| 1. |
- Bodin, Ida, et al.
(författare)
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Work domain analysis of an intensive care unit : An Abstraction Hierarchy based on a bed-side approach
- 2016
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Ingår i: Proc. Human Factors and Ergonomics Society Europe Chapter 2015 Annual Conference.
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Konferensbidrag (refereegranskat)abstract
- Work in intensive care units requires interaction with several medical devices and interpretation of dynamic information from several sources. The aim of the current study was to gain understanding of the work domain to support the development of a holistic information environment and further analyses of risky situations. A total of 18 hours of bed-side observations at an intensive care unit and interviews with three experienced intensive care unit nurses were conducted in order to receive input data for the modelling of the work domain. The domain was modelled in an abstraction hierarchy, as according to the first phase of the cognitive work analysis framework. The results show that the ultimate purpose of the work carried out in an intensive care unit is keeping patients alive while gaining time for treatment, but also to perform treatment and relieve symptoms. The purpose is represented at the top level of the model, and lower levels include functions as supporting the patients’ vital functions and avoiding secondary complications. With this work domain analysis as a basis, three different design challenges identified can be dealt with systematically.
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| 2. |
- Bohlin, Sofia, et al.
(författare)
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Change in smoking habits after having been screened for abdominal aortic aneurysm
- 2014
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Ingår i: European Journal of Vascular and Endovascular Surgery. - : Elsevier BV. - 1078-5884 .- 1532-2165. ; 48:2, s. 138-43
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVES: To study smoking habits among men with abdominal aortic aneurysm at screening at 65 years of age, and during follow-up, as a base-line study to evaluate future interventions.DESIGN: Nested case-control study.PATIENTS AND METHODS: Between 2006 and 2011, 8150 65-year-old men (compliance 85%) were screened for AAA in Uppsala County, Sweden. Among 292 men with an aortic diameter of at least 25 mm, 77 were active smokers at the time of screening. At follow-up of smoking habits in 2012, 53 men (69%) participated in this study, 28 had an AAA of at least 30 mm and 25 a sub-aneurysmal aorta (SAA) 25-29 mm at baseline. For each case, one control was randomly selected, all active smokers with aortic diameter less than 25 mm at baseline, matched for age and year of screening. Telephone interviews were performed at a median 34 months (range: 4-67) after screening.RESULTS: Men with AAA had hypertension more often than controls (68% vs. 23%, p < .001). Men with AAA and SAA reported more smoking years than controls (p = .017). Cessation rate among patients with AAA did not differ significantly compared with men with an aorta less than 30 mm (29% vs. 15%, p = .159), but they had reduced their consumption of cigarettes/day significantly more than men with SAA and controls (-8.2 vs. -3.0 vs. -4.5, p = .030). Men with AAA recalled having been informed about the importance of smoking cessation at the time of screening more often (p = .031). There was no difference in growth of the AAA between those who continued, and those who quit smoking (2.03 vs. 2.01 mm/year, p = .982), but the study was not powered to study AAA growth.CONCLUSIONS: Although counselling in a normal healthcare setting had some effect, the results indicate a need to tailor interventions to further increase smoking cessation rates among men diagnosed with both AAA and SAA.
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| 3. |
- Carlson, Sara, et al.
(författare)
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Using Cognitive Work Analysis to Model the Impact of Digitalization on Intensive Care Nursing
- 2024
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Ingår i: Journal of Cognitive Engineering and Decision Making. - London : Sage Publications. - 1555-3434 .- 2169-5032.
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Tidskriftsartikel (refereegranskat)abstract
- The continuous development of health IT fuels a process of ongoing digitalization that affects the work of hospital staff. A Cognitive Work Analysis methodology was used to investigate the impact of digitalization through a Clinical Information System (CIS), an addition to the basic Electronic Medical Record, on one intensive care unit (ICU). Both observations and semi-structured interviews were performed. The replacement of a paper charting system with a digital CIS that meant some of the administrative tasks could be automated and other tasks being performed on a computer screen instead of using paper. The nurses’ work domain was modeled and compared to a study performed prior to the implementation of the CIS. The study demonstrates the potential utility of the Cognitive Work Analysis approach (when applied both pre and post-implementation) to evaluate the impact of a CIS on ICU nurses.
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| 4. |
- Edfeldt, Katarina, 1979-, et al.
(författare)
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Missed nursing care in surgical care– a hazard to patient safety : a quantitative study within the inCHARGE programme
- 2024
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Ingår i: BMC Nursing. - : BioMed Central (BMC). - 1472-6955. ; 23:1
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Tidskriftsartikel (refereegranskat)abstract
- BackgroundMissed nursing care occurs globally, and the consequences are severe for the patients when fundamental care needs are not fulfilled, nor delivered in a person-centred way. This study aimed to investigate the occurrence and cause of missed nursing care, and the relationship between registered nurses’ and nursing assistants’ perceptions of missed nursing care, in a surgical care context.MethodsA quantitative study was performed using the MISSCARE survey, measuring missed nursing care and associated reasons, in three surgical wards with registered nurses and nursing assistants as the participants (n = 118), during May-November in 2022. The MISSCARE survey also covers background data such as job satisfaction and intention to leave. The survey was distributed paper-based and the response rate was 88%.ResultsAspects of nursing care rated to be missed the most were ‘attending interdisciplinary care conferences’, ‘turning patient every 2 h’, ‘ambulation 3 times per day or as ordered’, and ‘mouth care’. Differences between registered nurse and nursing assistant ratings were detected for eight out of 24 items, where registered nurses rated more missed nursing care. The uppermost reasons for missed nursing care were ‘inadequate number of staff’ and ‘unexpected rise in patient volume and/or acuity on the unit’. Registered nurses and nursing assistants rated differently regarding six of 17 items. Almost every fourth staff member (24.6%, n = 29) had the intention to leave within a year in the present department.ConclusionsThe occurrence of missed nursing care is frequent in the surgical context, and in combination with a high number of staff members intending to leave their employment, poses a hazard to patient safety. Registered nurses, holding higher educational levels, reported more missed care compared with the nursing assistants. The main reason for missed nursing care was an inadequate number of staff. These findings support a warranted investment in nursing within the organisation. The results can be used to form strategies and interventions, to reduce nurse attrition and optimise competence utilisation, and to achieve safe person-centered fundamental care.
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| 5. |
- Edfeldt, Katarina, 1979-, et al.
(författare)
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Oral health and oral care in patients in a surgical context : A quantitative study comparing patients' and nurses' assessments
- 2023
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Ingår i: Journal of Clinical Nursing. - : John Wiley & Sons. - 0962-1067 .- 1365-2702. ; 33:6, s. 2201-2208
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Tidskriftsartikel (refereegranskat)abstract
- AimsTo investigate fundamental care delivery regarding oral care in a surgical context, and to compare patients' self-reported oral health with registered nurse assessments.DesignA descriptive and comparative study, with a consecutive selection.MethodsA patient oral health rating tool, including questions about performed oral care, was distributed to patients (n = 50), at four surgical wards in Sweden. The response rate was 72%. Oral health status was assessed by a registered nurse using the Revised Oral Assessment Guide (ROAG), and a comparison between patient and registered nurse assessment was performed by calculating Cohen's kappa coefficient and percentage agreement.ResultsPatients (38%) reported severe oral symptoms, mostly dry lips and not an adequate amount of saliva, and 80% were not offered help with oral care. ROAG assessments revealed that 74% had problems with oral health. Almost half of the patients (48%) needed assistance with oral care but only 10% received help. Registered nurses assessed the patient's oral health as worse than the patient's self-assessment did.ConclusionThere are deficiencies in fundamental care delivery regarding oral care in a surgical care context. Oral health assessments need to be performed by registered nurses. Routines for systematic oral assessments and for oral care need to be implemented by nurse managers to ensure that patients' fundamental care needs are fulfilled.Implications for the Profession and Patient CareOral health assessments need to be performed regularly by registered nurses since it is insufficient that patients self-assess their oral health. Nurse managers needto provide and implement routines for nurse assessments and oral care in surgical care contexts.ImpactThere are deficiencies in patients' oral health and oral care, and registered nurses need to perform oral health assessments. Nurse managers need to implement routines for registered nurse assessments and oral care.Patient ContributionPatients admitted to a surgical ward were included in the study after being screened for inclusion criteria. After participants signed informed consent, they filled in a questionnaire about oral health and oral care, and a registered nurse performed an oral health assessment.Reporting MethodThis study was carried out according to the STROBE checklist.
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| 6. |
- Engström, Joakim, et al.
(författare)
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Maintenance of Airway Pressure During Filter Exchange Due to Auto-Triggering
- 2014
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Ingår i: Respiratory care. - : Daedalus Enterprises. - 0020-1324 .- 1943-3654. ; 59:8, s. 1210-1217
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Daily routine ventilator-filter exchange interrupts the integrity of the ventilator circuit. We hypothesized that this might reduce positive airway pressure in mechanically ventilated ICU patients, inducing alveolar collapse and causing impaired oxygenation and compliance of the respiratory system. METHODS: We studied 40 consecutive ICU subjects (P-aO2/F-IO2 ratio <= 300 mm Hg), mechanically ventilated with pressure-regulated volume control or pressure support and PEEP >= 5 cm H2O. Before the filter exchange, (baseline) tidal volume, breathing frequency,end-inspiratory plateau pressure, and PEEP were recorded. Compliance of the respiratory system was calculated; F-IO2, blood pressure, and pulse rate were registered; and P-aO2, P-aCO2, pH, and base excess were measured. Measurements were repeated 15 and 60 min after the filter exchange. In addition, a bench test was performed with a precision test lung with similar compliance and resistance as in the clinical study. RESULTS: The exchange of the filter took 3.5 +/- 1.2 s (mean +/- SD). There was no significant change in P-aO2 (89 +/- 16 mm Hg at baseline vs 86 +/- 16 mm Hg at 15 min and 88 +/- 18 mm Hg at 60 min, P = .24) or in compliance of the respiratory system (41 +/- 11 mL/cm H2O at baseline vs 40 +/- 12 mL/cm H2O at 15 min and 40 +/- 12 mL/cm H2O at 60 min, P = .32). The bench study showed that auto-triggering by the ventilator when disconnecting from the expiratory circuit kept the tracheal pressure above PEEP for at least 3 s with pressure controlled ventilation. CONCLUSIONS: This study showed that a short disconnection of the expiratory ventilator circuit from the ventilator during filter exchange was not associated with any significant deterioration in lung function 15 and 60 min later. This result may be explained by auto-triggering of the ventilator with high inspiratory flows during the filter exchange, maintaining airway pressure. (ISRCTN.org registration ISRCTN76631800.)
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| 7. |
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| 8. |
- Engström, Joakim, 1983-
(författare)
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Patient safety in the Intensive Care Unit : With special reference to Airway management and Nursing procedures
- 2016
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- The overall aim of the present thesis was to study aspects of patient safety in critically ill patients with special focus on airway management, respiratory complications and nursing procedures. Study I describes a method called pharyngeal oxygen administration during intubation in an experimental acute lung injury model. The study showed that pharyngeal oxygenation prevented or considerably increased the time to life-threatening hypoxemia at shunt fractions by at least up to 25% and that this technique could be implemented in airway algorithms for the intubation of hypoxemic patients. In study II, we investigated short-term disconnection of the expiratory circuit from the ventilator during filter exchange in critically ill patients. We demonstrated that when using pressure modes in the ventilator, there was no indication of any significant deterioration in the patient's lung function. A bench test suggests that this result is explained by auto-triggering with high inspiratory flows during the filter exchange, maintaining the airway pressure. Study III was a clinical observational study of critically ill patients in which adverse events were studied in connection with routine nursing procedures. We found that adverse events were common, not well documented, and potentially harmful, indicating that it is important to weigh the risks and benefits of routine nursing when caring for unstable, critically ill patients. In study IV, we conducted a retrospective database study in patients with pelvis fractures treated in the intensive care unit. We found that the incidence of respiratory failure was high, that the procedure involved in surgical stabilization affected the respiratory status in patients with lung contusion, and that the mortality was low and probably not influenced by the respiratory condition. In conclusion, the results obtained in the present thesis have increase our knowledge in important areas in the most severely ill patients and have underlined the need for improvements in the field of patient safety.
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| 9. |
- Engström, Joakim, et al.
(författare)
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Physiological changes associated with routine nursing procedures in critically ill are common : an observational pilot study
- 2017
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Ingår i: Acta Anaesthesiologica Scandinavica. - : Wiley. - 0001-5172 .- 1399-6576. ; 61:1, s. 62-72
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Nursing procedures that are routinely performed in the intensive care unit (ICU) are assumed to have minimal side effects. However, these procedures may sometimes cause physiological changes that negatively affect the patient. We hypothesized that physiological changes associated with routine nursing procedures in the ICU are common.METHODS: A clinical observational study of 16 critically ill patients in a nine-bed mixed university hospital ICU. All nursing procedures were observed, and physiological data were collected and subsequently analyzed. Minor physiological changes were defined as minimal changes in respiratory or circulatory variables, and major physiological changes were marked as hyper/hypotension, bradycardia/tachycardia, bradypnea/tachypnea, ventilatory distress, and peripheral blood oxygen desaturation.RESULTS: In the 16 patients, 668 procedures generated 158 major and 692 minor physiological changes during 187 observational hours. The most common procedure was patient position change, which also generated the majority of the physiological changes. The most common major physiological changes were blood oxygen desaturation, ventilatory distress, and hypotension, and the most common minor changes were arterial pressure alteration, coughing, and increase in respiratory rate.CONCLUSION: In this pilot study, we examined physiological changes in connection with all regular routine nursing procedures in the ICU. We found that physiological changes were common and sometimes severe.
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| 10. |
- Fröjd, Camilla, 1967-
(författare)
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Cancer Patients’ Satisfaction with Doctors’ Care : Consequences and Contributing Conditions
- 2007
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- The main aims were to: explore whether there is a relation between doctors’ ability to identify patients’ worry and wish for information and self-efficacy with regard to communicating with patients about difficult matters; describe which cues doctors consider when estimating patients’ worry and wish for information, and investigate whether there is a relation between patients’ satisfaction with doctors’ care and patients’ psychosocial function. Eleven doctors and 69 patients (of which 36 patients participated in the longitudinal study) with carcinoid tumours participated. Doctors’ self-efficacy, and ability to identify patients’ worry/wish for information were investigated at patients’ first admission. Doctors were interviewed about which cues they considered when estimating patients worry/wish for information. Patients’ satisfaction with care (CASC SF 4.0) and psychosocial function (EORTC QLQ-C30, HADS) were measured longitudinally, during the first year after diagnosis. Doctors reported higher self-efficacy when showing good ability to identify patients’ wish for information, than when showing less good ability, overestimated patients’ worry and underestimated patients’ wish for information. Doctors considered patients’ verbal behaviour and body language together with knowledge and experience when estimating patients worry and wish for information. Patients who met doctors showing good ability to identify their wish for information, reported a higher cognitive function than patients who met doctors showing less good ability. At all assessments patients expressed high satisfaction with doctor’ care and patients’ satisfaction did not change over time. Patients’ satisfaction with doctors’ care were related to their psychosocial function shortly after the first three admissions to specialist care. Patients with carcinoid tumours in some respects reported a worse HRQoL than the general Swedish population. Fatigue, diarrhoea, limited possibilities to work/pursue daily activities, and worry that the illness will get worse were among the most prevalent, and worst, aspects of disease- and treatment related distress.
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