| 1. |
- Olsson, Annakarin, et al.
(författare)
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A scoping review of complexity science in nursing
- 2020
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Ingår i: Journal of Advanced Nursing. - : John Wiley & Sons, Ltd. - 0309-2402 .- 1365-2648. ; 76:8, s. 1961-1976
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Forskningsöversikt (refereegranskat)abstract
- Abstract: Aim To describe how complexity science has been integrated into nursing.Design: A scoping review. Data source/review method Academic Search Elite, Scopus, PsycINFO, Cumulative Index to Nursing and Allied Health Literature, PubMed and Web of Science were searched November 2016, updated in October 2017 and January 2020. The working process included: problem identification, literature search, data evaluation, synthesizing and presentation. Results Four categories were found in the included 89 articles: 1) how complexity science is integrated into the nursing literature in relation to nursing education and teaching; 2) patients? symptoms, illness outcome and safety as characteristics of complexity science in nursing; 3) that leaders and managers should see organizations as complex and adaptive systems, rather than as linear machines; and 4) the need for a novel approach to studying complex phenomena such as healthcare organizations. Lastly, the literature explains how complexity science has been incorporated into the discourse in nursing and its development.Conclusion: The review provided strong support for use in complexity science in the contemporary nursing literature. Complexity science is also highly applicable and relevant to clinical nursing practice and nursing management from an organizational perspective. The application of complexity science as a tool in the analysis of complex nursing systems could improve our understanding of effective interactions among patients, families, physicians and hospital and skilled nursing facility staff as well as of education.Impact: Understanding complexity science in relation to the key role of nurses in the healthcare environment can improve nursing work and nursing theory development. The use of complexity science provides nurses with a language that liberates them from the reductionist view on nursing education, practice and management.
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| 2. |
- Olsson, Annakarin, et al.
(författare)
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Follow the protocol and kickstart the heart : Intensive care nurses' reflections on being part of rescue situations in interdisciplinary teams
- 2021
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Ingår i: Nursing Open. - : Wiley. - 2054-1058. ; 8:6, s. 3325-3333
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Tidskriftsartikel (refereegranskat)abstract
- AIM: To describe intensive care nurses' reflections on being part of interdisciplinary emergency teams involved in in-hospital cardiopulmonary resuscitation.DESIGN: A qualitative descriptive design.METHODS: Eighteen intensive care nurses from two regions and three hospitals in Sweden were interviewed. The data were analysed with General Inductive Analysis.RESULTS: The work for intensive care nurses in the emergency team was reflected in three phases: prevention, intervention and mitigation-referred as before, during and after the CPR situation.CONCLUSIONS: The findings describe the complexity of being an intensive care nurse in an interdisciplinary emergency team, which entails managing advanced care with limited and unknown resources in a non-familiar environment. The present findings have important clinical implications concerning the value of having debriefing sessions to reflect on and to talk about obstacles to and prerequisites for performing successful resuscitation.
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| 3. |
- Parenmark, Fredric, 1974-
(författare)
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Premature Discharge from Intensive Care with Special Reference to Night-Time Discharge and Capacity Transfers
- 2023
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Objectives Intensive care is an expensive and limited resource, and when a demand supply mismatch between available beds and influx of patients occurs, one temporary measure is to discharge a patient to make room for the new admission. Sometimes the patient is discharged sooner from its original ICU than ideal; i.e., a so-called ‘premature discharge’. This could be either to a different ward within the same hospital if the patient is deemed well enough to cope with a lower level of care, or to another intensive care unit if critical care is still to be provided. Data from the Swedish intensive care register (SIR) showed that there was a high incidence and increased mortality of patients discharged at night. There were also differences in mortalities between patients that were transferred from one ICU to another. I have analysed the mortality associated with different types of ICU-to-ICU transfers and control groups and examined a national quality improvement project regarding discharges at night to see if mortality, incidence, or discharge culture could change. Methods All three studies are conducted with data from the Swedish intensive care register and vital status was ascertained by linking SIR to the Swedish population register. Study I consisted of two parts: mortality, and incidence of night-time discharge. The quality improvement project in Study I was analysed in a before and after approach with local improvement projects at different ICUs. In Studies II and III, transfers were grouped by the attending intensivist according to SIR guidelines into one of three defined categories: capacity transfer, clinical transfer, or repatriation. The groups were compared to each other in Study II, and capacity transfers were matched to a control group that remained in the ICU in Study III. Multilevel logistic regression was used, and all studies contained some statistics using individual ICUs as a random factor. Life sustaining treatment limitations were included in Studies II and III. Results In Study I, there was a decrease in night-time discharges during the study period. The incidence fell from 7.0% in 2006 to 4.9% in 2015. Alongside this, the mortality associated with night-time discharge was reduced, the odds ratio fell from 1.20 to 1.06 with a loss of significance. All this coincided in time with the national improvement project. Study II showed that 14.8% of all discharges from a Swedish ICU ended with transfer to another ICU, and that an increased mortality rate was associated with ICU-to-ICU transfers during periods of demand–supply mismatch. Capacity transfers were 15.8% of all transfers accounting for roughly 2.0% of ICU survivors. One in four capacity transferred patient died within 30 days of discharge, compared to one in seven for transfers due to clinical reasons. The third study showed that capacity transfer was associated with an average risk increase in 30-day mortality of 4.7%, and a 180-day mortality of 4.9% compared to non-transferred patients when analysed using a potential outcomes framework. Conclusion The studies concludes that patients experiencing a capacity transfer are exposed to increased mortality risk, both when compared to other types of inter hospital ICU-to-ICU transfers as well as when compared to patients that were not transferred. The increased risk appeared to be unrelated to patient characteristics and illness severity as well as many additional factors measured in the referring ICU. The studies also suggest that a suboptimal outcome after premature discharge at night can be changed and that a national project to adjust outcome and incidence can be undertaken with positive results.
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| 4. |
- Sjöberg, Fredric, et al.
(författare)
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Experiences of patient violence in Swedish intensive care units
- 2023
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Konferensbidrag (refereegranskat)abstract
- Introduction: In the intensive care unit (ICU), every second patient develops acute brain dysfunction and delirium, because of severe illness and/or medical treatment (1). ICU patients may have delusions and even believe that the healthcare personnel try to infict harm upon them (2). This belief in combination with psychomotor agitation may lead to violent incidents in intense resistance (3). Except for debilitating consequences for patients, violent incidents are major problems in healthcare causing physical and psychological harm to healthcare workers (4–6). However, systematic approaches to describe healthcare workers’ experiences and management of aggressive ICU patients are needed.Objectives: To explore ICU healthcare workers’ experiences and perceptions of violent behaviors in patients with acute brain dysfunction.Methods: A qualitative descriptive design including focus group interviews with 36 ICU healthcare workers (physicians, nurses, nurse assistants and physiotherapists) in 4 Swedish ICUs who had experience of managing aggressive patients with acute brain dysfunction. A six-step refective thematic analysis was used to analyse data.Results: Nurses and assistant nurses were perceived to be at a nincreased risk of being exposed to violence, while physicians were mostly exposed to verbal assaults and threats from relatives. Delusions were perceived to be associated with a higher risk of violence in bedside work. The healthcare workers stated that incidents were under-reported, where only serious threats or physical assaults were reported. Most violent situations were experienced as unavoidable due to the patients’ illness.Conclusions: This study contributes an understanding of workplace violence in the ICU and may serve as a basis for development of violence prevention strategies useful in care and treatment of delirious patients.
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| 5. |
- Sjöberg, Fredric, et al.
(författare)
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Nurses' experiences of performing cardiopulmonary resuscitation in intensive care units : a qualitative study
- 2015
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Ingår i: Journal of Clinical Nursing. - : Wiley. - 0962-1067 .- 1365-2702. ; 24:17-18, s. 2522-2528
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Tidskriftsartikel (refereegranskat)abstract
- Aims and objectives: To describe the nurses' experiences of performing cardiopulmonary resuscitation in intensive care units.Background: Research in the area of resuscitation is primarily concentrated on medical and biophysical aspects. The subjective experiences of those who perform cardiopulmonary resuscitation and their emotions are more seldom addressed. Design: Qualitative descriptive design.Methods: Qualitative semi-structured interviews were used (n = 8). Data were analysed with content analysis.Results: Three categories describe the experiences of nurses: training and precardiopulmonary resuscitation; chaos and order during cardiopulmonary resuscitation; and debriefing postcardiopulmonary resuscitation. The study results indicate that the health care staff find it necessary to practice cardiopulmonary resuscitation, as it provides them with a basic feeling of security when applying it in actual situations.Conclusion: We argue that postcardiopulmonary resuscitation debriefing must be viewed in the light of its eigenvalue with a specific focus on the staff's experiences and emotions, and not only on the intention of identifying errors.Relevance to clinical practice: Debriefing is of the utmost importance for the nurses. Clinical leaders may make use of the findings of this study to introduce debriefing forums as a possible standard clinical procedure.
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| 6. |
- Sjöberg, Fredric, et al.
(författare)
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The paradox of workplace violence in the intensive care unit : a focus group study
- 2024
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Ingår i: Critical Care. - : Springer. - 1364-8535 .- 1466-609X. ; 28:1
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Tidskriftsartikel (refereegranskat)abstract
- Background: Conflicts with patients and relatives occur frequently in intensive care units (ICUs), driven by factors that are intensified by critical illness and its treatments. A majority of ICU healthcare professionals have experienced verbal and/or physical violence. There is a need to understand how healthcare professionals in ICUs experience and manage this workplace violence. Methods: A qualitative descriptive analysis of four hospitals in Sweden was conducted using semi-structured focus-group interviews with ICU healthcare professionals. Results: A total of 34 participants (14 nurses, 6 physicians and 14 other staff) were interviewed across the four hospitals. The overarching theme: “The paradox of violence in healthcare” illustrated a normalisation of violence in ICU care and indicated a complex association between healthcare professionals regarding violence as an integral aspect of caregiving, while simultaneously identifying themselves as victims of this violence. The healthcare professionals described being poorly prepared and lacking appropriate tools to manage violent situations. The management of violence was therefore mostly based on self-taught skills. Conclusions: This study contributes to understanding the normalisation of violence in ICU care and gives a possible explanation for its origins. The paradox involves a multifaceted approach that acknowledges and confronts the structural and cultural dimensions of violence in healthcare. Such an approach will lay the foundations for a more sustainable healthcare system.
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