| 1. |
- Samuelson, Karin, et al.
(författare)
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Intensive care sedation of mechanically ventilated patients: a national Swedish survey
- 2003
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Ingår i: Intensive and Critical Care Nursing. - 1532-4036 .- 0964-3397. ; 19:6, s. 350-362
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Tidskriftsartikel (refereegranskat)abstract
- Sedation in critically ill patients is a complex issue and at the same time an important concept for ensuring patient comfort. The aim of this study was to review the current practice of sedation for patients on mechanical ventilation in Swedish intensive care units (ICUs). Questionnaires were sent by post to head nurses in 89 ICUs with mechanically ventilated patients. By August 2000, 87 (98%) questionnaires had been returned. The results show that mechanically ventilated patients were routinely sedated in 91% of ICUs. Midazolam or propofol in combination with an opioid were the drugs preferred by 76%. Heavy sedation was most usual in 63% of ICUs but, when asked about the sedation level preferred by nurses, 78% chose light sedation (P=0.001). Only 16% used sedation scales. This study indicates that local habits and personal attitudes seem to have a great impact on sedation routines. It therefore appears worthwhile for ICUs to review their practice and, if necessary, to consider implementing sedation scales and sedation guidelines. Research pertaining to potential complications and patient comfort in relation to different sedation levels as well as further validation of the efficacy of sedation scales is needed.
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| 2. |
- Backe, Marita, et al.
(författare)
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Patients’ conceptions of their life situation within the first week after a stroke event : A qualitative analysis
- 1996
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Ingår i: Intensive & Critical Care Nursing. - London : Churchill Livingstone. - 0964-3397 .- 1532-4036. ; 12:5, s. 285-294
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Tidskriftsartikel (refereegranskat)abstract
- The aim of this study was to find out how stroke patients conceived their life situation within the first week of the acute care phase as seen from the nurses’ viewpoint. Six patients were interviewed within 3 weeks from their first stroke, using questions based on a holistic philosophy and analysed with the phenomonographic approach. Two main categories emerged from the results: the feeling of unreality and the awareness of a changed role in life, together with six subcategories; feeling of a changed perception of the body; feeling of being confused; loss of capability; awareness of confined life space; the importance of support and encouragement; and the will to look for new opportunities. The study concludes that the body change resulting from a stroke leads to both physical and psychological trauma, in which the psychological crisis can be very deep and best described as a personal catastrophe. The patient’s capability to receive and understand information becomes blocked, which influences both the nurse and the patient’s next of kin with regard to their care of the patient. Conversations with the patient must be frequent so that the acute care can be evaluated and agreement reached between the patient’s wishes and the nurses’ objectives. The results indicate the significance of intervention programmes based on crisis theory within the first week of a stroke event.
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| 3. |
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| 4. |
- Dahl, Å, et al.
(författare)
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Nurses' clinical experiences of the inverse bed position on a neurointensive care unit - A phenomenographic study
- 2003
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Ingår i: Intensive & Critical Care Nursing. - 0964-3397 .- 1532-4036. ; 19:5, s. 289-298
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Tidskriftsartikel (refereegranskat)abstract
- Our knowledge of unstable critically ill patients placed in an inverse bed position on the neurointensive care unit (NICU) is fairly limited. The purpose of this study was to ascertain the variation in nurses' conceptions of the impact of clinical experiences on the care and working environments among patients with the head towards the centre of the room on an NICU. An important research question was: how is the nursing care of patients facing inwards on an NICU perceived? Interviews were conducted and analysed with 15 nurses, using the method of phenomenography. From a nursing perspective, four descriptive categories were found, which partly distinguished the nursing psychosocial environment from the physical environment. These were safety and security of mobile computer tomography (CT) on the NICU, availability and overview, integrated holistic view in an open nursing psychosocial environment and adaptation of practical equipment. In conclusion, inverse bed position is important for more individualised neurointensive nursing care among unstable patients subjected to frequent CT scans on the unit. More stable patients should be turned back to the traditional bed position in order to promote their recovery process. This new knowledge is important for the development of quality assurance, with regard to, amongst other things, the patient's dignity. ⌐ 2003 Elsevier Ltd. All rights reserved.
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| 5. |
- Hall-Lord, M-L., et al.
(författare)
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Elderly patients' experiences of pain and distress in intensive care : A grounded theory study
- 1994
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Ingår i: Intensive & Critical Care Nursing. - : Elsevier BV. - 0964-3397 .- 1532-4036. ; 10:2, s. 133-141
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Tidskriftsartikel (refereegranskat)abstract
- The aim of the present study was to develop a theoretical understanding of elderly patients' experiences of pain and distress in intensive care, using a grounded theory approach. 18 patients, 7 women and 11 men, were interviewed and observed in an intensive care unit (ICU). Their average age was 76.5, varying from 70–85. A model was generated from data, according to which elderly patients' experiences of pain and distress in intensive care can be described as four interrelated aspects: a sensory, an intellectual, an emotional, and an existential dimension. 16 categories form the four dimensions. The categories, in turn, are grounded in a number of interview and observational data. The sensory dimension is formed by the categories physical pain, physical discomfort, fatigue, and breathing problems, and the intellectual dimension by the categories not knowing, difficulty in expressing oneself/not being understood and confused perception of reality. The categories in the emotional dimension are worry, fear, resignation, bitterness, anger/irritation and dependency. Finally, the existential dimension is formed by the categories despair, threat to life and death acceptance. The categories within the four dimensions may be separate, but often they interact and influence each other in various ways. The model is discussed in relation to existing models and definitions of pain, where the intellectual and existential dimensions in particular have not been emphasized in a similar way.
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| 6. |
- Johansson, Ingrid, et al.
(författare)
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Coping strategies when an adult next-of-kin/close friend is in critical care: a grounded theory analysis
- 2002
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Ingår i: Intensive and Critical Care Nursing. - 0964-3397 .- 1532-4036. ; 18:2, s. 96-108
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Tidskriftsartikel (refereegranskat)abstract
- The aim of the study was to generate a theoretical model of how relatives/close friends cope when faced with having an adult next-of-kin/close friend admitted to critical care. Using interviews, data were collected from 18 relatives/close friends of adult patients in thoracic surgical, neurosurgical, coronary, and general ICUs in south-west Sweden. The design incorporated grounded theory methodology. The results indicate the relatives/close friends tried to make the experience of their situation easier, but that the approaches used differed in accordance with the individual’s internal and external resources. Four coping strategies exhibiting different characteristics were identified: the relatives/close friends alleviated, recycled, mastered, or excluded their feelings. Factors determining the choice of coping strategy were social background, previous experience of ICU-care and how the situation was apprehended. The theoretical model described in this article can contribute to expanding nurses’ understanding of the coping strategies of relatives/close friends in critical care.
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| 7. |
- Lilja, Ylva, et al.
(författare)
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Effects of extended preoperative information on perioperative stress : an anaesthetic nurse intervention for patients with breast cancer and total hip replacement
- 1998
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Ingår i: Intensive & Critical Care Nursing. - Oxford : Elsevier. - 0964-3397 .- 1532-4036. ; 14:6, s. 276-282
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Tidskriftsartikel (refereegranskat)abstract
- An anaesthetic nurse intervention was performed in order to evaluate the effects of extended preoperative information, given by anaesthetic nurses, on perioperative stress in patients operated on for breast cancer or total hip replacement (THR). Forty-six consecutive patients scheduled for surgery for breast cancer, and 55 for THR, were randomized into two groups which were given different modes of preoperative information. Patients in the control group were informed about pre-and postoperative routines by a ward nurse. Patients in the intervention group were given extended formalized information by an anaesthetic nurse. Wilcoxon rank sum test was used to show relations between variables. There were no significant differences between the intervention group and control group for patients with breast cancer or for patients with THR. Breast cancer patients in the intervention group were significantly more anxious than THR patients in the intervention group (P<0.01). Breast cancer patients in the intervention group showed the highest anxiety scores on the Hospital Anxiety and Depression Scale (HADS) scale on the day of surgery. This information may reflect an increased level of anxiety due to the extended information given preoperatively. The information may thus have had a negative effect on breast cancer patients, resulting in an increased state of anxiety. The result indicates a need for individualized modes of information to provide a proper balance between enough and too much information. © 1998 Harcourt Brace & Co. Ltd.
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| 8. |
- Lindahl, Berit, et al.
(författare)
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The role of advocacy in critical care nursing : a caring response to another
- 1998
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Ingår i: Intensive & Critical Care Nursing. - : Churchill Livingstone. - 0964-3397 .- 1532-4036. ; 14:4, s. 179-186
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Tidskriftsartikel (refereegranskat)abstract
- With the aim of clarifying critical care nursing, six critical care nurses, working in a Swedish intensive care unit (ICU) were each asked to narrate a care situation with which they had been satisfied or dissatisfied. The stories were tape-recorded and analysed using a phenomenological-hermeneutic approach inspired by the philosophy of Ricoeur. The themes uncovered in the analysis describe the nurse's role of advocacy as: to build a caring relationship, to carry out a commitment, to empower, to make room for and interconnect, to be a risk-taker, to be a moral agent and to create a trusting atmosphere conducive to recovery. The meaning of the role of advocacy lies in a moral and existential response to another human being, an expression of caring. Advocacy rests on the patient-nurse relationship and occurs as an outspoken demand of another human being whose autonomy is threatened. The results are discussed from the ethical perspectives of Lögstrup, Watson's concept of care, and existential advocacy as expressed by Gadow.
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| 9. |
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| 10. |
- Svantesson, Mia, et al.
(författare)
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End-of-life decisions in Swedish ICUs : how do physicians from the admitting department reason?
- 2003
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Ingår i: Intensive & Critical Care Nursing. - 0964-3397 .- 1532-4036. ; 19:4, s. 241-251
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE: To study how physicians from the admitting department reason during the decision-making process to forego life-sustaining treatment of patients in intensive care units (ICUs). DESIGN: Qualitative interview that applies a phenomenological approach. SETTING: Two ICUs at one secondary and one tertiary referral hospital in Sweden. PARTICIPANTS: Seventeen admitting-department physicians who have participated in decisions to forego life-sustaining treatment. RESULTS: The decision-making process as it appeared from the physicians' experiences was complex, and different approaches to the process were observed. A pattern of five phases in the process emerged in the interviews. The physicians described the process principally as a medical one, with few ethical reflections. Decision-making was mostly done in collaboration with other physicians. Patients, family and nurses did not seem to play a significant role in the process. CONCLUSION: This study describes how physicians reasoned when confronted with real patient situations in which decisions to forego life-sustaining treatment were mainly based on medical--not ethical--considerations.
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