-read in its entirety to facilitate familiarisation with the material. Second, the transcribed interviews were analysed, first one at a time and then across all interviews. Questions were developed and used to break down the empirical material, code and reorganise the contents, posing three theory-inspired questions related to socialisation to the transcribed material:
- How were nursing students taught:
Theoretically about homecare nursing? Clinically by nurses/supervisors in homecare nursing? By patients and relatives in patients’ homes?
Next, initial themes were constructed based on the coded material. The themes were constructed based on similarities and differences in the coded material. Similar codes were gathered into themes that answered the article's aim. All authors reviewed and developed the themes in a consensual analysis process. Potential discrepancies in data interpretation were discussed until consensus was reached. To ensure that the themes appropriately reflected the empirical material and that the empirical material relevant for the study's aim was covered by the constructed themes, the authors went back and forth in an iterative process between the constructed themes and the empirical data throughout the analysis process. The researchers initially carried out the described steps separately, then co-jointly. The process encompassed ongoing discussions, including comparisons of the thematic constructions, with constant focus on and guidance by the theoretical framework. In that way, the three themes were refined, defined, and named: Unprepared students stepped out from university college, Clinical supervisors as instructive and questioned role models, and Patients and relatives acted as co-supervisors. Quotations were selected from the empirical material to illustrate the analysis and interpretation of data.
Findings
Initially, the participants’ socio-demographic characteristics are presented. The study included eight women, aged 23–55 years (median age = 25). All of them were proficient in Danish, although their mother tongues were Somali, English, Pashto, Bosnian, Russian and Nepali. Four of the women were born in Denmark, the other four in other countries. The students not born in Denmark had lived in Denmark between six and 19 years (mean = 13 years) and had a former education. Of those students, two had a master’s degree in Natural Sciences from abroad, of whom one also had a nursing assistant education. The other two non-Danish-born students had a nursing assistant education. For the four students born in Denmark, the nurse education was their first education after sixth-form college.
Unprepared students stepped out from university college
The university college was regarded as a sub-world for theoretical learning about homecare practice and entering strangers’ homes. However, students experienced that the theoretical nursing education provided them with an empty box of knowledge, with which they moved empty-handed into homecare practice.
[Theoretical teaching in homecare] It has not been discussed or a [teaching] theme. (S1)
I do not think this [homecare] has been a [theoretical] focus at all. I learned about it in homecare settings [clinical education], and […] at work [part time job]. (S6)
Theoretical knowledge about homecare practice in general was not provided through university college, which meant that students had no theoretical knowledge or skills that could help them internalise and reflect upon the sub-world of homecare practice. The basic question ‘What characterises the job of a homecare nurse?’ was raised by a student, speaking for lack of socialisation through their attendance at university college into the codes and rules of conduct pertaining to homecare nursing.
In fact, I’m still in doubt about what a homecare nurse does […] I miss an overview of what tasks the homecare nurse has exactly. What exactly is she responsible for? (S5)
In addition, students demanded theoretical knowledge in specific areas relevant for the sub-world of homecare, such as homecare-relevant documentation technology, care at the time of death, and COVID-19 security procedures in homecare.
[Asked an IT manager in homecare practice] Why do we not get teaching in Cura [Homecare documentation system] like we have in EPJ [electronic patient journal used at hospitals] at the university college? [Supervisor] went directly to the person responsible for education because there is a lack of focus on this to provide an insight into how homecare works. […] And all that about getting into a patient’s own home […] compared to when they are at the hospital. It is completely different […] I really miss that we were not taught in that theme. (S4)
What tasks does the home nurse have exactly? What is the nurse responsible for, specifically, e.g. in the event of death? (S5)
We were not [theoretically] taught [about COVID-19]. [In homecare] they told me: ‘Just for your information, we do this in relation to COVID blablabla’. But no definite teaching [neither in theory nor clinic]. [Own knowledge search] I see the news and follow it, otherwise I go to www.corona.dk, where I update myself on the latest guidelines and everything like that. (S6)
Some students challenged themselves through theoretical reflections about their practice experiences in homecare. Reflection about the apprehended characteristics and rules of homecare nursing through practice experiences supported students’ internalisation of homecare practice during their clinical education and hence a secondary socialisation process. Such experiences occurred in patients’ homes and were reflected upon together with the supervisors and/or at home post work.
I love theories. Then I have something to work from. Every time I do something or observe something, a theory comes up directly. For example, Kari Martinsen, who talks about trust relationships or professional judgment. They told me in my last internship that I liked having theories to apply [on clinical situations]. (S4)
This displayed a wish for secondary socialisation into homecare nursing through college university, with the latter not living up to students’ needs and expectations.
Clinical supervisors as instructive and questioned role models
Students attended to their knowledge development by using the supervisors actively in homecare settings for their learning process and competence development. Clinical supervisors thus contributed to students’ socialisation into homecare nursing, providing them with knowledge and role-modelling to internalise the codes and rules of conduct specific to the homecare sub-world.
[Knowledge about getting into strangers’ homes] That was something I talked to the homecare nurses about. […] When you enter a patient’s home, it is important to keep in mind that it is the patient’s home, and we need to be aware of that. It was something that was their focus [the nurses], and not something we get from the [theoretical part of the] education. (S2)
From the students' perspective, supervisors also silently taught students how diagnoses were used to label patients as e.g. ‘good’ or ‘bad’ patients. Students saw tendencies in healthcare professionals towards labelling and stigmatisation of people with severe mental illness and/or alcohol/drug (mis)use. This created a dissonance in relation to the theoretical understanding that all people are equal in healthcare.
The nurse thought we were there to give him an injection for B12 deficiency, and not for schizophrenia. […] Later, I read up on the patient's case, and found out that the B12 was [given due to schizophrenia]. I talked to her [nurse] about it. But she was not very accommodating to talk about schizophrenia. I wonder if it's because it's something you do not talk about or something you should not talk about. (S8)
Supervisors had the power to judge students as (un)fit for their future profession, which forced students to do what was expected of them without resisting. This meant that students could be excluded from the sub-world of homecare and subsequently fail in their nursing education if they did not live up to this sub-world's explicit and implicit norms and expectations.
I was only in the 3rd semester, and I did not know if it was safe sending me to that patient [extroverted due to frontal dementia]. But I went there because I had to pass my internship period. (S1)
In hands-on moments in patients’ homes, students supported patients with different activities such as personal hygiene. Supervisors functioned as instructors and hence ‘socialisators
When the supervisor was present, I took the lead. She took over when I needed help and […] gave me advice on what to do. […] What I could do alone I did myself. What we were supposed to be two people for, e.g. moving with a lift, she took part in the work. (S2)
Sometimes, students experienced a lack of knowledge in supervisors, for example in relation to COVID-19. This could imply that students tacitly internalised the fact that personal interpretations overruled guidelines and scientific know-ledge in homecare practice actions and interactions.
There was chaos. What is meant by that? What’s going to happen now? Why are there no posters? Do I have to wear a visor all the time? […] Well, that was really bad. (S4)
Some students nonetheless searched for relevant knowledge themselves elsewhere, such as through web-based searches on COVID-19-related information regarding homecare. They took responsibility for their own socialisation into ‘adequate conduct’ in homecare contexts considering the COVID-19 pandemic, as advocated by sources deemed as relevant by students, balancing the understanding of evidence-based practice in the sub-world of medicine in general.
I knew very well that viruses mutate, and I have always wondered if they make a vaccine. That’s fine, but when viruses tend to mutate all the time, what should they do afterwards if they mutate? I’ve had a lot of questions, and of course I’ve researched what kind of COVID virus it is. (S5)
Other students personally distanced themselves in relation to knowledge about COVID-19 and homecare. In these cases, the students’ personal history could challenge the medical logic and thereby also the professional knowledge and skills demanded in the sub-world of homecare.
I only do what I get to know out here [in homecare]. I think it takes up too much space in society. I’m tired of it. In the beginning [of the pandemic], I searched […] on Facebook and […] on the municipality’s website. (S4)
Students were trained to a competence through which they reproduced the existing clinical practice in the homecare practice sub-world. This was done without having to reflect theoretically about their actions on higher levels of abstraction and without challenging the current logics and action patterns, let alone understanding what went on in homecare practice from a theoretical perspective.
Patients and relatives acted as co-supervisors
From the perspective of nursing students, patients socialised students into their specific sub-world of a home. This encompassed the norms of the home and lived life, and expectations of healthcare professionals (inter)acting in this specific sub-world.
The other nurses talked about her [older lady] being angry and tired and she wanted it her way. […] I went in with an open mind and I ended up loving to get there. She was amazing […] The last thing she said before I stopped internship was if I couldn't wait until she was dead. (S3)
I observe myself, I observe the situation, and then I must be present, and be very aware of the other party's wishes. […] When we work with patients, we must always be there for them – and respect them to a great extent. […]. When I respect their opinion, and come to strangers' homes, then of course I must also respect the surroundings I come to. That is actually what I became aware of these recent months. (S5)
In their encounters with patients, students externalised their personality in the homecare practice sub-world. This personal involvement strengthened their relationships and possibilities for acting in line with general internalised theoretical understandings of professional person-centred care.
Relatives also socialised students to the right behaviour, attitudes and actions in patients’ homes, both in relation to patients and relatives. It allowed the students to (inter)act adequately in relation to the hosts’ expectations and wishes in homecare encounters.
She [healthy spouse] was not like that for cosy talk. She seemed quite stressed about having such a sick man […] [On the first visit] I was just trying to just say. ‘I’m just sitting right here [medicine dispensing]. You don't have to think about me, just do yours.’ […] There was not so much talk the first time, but then, the second time, it loosened up. (S3)
It was not only patients and relatives who socialised nursing students into homecare. Also, patients’ homes and associated objects, the atmosphere and inhabitants/guests had significance for how students entered the patients’ homes and interpreted patients and their encounters with them.
I appreciate coming into most homes. It has something to do with what homes look like and what they are like as a person. I have been to some very nice homes, where you take off your shoes, because you say to yourself ‘that it's a little too bad for the floor if I walk with shoes on inside their home’. […] I also came across someone where […] the floor is dirty … and it's dirty everywhere and it smells a lot from smoking. (S7)
Both patients and relatives functioned as teachers and assessors for nursing students, with the ability to socialise them towards professional performance within their homes and thus the homecare sub-world. It meant that patients and relatives supported students' learning processes and competence development by translating general knowledge into specific situations. They thus widened students’ understanding of the complexities and diversity of encounters with people in homecare.
Discussion
This discussion focuses on two main findings. First, we discuss the fact that homecare nursing is a matter of clinical socialisation rather than acquisition of both theoretical and clinical competencies through education in Denmark. Second, we discuss how students learn clinical homecare practice. Finally, the study's methods are discussed.
The results show how Danish nurse education had a spare theoretical focus on homecare and entering strangers’ homes in the university college teaching, from the perspective of nursing students. According to the students, the university college education had hospital contexts in the foreground for teaching. This goes in line with the specialisation in medicine, including a hierarchy of diagnoses and/or specialisations with political priority in the healthcare system in the Western world. 34 In principle, homecare is not specialised, but a practice calling for general competencies in professionals. In their analysis of nursing textbooks, Beedholm and Frederiksen 35 show how a growth in humanistic theories from the 1950s onwards provided an opportunity to replace the medical discourse with a humanistic discourse, driven by a professional interest to describe nursing as an independent profession. Nursing education’s current executive order and curriculum have been explicitly cleared from medical influences, 2 but the historical connectedness of nursing and medicine persists. Several studies show how nursing is subjected to medicine, where diagnosing and treatment often rule the nurses’ clinical reality, 36 also within homecare. 37 The findings indicated that (historical and) structural conditions such as the education curriculum indirectly supported the medical logic and framed the possibilities for teaching and learning about homecare nursing. This is also supported by the fact that homecare nursing has historically had a relatively low position in the medical field, fighting for acknowledgement and education in line with hospital nursing. 1
The findings show that nursing students adapted to the homecare situation in patients’ homes, where the patients themselves, supervisors and relatives affected the students’ learning processes and socialisation into the nursing profession. Students calibrated their encounters, behaviour and learning processes in the patients’ homes with their educational curricula, supervisors’ behaviour, and encounters with patients and family in their homes; factors that were all at play in the students’ socialisation into the nursing profession. Homecare education was based on on-the-spot, spontaneous clinical learning, where personal relations came through as being more important than technical and professional skills for recognition as a ‘good and competent’ nursing student. Lee and Yang 38 show that lack of support in experiential learning can result in failure to manage the hidden curriculum and theoretical and practical skills in education in homecare, arguing that nursing educators need to orientate students to the professional culture prior to beginning clinical placements. Further, studies show that clinical supervisors, their professional experiences, and engagement in students’ learning processes are important for students’ socialisation into clinical settings,39,40 and for introduction and retainment of new graduate nurses in clinical settings. 41 Tanguy 42 dealt with the concept of master teaching and showed how a vocational education is also a social measure used to integrate young people into their work practice post graduation. Although nurse education no longer operates with the concept of master teaching, homecare training apparently works through master teaching, including a strong socialising power in relation to students' inclusion in and exclusion from the community of practice. Concurrently, this form of education involves a master teacher assessment of whether students are professionally competent in the field. Using Windolf's 43 terminology, the student can be described as ‘socialisand’, i.e. the one who must learn something in a conscious/unconscious learning relationship, and homecare nurses/supervisors as ‘socialisators’, with the right to assess students’ professional competence. The development of professional competencies in clinical practice is concurrently a question of ability and requirements to fit into the community of practice, including this sub-world's (un)written rules. The acquisition and development of professional competencies occur in several ways, with both known and hidden, planned, and unplanned curricula and learning potentials in the encounters with homecare practice. 38 Also, patients and relatives act as socialisators. Students, however, wished for more theoretical education about homecare, indicating that there may be room for development of theoretical aspects in the educational curricula as also shown in other studies.44,45
Finally, the study's method and limitations are discussed shortly. The study consisted of interviews with nursing students narrating their stories about clinical education in homecare. There are differences between what people do and say they are doing because of embodied structural frames and tacit knowledge. 46 This study only showed the students’ narratives. Further, training and learning in homecare practice are relational processes, embedded in social contexts and social relationships. This study only showed these practices from the students’ perspectives. Perspectives of university college teachers, clinical supervisors, patients, and their relatives are absent and might be significant to enhance the understanding of the complexities of homecare nursing and education within this specific area. We argue that ethnic background does not come through as the main issue in the current findings, although all participants in the current study reported a different ethnic origin than the country in which they were being educated, that is, Denmark. However, this claim can only be strengthened through additional studies, which also include nursing students with non-other ethnic backgrounds. This to explore what might depend on the structural educational framework and what might depend on ethnicity when it comes to the narratives of being educated in homecare settings. The current study's limited sample must be taken into consideration when interpreting the results and drawing conclusions. The results are based on a limited sample of female students with a non-Danish background from one single university college, hence limiting the transferability of the results to other nurse programmes and contexts. 47 It is always questionable at what point data saturation is achieved and, from a philosophical perspective, impossible per se as an interview is a moving target conditional on new questions and new responses occurring throughout the interview process. 48 Further studies can help build upon the current findings. Berger and Luckmann's 28 theoretical framework made it possible to transfer the researchers' pre-understandings to a theoretical level, facilitating stringency and transparency in the analysis and strengthening the study's trustworthiness.
Conclusion
The study showed that the education’s theoretical part scarcely supported nursing students with theoretical knowledge, which could have increased the students’ theoretical awareness in homecare and thus helped them internalise this sub-world in their professional development. This raises questions about the content of the curriculum and the potential value of a theoretical foundation focusing on homecare to help students in their acquisition of professional knowledge, skills, and competencies. Clinical supervisors, patients and relatives, however, supported the students’ socialisation into homecare in various ways, with supervisors seen as both instructive and questioned role-models. The organisation and structure of education in homecare pointed to a clinical, professional socialisation of the students in the patients’ homes, rather than an educational socialisation with an inherent formation at the university college. Further, the students’ non-Danish ethnic backgrounds did not come through as a major issue related to their socialisation into homecare nursing. This study calls for further studies to illuminate the complexities of homecare nursing and education within this specific area from relational perspectives.
Supplemental Material
sj-docx-1-njn-10.1177_20571585211052752 - Supplemental material for Socialising of nursing students into homecare practice in Denmark: a Berger and Luckmann-inspired interview study
Supplemental material, sj-docx-1-njn-10.1177_20571585211052752 for Socialising of nursing students into homecare practice in Denmark: a Berger and Luckmann-inspired interview study by Stinne Glasdam, Jette Westenholz Jørgensen and Sigrid Stjernswärd in Nordic Journal of Nursing Research
Footnotes
Ethics approval and consent to participate
The study was carried out in accordance with ethical research principles as stated in the Declaration of Helsinki.32 Participants gave their written, informed consent to participate in the study after receiving verbal and written information about the study.
Data availability statement
The authors elect to not share data for confidentiality reasons.
Author contributions
Stinne Glasdam: conceptualisation, methodology, formal analysis, writing – original draft preparation, writing – review & editing, project administration. Jette Westenholz Jørgensen: methodology, investigation, writing – original draft preparation, writing – review & editing, project administration. Sigrid Stjernswärd: conceptualisation, methodology, formal analysis, writing – original draft preparation, writing – review & editing.
Funding
The authors disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: This work was supported by the VIA University College who funded the transcriptions.
Conflict of interest
The authors declare that there is no conflict of interest.
Supplemental material
Supplemental material for this article is available online.
References
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