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  • 1.
    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.

  • 2.
    Johansson, Lotta
    et al.
    University of Gothenburg, Sweden.
    Knutsson, Susanne
    Jönköping University, Sweden.
    Bergbom, Ingegerd
    University of Gothenburg, Sweden;University of Borås, Sweden.
    Lindahl, Berit
    University of Borås, Sweden.
    Noise in the ICU patient room: Staff knowledge and clinical improvements2016In: Intensive & Critical Care Nursing, ISSN 0964-3397, E-ISSN 1532-4036, Vol. 35, p. 1-9Article in journal (Refereed)
    Abstract [en]

    Introduction: The acoustic environment in the intensive care unit patient room, with high sound levels and unpredictable sounds, is known to be poor and stressful. Therefore, the present study had two aims: to investigate staff knowledge concerning noise in the intensive care unit and: to identify staff suggestions for improving the sound environment in the intensive care unit patient room.

    Method: A web-based knowledge questionnaire including 10 questions was distributed to 1047 staff members at nine intensive care unit. Moreover, 20 physicians, nurses and enrolled nurses were interviewed and asked to give suggestions for improvement.

    Results: None of the respondents answered the whole questionnaire correctly; mean value was four correct answers. In the interview part, three categories emerged: improving staff's own care actions and behaviour; improving strategies requiring staff interaction; and improving physical space and technical design.

    Conclusion: The results from the questionnaire showed that the staff had low theoretical knowledge concerning sound and noise in the intensive care unit. However, the staff suggested many improvement measures, but also described difficulties and barriers. The results from this study can be used in the design of future interventions to reduce noise in the intensive care unit as well as in other settings.

  • 3.
    Johansson, Maria
    et al.
    Linnaeus University, Faculty of Health and Life Sciences, Department of Health and Caring Sciences. County Hospital Kalmar, Sweden.
    Hanson, Elizabeth
    Linnaeus University, Faculty of Health and Life Sciences, Department of Health and Caring Sciences. School of Nursing & Midwifery, UK.
    Runeson, Ingrid
    Linnaeus University, Faculty of Health and Life Sciences, Department of Health and Caring Sciences.
    Wåhlin, Ingrid
    Linnaeus University, Faculty of Health and Life Sciences, Department of Health and Caring Sciences. County Hospital Kalmar, Sweden ; Kalmar County Council, Sweden.
    Family members’ experiences of keeping a diary during a sick relative’s stay in the intensive care unit: A hermeneutic interview study2015In: Intensive & Critical Care Nursing, ISSN 0964-3397, E-ISSN 1532-4036, Vol. 31, no 4, p. 241-249Article in journal (Refereed)
    Abstract [en]

    Objective

    The aim of the study was to explore family members’ experiences with keeping a diary during a sick relative's stay in the ICU.

    Design

    A qualitative method with a hermeneutic approach was used. Eleven participants, who recorded nine diaries in total, were interviewed. The collected data were analysed using a hermeneutic approach inspired by Gadamer.

    Results

    The analysis revealed a meta-theme: ‘it [writing in the diary] felt like contact’ which was created by a feeling of togetherness and the opportunity to communicate with the patient. Keeping a diary likely meets the needs of family members in several ways because it becomes a way to be present at the patient's bedsides, to provide caregiving, to maintain hope and to relay cogent information. However, concerns regarding negative aspects of diary keeping were also raised; for example, the diary created feelings of stress, guilt and failure and exposed intimate details.

    Conclusion

    The diary symbolised the maintenance of relationships with the patients and was a substitute for the usual opportunities for communication. Furthermore, it was instrumental in meeting the needs of the majority of family members in several ways. Nevertheless, the diary did have negative effects for certain individuals, which highlights the importance of an individualised approach.

  • 4.
    Knutsson, Susanne
    et al.
    Jönköping University, Sweden.
    Bergbom, Ingegerd
    University of Gothenburg, Sweden.
    Children's thoughts and feelings related to visiting critically ill relatives in an adult ICU: A qualitative study2016In: Intensive & Critical Care Nursing, ISSN 0964-3397, E-ISSN 1532-4036, Vol. 32, p. 33-41Article in journal (Refereed)
    Abstract [en]

    OBJECTIVES:

    To describe and understand children's thoughts and feelings related to visiting critically ill relatives or family members in an adult intensive care unit.

    DESIGN:

    A qualitative descriptive study.

    METHOD:

    Twenty-eight children (14 girls; 14 boys) that had visited a critically ill relative or family member in an adult intensive care unit were invited to participate in an interview. The material was analysed inspired by Gadamer's hermeneutic philosophy and Doverborg and Pramling Samuelsson's method about interviews and dialogues with children.

    RESULTS:

    Children with a seriously ill/injured relative suffer. However, visiting seems to alleviate suffering. Visiting and being present as a part of the situation brought positive feelings of involvement and made it possible to show that they wanted to care for the relative. The sick relative was always on the child's mind and seeing and being with them in the intensive care unit resulted in relief and calmness, even if the relative's situation sometimes evoked feelings of despair and fear.

    CONCLUSION:

    Knowledge and awareness of the fact that children are affected by the relative's condition and for their wellbeing needs to visit, caring actions must focus on helping the child become involved in the relative's situation in order to alleviate suffering.

  • 5.
    Knutsson, Susanne
    et al.
    Jönköping University, Sweden.
    Enskär, Karin
    Jönköping University, Sweden.
    Golsäter, Marie
    Jönköping University, Sweden;Jönköping Region, Sweden.
    Nurses' experiences of what constitutes the encounter with children visiting a sick parent at an adult ICU2017In: Intensive & Critical Care Nursing, ISSN 0964-3397, E-ISSN 1532-4036, Vol. 39, p. 9-17Article in journal (Refereed)
    Abstract [en]

    BACKGROUND:

    Despite a cultural change in visitation policies for children (0-17 years) in the intensive care unit (ICU) to a more open approach, children are still restricted from visiting for various reasons. To overcome these obstacles, it is vital to determine what is needed while encountering a child.

    AIM:

    To elucidate nurses' experiences of what constitutes the encounter with children visiting a sick parent in an adult ICU.

    METHOD:

    An explorative inductive qualitative design was used, entailing focus group interviews with 23 nurses working at a general ICU. The interviews were analysed according to inductive content analysis.

    RESULTS:

    The findings show components that constitute the encounter with children as relatives at the ICU, as experienced by ICU nurses: nurses need to be engaged and motivated; parents need to be motivated; the child needs individual guidance; and a structured follow-up is needed. This reflects a child-focused encounter.

    CONCLUSIONS:

    Nurses need to adopt a holistic view, learn to see and care for the child individually, and be able to engage parents in supporting their children. To accomplish this the nurses need engagement and motivation, and must have knowledge about what constitutes a caring encounter, in order to achieve a caring child-focused encounter.

  • 6.
    Knutsson, Susanne
    et al.
    University of Gothenburg, Sweden.
    Otterberg, Cecilia L.
    Sahlgrenska University Hospital, Sweden.
    Bergbom, Ingegerd L.
    University of Gothenburg, Sweden.
    Visits of children to patients being cared for in adult ICUs: policies, guidelines and recommendations2004In: Intensive & Critical Care Nursing, ISSN 0964-3397, E-ISSN 1532-4036, Vol. 20, no 5, p. 264-274Article in journal (Refereed)
    Abstract [en]

    Little is known about the frequency of children visiting their nearest relatives in adult ICUs or if there are any policies/guidelines or recommendations regarding these. The aims of this multi-centre descriptive study were to survey Swedish ICUs policies/guidelines or recommendations, and examine the reasons given both for and against restricting child visits; if parents/guardians sought advice in connection with such visits, and if any differences in demographic data could be ascertained. Fifty-six Lead Nurse Managers (LNM), representing as many general adult ICUs, participated by answering a questionnaire. Only one ICU had written policy/guidelines concerning child visits; most ICUs (70%) had no policies/guidelines at all. All LNMs reported that their ICU was positive to child visits, but only two actively encouraged these. Nineteen (34%) of the ICUs restricted child visits. More than 50% of the LNMs reported that only about half of their patients ever had visits from children. Seventy percent of the ICUs had no restrictions on visiting hours, but 30% imposed some form of restriction. Twenty LNMs reported that 75% of the parents/guardians of children 0-6 years old asked for advice about child visits. However, those responsible for children >12 years of age seldom asked for any advice at all.

  • 7.
    Lindberg, Catharina
    et al.
    Blekinge Institute of Technology.
    Sivberg, Bengt
    Lund University.
    Willman, Ania
    Blekinge Institute of Technology;Malmö University.
    Fagerström, Cecilia
    Blekinge Institute of Technology;Blekinge Centre of Competence.
    A trajectory towards partnership in care - patient experiences of autonomy in intensive care: a qualitative study2015In: Intensive & Critical Care Nursing, ISSN 0964-3397, E-ISSN 1532-4036, Vol. 31, no 5, p. 294-302Article in journal (Refereed)
    Abstract [en]

    Objective: The aim of this study was to describe and elucidate patient experiences of autonomy in an intensive care context from a caring perspective.

    Background: Patients in intensive care units (ICUs) are critically ill and in a dependent and vulnerable position. There is thus a risk of staff taking command not only of the patients’ vital functions but also of their decision-making.

    Methods: A qualitative design was selected. Individual interviews were conducted with 11 adult patients with an intensive care episode of two days or more at six Swedish ICUs. The data were analysed using Inductive Content Analysis.

    Findings: Patient autonomy in intensive care was shown to be ’A trajectory towards partnership in care depending on state of health and mutual understanding’. It was experienced through acknowledged dependence, being recognised as a person, invited participation and becoming a co-partner in care.

    Conclusion: Patients in need of intensive care wanted to be involved in making decisions about their care as this creates a trusting and healthy care environment. Greater awareness is required about the ICU patient not only being a passive care recipient but also an active agent and where involvement in decision-making and participation in care are crucial.

  • 8.
    Schandl, Anna
    et al.
    Karolinska University Hospital Solna.
    Falk, Ann-Charlotte
    Karolinska University Hospital Solna;Karolinska Institutet.
    Frank, Catharina
    Linnaeus University, Faculty of Health and Life Sciences, Department of Health and Caring Sciences. Karolinska Institutet.
    Patient participation in the intensive care unit2017In: Intensive & Critical Care Nursing, ISSN 0964-3397, E-ISSN 1532-4036, Vol. 42, p. 105-109Article in journal (Refereed)
    Abstract [en]

    Objective: Patient participation in healthcare is important for optimizing treatment outcomes and for ensuring satisfaction with care. The purpose of the study wasto explore critical care nurses' perceptions of patient participation for critically ill patients. Design and settings: Qualitative data were collected in four separate focus group interviews with 17 nurses from two hospitals. The interviews were analyzed using qualitative content analysis. Findings: Initially, the nurses stated that patient participation in the intensive care unit (ICU) was dependent on the patient's health condition and consciousness. However, during the interviews three descriptive categories emerged from their experience, that is: passive patient participation, one-way communication and nurse/patient interaction. Conclusion: In the ICU, the possibilities for patient participation in nursing care are not only dependent on the patient's health condition but also on the nurse's ability to include patients in various care actions despite physical and/or mental limitations. When the patient is not able to participate, nurses strive to achieve participation through relatives' knowledge and/or other external sources of information. (c) 2017 Elsevier Ltd. All rights reserved.

  • 9.
    Söderström, Ing-Mari
    et al.
    Linnaeus University, Faculty of Health, Social Work and Behavioural Sciences, School of Health and Caring Sciences.
    Saveman, Britt-Inger
    University of Kalmar, School of Human Sciences.
    Hagberg, Margaretha
    Linnaeus University, Faculty of Health, Social Work and Behavioural Sciences, School of Health and Caring Sciences.
    Benzein, Eva
    Linnaeus University, Faculty of Health, Social Work and Behavioural Sciences, School of Health and Caring Sciences.
    Family adaptation in relation to a family member's stay in ICU2009In: Intensive & Critical Care Nursing, ISSN 0964-3397, E-ISSN 1532-4036, Vol. 25, no 5, p. 250-257Article in journal (Refereed)
    Abstract [en]

    Objectives: To describe and interpret the family adaptation during the ICU hospitalisation andup to 18 months after discharge.Research methodology/design: A qualitative design was chosen.Main outcome measures: Individual and family interviews with eight families including 31 familymembers. A hermeneutical analysis was performed and paradigm cases were constructed.Results: The result is presented in three themes: striving for endurance, striving for consolationand striving to rebuild life under new conditions. The family adaptation started at the onset ofthe critical incident and continued during the ICU stay and after discharge. The family membersmetaphorically went through peaks and valleys during the whole process of adaptation.Conclusion: Adaptation is an issue for the whole family and is facilitated by being able to stayclose to the patient and receive supportive unambiguous information from the staff both duringthe ICU stay and after discharge.

  • 10.
    Wåhlin, Ingrid
    et al.
    Kalmar Hospital ; Linköping University ; Kalmar County Council.
    Ek, Anna-Christina
    Linköping University.
    Idvall, Ewa
    Linköping University ; Kalmar County Council.
    Empowerment in intensive care: patient experiences compared to next of kin and staff beliefs2009In: Intensive & Critical Care Nursing, ISSN 0964-3397, E-ISSN 1532-4036, Vol. 25, no 6, p. 332-340Article in journal (Refereed)
    Abstract [en]

    Experiences of critically ill patients are an important aspect of the quality of care in intensive care units. If next of kin and staff try to empower the patient, this is probably performed in accordance with their beliefs about what patients experience as empowering. As intensive care patients often have difficulties communicating, staff and next of kin need to interpret their wishes, but there is limited knowledge about how correct picture next of kin and staff have of the intensive care patient's experiences. The aim of this study was to compare intensive care patients' experiences of empowerment with next of kin and staff beliefs. Interviews with 11 intensive care patients, 12 next of kin and 12 staff were conducted and analysed using a content analysis method. The findings showed that the main content is quite similar between patient experiences, next of kin beliefs and staff beliefs, but a number of important differences were identified. Some of these differences were regarding how joy of life and the will to fight were generated, the character of relationships, teamwork, humour, hope and spiritual experiences. Staff and next of kin seemed to regard the patient as more unconscious than the patient him/herself did.

  • 11.
    Wåhlin, Ingrid
    et al.
    Kalmar Hospital ; Linköping University ; Kalmar County Council.
    Ek, Anna-Christina
    Linköping University.
    Idvall, Ewa
    Linköping University ; Kalmar County Council.
    Patient empowerment in intensive care: an interview study2006In: Intensive & Critical Care Nursing, ISSN 0964-3397, E-ISSN 1532-4036, Vol. 22, no 6, p. 370-377Article in journal (Refereed)
    Abstract [en]

    Intensive care patients often experience a lack of control, as well as inner chaos. Experiences from intensive care can continue to affect patients for a long time. Empowerment is a positive and dynamic process that focuses on people's strengths, rights and abilities. It takes on different expressions for different people in different environments and must be described by the people involved. The aim of this study was to describe patient empowerment in an intensive care situation. The study was based on open-ended interviews with 11 patients in two intensive care units. The interviews were analysed according to the empirical phenomenological psychological method. The results showed that patient empowerment in intensive care consists of strengthening and stimulating the patients' own inherent joy of life and will to fight. A positive environment that encouraged feelings of value and motivation and in which the patient felt safe, received additional care and participated as he/she wished had a positive influence.

  • 12.
    Wåhlin, Ingrid
    et al.
    Linköping University ; Kalmar Hospital.
    Ek, Anna-Christina
    Linköping University.
    Idvall, Ewa
    Malmö University ; Malmö University Hospital.
    Staff empowerment in intensive care: nurses' and physicians' lived experiences2010In: Intensive & Critical Care Nursing, ISSN 0964-3397, E-ISSN 1532-4036, Vol. 26, no 5, p. 262-269Article in journal (Refereed)
    Abstract [en]

    AIM: The purpose of the study was to describe empowerment from the perspective of intensive care staff. What makes intensive care staff experience inner strength and power?

    BACKGROUND: Intensive care staff are repeatedly exposed to traumatic situations and demanding events, which could result in stress and burnout symptoms. A higher level of psychological empowerment at the workplace is associated with increased work satisfaction and mental health, fewer burnout symptoms and a decreased number of sick leave days.

    METHOD: Open-ended interviews were conducted with 12 intensive care unit (ICU) staff (four registered nurses, four enrolled nurses and four physicians) in southern Sweden. Data were analysed using a phenomenological method.

    FINDINGS: Intensive care staff were found to be empowered both by internal processes such as feelings of doing good, increased self-esteem/self-confidence and increased knowledge and skills, and by external processes such as nourishing meetings, well functioning teamwork and a good atmosphere.

    CONCLUSION: Findings show that not only personal knowledge and skills, but also a supporting atmosphere and a good teamwork, has to be focused and encouraged by supervisors in order to increase staff's experiences of empowerment. Staff also need a chance to feel that they do something good for patients, next of kin and other staff members.

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