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  • 1. Almerud, S
    et al.
    Alapack, RJ
    Fridlund, Bengt
    Jönköping University, School of Health Science, HHJ, Dep. of Nursing Science. Jönköping University, School of Health Science, HHJ. Quality improvements, innovations and leadership in health care and social work.
    Ekebergh, M
    Caught in an artificial split: a phenomenological study of being a caregiver in the technologically intense environment.2008In: Intensive & Critical Care Nursing, ISSN 0964-3397, E-ISSN 1532-4036, Vol. 24, no 2, p. 130-136Article in journal (Refereed)
    Abstract [en]

    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

  • 2. Almerud, S
    et al.
    Alapack, R.J.
    Fridlund, Bengt
    Växjö University.
    Ekebergh, Margaretha
    University of Borås, School of Health Science.
    Caught in an Artificial Split: A Phenomenological Study of Being a Caregiver in the Technologically Intense Environment2007In: Intensive & Critical Care Nursing, ISSN 0964-3397, E-ISSN 1532-4036, Vol. 24, no 2, p. 130-136Article in journal (Refereed)
    Abstract [en]

    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.

  • 3.
    Andersson, Maria
    et al.
    Karlstad University, Faculty of Health, Science and Technology (starting 2013), Department of Health Sciences.
    Hall-Lord, Marie Louise
    Karlstad University, Faculty of Health, Science and Technology (starting 2013), Department of Health Sciences.
    Wilde-Larsson, Bodil
    Karlstad University, Faculty of Health, Science and Technology (starting 2013), Department of Health Sciences.
    Persenius, Mona
    Karlstad University, Faculty of Health, Science and Technology (starting 2013), Department of Health Sciences.
    Patient photographs-A landmark for the ICU staff: A descriptive study.2013In: Intensive & Critical Care Nursing, ISSN 0964-3397, E-ISSN 1532-4036, Vol. 29, no 4, p. 193-201Article in journal (Refereed)
    Abstract [en]

    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.

  • 4.
    Andersson, Maria
    et al.
    Karlstad University, Faculty of Health, Science and Technology (starting 2013), Department of Health Sciences (from 2013).
    Wilde-Larsson, Bodil
    Karlstad University, Faculty of Health, Science and Technology (starting 2013), Department of Health Sciences (from 2013).
    Persenius Wentzel, Mona
    Karlstad University, Faculty of Health, Science and Technology (starting 2013), Department of Health Sciences (from 2013).
    Intensive care nurses fail to translate knowledge and skills into practice: A mixed-methods study on perceptions of oral care2019In: Intensive & Critical Care Nursing, ISSN 0964-3397, E-ISSN 1532-4036, Vol. 52, p. 51-62Article in journal (Refereed)
    Abstract [en]

    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

  • 5. Backe, M
    et al.
    Larsson, K
    Fridlund, Bengt
    Högskolan i Halmstad.
    Patients' conceptions of their life situation within the first week after a stroke event: a qualitative analysis1996In: Intensive & Critical Care Nursing, ISSN 0964-3397, E-ISSN 1532-4036, Vol. 12, no 5, p. 285-294Article in journal (Refereed)
  • 6.
    Backe, Marita
    et al.
    Department of Medicine, Halmstad County Hospital, Halmstad, Sweden.
    Larsson, Kerstin
    Department of Medicine, Halmstad County Hospital, Halmstad, Sweden.
    Fridlund, Bengt
    Halmstad University, School of Health and Welfare, Centre of Research on Welfare, Health and Sport (CVHI). Department of Primary Health Care, Göteborg University, Göteborg, Sweden.
    Patients’ conceptions of their life situation within the first week after a stroke event: A qualitative analysis1996In: Intensive & Critical Care Nursing, ISSN 0964-3397, E-ISSN 1532-4036, Vol. 12, no 5, p. 285-294Article in journal (Refereed)
    Abstract [en]

    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.

  • 7.
    Backman, Carl G.
    et al.
    Vrinnevi Hosp Norrkoping, Sweden.
    Ahlberg, Mona
    Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Department of Anaesthesiology and Intensive Care in Norrköping. Linköping University, Department of Medical and Health Sciences, Division of Nursing Science. Linköping University, Faculty of Medicine and Health Sciences.
    Jones, Christina
    Univ Liverpool, England.
    Hollman Frisman, Gunilla
    Linköping University, Department of Medical and Health Sciences, Division of Nursing Science. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Department of Anaesthesiology and Intensive Care in Norrköping.
    Group meetings after critical illness-Giving and receiving strength2018In: Intensive & Critical Care Nursing, ISSN 0964-3397, E-ISSN 1532-4036, Vol. 46, p. 86-91Article in journal (Refereed)
    Abstract [en]

    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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  • 8.
    Ballangrud, Randi
    et al.
    Karlstad University, Faculty of Health, Science and Technology (starting 2013), Department of Health Sciences. Norway.
    Hall-Lord, Marie Louise
    Karlstad University, Faculty of Health, Science and Technology (starting 2013), Department of Health Sciences. Norway.
    Persenius, Mona
    Karlstad University, Faculty of Health, Science and Technology (starting 2013), Department of Health Sciences.
    Hedelin, Birgitta
    Norway.
    Intensive care nurses' perceptions of simulation-based team training for building pation safety in intensive care: A descriptive qualittaive study2014In: Intensive & Critical Care Nursing, ISSN 0964-3397, E-ISSN 1532-4036, Vol. 30, no 4, p. 179-187Article in journal (Refereed)
    Abstract [en]

    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.

  • 9.
    Ballangrud, Randi
    et al.
    Karlstad University, Faculty of Social and Life Sciences, Department of Nursing.
    Hedelin, Birgitta
    Karlstad University, Faculty of Social and Life Sciences, Department of Nursing.
    Hall-Lord, Marie-Louise
    Karlstad University, Faculty of Social and Life Sciences, Department of Nursing.
    Nurses’ perceptions of patient safety climate in intensive care units: A cross-sectional study2012In: Intensive & Critical Care Nursing, ISSN 0964-3397, E-ISSN 1532-4036, Vol. 28, no 6, p. 344-354Article in journal (Refereed)
    Abstract [en]

    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.

  • 10.
    Bjurling-Sjöberg, P.
    et al.
    Department of Anesthesiology, Mälar Hospital, Eskilstuna, Sweden.
    Engström, Gabriella
    Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare. Christine E. Lynn College of Nursing, Florida Atlantic University, Boca Raton, FL, United States.
    Lyckner, S.
    Department of Anesthesiology, Mälar Hospital, Eskilstuna, Sweden.
    Rydlo, Cecilia
    Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare.
    Intensive care nurses' conceptions of a critical pathway in caring for aortic-surgery patients: A phenomenographic study2013In: Intensive & Critical Care Nursing, ISSN 0964-3397, E-ISSN 1532-4036, Vol. 29, no 3, p. 166-173Article in journal (Refereed)
    Abstract [en]

    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.

  • 11.
    Bjurling-Sjöberg, Petronella
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Caring Sciences. Malar Hosp, Dept Anesthesiol, S-63220 Eskilstuna, Sweden.
    Engström, Gabriella
    Malardalen Univ, Sch Hlth Care & Social Welf, Eskilstuna, Sweden; Florida Atlantic Univ, Christine E Lynn Coll Nursing, Boca Raton, FL 33431 USA.
    Lyckner, Sara
    Malar Hosp, Dept Anesthesiol, S-63220 Eskilstuna, Sweden.
    Rydlo, Cecilia
    Malardalen Univ, Sch Hlth Care & Social Welf, Eskilstuna, Sweden.
    Intensive care nurses' conceptions of a critical pathway in caring for aortic-surgery patients: a phenomenographic study2013In: Intensive & Critical Care Nursing, ISSN 0964-3397, E-ISSN 1532-4036, Vol. 29, no 3, p. 166-173Article in journal (Refereed)
    Abstract [en]

    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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    Bjurling-Sjöberg,2013
  • 12.
    Blom, Helen
    et al.
    Department of Intensive Care Unit, Skaraborg Hospital, Skövde, Sweden.
    Gustavsson, Christina
    Department of Intensive Care Unit, Skaraborg Hospital, Skövde, Sweden.
    Johansson Sundler, Annelie
    University of Skövde, School of Life Sciences.
    Participation and support in intensive care as experienced by close relatives of patients: A phenomenological study2013In: Intensive & Critical Care Nursing, ISSN 0964-3397, E-ISSN 1532-4036, Vol. 29, no 1, p. 1-8Article in journal (Refereed)
    Abstract [en]

    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.

  • 13. Blom, Helen
    et al.
    Gustavsson, Christina
    Sundler J, Annelie
    University of Borås, Faculty of Caring Science, Work Life and Social Welfare.
    Participation and support in intensive care as experienced by close relatives of patients: a phenomenological study.2013In: Intensive & Critical Care Nursing, ISSN 0964-3397, E-ISSN 1532-4036, Vol. 29, no 1, p. 1-8Article in journal (Refereed)
    Abstract [en]

    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 important 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 professionals, especially critical care nurses, need to create an atmosphere that invites relatives to participate in the care provided at an ICU.

  • 14.
    Blom, Helene
    et al.
    Skaraborg Hospital.
    Gustavsson, Christina
    Skaraborg Hospital.
    Johansson Sundler, Annelie
    Högskolan i Skövde, Institutionen för vård och natur.
    Participation and support in intensive care as experienced by close relatives of patients: A phenomenological study2013In: Intensive & Critical Care Nursing, ISSN 0964-3397, E-ISSN 1532-4036, Vol. 29, no 1, p. 1-8Article in journal (Refereed)
    Abstract [en]

    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.

  • 15. Boström, I.
    et al.
    Hall-Lord, M-L.
    Larsson, Gerry
    The Centre for Public Health Research, The County Council of Värmland.
    Wilde, B.
    Nursing theory based changes of work organisation in an ICU: Effects on quality of care1992In: Intensive & Critical Care Nursing, ISSN 0964-3397, E-ISSN 1532-4036, Vol. 8, no 1, p. 10-16Article in journal (Refereed)
  • 16. Corrigan, I
    et al.
    Samuelson, KA
    Fridlund, Bengt
    Växjö universitet.
    Thomé, B
    The meaning of posttraumatic stress-reactions following critical illness or injury and intensive care treatment2007In: Intensive & Critical Care Nursing, ISSN 0964-3397, E-ISSN 1532-4036, Vol. 23, no 4, p. 206-215Article in journal (Refereed)
  • 17. Cronqvist, A
    et al.
    Theorell, T
    Burns, Tom R.
    Uppsala University, Disciplinary Domain of Humanities and Social Sciences, Faculty of Social Sciences, Department of Sociology.
    Lützén, K
    Dissonant imperatives in nursing: a conceptualization of stress in intensive care in Sweden.2001In: Intensive & Critical Care Nursing, ISSN 0964-3397, E-ISSN 1532-4036, Vol. 17, no 4, p. 228-236Article in journal (Refereed)
    Abstract [en]

    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.

  • 18.
    Cronqvist, Agneta
    et al.
    Department of Nursing, Karolinska Institutet, Stockholm, Sweden.
    Theorell, T
    Burns, T
    Lützén, Kim
    Dissonant imperatives in nursing: a conceptualization of stress in intensive care in Sweden.2001In: Intensive & Critical Care Nursing, ISSN 0964-3397, E-ISSN 1532-4036, Vol. 17, no 4, p. 228-36Article in journal (Refereed)
    Abstract [en]

    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.

  • 19. Dahl, Å
    et al.
    Nyberg, H
    Edell-Gustafsson, Ulla
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Care, Nursing Science.
    Nurses' clinical experiences of the inverse bed position on a neurointensive care unit - A phenomenographic study2003In: Intensive & Critical Care Nursing, ISSN 0964-3397, E-ISSN 1532-4036, Vol. 19, no 5, p. 289-298Article in journal (Refereed)
    Abstract [en]

    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.

  • 20.
    Döös, Marianne
    et al.
    Stockholm University, Faculty of Social Sciences, Department of Education.
    Vinell, Helene
    von Knorring, Mia
    Going beyond "two-getherness": Nurse managers' experiences of working together in a leadership model where more than two share the same chair2017In: Intensive & Critical Care Nursing, ISSN 0964-3397, E-ISSN 1532-4036, Vol. 43, p. 39-46Article in journal (Refereed)
    Abstract [en]

    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.

  • 21.
    Ednell, Anna-Karin
    et al.
    Intensive Care Unit, Gällivare Hospital.
    Siljegren, Sara
    Intensive Care Unit, Kiruna Hospital.
    Engström, Åsa
    Luleå University of Technology, Department of Health Sciences, Nursing Care.
    The ICU Patient Diary: a Nursing Intervention that is Complicated in its Simplicity : a Qualitative Study2017In: Intensive & Critical Care Nursing, ISSN 0964-3397, E-ISSN 1532-4036, Vol. 40, p. 70-76Article in journal (Refereed)
    Abstract [en]

    Background

    Writing a diary for intensive care patients has been shown to facilitate patientrecovery and prevent post-traumatic stress following hospitalisation.

    Aim

    This study aimed to describe the experiences of critical care nurses’ (CCNs’) in writing personal diaries for ICU patients.

    Method

    The 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.

    Findings

    The 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.

    Conclusion

    CCNs 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.

  • 22.
    Egerod, Ingrid
    et al.
    University of Copenhagen, Rigshospitalet.
    Kaldan, Gudrun
    University of Copenhagen, Rigshospitalet.
    Lindahl, Berit
    University of Borås, Faculty of Caring Science, Work Life and Social Welfare.
    Saetre Hansen, Britt
    Department of Anaesthesiology and Intensive Care, Stavanger University Hospital.
    Froulund Jensen, Janet
    Department of Anesthesiology, Holbæk Hospital.
    Oxenboll Collet, Marie
    Department of Intensive Care 4131, Copenhagen University Hospital.
    Halvorsen, Krisitin
    Department of Nursing and Health Promotion, Faculty of Health Sciences, Oslo Metropolitan University.
    Eriksson, Thomas
    University of Borås, Faculty of Caring Science, Work Life and Social Welfare.
    Olausson, Sepideh
    Jensen, Hanne Irene
    Department of Anaesthesiology and Intensive Care, Vejle and Middelfart Hospitals.
    Trends and recommendations for critical care nursing research in the Nordic countries: Triangulation of review and survey dataIn: Intensive & Critical Care Nursing, ISSN 0964-3397, E-ISSN 1532-4036Article in journal (Refereed)
    Abstract [en]

    Background

    Priorities for critical care nursing research have evolved with societal trends and values. In the 1980s priorities were the nursing workforce, in 1990s technical nursing, in 2000s evidence-based nursing and in 2010s symptom management and family-centred care.

    Objectives

    To identify current trends and future recommendations for critical care nursing research in the Nordic countries.

    Methods

    We triangulated the results of a literature review and a survey. A review of two selected critical care nursing journals (2016–2017) was conducted using content analysis to identify contemporary published research. A self-administered computerised cross-sectional survey of Nordic critical care nursing researchers (2017) reported current and future areas of research.

    Results

    A review of 156 papers identified research related to the patient (13%), family (12%), nurse (31%), and therapies (44%). Current trends in the survey (n = 76, response rate 65%) included patient and family involvement, nurse performance and education, and evidence-based protocols. The datasets showed similar trends, but aftercare was only present in the survey. Future trends included symptom management, transitions, rehabilitation, and new nursing roles.

    Conclusion

    Critical care nursing research is trending toward increased collaboration with patient and family, delineating a shift toward user values. Recommendations include long-term outcomes and impact of nursing.

  • 23. Engström, A.
    et al.
    Andersson, S.
    Söderberg, Siv
    Re-visiting the ICU. Experiences of follow-up visits to an ICU after discharge: A qualitative study2008In: Intensive & Critical Care Nursing, ISSN 0964-3397, E-ISSN 1532-4036, Vol. 24, no 4, p. 233-241Article in journal (Refereed)
    Abstract [en]

    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.

  • 24.
    Engström, Birgitta
    et al.
    Ambulance Care, Department of Health Care Centre, Pajala.
    Uusitalo, Anders
    Ambulance Care, Department of Health Care Centre, Pajala.
    Engström, Åsa
    Luleå University of Technology, Department of Health Sciences, Nursing Care.
    Relatives' involvement in nursing care: a qualitative study describing critical care nurses' experiences2011In: Intensive & Critical Care Nursing, ISSN 0964-3397, E-ISSN 1532-4036, Vol. 27, no 1, p. 1-9Article in journal (Refereed)
    Abstract [en]

    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.

  • 25.
    Engström, Åsa
    et al.
    Luleå University of Technology, Department of Health Sciences, Nursing Care.
    Andersson, Staffan
    Söderberg, Siv
    Re-visiting the ICU Experiences of follow-up visits to an ICU after discharge: a qualitative study2008In: Intensive & Critical Care Nursing, ISSN 0964-3397, E-ISSN 1532-4036, Vol. 24, no 4, p. 233-241Article in journal (Refereed)
    Abstract [en]

    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.

  • 26.
    Engström, Åsa
    et al.
    Luleå University of Technology, Department of Health Sciences, Nursing Care.
    Nyström, Natalie
    ICU/Emergency Department, Kiruna Hospital.
    Sundelin, Gunilla
    Strömsund's Health Care Centre.
    Rattray, Janice
    School of Nursing and Midwifery, University of Dundee.
    People's experiences of being mechanically ventilated in an ICU: a qualitative study2013In: Intensive & Critical Care Nursing, ISSN 0964-3397, E-ISSN 1532-4036, Vol. 29, no 2, p. 88-95Article in journal (Refereed)
    Abstract [en]

    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.

  • 27. Engström, Åsa
    et al.
    Söderberg, Siv
    Luleå University of Technology, Department of Health Sciences, Nursing Care.
    The experiences of partners of critically ill persons in an intensive care unit2004In: Intensive & Critical Care Nursing, ISSN 0964-3397, E-ISSN 1532-4036, Vol. 20, no 5, p. 299-310Article in journal (Refereed)
    Abstract [en]

    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

  • 28.
    Engwall, Marie
    et al.
    University of Borås, Faculty of Caring Science, Work Life and Social Welfare.
    Fridh, Isabell
    University of Borås, Faculty of Caring Science, Work Life and Social Welfare.
    Johansson, Lotta
    Bergbom, Ingegerd
    University of Borås, Faculty of Caring Science, Work Life and Social Welfare.
    Lindahl, Berit
    University of Borås, Faculty of Caring Science, Work Life and Social Welfare.
    Lighting, sleep and circadian rhythm: An intervention study in the intensive care unit.2015In: Intensive & Critical Care Nursing, ISSN 0964-3397, E-ISSN 1532-4036, Vol. 31, no 6, p. 325-335Article in journal (Refereed)
    Abstract [en]

    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' sleep", "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.

  • 29.
    Engwall, Marie
    et al.
    University of Borås, Faculty of Caring Science, Work Life and Social Welfare. Sahlgrenska University Hospital.
    Fridh, Isabell
    University of Borås, Faculty of Caring Science, Work Life and Social Welfare.
    Jutengren, Göran
    University of Borås, Faculty of Caring Science, Work Life and Social Welfare.
    Bergbom, Ingegerd
    University of Borås, Faculty of Caring Science, Work Life and Social Welfare. Sahlgrenska University Hospital.
    Sterner, Anders
    University of Borås, Faculty of Caring Science, Work Life and Social Welfare.
    Lindahl, Berit
    University of Borås, Faculty of Caring Science, Work Life and Social Welfare. Sahlgrenska University Hospital.
    The effect of cycled lighting in the intensive care unit on sleep, activity and physiological parameters: A pilot study2017In: Intensive & Critical Care Nursing, ISSN 0964-3397, E-ISSN 1532-4036, Vol. 41, p. 26-32, article id S0964-3397(17)30032-0Article in journal (Refereed)
    Abstract [en]

    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.

  • 30.
    Eriksson, Thomas
    et al.
    Sahlgrenska University Hospital, University of Gothenburg.
    Bergbom, I
    Sahlgrenska Academy, University of Gothenburg.
    Lindahl, Berit
    University of Borås, Faculty of Caring Science, Work Life and Social Welfare.
    The experiences of patients and their families of visiting during whilst in an intensive care unit: A hermeneutic interview study2011In: Intensive & Critical Care Nursing, ISSN 0964-3397, E-ISSN 1532-4036, Vol. 27, no 2, p. 60-67Article in journal (Refereed)
    Abstract [en]

    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.

  • 31.
    Eriksson, Thomas
    et al.
    University of Borås, Faculty of Caring Science, Work Life and Social Welfare.
    Bergbom, Ingegerd
    Göteborgs Universitet.
    Lindahl, Berit
    University of Borås, Faculty of Caring Science, Work Life and Social Welfare.
    The experiences of patients and their families of visiting whilst in an intensive care unit--a hermeneutic interview study.2011In: Intensive & Critical Care Nursing, ISSN 0964-3397, E-ISSN 1532-4036, Vol. 27, no 2, p. 60-66Article in journal (Refereed)
    Abstract [en]

    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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  • 32. Eriksson, Thomas
    et al.
    Lindahl, Berit
    University of Borås, School of Health Science.
    Bergbom, I
    Visits in an intensive care unit: an observational hermeneutic study2010In: Intensive & Critical Care Nursing, ISSN 0964-3397, E-ISSN 1532-4036, Vol. 26, no 1, p. 51-57Article in journal (Refereed)
    Abstract [en]

    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.

  • 33.
    Falk, A. -C
    et al.
    Karolinska University Hospital;Karolinska Institutet.
    Schandl, Anna
    Karolinska University Hospital;Karolinska Institutet.
    Frank, Catharina
    Linnaeus University, Faculty of Health and Life Sciences, Department of Health and Caring Sciences.
    Barriers in achieving patient participation in the critical care unit2019In: Intensive & Critical Care Nursing, ISSN 0964-3397, E-ISSN 1532-4036, Vol. 51, p. 15-19Article in journal (Refereed)
    Abstract [en]

    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.

  • 34.
    Falk, Anna
    et al.
    Perioperative Medicine and Intensive Care Function, Karolinska University Hospital, Stockholm, Sweden; Faculty of Medicine and Health, School of Health Sciences, Örebro University, Örebro, Sweden.
    Eriksson, Mats
    Örebro University, School of Health Sciences.
    Stenman, Malin
    Perioperative Medicine and Intensive Care Function, Karolinska University Hospital, Stockholm, Sweden; Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden.
    Depressive and/or anxiety scoring instruments used as screening tools for predicting postoperative delirium after cardiac surgery: A pilot study2020In: Intensive & Critical Care Nursing, ISSN 0964-3397, E-ISSN 1532-4036, article id 102851Article in journal (Refereed)
    Abstract [en]

    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.

  • 35. Forsberg, A.
    et al.
    Engström, A.
    Söderberg, Siv
    Luleå University of Technology.
    From reaching the end of the road to a new lighter life - People's experiences of undergoing gastric bypass surgery2014In: Intensive & Critical Care Nursing, ISSN 0964-3397, E-ISSN 1532-4036, Vol. 30, no 2, p. 93-100Article in journal (Refereed)
    Abstract [en]

    Objectives: It is limited research that focuses on people's experiences from prior to surgery to the postoperative period after a gastric bypass. The aim of this retrospective study was to describe people's experiences of undergoing gastric bypass surgery. Method: A qualitative approach was used. Interviews with ten participants were subjected to qualitative content analysis. Results: The analysis of the interviews resulted in one theme: from reaching the end of the road to a new lighter life. Prior to surgery participants described a sense of inferiority and that they were not able to 'take any more'. Shortly after surgery participants felt both vulnerable and safe in the unknown environment and expressed needs of orientation and to have the staff close. Despite information prior to surgery it was difficult to imagine ones' situation after homecoming, thus it was worth it so far. Conclusion: The care given in the acute postoperative phase for people who undergo gastric bypass surgery, should aim to provide predictability and management based on individual needs. Being treated with respect, receiving closeness, and that the information received prior to surgery complies with what then happens may facilitate postoperative recovery after a gastric bypass surgery. © 2013 Elsevier Ltd.

  • 36. Forsberg, Angelica
    et al.
    Engström, Åsa
    Söderberg, Siv
    Luleå University of Technology.
    From reaching the end of the road to a new lighter life – People's experiences of undergoing gastric bypass surgery2014In: Intensive & Critical Care Nursing, ISSN 0964-3397, E-ISSN 1532-4036, Vol. 30, no 2, p. 93-100Article in journal (Refereed)
    Abstract [en]

    SummaryObjectives It is limited research that focuses on people's experiences from prior to surgery to the postoperative period after a gastric bypass. The aim of this retrospective study was to describe people's experiences of undergoing gastric bypass surgery. Method A qualitative approach was used. Interviews with ten participants were subjected to qualitative content analysis. Results The analysis of the interviews resulted in one theme: from reaching the end of the road to a new lighter life. Prior to surgery participants described a sense of inferiority and that they were not able to ‘take any more’. Shortly after surgery participants felt both vulnerable and safe in the unknown environment and expressed needs of orientation and to have the staff close. Despite information prior to surgery it was difficult to imagine ones’ situation after homecoming, thus it was worth it so far. Conclusion The care given in the acute postoperative phase for people who undergo gastric bypass surgery, should aim to provide predictability and management based on individual needs. Being treated with respect, receiving closeness, and that the information received prior to surgery complies with what then happens may facilitate postoperative recovery after a gastric bypass surgery.

  • 37.
    Forsberg, Angelica
    et al.
    Luleå University of Technology, Department of Health Sciences, Nursing Care.
    Engström, Åsa
    Luleå University of Technology, Department of Health Sciences, Nursing Care.
    Söderberg, Siv
    Luleå University of Technology, Department of Health Sciences, Nursing Care.
    From reaching the end of the road to a new lighter life: People's experiences of undergoing Gastric Bypass surgery2014In: Intensive & Critical Care Nursing, ISSN 0964-3397, E-ISSN 1532-4036, Vol. 30, no 2, p. 93-100Article in journal (Refereed)
    Abstract [en]

    ObjectivesIt is limited research that focuses on people's experiences from prior to surgery to the postoperative period after a gastric bypass. The aim of this retrospective study was to describe people's experiences of undergoing gastric bypass surgery.MethodA qualitative approach was used. Interviews with ten participants were subjected to qualitative content analysis.ResultsThe analysis of the interviews resulted in one theme: from reaching the end of the road to a new lighter life. Prior to surgery participants described a sense of inferiority and that they were not able to ‘take any more’. Shortly after surgery participants felt both vulnerable and safe in the unknown environment and expressed needs of orientation and to have the staff close. Despite information prior to surgery it was difficult to imagine ones’ situation after homecoming, thus it was worth it so far.ConclusionThe care given in the acute postoperative phase for people who undergo gastric bypass surgery, should aim to provide predictability and management based on individual needs. Being treated with respect, receiving closeness, and that the information received prior to surgery complies with what then happens may facilitate postoperative recovery after a gastric bypass surgery.

  • 38.
    Forsberg, Anna
    et al.
    Lund University, Lund, Sweden / Skåne University Hospital, Lund, Sweden.
    Flodén, Anne
    School of Health Sciences, Jönköping University, PO Box 1026, SE-551 11 Jönköping, Sweden.
    Lennerling, Anette
    Sahlgrenska University Hospital, Gothenburg, Sweden / University of Gothenburg, Göteborg, Sweden.
    Karlsson, Veronika
    Högskolan i Skövde, Institutionen för hälsa och lärande. Högskolan i Skövde, Forskningsspecialiseringen Hälsa och Lärande. Department of Anesthesia and Intensive Care, Sahlgrenska University Hospital, Gothenburg, Sweden. (Äldre och långvariga hälsoproblem, Older Adults and Long-Term Health Problems).
    Nilsson, Madeleine
    Sahlgrenska University Hospital, Gothenburg, Sweden.
    Fridh, Isabell
    University of Gothenburg, Göteborg, Sweden / University of Borås, Borås, Sweden.
    The core of after death in relation to organ donation: A grounded theory study2014In: Intensive & Critical Care Nursing, ISSN 0964-3397, E-ISSN 1532-4036, Vol. 30, no 5, p. 275-282Article in journal (Refereed)
    Abstract [en]

    Objectives: The aim of this study was to investigate how intensive and critical care nurses experience and deal with after death care i.e. the period from notification of a possible braindead person, and thereby a possible organ donor, to the time of post-mortem farewell. Research methodology: Grounded theory, based on Charmaz' framework, was used to explore what characterises the ICU-nurses concerns during the process of after death and how they handle it. Data was collected from open-ended interviews. Findings: The core category: achieving a basis for organ donation through dignified and respectful care of the deceased person and the close relatives highlights the main concern of the 29informants. This concern is categorised into four main areas: safe guarding the dignity of the deceased person, respecting the relatives, dignified and respectful care, enabling a dignified farewell. Conclusion: After death care requires the provision of intense, technical, medical and nursing interventions to enable organ donation from a deceased person. It is achieved by extensive nursing efforts to preserve and safeguard the dignity of and respect for the deceased person and the close relatives, within an atmosphere of peace and tranquillity.

  • 39.
    Forsberg, Anna
    et al.
    Department of Health Sciences at Lund University, Lund, Sweden / Skåne University Hospital, Department of Transplantation and Cardiology, Sweden.
    Flodén, Anne
    School of Health Sciences, Jönköping University, Jönköping, Sweden.
    Lennerling, Annette
    The Transplant Center, Sahlgrenska University Hospital, Gothenburg, Sweden / Institute of Health and Care Sciences, University of Gothenburg, Sweden.
    Karlsson, Veronika
    University of Skövde, School of Health and Education. University of Skövde, Health and Education.
    Nilsson, Madeleine
    Queen Silvia’s Children Hospital, Sahlgrenska University Hospital, Gothenburg, Sweden.
    Fridh, Isabell
    Institute of Health and Care Sciences, University of Gothenburg,Sweden / School of Health Sciences, University of Borås, Sweden.
    The core of after death care in relation to organ donation: A grounded theory study2014In: Intensive & Critical Care Nursing, ISSN 0964-3397, E-ISSN 1532-4036, Vol. 30, no 5, p. 275-282Article in journal (Refereed)
  • 40. Forsberg, Anna
    et al.
    Flodén, Anne
    Lennerling, Annette
    Karlsson, Veronika
    Nilsson, Madeleine
    Fridh, Isabell
    University of Borås, School of Health Science.
    The core of after death in relation to organ donation: A grounded theory study2014In: Intensive & Critical Care Nursing, ISSN 0964-3397, E-ISSN 1532-4036, Vol. 30, no 5, p. 275-282Article in journal (Refereed)
    Abstract [en]

    OBJECTIVES: The aim of this study was to investigate how intensive and critical care nurses experience and deal with after death care i.e. the period from notification of a possible brain dead person, and thereby a possible organ donor, to the time of post-mortem farewell. RESEARCH METHODOLOGY: Grounded theory, based on Charmaz' framework, was used to explore what characterises the ICU-nurses concerns during the process of after death and how they handle it. Data was collected from open-ended interviews. FINDINGS: The core category: achieving a basis for organ donation through dignified and respectful care of the deceased person and the close relatives highlights the main concern of the 29 informants. This concern is categorised into four main areas: safeguarding the dignity of the deceased person, respecting the relatives, dignified and respectful care, enabling a dignified farewell. CONCLUSION: After death care requires the provision of intense, technical, medical and nursing interventions to enable organ donation from a deceased person. It is achieved by extensive nursing efforts to preserve and safeguard the dignity of and respect for the deceased person and the close relatives, within an atmosphere of peace and tranquillity.

  • 41. Forsgren, Lena M.
    et al.
    Eriksson, Mats
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    Delirium-awareness, observation and interventions in intensive care units: a national survey of Swedish ICU head nurses2010In: Intensive & Critical Care Nursing, ISSN 0964-3397, E-ISSN 1532-4036, Vol. 26, no 5, p. 296-303Article in journal (Refereed)
    Abstract [en]

    OBJECTIVES: To survey the awareness and observation of delirium, and interventions used for delirium in Swedish intensive care units (ICUs) and to examine the influence of hospital categories and staff education on the afore-mentioned.

    DESIGN: A questionnaire was sent to all Swedish adult patient ICUs (n=82) and completed by 55 units.

    RESULTS: The reported prevalence of delirium was 9.4%. Assessment of delirium was performed by 62% of the ICUs, commonly by observing symptoms. Most of the suggested non-pharmacologic interventions were reported to be used by at least 85% of the units. Drugs were used by 96%, most commonly haloperidol, propofol and benzodiazepines. Written pharmacological guidelines existed in 26% of the units, while 9% had non-pharmacological guidelines. Regular observation of delirium was more common in larger hospitals than in smaller ones and education was associated with reporting a higher prevalence of delirium.

    CONCLUSION: As in other countries, this study demonstrated that the awareness of delirium in ICUs is low with a lack of implementation of validated screening tools for its diagnosis. Emphasis should be placed on education and implementation of these tools to improve the quality of care for ICU patients.

  • 42.
    Fredriksen, Sven-Tore D.
    et al.
    Nordic Council of Ministers, Nordic School of Public Health NHV.
    Ringsberg, Karin C
    Nordic Council of Ministers, Nordic School of Public Health NHV.
    Living the situation stress-experiences among intensive care patients.2007In: Intensive & Critical Care Nursing, ISSN 0964-3397, E-ISSN 1532-4036, Vol. 23, no 3, p. 124-31Article in journal (Refereed)
    Abstract [en]

    The study is about the types of stress that patients in intensive care units experience. Ten reviewed articles selected from Cinahl and Pubmed between 1994 and 2003 constitute the data. The paper is a literature review, and the data is analysed from the phenomenological-hermeneutical point of view. Stress related to the body, room and relationships is discussed. Experiences of stress that are related to the body include bodily stress reactions, deprivation of control, emotions related to technical equipment, procedures and loss of meaning. Stress related to the room highlights the environment and the situation in which the patient finds him/herself. The ethical relations of professionals and separation of patients from their significant others constitute stress related to relationships.

  • 43.
    Fredriksson, Ann Charlotte
    et al.
    Dep. Anesthesia and Intensive Care, Malmö University Hospital, Sweden.
    Hellström, Lars
    Faculty of Health and Society, Department of Nursing, Malmö University, Sweden.
    Nilsson, Ulrica
    Dep. Anesthesia and Intensive Care/Centre for Health Care Sciences, Örebro University Hospital.
    Patients' perception of music versus ordinary sound in a postanaesthesia care unit: a randomised crossover trial2009In: Intensive & Critical Care Nursing, ISSN 0964-3397, E-ISSN 1532-4036, Vol. 25, no 4, p. 208-213Article in journal (Refereed)
    Abstract [en]

    We performed an experimental single-blind crossover design study in a postanaesthesia care unit (PACU): (i) to test the hypothesis that patients will experience a higher degree of wellbeing if they listen to music compared to ordinary PACU sounds during their early postoperative care, (ii) to determine if there is a difference over time, and (iii) to evaluate the importance of the acoustic environment and whether patients prefer listening to music during their stay. Two groups received a three-phase intervention: one group (n=23) experienced music–ordinary sound–music and the second group (n=21) experienced ordinary sound–music–ordinary sound. Each period lasted 30min, and after each period the patients assessed their experience of the sound. The results demonstrated a significant difference (p<0.001) between groups in the proportions of patients reporting that the acoustic environment was of great importance for their wellbeing during the three-phase intervention, and most participants (n=36 versus n=8) noticed that they were exposed to different sounds during the PACU period. The results also revealed that most participants (n=32) preferred listening to music versus listening to ordinary sound (n=3) while in the PACU (p<0.001). These findings promote use of listening to music to establish a healing environment for patients in a postanaesthesia care unit.

  • 44.
    Fredriksson, Ann-Charlotte
    et al.
    Dep. Anesthesia and Intensive Care, Malmö University Hospital, Sweden; Faculty of Health and Society, Department of Nursing, Malmö University, Sweden.
    Hellström, Leif
    Faculty of Health and Society, Department of Nursing, Malmö University, Sweden.
    Nilsson, Ulrica
    Dep. Anesthesia and Intensive Care/Centre for Health Care Sciences, Örebro University Hospital, Örebro, Sweden.
    Patients' perception of music versus ordinary sound in a postanaesthesia care unit: a randomised crossover trial2009In: Intensive & Critical Care Nursing, ISSN 0964-3397, E-ISSN 1532-4036, Vol. 25, no 4, p. 208-213Article in journal (Refereed)
    Abstract [en]

    We performed an experimental single-blind crossover design study in a postanaesthesia care unit (PACU): (i) to test the hypothesis that patients will experience a higher degree of wellbeing if they listen to music compared to ordinary PACU sounds during their early postoperative care, (ii) to determine if there is a difference over time, and (iii) to evaluate the importance of the acoustic environment and whether patients prefer listening to music during their stay. Two groups received a three-phase intervention: one group (n=23) experienced music-ordinary sound-music and the second group (n=21) experienced ordinary sound-music-ordinary sound. Each period lasted 30 min, and after each period the patients assessed their experience of the sound. The results demonstrated a significant difference (p<0.001) between groups in the proportions of patients reporting that the acoustic environment was of great importance for their wellbeing during the three-phase intervention, and most participants (n=36 versus n=8) noticed that they were exposed to different sounds during the PACU period. The results also revealed that most participants (n=32) preferred listening to music versus listening to ordinary sound (n=3) while in the PACU (p<0.001). These findings promote use of listening to music to establish a healing environment for patients in a postanaesthesia care unit.

  • 45.
    Fridh, Isabell
    University of Borås, School of Health Science.
    Caring for the dying patient in the ICU: The past, present and the future2014In: Intensive & Critical Care Nursing, ISSN 0964-3397, E-ISSN 1532-4036, Vol. 30, no 6, p. 306-311Article in journal (Refereed)
    Abstract [en]

    The aim of this paper is to present the state of the science concerning issues in end-of-life (EOL) care which have an impact on intensive care nurses possibilities to provide nursing care for dying patients and their families. The perspective of families is also illuminated and finally ethical challenges in the present and for the future are discussed. The literature review revealed that the problem areas nurses report concerning EOL care have been the same over three decades. Most problems are related to inter-disciplinary collaboration and communication with the medical profession about the transition from cure to comfort care. Nurses need enhanced communication skills in their role as the patient's advocate. Education in EOL care and a supportive environment are prerequisites for providing EOL care. Losing a loved one in the ICU is a stressful experience for close relatives and nursing care has a profound impact on families' memories of the EOL care given to their loved ones. It is therefore important that ICU nurses are aware of families' needs when a loved one is dying and that follow-up services are appreciated by bereaved family members. Ethical challenges are related to changed sedation practices, organ donation, globalisation and cultural sensitivity.

  • 46.
    Fridh, Isabell
    et al.
    Insitutionen för vårdvetenskap och hälsa, Sahlgrenska akademin, Göteborgs universitet.
    Forsberg, Anna
    Bergbom, Ingegerd
    Close relatives' experiences of caring and of the physical environment when a loved one dies in an ICU.2009In: Intensive & Critical Care Nursing, ISSN 0964-3397, E-ISSN 1532-4036, Vol. 25, no 3Article in journal (Refereed)
    Abstract [en]

    AIM: The aim of this study was to explore close relatives' experiences of caring and the physical environment when a loved one dies in an intensive care unit (ICU).

    METHOD: Interviews were conducted with 17 close relatives of 15 patients who had died in three adult ICUs. The interviews were analysed using a phenomenological-hermeneutic method.

    FINDINGS: The analysis resulted in seven themes; Being confronted with the threat of loss, Maintaining a vigil, Trusting the care, Adapting and trying to understand, Facing death, The need for privacy and togetherness and Experiencing reconciliation. The experience of a caring relationship was central, which meant that the carers piloted the close relatives past the hidden reefs and through the dark waters of the strange environment, unfamiliar technology, distressing information and waiting characterised by uncertainty. Not being piloted meant not being invited to enter into a caring relationship, not being allowed access to the dying loved one and not being assisted in interpreting information.

    CONCLUSION: The participants showed forbearance with the ICU-environment. Their dying loved one's serious condition and his or her dependence on the medical-technical equipment were experienced as more frightening than the equipment as such. Returning for a follow-up-visit provided an opportunity for reconciliation and relief from guilt.

  • 47.
    Fridh, Isabell
    et al.
    Instiutionen för vårdvetenskap och hälsa,Sahlgrenska akademin, Göteborgs universitet.
    Forsberg, Anna
    Bergbom, Ingegerd
    University of Borås, Faculty of Caring Science, Work Life and Social Welfare.
    Doing one's utmost: nurses' descriptions of caring for dying patients in an intensive care environment.2009In: Intensive & Critical Care Nursing, ISSN 0964-3397, E-ISSN 1532-4036, Vol. 25, no 5, p. 233-241Article in journal (Refereed)
    Abstract [en]

    AIM: The aim of this study was to explore nurses' experiences and perceptions of caring for dying patients in an intensive care unit (ICU) with focus on unaccompanied patients, the proximity of family members and environmental aspects.

    METHOD: Interviews were conducted with nine experienced ICU nurses. A qualitative descriptive approach was employed. The analysis was performed by means of conventional content analysis [Hsieh HF, Shannon SE. Three approaches to qualitative content analysis. Qual Health Res 2005;15:1277-88] following the steps described by e.g. Elo and Kyngas [Elo S, Kyngas H. The qualitative content analysis process. J Adv Nurs 2008;62:107-15].

    FINDINGS: The analysis resulted in a main category; Doing one's utmost, described by four generic categories and 15 sub-categories, comprising a common vision of the patients' last hours and dying process. This description was dominated by the nurses' endeavour to provide dignified end-of-life care (EOLC) and, when relatives were present, to give them an enduring memory of their loved one's death as a calm and dignified event despite his/her previous suffering and death in a high-technological environment.

    CONCLUSION: This study contributes new knowledge about what ICU nurses focus on when providing EOLC to unaccompanied patients but also to those whose relatives were present. Nurses' EOLC was mainly described as their relationship and interaction with the dying patient's relatives, while patients who died alone were considered tragic but left a lesser impression in the nurses' memory.

  • 48.
    Fridlund, Bengt
    et al.
    Högskolan i Halmstad.
    Carlsson, B
    Acute myocardial infarction patients' chest pain as monitored and evaluated by ambulance personnel1992In: Intensive & Critical Care Nursing, ISSN 0964-3397, E-ISSN 1532-4036, Vol. 8, no 2, p. 113-117Article in journal (Refereed)
  • 49.
    Fridlund, Bengt
    et al.
    Högskolan i Halmstad.
    Hansson, H
    Swedish emergency hospitals' readiness for disaster: incidence, interest and training1991In: Intensive & Critical Care Nursing, ISSN 0964-3397, E-ISSN 1532-4036, Vol. 7, no 3, p. 164-170Article in journal (Refereed)
  • 50.
    Fridlund, Bengt
    et al.
    Högskolan i Halmstad.
    Stener-Bengtsson, A
    Wännman, A-L
    Social support and social network after acute myocardial infarction: a critically ill male patients' needs, choice and motives1993In: Intensive & Critical Care Nursing, ISSN 0964-3397, E-ISSN 1532-4036, Vol. 9, no 2, p. 88-94Article in journal (Refereed)
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