| 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. |
- 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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| 10. |
- Wahlin, Ulla, et al.
(författare)
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Loving care in the ambulance service
- 1995
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Ingår i: Intensive & Critical Care Nursing. - London : Churchill Livingstone. - 0964-3397 .- 1532-4036. ; 11:6, s. 306-313
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Tidskriftsartikel (refereegranskat)abstract
- The ambulance service should offer good care signified by humane and individual treatment of the patients, based on love to our fellow man. The aim of this study was to find out how loving care was practised in one ambulance service. The method for the study was the critical incident technique. Twelve paramedics, the majority of whom are qualified nurses, took part in the study; they were asked to describe, in writing, critical incidents in which they had acted with loving care. The paramedics’ writings disclosed their ability to do their job with loving care, bearing on their cognizance, solicitude and empathy. On the whole, subject cognizance, the ability to judge and treat based upon the monitored symptoms of the patients, was apparent. In the main, subject solicitude loving care was shown through humbleness, consideration, closeness and being in rapport, and generally subject empathy, the paramedic’s empathic capacity and his knowledge about man’s behaviour in a crisis, became evident. From a clinical standpoint the study shows the importance of the paramedics possessing professional skill. As a contribution to science the study adds to continued research based upon descriptions made by other groups of personnel about the phenomenon to be studied; namely, loving care. © 1995 Pearson Professional Ltd.
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| 11. |
- Ahlberg, Mona, et al.
(författare)
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Family functioning of families experiencing intensive care and the specific impact of the COVID-19 pandemic: A grounded theory study
- 2023
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Ingår i: Intensive & Critical Care Nursing. - : ELSEVIER SCI LTD. - 0964-3397 .- 1532-4036. ; 76
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Tidskriftsartikel (refereegranskat)abstract
- Objectives: In order to provide a deeper understanding of family functioning, the aim of this study was to identify, describe and conceptualise the family functioning of families where a formerly critically ill family member had stayed at the intensive care unit, with the impact of a pandemic.Research methodology/design: The study has a grounded theory design including interviews with eight families.Setting: Former adult intensive care patients cared for Covid-19 infection and their family. Eight patients and twelve family members from three different intensive care units.Main outcome measures: The results presented are grounded in data and identified in the core category "Existential issues" and the categories "Value considerateness; Anxiety and insecurity in life; Insight into the unpredictability of life." Findings: The core category could be found in all data and its relationship and impact on the categories and each other. The core is a theoretical construction, whereas the family functioning of families where a formerly critically ill family member had stayed at the intensive care unit was identified, described, and conceptualised. Being able to talk repeatedly about existential issues and the anxiety and insecurity in life, with people that have similar experiences helps the patient and their family to consider and gain insight into the unpredictability of life, and thereby better cope with changes in life.Conclusion: There is awareness about the love that exists within the family. A willing to supporting each other in the family even if the critical illness made the family anxious and afraid. Implications for clinical practice: Even if the pandemic Covid-19 led to restrictions inhibiting family focused nursing, it is important to confirm the family as a part of the caring of the ICU patient. The patients are not alone, their family are fighting together for the future.
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| 12. |
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| 13. |
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| 14. |
- Almerud, S, et al.
(författare)
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Caught in an Artificial Split : A Phenomenological Study of Being a Caregiver in the Technologically Intense Environment
- 2007
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Ingår i: Intensive & Critical Care Nursing. - : Churchill Livingstone. - 0964-3397 .- 1532-4036. ; 24:2, s. 130-136
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Tidskriftsartikel (refereegranskat)abstract
- A symbiotic relationship exists between technology and caring, however, technologically advanced environments challenge caregivers. The aim of this study is to uncover the meaning of being a caregiver in the technologically intense environment. Ten open-ended interviews with intensive care personnel comprise the data. A phenomenological analysis shows that ambiguity abounds in the setting. The act of responsibly reading and regulating instruments easily melds the patient and the machinery into one clinical picture. The fusion skews the balance between objective distance and interpersonal closeness. The exciting captivating lure of technological gadgets seduces the caregivers and lulls them into a fictive sense of security and safety. It is mind-boggling and heart-rending to juggle ‘moments’ of slavish mastery and security menaced by insecurity in the act of monitoring a machine while caring for a patient. Whenever the beleaguered caregiver splits technique from human touch, ambiguity decays into ambivalence. Caring and technology become polarized. Everyone loses. Caregiver competence wanes; patients suffer. The intensive care unit should be technologically sophisticated, but also build-in a disclosive space where solace, trust, and reassurance naturally happen. Caring professionals need to balance state-of-the-art technology with integrated and comprehensive care and harmonize the demands of subjectivity with objective signs.
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| 15. |
- Almerud, S, et al.
(författare)
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Caught in an artificial split : a phenomenological study of being a caregiver in the technologically intense environment.
- 2008
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Ingår i: Intensive & Critical Care Nursing. - 0964-3397 .- 1532-4036. ; 24:2, s. 130-136
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Tidskriftsartikel (refereegranskat)abstract
- A symbiotic relationship exists between technology and caring, however, technologically advanced environments challenge caregivers. The aim of this study is to uncover the meaning of being a caregiver in the technologically intense environment. Ten open-ended interviews with intensive care personnel comprise the data. A phenomenological analysis shows that ambiguity abounds in the setting. The act of responsibly reading and regulating instruments easily melds the patient and the machinery into one clinical picture. The fusion skews the balance between objective distance and interpersonal closeness. The exciting captivating lure of technological gadgets seduces the caregivers and lulls them into a fictive sense of security and safety. It is mind-boggling and heart-rending to juggle 'moments' of slavish mastery and security menaced by insecurity in the act of monitoring a machine while caring for a patient. Whenever the beleaguered caregiver splits technique from human touch, ambiguity decays into ambivalence. Caring and technology become polarized. Everyone loses. Caregiver competence wanes; patients suffer. The intensive care unit should be technologically sophisticated, but also build-in a disclosive space where solace, trust, and reassurance naturally happen. Caring professionals need to balance state-of-the-art technology with integrated and comprehensive care and harmonize the demands of subjectivity with objective signs
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| 16. |
- Almqvist, Daniel, et al.
(författare)
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Strategies for a safe interhospital transfer with an intubated patient or where readiness for intubation is needed: A critical incidents study
- 2023
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Ingår i: Intensive & Critical Care Nursing. - : Elsevier. - 0964-3397 .- 1532-4036. ; 74
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Tidskriftsartikel (refereegranskat)abstract
- Introduction: The number of interhospital transports with intubated patients or where intubation readiness is required is increasing in Sweden and globally. Specialist nurses are often responsible for these transports, which involve numerous risks for critically ill patients.Aim: The aim of this study was to describe nurse anaesthetists’ and intensive care nurses’ strategies for safe interhospital transports with intubated patients or where intubation readiness is required.Method: A qualitative study was conducted using the critical incident technique. During March and April 2020, 12 semi-structured interviews were conducted with nurse anaesthetists and intensive care nurses. Data were analysed according to the critical incident technique, and a total of 197 critical incidents were identified. The analysis revealed five final strategies for safe interhospital transport.Results: Participants described the importance of ensuring clear and adequate information transfers between caregivers to obtain vital patient information that enables the nurse in charge to identify risks and problems in advance and create an action plan. Stabilising and optimising the patient's condition before departure and preparing drugs and equipment were other strategies described by the participants, as well as requesting assistance or support if questions or complications arose during transport.Conclusion: Transports with intubated patients or where intubation readiness is required are complex and require systematic patient-safety work to ensure that strategies for increasing patient safety and decreasing risks are visible to the nurses in charge, that they are applied, and that they are, indeed, effective.
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| 17. |
- Andersson, Maria, et al.
(författare)
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Critical care nurses’ experiences of working during the first phase of the COVID-19 pandemic –Applying the Person-centred Practice Framework
- 2022
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Ingår i: Intensive & Critical Care Nursing. - : Elsevier. - 0964-3397 .- 1532-4036. ; 69
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Tidskriftsartikel (refereegranskat)abstract
- Aim:The aim of the study was to deductively study person-centred care, based on critical care nurses’ experiences during the first phase of the covid-19 pandemic.Design:The study used a qualitative design.Method:Data collection was conducted as individual interviews and was analysed with qualitative content analysis with a deductive approach.Participants:Six critical care nurses working in a special covid-19 intensive care unit during the first phase of the pandemic participated.Findings:The findings are presented within the four domains of person-centred practice: the prerequisites, the care environment, person-centred processes and person-centred outcomes. While the ambition and knowledge about how to work in accordance with person-centred practice were high, there were several obstacles to perform it.Conclusion:We need to prepare ahead of time so that nurses have optimal organisational prerequisites to be able to work in accordance with person-centred practice, also during pandemics and other crisis, which means to be able to give nursing care in accordance with the ill person’s needs and resources.
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| 18. |
- Andersson, Maria, 1969-, et al.
(författare)
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Critical care nurses’ perception of moral distress in intensive care during the COVID-19 pandemic – A pilot study
- 2022
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Ingår i: Intensive & Critical Care Nursing. - : Elsevier. - 0964-3397 .- 1532-4036. ; 72
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Tidskriftsartikel (refereegranskat)abstract
- Objectives: To describe critical care nurses’ perception of moral distress during the second year of the COVID-19 pandemic.Design/Methods: A cross-sectional study involving a questionnaire was conducted. Participants responded to the Italian version of the Moral Distress Scale-Revised, which consists of 14 items divided in dimensions Futile care (three items), Ethical misconduct (five items), Deceptive communication (three items) and Poor teamwork (three items). For each item, participants were also invited to write about their experiences and participants’ intention to leave a position now was measured by a dichotomous question. The data were analysed with descriptive statistics and qualitative content analysis. The study followed the checklist (CHERRIES) for reporting results of internet surveys.Setting: Critical care nurses (n = 71) working in Swedish adult intensive care units.Results: Critical care nurses experienced the intensity of moral distress as the highest when no one decided to withdraw ventilator support to a hopelessly ill person (Futile care), and when they had to assist another physician or nurse who provided incompetent care (Poor teamwork). Thirty-nine percent of critical care nurses were considering leaving their current position because of moral distress.Conclusions: During the COVID-19 pandemic, critical care nurses, due to their education and experience of intensive care nursing, assume tremendous responsibility for critically ill patients. Throughout, communication within the intensive care team seems to have a bearing on the degree of moral distress. Improvements in communication and teamwork are needed to reduce moral distress among critical care nurses.
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| 19. |
- Andersson, Maria, 1969-, et al.
(författare)
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Intensive care nurses fail to translate knowledge and skills into practice : A mixed-methods study on perceptions of oral care
- 2019
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Ingår i: Intensive & Critical Care Nursing. - : Elsevier. - 0964-3397 .- 1532-4036. ; 52, s. 51-60
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Tidskriftsartikel (refereegranskat)abstract
- Objectives: To identify intensive care nurses’ perceptions of oral care according to Coker et al.'s (2013) conceptual framework and to contribute to the knowledge base of oral care in intensive care. Design/methods: This was a concurrent embedded mixed-methods design, with more weight given to the quantitative part. Participants responded to the Nursing Care related to Oral Health questionnaire, including perceptions of oral care antecedents (18 items), defining attributes (17 items), and consequences (6 items) and two open-ended questions. The data were analysed with descriptive and correlation statistics and qualitative content analysis. Setting: Intensive care nurses (n = 88) in six general intensive care units. Results: Intensive care nurses perceived that an important part of nursing care was oral care, especially to intubated patients. They perceived that the nursing staff was competent in oral care skills and had access to different kinds of equipment and supplies to provide oral care. The oral cavity was inspected on a daily basis, mostly without the use of any assessment instruments. Oral care seemed to be task-oriented, and documentation of the patients’ experiences of the oral care process was rare. Conclusions: The antecedents, knowledge and skills are available to provide quality oral care, but intensive care nurses seem to have difficulties translating these components into practice. Thus they might have to shift their task-oriented approach towards oral care to a more person-centred approach in order to be able to meet patients’ needs. © 2018 Elsevier Ltd
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| 20. |
- Andersson, Maria, 1969-, et al.
(författare)
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Patient photographs-A landmark for the ICU staff : A descriptive study.
- 2013
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Ingår i: Intensive & Critical Care Nursing. - : Elsevier BV. - 0964-3397 .- 1532-4036. ; 29:4, s. 193-201
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVES: The purpose of this study was to investigate ICU staff's perceptions of photographs displayed at the bedsides of unconscious patients and whether profession, years in ICU and work status had any influence on these perceptions.RESEARCH METHODOLOGY: A cross-sectional study was used comprising a questionnaire with statements and one open-ended question. All registered nurses, enrolled nurses and anaesthetists working in one ICU in Sweden were included. A total of 85 participants returned a questionnaire (response rate=77%).RESULTS: The findings of the study revealed that a photograph of the patient helped the ICU staff to relate to the patient as a person. Profession, years in ICU and work status had influence on the ICU staff's perceptions. From the content analysis two categories emerged: "getting closer and see the person" and "a landmark bringing hope".CONCLUSION: The ICU staff need to consider how close to the patient they want to be and why the patient's recovery is worth striving for. Keeping a professional approach is one of the challenges of working in ICU. A photograph can be an inexpensive and easy way of preventing the loss of identity of the patient as an individual within the technocratic environments of the ICU.
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| 21. |
- Andersson, Maria, et al.
(författare)
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The four domains of the person-centred practice framework from the perspective of critical care nurses in intensive care units during a pandemic
- 2023
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Ingår i: Intensive & Critical Care Nursing. - : Elsevier. - 0964-3397 .- 1532-4036. ; 78
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Tidskriftsartikel (refereegranskat)abstract
- Objectives: The aim was to describe the Person-Centred Practice Framework’s four domains (prerequisites, care environment, person-centred processes, and person-centred outcomes) through the perspectives of critical care nurses working in intensive care units during the second year of the COVID-19 pandemic. Furthermore, the aim was to investigate the relationships between prerequisites, care environment, person-centred processes, and person-centred outcomes. Design/methods: A cross-sectional study involving questionnaires. Prerequisites were measured using person- related conditions, the care environment by using the Person-Centred Climate Questionnaire–Staff version, the person-centred processes by using the Person-Centred Care Assessment Tool and person-centred outcomes were measured with one question about present health and well-being and by using Self-rated Exhaustion Disorder. Descriptive and analytic statistics were used. Data was collected from July 2021 to November 2021. Setting: Critical care nurses (n =217) working in 15 Swedish adult intensive care units. Results: Participants’ average length of experience in intensive care units was 14 years, and most participants experienced increased nursing care responsibilities. They perceived the climate as safe but had limitations in terms of its everydayness and community. Participants perceived the organisations both supported and hindered personalized care. Most participants experienced a variety of exhaustion symptoms, and their health had positive relationship with community. Conclusion: By showing how prerequisites, care environment, person-centred process influences critical care nurses’ health and well-being, organisations might identify aspects in the work environment that require targeted interventions to reach healthy workplaces. Implications for clinical practice: To preserve the health and well-being of critical care nurses and to flourish as humans in their professional roles, they need to interact with and form relationships with their colleagues, patients, and relatives. Organisations should have a person-centred approach for every individual in the workforce to harness each critical care nurses’ knowledge and skills for individuals to growth in their roles.
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| 22. |
- Backman, Carl G., et al.
(författare)
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Group meetings after critical illness-Giving and receiving strength
- 2018
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Ingår i: Intensive & Critical Care Nursing. - : ELSEVIER SCI LTD. - 0964-3397 .- 1532-4036. ; 46, s. 86-91
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Tidskriftsartikel (refereegranskat)abstract
- Introduction: An increasing number of intensive care patients are surviving critical illness, but many develop mental, cognitive and physical impairments after discharge. Adapting to a new life situation, often with major challenges, implies the need of support. Therefore, it is important to develop interventions aimed at promoting recovery. Objective: The aim was to describe former intensive care patients feelings of sharing their experience of critical illness with other former patients. Method: Former intensive care patients (n = 17) participated in group meetings and wrote about their thoughts in a notebook after each group meeting. To deepen the understanding of the former patients experience 11 of the former patients were interviewed. The notes in the notebooks and the interviews were analysed using qualitative content analysis. Findings: Meeting others revealed to the former patients new dimensions of being critically ill, and they both gave and received strength from each other. The meetings were meaningful as they gained insight into other patients lives, and realised what it meant to survive intensive care. Conclusions: The group meetings meant sharing experiences and understanding the process of survival after critical illness. Giving and receiving strength from others helped the participants to go further. (C) 2017 Elsevier Ltd. All rights reserved.
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| 23. |
- Ballangrud, Randi, 1959-, et al.
(författare)
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Intensive care nurses' perceptions of simulation-based team training for building pation safety in intensive care: A descriptive qualittaive study
- 2014
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Ingår i: Intensive & Critical Care Nursing. - : Elsevier. - 0964-3397 .- 1532-4036. ; 30:4, s. 179-187
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Tidskriftsartikel (refereegranskat)abstract
- Objectives: To describe intensive care nurses' perceptions of simulation-based team training for building patient safety in intensive care. Background: Failures in team processes are found to be contributory factors to incidents in an intensive care environment. Simulation-based training is recommended as a method to make health-care personnel aware of the importance of team working and to improve their competencies. Design: The study uses a qualitative descriptive design. Methods: Individual qualitative interviews were conducted with 18 intensive care nurses from May to December 2009, all of which had attended a simulation-based team training programme. The interviews were analysed by qualitative content analysis. Results: One main category emerged to illuminate the intensive care nurse perception: "training increases awareness of clinical practice and acknowledges the importance of structured work in teams". Three generic categories were found: "realistic training contributes to safe care", "reflection and openness motivates learning" and "finding a common understanding of team performance". Conclusions: Simulation-based team training makes intensive care nurses more prepared to care for severely ill patients. Team training creates a common understanding of how to work in teams with regard to patient safety.
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| 24. |
- Ballangrud, Randi, 1959-, et al.
(författare)
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Nurses’ perceptions of patient safety climate in intensive care units : A cross-sectional study
- 2012
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Ingår i: Intensive & Critical Care Nursing. - : Elsevier. - 0964-3397 .- 1532-4036. ; 28:6, s. 344-354
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVES:To investigate registered nurses' perceptions of the patient safety climate in intensive care units and to explore potential predictors for overall perception of safety and frequency of incident reporting. RESEARCH METHODOLOGY/DESIGN: A cross-sectional design was conducted, using the questionnaire Hospital Survey on Patient Safety Culture, measuring 12 patient safety climate dimensions: seven at unit and three at hospital level, two outcomes and in addition two outcome items.SETTING:Ten intensive care units (ICUs) in six hospitals in one hospital trust in Norway.RESULTS:In total, 220 registered nurses (RNs) responded (72%). Seven of 12 dimensions achieved a RN proportion of positive scores over 55%. Five achieved a lower proportion. Significant differences in RNs' perceptions of patient safety were found between types of units and between the four hospitals. The total variance in the outcome measure explained by the model as a whole was for the outcome dimensions "overall perception of safety" 32%, and "frequency of incident reporting" 32%. The variables at the unit level made a significant contribution to the outcome.CONCLUSION:RNs in ICU are most positive to patient safety climate at unit level, hence improvements are needed concerning incident reporting, feedback and communication about errors and organisational learning and continuous improvement.
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| 25. |
- Bjurling-Sjöberg, Petronella, et al.
(författare)
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Intensive care nurses' conceptions of a critical pathway in caring for aortic-surgery patients : A phenomenographic study
- 2013
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Ingår i: Intensive & Critical Care Nursing. - : Elsevier BV. - 0964-3397 .- 1532-4036. ; 29:3, s. 166-173
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Tidskriftsartikel (refereegranskat)abstract
- The aim of the present study was to identify and describe intensive care nurses' different conceptions of a critical pathway in caring for patients that have undergone aortic-surgery. Individual semi-structured interviews with eight specialist registered nurses at a Swedish intensive care unit were conducted and phenomenographically analysed. Three descriptive categories, with a total of five sub-categories, constituted the outcome-space of how the pathway was conceived of in caring: as a guide open to individual patients needs (clinical judgement governs caring and patient autonomy governs caring), as an instrument to promote patient safety (a source of knowledge, a planning tool and a reference standard) and as a source of support for professional confidence. In accordance with current literature, the nurses in the present study identified a number of advantages in applying the pathway in caring even if they were also conscious that the use of a pathway can give rise to unreflective standardisation. The nurses' conceptions indicate that the pathway prescribed for managing patients who have undergone aortic surgery is supportive and facilitates patient safety without jeopardising respect for the patient's individual care needs. This insight may be used to influence a thoughtful dialogue about the practice of pathways in intensive care.
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| 26. |
- Blom, Helen, et al.
(författare)
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Participation and support in intensive care as experienced by close relatives of patients : A phenomenological study
- 2013
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Ingår i: Intensive & Critical Care Nursing. - : Elsevier. - 0964-3397 .- 1532-4036. ; 29:1, s. 1-8
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Tidskriftsartikel (refereegranskat)abstract
- Aim: The aim of this study was to explore participation and support as experienced by close relatives of patients at an intensive care unit (ICU).Method: This study used the phenomenological approach as developed by Dahlberg et al. (2008) as a method for reflective lifeworld research. Seven close relatives of critically ill patients cared for at an ICU were interviewed. The data were analysed with a focus on meanings.Results: Being allowed to participate in the care of critically ill patients at an ICU is impor-tant for close relatives to the patients. Their experiences can be described as having four constituents: participation in the care of and being close to the patient; confidence in the care the patient receives; support needed for involvement in caregiving; and vulnerability. Conclusion: Participation with and support from health-care professionals are important for the relatives’ well-being and their ability to contribute to the patients’ care. Health-care profes-sionals, especially critical care nurses, need to create an atmosphere that invites relatives to participate in the care provided at an ICU.
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| 27. |
- Cederwall, Carl-Johan, et al.
(författare)
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Care practices for patients requiring mechanical ventilation more than seven days in Swedish intensive care units: A national survey.
- 2023
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Ingår i: Intensive & critical care nursing. - : Elsevier BV. - 0964-3397 .- 1532-4036. ; 74
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Tidskriftsartikel (refereegranskat)abstract
- To identify care practices in Swedish intensive care units specific to patients requiring mechanical ventilation for >7days.We conducted a national cross-sectional survey inviting all adult Swedish ICUs (n=79). Nurse managers were invited by email to complete a questionnaire by telephone. The questionnaire included seven domains: ventilator weaning, mobilisation, communication, nutrition, symptom assessment, psychosocial support and organisational characteristics.We received responses from 77 units (response rate, 97%). Weaning protocols were available in 42 (55%) units, 52 (68%) used individualised weaning strategies and 50 (65%) involved physicians and nurses in collaborative decision making. In 48 units (62%), early mobilisation was prioritised using bed cycling but only 26 (34%) units had mobilisation protocols. Most of the intensive care units (74, 96%) had nutrition protocols but only 2 (3%) had dedicated dieticians. Delirium screening tools were available in 49 (64%) ICUs, 3 (4%) assessed anxiety and none assessed dyspnoea. Nineteen (25%) units employed a primary nursing model and 11 (14%) indicated person-centred care policies. Regular case conferences, including family participation, were held by 39 (51%) units.We found that an individualised approach to ventilator weaning, decided by physicians and nurses in collaboration, was the predominant approach, although weaning protocols were available in some intensive care units. Most units prioritised early mobilisation, though few used protocols. Nutritional protocols were widely adopted, as few units had a dedicated dietician.
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| 28. |
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| 29. |
- Cronqvist, Agneta, et al.
(författare)
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Dissonant imperatives in nursing : a conceptualization of stress in intensive care in Sweden.
- 2001
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Ingår i: Intensive & Critical Care Nursing. - : Elsevier BV. - 0964-3397 .- 1532-4036. ; 17:4, s. 228-36
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Tidskriftsartikel (refereegranskat)abstract
- The aim of this study was to explore nurses' experiences of stress within the context of intensive care. The theoretical perspective for the study builds on a cognitive-phenomenological-transactional theory of stress and coping and the theory of cognitive dissonance. Respondents were 36 registered nurses recruited from 10 intensive care units (general, neonatal and thoracic units). Their experience as nurses ranged from one to 32 years. These intensive care units had similar structural characteristics, namely a high working pace, advanced technology, constrained finances, frequent reorganizations, a shortage of registered nurses and all were filled to overcapacity. Data were collected in open-ended interviews that were audio-taped and transcribed. A content analysis identified four contradictory themes: (1) controlled by the work situation--needing to be in control; (2) constrained by prioritization--wanting to do more; (3) lacking the authority to act--knowing that something should be done; and (4) professional distance--interpersonal involvement. These four themes were synthesized at a higher level of abstraction into a main theme: stress induced by dissonant imperatives, which conceptualizes nursing stress in the intensive care unit. In conclusion, dissonant imperatives might lead to stress in intensive care nursing.
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| 30. |
- De Lange, Eva, et al.
(författare)
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The clinical effectiveness of the corrected nose-earlobe-xiphoid distance formula in determining the internal length of a nasogastric tube in adults : A retrospective study
- 2024
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Ingår i: Intensive & Critical Care Nursing. - : Elsevier. - 0964-3397 .- 1532-4036. ; 85
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Tidskriftsartikel (refereegranskat)abstract
- INTRODUCTION: Accurate determination of the internal length of nasogastric tubes is essential for the safe and effective completion of blind insertions, a routine nursing procedure. The widely used nose-earlobe-xiphoid distance lacks evidence and effectiveness. A recent randomized controlled trial proposed an alternative, the corrected nose-earlobe-xiphoid distance formula. However, its effectiveness in real-world clinical practice has not yet been studied.OBJECTIVE: This study assessed the real-world clinical effectiveness of the corrected nose-earlobe-xiphoid distance formula for determining the internal nasogastric tube length in adult patients admitted to hospitalization or intensive care units. DESIGN: A single-center retrospective clinical effectiveness study was conducted, utilizing routinely collected observational data.SETTING AND MAIN OUTCOME MEASURES: Between October 2020 and November 2022, 358 adult patients in a general hospital requiring a nasogastric feeding tube were included. The primary outcome involved assessing nasogastric tube tip positioning (>3 cm below the lower esophageal sphincter) by an advanced practice nurse through X-ray verification. Secondary outcomes, obtained from patient records for a random subgroup of 100 participants, were reporting clarity and evaluation of the tip position by reviewing radiologists.RESULTS: Following evaluation by an advanced practice nurse, all nasogastric feeding tubes were determined to be correctly positioned. Among the subgroup of 100 tubes, X-ray protocols, as documented by the reviewing radiologists, showed varying levels of reporting clarity for the tube tip: 4.0 % lacked reporting, 33.0 % had ambiguous reporting and 63.0 % had unambiguous reporting.CONCLUSION: The corrected nose-earlobe-xiphoid distance formula demonstrates potential to emerge as a safer alternative to existing methods for determining the internal length of nasogastric tubes.IMPLICATIONS FOR CLINICAL PRACTICE: In addition to healthcare provider education and training, a checklist-based framework is recommended for radiologists to unambiguously report nasogastric tube tip positions.
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| 31. |
- Döös, Marianne, 1949-, et al.
(författare)
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Going beyond "two-getherness" : Nurse managers' experiences of working together in a leadership model where more than two share the same chair
- 2017
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Ingår i: Intensive & Critical Care Nursing. - : Elsevier BV. - 0964-3397 .- 1532-4036. ; 43, s. 39-46
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Tidskriftsartikel (refereegranskat)abstract
- Objective: To explore nurse manager experiences of working in leadership constellations where more than two managers share leadership, and to compare this multilateral sharing form to what is known about experiences of working in joint leadership in pairs.Design and setting: A qualitative design based on semi-structured interviews with nurse managers in two multilaterally shared leadership constellations at two intensive care units at an emergency hospital in Sweden. Data were analysed using a thematic and comparative approach.Findings: The comparative analysis identified four aspects that differ decisively from the positive picture in the literature on joint pair leadership: the perception of mandate with reduced decision-making power and reduced access to forums, the way of working with a strict division of tasks and a rotating schedule, a need to cope with the increasing number of internal relations and a feeling of doubt concerning trust.Conclusion: Shared leadership between nurse managers has gone from being a tight collaboration based on a feeling of “two-getherness”, to being an organisational solution multilateral in character. In this transformation, a weakening of leadership qualities has occurred. Further research is necessary on how this new organisational solution impacts the nurse managers, their staff and the care provided in healthcare organisations generally.
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| 32. |
- Ednell, Anna-Karin, et al.
(författare)
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The ICU Patient Diary : a Nursing Intervention that is Complicated in its Simplicity : a Qualitative Study
- 2017
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Ingår i: Intensive & Critical Care Nursing. - : Elsevier. - 0964-3397 .- 1532-4036. ; 40, s. 70-76
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Tidskriftsartikel (refereegranskat)abstract
- BackgroundWriting a diary for intensive care patients has been shown to facilitate patientrecovery and prevent post-traumatic stress following hospitalisation.AimThis study aimed to describe the experiences of critical care nurses’ (CCNs’) in writing personal diaries for ICU patients.MethodThe study was conducted with a qualitative design. Ten CCNs from two hospitals participated. Data were collected with semi-structured interviews and analysed using a qualitative thematic content analysis.FindingsThe result consists of a theme: Patient diary: a complex nursing intervention in all its simplicity, as well as four categories: Writing informatively and with awareness shows respect and consideration; The diary is important for both patient and CCN; To jointly create an organisation that facilitates and develops the writing; Relatives’ involvement in the diary is a matter of course.ConclusionCCNs are aware of the diary’s importance for the patient and relatives, but experience difficulties in deciding which patients should get this intervention and how to prioritize it. Writing a personal diary for an ICU patient is a nursing intervention that is complicated in its simplicity.
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| 33. |
- Egerod, Ingrid, et al.
(författare)
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ICU-recovery in Scandinavia : a comparative study of intensive care follow-up in Denmark, Norway and Sweden
- 2013
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Ingår i: Intensive and Critical Care Nursing. - : Elsevier BV. - 1532-4036 .- 0964-3397. ; 29:2, s. 11-103
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVES: The aim of our study was to describe and compare models of intensive care follow-up in Denmark, Norway and Sweden to help inform clinicians regarding the establishment and continuation of ICU aftercare programmes.METHODS: Our study had a multi-centre comparative qualitative design with triangulation of sources, methods and investigators. We combined prospective data from semi-structured key-informant telephone interviews and unreported data from a precursory investigation.RESULTS: Four basic models of follow-up were identified representing nurse-led or multidisciplinary programmes with or without the provision of patient diaries. A conceptual model was constructed including a catalogue of interventions related to the illness trajectory. We identified three temporal areas for follow-up directed towards the past, present or future.CONCLUSIONS: ICU follow-up programmes in the Scandinavian countries have evolved as bottom-up initiatives conducted on a semi-voluntary basis. We suggest reframing follow-up as an integral part of patient therapy. The Scandinavian programmes focus on the human experience of critical illness, with more attention to understanding the past than looking towards the future. We recommend harmonization of programmes with clear goals enabling programme assessment, while moving towards a paradigm of empowerment, enabling patient and family to take an active role in their recovery and wellbeing.
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| 34. |
- Egerod, I., et al.
(författare)
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Images of suffering depicted in diaries of family caregivers in the acute stage of necrotising soft tissue infection: A content analysis
- 2017
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Ingår i: Intensive and Critical Care Nursing. - : Elsevier BV. - 0964-3397 .- 1532-4036. ; 41, s. 57-62
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Tidskriftsartikel (refereegranskat)abstract
- Objectives: Severe necrotising soft tissue infections (NSTI) are rare life threatening rapidly progressing bacterial infections requiring immediate diagnosis and treatment. The aim of the study was to explore the experience of family caregivers of patients with necrotising soft tissue infection during the acute stage of disease. Methods: Our study had a qualitative descriptive binational design using qualitative content analysis to explore diaries written by close family members (n = 15). Participants were recruited from university hospitals in Denmark and Sweden. Findings: Three main categories emerged: Trajectory, Treatment, and Patient & Family. The first helped us construct an overview of the NSTI trajectory showing issues of importance to patient and family caregivers. The following categories were analysed further to describe four themes central to the family caregiver experience: craving information, needing to be near, suffering separation and network taking over. Conclusions: Necrotising soft tissue infections are uncommon causing shock and concern. Centralised treatment might involve physical separation of patient and family during the acute stage of illness. Family accommodations near the patient and accessibility to adequate communication devices at the bedside are recommended. Health professionals need to keep in mind the importance of information and reassurance on the wellbeing of the family and ultimately of the patient. (C) 2017 Elsevier Ltd. All rights reserved.
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| 35. |
- Eklind, Sara, et al.
(författare)
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The Intensive Care Unit diary : A significant complement in the recovery after intensive care. A focus group study.
- 2023
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Ingår i: Intensive & Critical Care Nursing. - : Elsevier. - 0964-3397 .- 1532-4036. ; 74
-
Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVES: The aim of this study was to gain an increased understanding of the intensive care unit diary and how it affects patients' recovery after intensive care.METHODOLOGY/DESIGN: The study had a qualitative design and was conducted by two focus group interviews in October 2021 and was analysed with thematic analysis.SETTING: Ventilator treated intensive care patients with a length of stay ≥ 72 hours who had received a written diary were included. The study was conducted at two university hospitals in the south of Sweden.FINDINGS: The intensive care unit diary can be an important complement to the medical record and notes taken by family members by enhancing understanding of critical illness. The patients experience several prominent feelings from reading the diary such as guilt, fear, and anxiety as well as feelings of being cared for. The design and content of the diary can be important used as a tool in patients' recovery after intensive care.CONCLUSION: Understanding their critical illness and the time in intensive care seems important to former intensive care patients. In this respect, the intensive care unit diary on its own does not provide significant information and thus need to be complemented by information from the medical record and notes taken by family members. Therefore, the diary can be used as a complement that might increase patients' sense of coherence and facilitate recovery after intensive care.
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| 36. |
- Engström, Birgitta, et al.
(författare)
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Relatives' involvement in nursing care : a qualitative study describing critical care nurses' experiences
- 2011
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Ingår i: Intensive & Critical Care Nursing. - : Elsevier BV. - 0964-3397 .- 1532-4036. ; 27:1, s. 1-9
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Tidskriftsartikel (refereegranskat)abstract
- ObjectivesWhen patients become critically ill it also affects their relatives. The aim of this study was to describe critical care nurses’ experience of relatives’ involvement in the nursing care of patients in an intensive care unitMethodSemi-structured personal interviews with eight critical care nurses in an intensive care unit in the northern part of Sweden were conducted during 2010. The interview texts were subjected to qualitative content analysis which resulted in the formulation of two main categories and five sub-categories.FindingsThe findings showed that relatives’ involvement was appreciated and seen as great resource for both patients and critical care nurses. Protecting the integrity of patients was one reason for limiting their involvement. The environment and lack of time were experienced as other obstacles to the involvement of relatives.ConclusionAligning the needs of the relatives to be involved in the care with the needs of the patient and the work situation of the nurses requires open communication between all three parties.
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| 37. |
- Engström, Åsa, et al.
(författare)
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People's experiences of being mechanically ventilated in an ICU : a qualitative study
- 2013
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Ingår i: Intensive & Critical Care Nursing. - : Elsevier BV. - 0964-3397 .- 1532-4036. ; 29:2, s. 88-95
-
Tidskriftsartikel (refereegranskat)abstract
- In previous studies people receiving mechanical ventilation treatment have described experiencing distress over their inability to speak and feelings such as anxiety. More research is needed to improve their experience in the intensive care unit and promote recovery. The aim of this study was to describe the intensive care unit experiences of people undergoing mechanical ventilation.MethodQualitative, personal interviews were conducted during 2011 with eight people who were mechanically ventilated in an intensive care unit in the northern part of Sweden. Interview transcripts were analysed using qualitative content analysis.FindingsTwo themes emerged, with four and three categories, respectively. Being dependent for survival on other people and technical medical equipment created a sense of being vulnerable in an anxious situation and a feeling of uncertainty about one's own capacity to breathe. Having lines and tubes in one's body was stressful. Being given a diary and follow-up visit to the intensive care unit after the stay were important tools for filling in the missing time, but there was also one participant who did not want to remember his stay in the intensive care unit.ConclusionTo be dependent on other people and technical medical equipment for survival creates a sense of being delivered into the hands of others, as the people being mechanically ventilated could not trust their body to function.
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| 38. |
- Engström, Åsa, et al.
(författare)
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Re-visiting the ICU. Experiences of follow-up visits to an ICU after discharge : A qualitative study
- 2008
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Ingår i: Intensive & Critical Care Nursing. - : Elsevier BV. - 0964-3397 .- 1532-4036. ; 24:4, s. 233-241
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Tidskriftsartikel (refereegranskat)abstract
- The aim of this study is to describe how people who have been critically ill, and their close relatives experience a post-discharge, follow-up visit to the intensive care unit (ICU) that provided the care. There is a lack of studies from such a standpoint. The study design is qualitative. A total of 18 adults participated; nine had been critically ill and nine were close relatives, all made a post-discharge follow-up visit to an ICU in the northern part of Sweden. The study data was collected through personal interviews, conducted after the follow-up visit, using a narrative approach. The data were then subjected to qualitative thematic content analysis which resulted in four themes: receiving strength from returning together; making sense of the critical-illness experience; feeling grateful to have survived and the possibility of improving the care. People who had been critically ill and close relatives felt that returning together was valuable. Meeting the staff, with whom participants felt they had developed a relationship, made it possible for them to express their gratitude for the treatment and nursing care received, and to suggest improvements. The interviews revealed that the follow-up visit was seen as an important way of learning what had happened and why during the period of critical illness. © 2008 Elsevier Ltd. All rights reserved.
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| 39. |
- Engström, Åsa, et al.
(författare)
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The experiences of partners of critically ill persons in an intensive care unit
- 2004
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Ingår i: Intensive and Critical Care Nursing. - : Elsevier BV. - 0964-3397 .- 1532-4036. ; 20:5, s. 299-308
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Tidskriftsartikel (refereegranskat)abstract
- The aim of this study was to describe partners' experiences when their spouses received care in an intensive care unit (ICU). Seven partners were interviewed using a narrative approach. The interview texts were subjected to qualitative thematic content analysis. The analysis resulted in three themes; being present, putting oneself in second place and living in uncertainty. It was a shocking experience for the partners to see their critically ill spouse in the ICU. It was important to be able to be present; nothing else mattered. Showing respect, confirming the integrity and dignity of their critically ill spouse were also essential for partners. Receiving support from family and friends was important, as were understanding and accepting what had happened, obtaining information and the way in which this was given. The state of uncertainty concerning the outcome for the critically ill person was difficult to cope with. The partners wanted to hope, even though the prognosis was poor. © 2004 Elsevier Ltd. All rights reserved.
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| 40. |
- Engwall, Marie, et al.
(författare)
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Lighting, sleep and circadian rhythm: An intervention study in the intensive care unit
- 2015
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Ingår i: Intensive and Critical Care Nursing. - : Elsevier BV. - 0964-3397 .- 1532-4036. ; 31:6, s. 325-335
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Tidskriftsartikel (refereegranskat)abstract
- Patients in an intensive care unit (ICU) may risk disruption of their circadian rhythm. In an intervention research project a cycled lighting system was set up in an ICU room to support patients' circadian rhythm. Part I aimed to compare experiences of the lighting environment in two rooms with different lighting environments by lighting experiences questionnaire. The results indicated differences in advantage for the patients in the intervention room (n=48), in perception of daytime brightness (p =0.004). In nighttime, greater lighting variation (p =0.005) was found in the ordinary room (n = 52). Part II aimed to describe experiences of lighting in the room equipped with the cycled lighting environment. Patients (n=19) were interviewed and the results were presented in categories: "A dynamic lighting environment", "Impact of lighting on patients' steep", The impact of lighting/lights on circadian rhythm" and The Lighting calms". Most had experiences from sleep disorders and half had nightmares/sights and circadian rhythm disruption. Nearly all were pleased with the cycled lighting environment, which together with daylight supported their circadian rhythm. In night's actual lighting levels helped patients and staff to connect which engendered feelings of calm. (C) 2015 The Authors. Published by Elsevier Ltd. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).
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| 41. |
- Engwall, Marie, 1964, et al.
(författare)
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The effect of cycled lighting in the intensive care unit on sleep, activity and physiological parameters: A pilot study
- 2017
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Ingår i: Intensive and Critical Care Nursing. - : Elsevier BV. - 0964-3397 .- 1532-4036. ; 41, s. 26-32
-
Tidskriftsartikel (refereegranskat)abstract
- Patients in intensive care suffer from severe illnesses or injuries and from symptoms related to care and treatments. Environmental factors, such as lighting at night, can disturb patients' circadian rhythms. The aim was to investigate whether patients displayed circadian rhythms and whether a cycled lighting intervention would impact it. In this pilot study (N=60), a cycled lighting intervention in a two -bed patient room was conducted. An ordinary hospital room functioned as the control. Patient activity, heart rate, mean arterial pressure and body temperature were recorded. All data were collected during the patients' final 24h in the intensive care unit. There was a significant difference between day and night patient activity within but not between conditions. Heart rates differed between day and night significantly for patients in the ordinary room but not in the intervention room or between conditions. Body temperature was lowest at night for all patients with no significant difference between conditions. Patients in both conditions had a natural circadian rhythm; and the cycled lighting intervention showed no significant impact. As the sample size was small, a larger repeated measures study should be conducted to determine if other types of lighting or environmental factors can impact patients' well-being. (C) 2017 Elsevier Ltd. All rights reserved.
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| 42. |
- Eriksson, Thomas, et al.
(författare)
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The experiences of patients and their families of visiting during whilst in an intensive care unit : A hermeneutic interview study
- 2011
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Ingår i: Intensive & Critical Care Nursing. - : Elsevier. - 0964-3397 .- 1532-4036. ; 27:2, s. 60-67
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Tidskriftsartikel (refereegranskat)abstract
- Aim The aim of this study was to interpret and understand the meanings of the lived experiences of visiting of patients in an ICU and their families. Method The research design was hermeneutic, based on interviews. This study includes 12 interviews with seven patients and five relatives who had been in an ICU. The interview text was interpreted in a Gadamerian manner as different plays with actors and plots. Findings Patients’ narratives could be divided into two parts; recall of real life and unreal life experiences, the unreal being more common. Relatives’ narratives are described as being on stage and being backstage, i.e. in the room with the patient and outside it. Conclusion The final interpretation elucidated the experience of visiting as the sudden shift between being present in real life vs. being present in the real life of unreality. It was a process whereby the patient and the family build a new understanding of life that creates a new form of interplay within the family. The pre-critical illness life is no longer there – a new life has begun. To support patients and their families in this process of change a family-centred care perspective is necessary.
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| 43. |
- Eriksson, Thomas, 1959-, et al.
(författare)
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The experiences of patients and their families of visiting whilst in an intensive care unit - a hermeneutic interview study
- 2011
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Ingår i: Intensive and Critical Care Nursing. - : Elsevier BV. - 0964-3397 .- 1532-4036. ; 27:2, s. 60-66
-
Tidskriftsartikel (refereegranskat)abstract
- Aim The aim of this study was to interpret and understand the meanings of the lived experiences of visiting of patients in an ICU and their families. Method The research design was hermeneutic, based on interviews. This study includes 12 interviews with seven patients and five relatives who had been in an ICU. The interview text was interpreted in a Gadamerian manner as different plays with actors and plots. Findings Patients’ narratives could be divided into two parts; recall of real life and unreal life experiences, the unreal being more common. Relatives’ narratives are described as being on stage and being backstage, i.e. in the room with the patient and outside it. Conclusion The final interpretation elucidated the experience of visiting as the sudden shift between being present in real life vs. being present in the real life of unreality. It was a process whereby the patient and the family build a new understanding of life that creates a new form of interplay within the family. The pre-critical illness life is no longer there – a new life has begun. To support patients and their families in this process of change a family-centred care perspective is necessary.
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| 44. |
- Eriksson, Thomas, et al.
(författare)
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Visits in an intensive care unit : an observational hermeneutic study
- 2010
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Ingår i: Intensive & Critical Care Nursing. - : Churchill Livingstone. - 0964-3397 .- 1532-4036. ; 26:1, s. 51-57
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Tidskriftsartikel (refereegranskat)abstract
- Aim The aim was to interpret the interplay between critically ill patients and their next of kin in an ICU and to disclose a deeper understanding of the visiting situation. Method A hermeneutic research design with non-participant observation was chosen as the data collection method. Ten observations of 10 patients and 24 loved ones over a 20-h period were conducted. The text describing the observations of the interplay was interpreted in accordance with Gadamer's thoughts. Data were analysed by considering the text as a play with scenes, actors and plots. Findings Due to their medical condition the patients were unable to use their bodies in the usual way, which sends different signals to their loved ones, who in turn have difficulty deciding how to respond. Both parties become, in a manner of speaking, trapped or locked out by their own bodies. Conclusion The physical environment became a hindrance to the interplay as it was designed for medical and technical use and thus did not promote healing. The professionals are important for interpreting the signals from both patients and next of kin, as well as for finding caring strategies, such as physical contact that promote interplay, which in turn strengthens connectedness.
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| 45. |
- Falk, A. -C, et al.
(författare)
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Barriers in achieving patient participation in the critical care unit
- 2019
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Ingår i: Intensive & Critical Care Nursing. - : Elsevier. - 0964-3397 .- 1532-4036. ; 51, s. 15-19
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Tidskriftsartikel (refereegranskat)abstract
- Objectives: Patient participation in healthcare is important for optimizing treatment outcomes and for ensuring satisfaction with care. Therefore, this study aims to identify barriers to patient participation in the critical care unit, as identified by critical care nurses. Design and settings: Qualitative data were collected in four focus group interviews with 17 nurses from two separate hospitals. The interviews were analyzed using qualitative content analysis. Findings: The results show three main categories: nurse's attitude toward caring, the organization of the critical care unit and the patient's health condition. Conclusion: Barriers for patient participation in the ICU were found and this lead to a power imbalance between patient and nurse. In contrast to other care settings, this imbalance could be a consequence of the critical care organization and its degree of highly specialized care. The clinical application of our results is that these barriers should be considered when implementing patient participation in such a highly technological care situation as a critical care unit. (C) 2018 Elsevier Ltd. All rights reserved.
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| 46. |
- Falk, Ann-Charlotte, et al.
(författare)
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Missed nursing care in the critical care unit, before and during the COVID-19 pandemic : A comparative cross-sectional study
- 2022
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Ingår i: Intensive & Critical Care Nursing. - : Elsevier BV. - 0964-3397 .- 1532-4036. ; 72
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVES: Todescribe and evaluate reported missed nursing care in the critical care context during different phases of the COVID-19 pandemic in Sweden.RESEARCH METHODOLOGY: A comparative cross-sectional design was used, comparing missed nursing care in three samples: before the COVID-19 pandemic in 2019, during the second wave of the pandemic in spring 2020, and during the third wave of the pandemic in fall 2021.SETTING: The study was conducted at critical care units at a university hospital, Sweden.MAIN OUTCOME MEASURES: The MISSCARE Survey-Swedish version was used to collect data along with two study-specific questions concerning perception of patient safety and quality of care.RESULTS: Significantly more overtime hours and number of days absent due to illness were reported during the pandemic. The nurse/patient ratio was above the recommended level at all data collection time points. Most missed nursing care was reported in items concerning basic care. The most reported reasons for missed nursing care in all samples concerned inadequate staffing, urgent situations, and a rise in patient volume. Most nurses in all samples perceived the level of patient safety and quality of care as good, and the majority had no intention to leave their current position.CONCLUSION: The pandemic had a great impact on the critical care workforce but few elements of missed nursing care were affected. To measure and use missed nursing care as a quality indicator could be valuable for nursing managers, to inform them and improve their ability to meet changes in patient needs with different workforce approaches in critical care settings.
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| 48. |
- Falk, Anna, et al.
(författare)
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Depressive and/or anxiety scoring instruments used as screening tools for predicting postoperative delirium after cardiac surgery : A pilot study
- 2020
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Ingår i: Intensive & Critical Care Nursing. - : Elsevier. - 0964-3397 .- 1532-4036. ; 59
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Tidskriftsartikel (refereegranskat)abstract
- Background: Depression is common in patients with cardiac disease. Depression is a risk factor for developing postoperative delirium, a common and serious complication to cardiac surgery.Objectives: The aim was to evaluate if screening tools for depression can be used to predict postoperative delirium after cardiac surgery.Methods: This was a prospective population-based pilot study including 26 patients between 23 and 80 years of age undergoing cardiac surgery in Sweden during 2018. The day before surgery the participants filled out the depression screening instruments Hospital Anxiety and Depression Scale and Patient Health Questionnaire. After discharge the patient charts were examined for documentation of symptoms of delirium.Results: Five (20%) patients screened positive regarding depression using the Hospital Anxiety and Depression Scale and 7 patients (27%) screened positive using The Patient Health Questionnaire. Four (22%) patients showed symptoms of postoperative delirium, none of them screened positive for depression prior to surgery.Conclusion: We found no difference between the questionnaires PHQ-9 and HADS regarding identifying depressive symptoms. Moreover, we found that post-operative delirium, to a certain extent, can be detected by reading the patient́s charts postoperatively. However, this pilot study showed that screening tools for delirium need to be better implemented.
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- Flæten, Øystein Øygarden, et al.
(författare)
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Incidence, characteristics, and associated factors of pressure injuries acquired in intensive care units over a 12-month period : a secondary analysis of a quality improvement project
- 2024
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Ingår i: Intensive & Critical Care Nursing. - : Elsevier. - 0964-3397 .- 1532-4036. ; 81
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Tidskriftsartikel (refereegranskat)abstract
- Objectives: To determine the 12-month cumulative incidence, characteristics, and associated factors of pressure injuries acquired in Intensive Care Units.Setting: Four intensive care units in a Norwegian University Hospital.Research methodology: A prospective observational cohort study using data from daily skin inspections during a quality improvement project. We used descriptive statistics and logistic regression. Variables associated with the development of intensive care unit-acquired pressure injuries are presented with odds ratios (OR), and 95% confidence intervals.Results: The 12-month cumulative incidence of patients (N = 594) developing intensive care unit-acquired pressure injuries was 29 % (172/594) for all categories and 16 % (95/594) when excluding category I pressure injuries (no skin loss). Cumulative incidence for patients acquiring medical device-related pressure injuries was 15 % (91/594) and 11 % (64/594) for category II or worse. Compression stockings (n = 51) and nasogastric tubes (n = 22) were the most frequent documented medical devices related to pressure injuries. Development of pressure injuries category II or worse was significantly associated with vasoactive drug infusions (OR 11.84, 95 % CI [1.59; 88.13]) and longer intensive care unit length of stay (OR 1.06, 95 % CI [1.04; 1.08]).Conclusion: The 12-month cumulative incidence of intensive care unit-acquired pressure injuries was relatively high when category I pressure injuries were included, but comparable to other studies when category I was excluded. Some medical device-related pressure injuries were surprisingly frequent, and these may be prevented. However, associated factors of developing pressure injuries were present and deemed non-modifiable.Implications for clinical practice: Awareness about pressure injury prevention is needed in the intensive care unit considering high incidences. Nurses can detect category I pressure injuries early, which may be reversed. Our findings show several factors that clinicians can control to reduce the risk of pressure injuries in the intensive care unit.
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