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  • 1.
    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, Vol. 59, 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.

  • 2.
    Flæten, Øystein Øygarden
    et al.
    Department of Postoperative and Intensive Care Nursing, Division of Emergencies and Critical Care, Oslo University Hospital, Norway; Lovisenberg Diaconal University College, Oslo, Norway. Electronic address: oeyoey@ous-hf.no.
    Stafseth, Siv K
    Lovisenberg Diaconal University College, Oslo, Norway; Centre for Patient Centered Heart and Lung Research, Department of Cardiothoracic Surgery, Oslo University Hospital, Oslo, Norway.
    Vinje, Hilde
    Faculty of Chemistry, Biotechnology and Food Science, Norwegian University of Life Sciences, Ås, Norway.
    Johansen, Edda
    University of South-Eastern Norway, Faculty of Health and Social Sciences, Borre, Norway; General Intensive Care, Vestre Viken Hospital Trust, Drammen, Norway.
    Sunde, Kjetil
    Department of Anesthesia and Intensive Care Medicine, Division of Emergencies and Critical Care, Oslo University Hospital, Norway; Institute of Clinical Medicine, University of Oslo, Oslo, Norway.
    Wøien, Hilde
    Department of Postoperative and Intensive Care Nursing, Division of Emergencies and Critical Care, Oslo University Hospital, Norway; Institute of Health and Society, University of Oslo, Oslo, Norway.
    Beeckman, Dimitri
    Örebro University, School of Health Sciences. Ghent University, Skin Integrity Research Group (SKINT), University Centre for Nursing and Midwifery, Department of Public Health and Primary Care, Ghent, Belgium; Örebro University, Swedish Centre for Skin and Wound Research (SCENTR), School of Health Sciences, Örebro, Sweden; Odense University, Research Unit of Plastic Surgery, Department of Clinical Research, Faculty of Health Sciences, Odense, Denmark.
    Petosic, Antonija
    Department of Postoperative and Intensive Care Nursing, Division of Emergencies and Critical Care, Oslo University Hospital, Norway; The Norwegian Intensive Care Registry, Haukeland University Hospital, Helse Bergen, Bergen, Norway.
    Incidence, characteristics, and associated factors of pressure injuries acquired in intensive care units over a 12-month period: a secondary analysis of a quality improvement project2024In: Intensive & Critical Care Nursing, ISSN 0964-3397, E-ISSN 1532-4036, Vol. 81, article id 103587Article in journal (Refereed)
    Abstract [en]

    Objectives: To determine the 12-month cumulative incidence, characteristics, and associated factors of pressure injuries acquired in Intensive Care Units.

    Setting: Four intensive care units in a Norwegian University Hospital.

    Research methodology: A prospective observational cohort study using data from daily skin inspections during a quality improvement project. We used descriptive statistics and logistic regression. Variables associated with the development of intensive care unit-acquired pressure injuries are presented with odds ratios (OR), and 95% confidence intervals.

    Results: The 12-month cumulative incidence of patients (N = 594) developing intensive care unit-acquired pressure injuries was 29 % (172/594) for all categories and 16 % (95/594) when excluding category I pressure injuries (no skin loss). Cumulative incidence for patients acquiring medical device-related pressure injuries was 15 % (91/594) and 11 % (64/594) for category II or worse. Compression stockings (n = 51) and nasogastric tubes (n = 22) were the most frequent documented medical devices related to pressure injuries. Development of pressure injuries category II or worse was significantly associated with vasoactive drug infusions (OR 11.84, 95 % CI [1.59; 88.13]) and longer intensive care unit length of stay (OR 1.06, 95 % CI [1.04; 1.08]).

    Conclusion: The 12-month cumulative incidence of intensive care unit-acquired pressure injuries was relatively high when category I pressure injuries were included, but comparable to other studies when category I was excluded. Some medical device-related pressure injuries were surprisingly frequent, and these may be prevented. However, associated factors of developing pressure injuries were present and deemed non-modifiable.

    Implications for clinical practice: Awareness about pressure injury prevention is needed in the intensive care unit considering high incidences. Nurses can detect category I pressure injuries early, which may be reversed. Our findings show several factors that clinicians can control to reduce the risk of pressure injuries in the intensive care unit.

  • 3. 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.

  • 4.
    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.

  • 5.
    Loefgren Vretare, Linn
    et al.
    Faculty of Health, Science and Technology, Institution for Health, Nursing, Karlstad University, Sweden; Neonatal Intensive Care Unit, Akademiska Sjukhuset, Uppsala, Sweden.
    Anderzen-Carlsson, Agneta
    Örebro University, School of Health Sciences. Örebro University Hospital. Faculty of Health, Science and Technology, Institution for Health, Nursing, Karlstad University, Sweden; University Health Care Research Center, Faculty of Medicine and Health, Örebro University, Örebro, Sweden.
    The critical care nurse's perception of handover: A phenomenographic study2020In: Intensive & Critical Care Nursing, ISSN 0964-3397, E-ISSN 1532-4036, Vol. 58, article id 102807Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: To describe variations in critical care nurses' perceptions of handover.

    RESEARCH METHODOLOGY: Phenomenographic design using individual interviews for data-collection.

    SETTING: The critical care nurses participating in the study were recruited from critical care units in three hospitals in Sweden.

    FINDINGS: Five descriptive categories were identified: Communication between staff, Opportunity for learning, Patient-centred information gathering as a basis for continuous care, Responsibility for transfers, and Patient safety and quality of care.

    CONCLUSION: Nursing handover is a complex phenomenon, which is understood in various ways. Handover is mediated through communication and marks a shift in responsibility. Handover seems to be related to patient safety and quality of care. There is potential for improvement in the quality of nursing handover in clinical praxis, but further research is needed to determine ways of improving quality of handover.

  • 6.
    Löf, Lennart
    et al.
    Örebro University, School of Health and Medical Sciences.
    Berggren, Lars
    Örebro University, School of Health and Medical Sciences.
    Ahlström, Gerd
    ICU patients' recall of emotional reactions in the trajectory from falling critically ill to hospital discharge: follow-ups after 3 and 12 months2008In: Intensive & Critical Care Nursing, ISSN 0964-3397, E-ISSN 1532-4036, Vol. 24, no 2, p. 108-121Article in journal (Refereed)
    Abstract [en]

    Patients' memories of frightening ICU experiences may be a threat to later psychological recovery. The purpose of the study is to describe ICU patients' recall of their emotional reactions, from falling critically ill to hospital discharge; this at 3 and 12 months following discharge from the ICU. The study is qualitative and concerns eight ICU patients ventilated for more than 72h. The participants were interviewed twice and the data were subjected to qualitative content analysis. It emerged that the memories of emotions during the trajectory of critical illness were extensive, detailed and strong, and that unpleasant emotions were clearly stable over time. At 12 months as compared with 3 months, the unpleasant emotions were less intense and had less prominent; furthermore the ICU care was more greatly associated with a sense of security, and there was greater recall of caring doctors and nurses (though not of their names) as well as next of kin. CONCLUSIONS: The study generated knowledge not previously described about how ICU patients' recollection of their emotions during the trajectory of critical illness changes over time. This has implications regarding future study of patients' ICU memories and regarding patients' need for support in coping with such memories.

  • 7.
    Löf, Lennart
    et al.
    Örebro University, Department of Clinical Medicine.
    Berggren, Lars
    Örebro University, Department of Clinical Medicine.
    Ahlström, Gerd
    Severely ill ICU patients recall of factual events and unreal experiences of hospital admission and ICU stay--3 and 12 months after discharge2006In: Intensive & Critical Care Nursing, ISSN 0964-3397, E-ISSN 1532-4036, Vol. 22, no 3, p. 154-166Article in journal (Refereed)
    Abstract [en]

    There is a lack of knowledge regarding how critically ill patients recall of the ICU and their life-threatening condition changes over time. The purpose of this study is to describe critically ill and ventilator-treated patients' recollections of both factual events and unreal experiences at 3 and 12 months following discharge from the ICU. The study is qualitative and encompasses nine critically ill ICU patients, ventilator-treated for more than 72 h. The participants were interviewed twice, at 3 and 12 months after their discharge from the ICU. The interviews were analysed using qualitative content analysis. The patients in this study reported unreal experiences, memory confusion and/or disturbances before admittance to the ICU and before their respirator treatment. Their "unreal experiences" were far clearer than their memories of factual occurrences. Patients' fragmentary memories of factual events and their recall of unreal experiences were practically unchanged after 12 month. Their unreal experiences could still be recalled and related after 12 months, but not with the same expression and feeling as earlier (3 months). The unreal experiences were not - after 12 months - their initial recollections, as they had been after 3 months. Conclusions: Patients' recollections of both factual events and unreal experiences show very little variation between 3 and 12 months. The stability of long-term memory after 12 months shows that the recollection of their experiences had been both traumatic and emotionally charged. This study shows that critically ill patients were affected by cognitive disturbances and/or disturbed memory before their arrival at the ICU. This result indicates the need of ICU follow-up clinics.

  • 8.
    Petosic, Antonija
    et al.
    Department of Postoperative and Intensive Care Nursing, Division of Emergencies and Critical Care, Oslo University Hospital, Oslo, Norway; Institute of Health and Society, University of Oslo, Oslo, Norway; The Norwegian Intensive Care Registry, Haukeland University Hospital, Helse Bergen, Bergen, Norway.
    Berntzen, Helene
    Department of Postoperative and Intensive Care Nursing, Division of Emergencies and Critical Care, Oslo University Hospital, Oslo, Norway.
    Beeckman, Dimitri
    Örebro University, School of Health Sciences. Skin Integrity Research Group (SKINT), University Centre for Nursing and Midwifery, Department of Public Health and Primary Care, Ghent University, Ghent, Belgium; Swedish Centre for Skin and Wound Research (SCENTR), Nursing Science Unit, School of Health Sciences, Örebro University, Sweden.
    Flaatten, Hans
    Haukeland University Hospital, Bergen Norway.
    Sunde, Kjetil
    Department of Anesthesia and Intensive Care Medicine, Division of Emergencies and Critical Care, Oslo University Hospital, Oslo, Norway; Institute of Clinical Medicine, University of Oslo, Oslo, Norway.
    Wøien, Hilde
    Department of Postoperative and Intensive Care Nursing, Division of Emergencies and Critical Care, Oslo University Hospital, Oslo, Norway; Institute of Health and Society, University of Oslo, Oslo, Norway.
    Use of Facebook in a quality improvement campaign to increase adherence to guidelines in intensive care: A qualitative study of nurses' and physicians' experiences2023In: Intensive & Critical Care Nursing, ISSN 0964-3397, E-ISSN 1532-4036, Vol. 78, article id 103475Article in journal (Refereed)
    Abstract [en]

    OBJECTIVES: This study aimed to explore intensive care unit nurses' and physicians' experiences with professional content provided through closed Facebook groups, as part of a quality improvement campaign to improve guideline adherence.

    RESEARCH METHODOLOGY: This study used an exploratory qualitative design. In June 2018, data were collected through focus groups of intensive care nurses and physicians who also were members of closed Facebook groups. Data were analysed using reflexive thematic analysis, and the study was reported according to the consolidated criteria for reporting qualitative research.

    SETTING: The study's setting was four intensive care units at Oslo University Hospital, Norway. Professional content on Facebook comprised audit and feedback on quality indicators on intensive care topics with related pictures, videos, and weblinks.

    FINDINGS: Two focus groups of 12 participants were included in this study. Two main themes were identified: 'One size does not fit all ' described that quality improvement and implementation are influenced by several factors related to current recommendations and personal preferences. Various strategies are required to serve different purposes and meet individual needs. 'Matter out of place' described conflicting experiences of being offered or exposed to professional content on Facebook.

    CONCLUSION: Although the audit and feedback on quality indicators presented on Facebook motivated improvements, professional content on Facebook was perceived as inappropriate. Hospital platforms with applicable features of social media, such as reach, availability, convenience, ease, and possibility for commenting, were suggested to secure professional communication about recommended practices in intensive care units.

    IMPLICATIONS FOR CLINICAL PRACTICE: Social media platforms may be useful for professional communication among ICU personnel, but appropriate hospital applications with available and applicable social media features are recommended and needed. The use of several platforms may still be needed to reach all.

  • 9.
    Slettmyr, Anna
    et al.
    Division of Nursing, Department of Neurobiology, Care Science and Society, Karolinska Institute, Stockholm, Sweden.
    Frank, Catharina
    School of Health and Caring Sciences, Linnaeus University, Växjö, Sweden.
    Falk, Ann-Charlotte
    Department for Health Promoting Science, Sophiahemmet University, Stockholm, Sweden.
    The core of patient-participation in the Intensive Care Unit: The patient’s views2022In: Intensive & Critical Care Nursing, ISSN 0964-3397, E-ISSN 1532-4036, Vol. 68, article id 103119Article in journal (Refereed)
    Abstract [en]

    Objectives: Patient participation is an established concept in public welfare. However, reports of the phe-nomenon of patient participation during intensive care from the patient’s point of view are scarce.Therefore, the aim of this study was to explore the meaning of patient participation in the intensive careunit from the patient’s perspective.

    Research design: A qualitative design was used for the purpose of the study with a purposive convenientsample of nine adult patients with memories from their intensive care stay.

    Method: Data was collected through individual interviews and analysed using a phenomenologicalhermeneutical method.

    Findings: The results of our study show a variety of meanings and degrees of participation that continu-ously move on a sliding scale from acting as a captain to feelings of being on an isolated island. Patientparticipation varied due to individual cognitive abilities and individual preferences, and the caregiver’sattention altered between the body and the person through the continuum of care.

    Conclusion: Patient participation during ICU care is more than participation in decision-making processesor direct patient care decisions. An understanding of the concept participation from the individual patientis necessary to support person centred care and the patient’s relatives play an important role in duringthe entire care process.

  • 10.
    Svantesson, Mia
    et al.
    Örebro University, Department of Nursing and Caring Sciences.
    Sjökvist, Peter
    Thorsén, Håkan
    Örebro University, Department of Nursing and Caring Sciences.
    End-of-life decisions in Swedish ICUs: how do physicians from the admitting department reason?2003In: Intensive & Critical Care Nursing, ISSN 0964-3397, E-ISSN 1532-4036, Vol. 19, no 4, p. 241-251Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE:

    To study how physicians from the admitting department reason during the decision-making process to forego life-sustaining treatment of patients in intensive care units (ICUs).

    DESIGN:

    Qualitative interview that applies a phenomenological approach.

    SETTING:

    Two ICUs at one secondary and one tertiary referral hospital in Sweden.

    PARTICIPANTS:

    Seventeen admitting-department physicians who have participated in decisions to forego life-sustaining treatment.

    RESULTS:

    The decision-making process as it appeared from the physicians' experiences was complex, and different approaches to the process were observed. A pattern of five phases in the process emerged in the interviews. The physicians described the process principally as a medical one, with few ethical reflections. Decision-making was mostly done in collaboration with other physicians. Patients, family and nurses did not seem to play a significant role in the process.

    CONCLUSION:

    This study describes how physicians reasoned when confronted with real patient situations in which decisions to forego life-sustaining treatment were mainly based on medical--not ethical--considerations.

  • 11.
    Thermaenius, Johan
    et al.
    Department of Perioperative Medicine and Intensive Care, Karolinska University Hospital, Stockholm, Sweden.
    Schandl, Anna
    Department of Perioperative Medicine and Intensive Care, Karolinska University Hospital, Stockholm, Sweden; Department of Molecular Medicine and Surgery, Karolinska Institute, Karolinska University Hospital, Stockholm, Sweden.
    Sluys, Kerstin
    Department of Molecular Medicine and Surgery, Karolinska Institute, Karolinska University Hospital, Stockholm, Sweden; Red Cross University College, Stockholm, Sweden.
    Development and initial validation of the Swedish Family Satisfaction Intensive Care Questionnaire (SFS-ICQ)2019In: Intensive & Critical Care Nursing, ISSN 0964-3397, E-ISSN 1532-4036, Vol. 50, p. 118-124Article in journal (Refereed)
    Abstract [en]

    OBJECTIVES: Measuring patients satisfaction is an important part of continuous quality improvement in health care. In intensive care, family satisfaction is often used as a proxy for patient experience. At present, no suitable instrument to measure this has been fully validated in Sweden. The purpose of this study was to develop and validate a questionnaire intended to evaluate families' satisfaction of quality of care in Swedish intensive care units.

    METHODS: Based on literature and the modification of pertinent items in two existing North American questionnaires, a Swedish questionnaire was developed. Content validity was assessed by experts, and the cognitive method Think Aloud was used with twelve family members of intensive care patients in two different intensive care units. Data was analysed using qualitative content analysis.

    FINDINGS: Seven items in the questionnaire were identified as problematic, causing eight problems concerning questioning of content and 23 concerning misunderstanding. Six of these items were changed in order to be understood the way they were intended, and one item was removed.

    CONCLUSION: A family satisfaction questionnaire applicable in Swedish intensive care units has been developed and validated for respondents' understanding of the questions being asked. However, further psychometric testing should be performed when more data are available.

  • 12.
    Torsy, Tim
    et al.
    Department of Nursing, Odisee University College, Brussels, Belgium; University Centre for Nursing and Midwifery, Department of Public Health and Primary Care, Ghent University, Ghent, Belgium.
    Eriksson, Mats
    Örebro University, School of Health Sciences.
    Beeckman, Dimitri
    Örebro University, School of Health Sciences. University Centre for Nursing and Midwifery, Department of Public Health and Primary Care, Ghent University, Ghent, Belgium; School of Nursing & Midwifery, Royal College of Surgeons in Ireland (RCSI), Dublin, Ireland; Research Unit of Plastic Surgery, Department of Clinical Research, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark; School of Nursing and Midwifery, Monash University, Australia.
    Comment on Taylor SJ, Allan K, Clemente R. Undetected Cortrak tube misplacements in the United Kingdom 2010–17: An audit of trace interpretation. Intensive Crit Care Nurs. 2019 Dec;55:1027662020In: Intensive & Critical Care Nursing, ISSN 0964-3397, E-ISSN 1532-4036, Vol. 58, article id 102846Article in journal (Refereed)
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