| 1. |
- Lundqvist, Anita, et al.
(författare)
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Neonatal end-of-life care in Sweden.
- 2003
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Ingår i: Nursing in critical care. - : Wiley. - 1478-5153 .- 1362-1017. ; 8:5, s. 197-202
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Tidskriftsartikel (refereegranskat)abstract
- A survey was carried out of Swedish neonatal end-of-life regarding practice before birth, at birth, during dying and after death using a descriptive questionnaire with close-ended questions and individual comments The practice in 32 of 38 neonatal units, as described by the head nurse or the registered nurses, was largely similar. Respectful treatment of both the neonate and the parents during neonatal end-of-life care was indicated Differences were found in pre-natal care concerning the information about the risks of pre-term birth, the opportunity for parents to view a pre-term neonate and meet its family, as well as a social worker Practice directly after birth was also different. A little less than half of the units answered that they gave a description of the seriously ill neonate to the parents before the first visit to the ward Practice during dying indicated that only a few units permitted the neonate to die at home
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| 2. |
- Samuelson, Karin, et al.
(författare)
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A nurse-led intensive care after-care programme - development, experiences and preliminary evaluation.
- 2009
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Ingår i: Nursing in critical care. - : Wiley. - 1478-5153 .- 1362-1017. ; 14:5, s. 254-263
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: The benefits of critical care follow-up services include increased understanding of the long-term consequences of intensive care and entail helping patients and their next of kin to come to terms with their problems and distress following critical illness and intensive care treatment. AIMS: To establish an intensive care after-care programme and to conduct a preliminary evaluation of the follow-up service from the patients' and relatives' perspectives in a general intensive care unit (ICU) in Sweden. DESIGN: A descriptive and evaluative design was used, and data from the first year of the after-care programme were collected. The final programme was nurse led and included five main points; a patient diary with colour photographs, ward visits, a patient information pamphlet, a follow-up consultation 2-3 months after intensive care discharge and feedback to the ICU staff. An evaluation questionnaire was handed out to patients and next of kin attending the follow-up clinic, e.g. asking the respondents to rate their satisfaction of the consultation on a visual analogue scale (VAS). RESULTS: The first year of after-care statistics showed that 170 survivors with a stay of 48 h or more were discharged from the ICU, resulting in 190 ward visits and 79 follow-up consultations. The preliminary evaluation revealed that the 2-month follow-up consultation achieved a median VAS rating of 9.8 (ranging from 1 to 10, poor to excellent) from both patients and next of kin. CONCLUSION: The development and preliminary evaluation of this nurse-led intensive care programme resulted in a feasible programme, requiring modest resources, with a high level of patient and relative satisfaction. RELEVANCE TO CLINICAL PRACTICE: This paper attempts to share with professional colleagues important steps during the developmental process of establishing an intensive care follow-up service and presents the content and preliminary evaluation of a nurse-led intensive care after-care programme focusing on the patients' and relatives' perspectives.
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| 3. |
- Samuelson, Karin, et al.
(författare)
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Stressful experiences in relation to depth of sedation in mechanically ventilated patients.
- 2007
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Ingår i: Nursing in critical care. - : Wiley. - 1478-5153 .- 1362-1017. ; 12:2, s. 93-104
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Tidskriftsartikel (refereegranskat)abstract
- n mechanically ventilated patients, sedatives and analgesics are commonly used to ensure comfort, but there is no documented knowledge about the impact of depth of sedation on patients' perception of discomfort. The aim of this study was, therefore, to investigate the relationship between stressful experiences and intensive care sedation, including the depth of sedation. During 18 months, 313 intubated mechanically ventilated adults admitted to two general intensive care units (ICU) for more than 24 h were included. Patients (n= 250) were interviewed on the general ward 5 days after ICU discharge using the ICU Stressful Experiences Questionnaire. Patient data including sedation scores as measured by the Motor Activity Assessment Scale (MAAS) were collected from hospital records after the interview. Of the 206 patients with memories of the intensive care, 82% remembered at least one experience as quite a bit or extremely bothersome. Multivariate analyses showed that higher proportion of MAAS score 3 (indicating more periods of wakefulness), longer ICU stay and being admitted emergent were factors associated with remembering stressful experiences of the ICU as more bothersome. The findings indicate that the depth of sedation has an impact on patients' perception of stressful experiences and that light sedation compared with heavy seems to increase the risk of perceiving experiences in the ICU as more bothersome. In reducing discomfort, depth of sedation and patient comfort should be assessed regularly, non-pharmacological interventions taken into account and the use of sedatives and analgesics adapted to the individual requirements of the patient
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| 4. |
- Svensson, Marie-Louise, et al.
(författare)
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The use of propofol sedation in a paediatric intensive care unit.
- 2012
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Ingår i: Nursing in critical care. - : Wiley. - 1478-5153 .- 1362-1017. ; 17:4, s. 198-203
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Tidskriftsartikel (refereegranskat)abstract
- Background: The aim of this study was to prospectively evaluate and report the experience of the use of continuous intravenous propofol sedation in a paediatric intensive care unit (PICU). Methods: All children younger than 16 years who were admitted to the PICU at a University Hospital for slightly more than a year and received propofol infusion were included prospectively and data were recorded before and within 6 h after completion of the propofol infusion. Results: A total of 174 out of 955 children (18·2%) received propofol infusion for sedation. The median age was 2 years 10 months (range: 2 months to 16 years), duration of propofol infusion 13 h (range: 1·6-179 h) and dose of propofol 2·9 mg/kg/h (range: 0·3-6·5 mg/kg/h). No one developed signs of the propofol infusion syndrome (PRIS). Neither dose >3 mg/kg/h, duration of infusion >48 h nor both were found to be related to adverse metabolic derangements or circulatory failure. Eight children increased their lactate concentration ≥1·8 mmol/L during propofol infusion. All had a favourable outcome. One child who had received propofol infusion for 10 h died, but this occurred 14 h after the infusion ceased and was without doubt attributed to a multiple organ failure not related to the propofol infusion. Conclusion: Propofol infusion was used in this population at low risk of PRIS with no metabolic or circulatory adverse effects. These findings indicate that the occurrence of adverse effects may not be directly related to dose or duration of infusion, but emphasizes the risk that sporadic factors may be involved, such as genetic mutations. Guidelines are presented.
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| 5. |
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| 6. |
- Åkerman, Eva, et al.
(författare)
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Use and practice of patient diaries in Swedish intensive care units : a national survey
- 2010
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Ingår i: Nursing in Critical Care. - : Wiley. - 1362-1017 .- 1478-5153. ; 15:1, s. 26-33
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Tidskriftsartikel (refereegranskat)abstract
- Aims and objectives: To describe and compare the extent and application of patients' diaries in Sweden.Background: Since 1991, patient diaries have been used in intensive care unit (ICU) follow-up in Sweden. There is paucity of relevant data evaluating the effect of this tool and also on what premises patients are enrolled. Likewise, data are sparse on the diaries' design, content structure and the use of photographs.Design: Descriptive explorative design by a semi-structured telephone interview.Methods: The interview results were analysed with descriptive statistics and differences between the ICU levels were explored by χ2 analysis. Qualitative manifest content analysis was performed to explore the purpose of diary writing.Results: Of all ICUs (n = 85), 99% responded and 75% used diaries. The source of inspiration was collegial rather than from scientific data. The main reason for keeping a diary was to help the patient to recapitulate the ICU stay. Discrepancies between the different levels of ICUs were detected in patient selection, dedicated staff for follow-up and the use of photographs. Comparison between the χ2 analysis and the content analysis outcome displayed incongruence between the set unit-goals and the activities for achievement but did not explain the procedural differences detected.Conclusion: The uses of diaries in post ICU follow up were found to be common in Sweden. A majority used defined goals and content structure. However, there were differences in practice and patient recruitment among the levels of ICUs. These discrepancies seemed not to be based on evidence-based data nor on ongoing research or evaluation but merely on professional judgement. As ICU follow-up is resource intense and time consuming, it is paramount that solid criteria for patient selection and guidelines for the structure and use of diaries in post-ICU follow-up are defined.
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| 7. |
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| 8. |
- Bruce, K, et al.
(författare)
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The hand-over process and triage of ambulance-borne patients : The experience of emergency nurses
- 2005
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Ingår i: Nursing in Critical Care. - : Wiley-Blackwell Publishing Ltd.. - 1362-1017 .- 1478-5153. ; 10:4, s. 201-209
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Tidskriftsartikel (refereegranskat)abstract
- One of the most important tasks that a nurse faces in the emergency room, when receiving a patient, is handover and the triage function. The aim of the study was to explore the experiences of nurses receiving patients who were brought into hospital as emergencies by ambulance crews through an analysis of the handover and triage process. A qualitative descriptive interview study inspired by the phenomenological method was used with six emergency nurses. There are three elements to a handover: a verbal report, handing over documented accounts and the final symbolic handover when a patient is transferred from the ambulance stretcher onto the hospital stretcher. The study identified that the verbal communication between ambulance and emergency nurses was often very structured. The ideal handovers often involved patients with very distinct medical problems. The difficult handover or the ‘non-ideal’ one was characterized by a significantly more complicated care situation. The handover function was pivotal in ensuring that the patient received the correct care and that care was provided at the appropriate level. The most seriously afflicted patients arrived by ambulance; therefore, the interplay between pre-hospital and hospital personnel was vital in conveying this important information. To some extent, this functioned well, but this research has identified areas where this care can be improved.
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| 9. |
- Engström, Åsa, et al.
(författare)
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Experiences of ICU diaries : touching a tender wound
- 2009
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Ingår i: Nursing in Critical Care. - : Wiley. - 1362-1017 .- 1478-5153. ; 14:2, s. 61-67
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Tidskriftsartikel (refereegranskat)abstract
- The aim of this study was to describe peoples' experiences of a personal diary written when they were critically ill and receiving care in an intensive care unit (ICU). BACKGROUND: In some ICUs, diaries are written by the ICU staff and close relatives of those who are critically ill and mechanically ventilated, but there is a lack of studies that focus on the experiences of the formerly critically ill of personal diaries written when in an ICU. METHODS: Qualitative personal interviews were conducted with nine people who were formerly critically ill. The interview texts were analysed using qualitative content analysis. FINDINGS: From the analysis of the data, one theme emerged - touching a tender wound, with four categories: being afraid and being deeply touched, appreciating close relatives' notes, a feeling of unreality and gaining coherence. The participants were deeply touched when they read the diary for the first time. Parts of it were experienced as unreal, as if they were reading about someone else. The diary provided necessary knowledge about what had happened during the time when the participants were critically ill and from which they had only fragmented or no memories at all. Even though it aroused strong feelings, reading the diary was experienced as an important support for a long time after their stay in the ICU. Experiencing that one was not fully aware of what had happened and then reading about oneself being critically ill and about one's close relatives' experiences was interpreted as touching a tender wound. CONCLUSIONS AND RELEVANCE TO CLINICAL PRACTICE: It is suggested that a diary may be a tool that can help formerly critically ill people to gain a sense of coherence concerning their critical illness experience, but reading it can be painful and demanding.
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| 10. |
- Engström, Åsa, et al.
(författare)
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Mothers' experiences of a stay in an ICU after a complicated childbirth
- 2012
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Ingår i: Nursing in Critical Care. - : Wiley. - 1362-1017 .- 1478-5153. ; 17:2, s. 64-70
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Tidskriftsartikel (refereegranskat)abstract
- Background: To be cared for in an intensive care unit (ICU) after a complicated childbirth is often an unplanned and transforming experience, and there is lack of studies describing mothers' experiences of this phenomenon.Aim: The aim of this study was to describe the experiences of becoming a mother after a complicated delivery and a stay in an ICU.Methods: Qualitative personal interviews were conducted with eight mothers. The interview texts were subjected to qualitative thematic content analysis.Findings: The analysis resulted in one theme; wishing to be in control and together as a family, and six categories; being or not being prepared, feeling afraid, not being as ill as the others, knowing about the baby, worrying about the father and having someone to talk to. The findings highlight the need to receive continual information about what is happening, especially with the baby, and the need to be together as a family.Conclusion and relevance to clinical practice: The mothers need support and encouragement from the staff throughout their hospital stay, and sometimes afterwards. There is a need to receive information, especially about the baby, and to have one's family close by, when in an ICU despite illness severity. How the new family is met by the staff is of great importance.
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