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  • 1.
    Anderzén-Carlsson, Agneta
    et al.
    Örebro University, Department of Clinical Medicine. Örebro University Hospital, Örebro, Sweden.
    Kihlgren, Mona
    Örebro University Hospital, Örebro, Sweden.
    Svantesson, Mia
    Örebro University, Örebro, Sweden; Örebro University Hospital, Örebro, Sweden.
    Sorlie, Venke
    Örebro university Hospital, Örebro, Sweden; Dept Social Sci, Bodo Univ, Bodo, Norway.
    Parental handling of fear in children with cancer: caring in the best interests of the child2010In: Journal of Pediatric Nursing: Nursing Care of Children and Families, ISSN 0882-5963, E-ISSN 1532-8449, Vol. 25, no 5, p. 317-326Article in journal (Refereed)
    Abstract [en]

    The aim of this study was to gain a deeper understanding of how parents of children with cancer handle the fear in their children. Fifteen parents of 11 children participated in focus-group interviews. Data were analyzed by a phenomenological hermeneutical method. The results suggest that the parents' handling was equivalent with caring in the best interests of the child. This included striving for the security and well-being of the child up to a certain point where the parents instead used their authority to maintain the child's physical health rather than trying to prevent or relieve the child's fear.

  • 2.
    Anderzén-Carlsson, Agneta
    et al.
    Örebro University, Department of Clinical Medicine.
    Kihlgren, Mona
    Svantesson, Mia
    Örebro University, Department of Clinical Medicine.
    Sörlie, Venke
    Children's fear as experienced by the parents of children with cancer2007In: Journal of Pediatric Nursing: Nursing Care of Children and Families, ISSN 0882-5963, E-ISSN 1532-8449, Vol. 22, no 3, p. 233-244Article in journal (Refereed)
    Abstract [en]

    It is known that children with cancer experience and express fear, but little is found in the literature about how the parents experience their child's fear. This study aimed to highlight the parents' lived experience and understanding of their child's fear. Focus group interviews with 15 parents were performed. Data were analyzed through a phenomenological hermeneutic method. Fear in children with cancer is described by the parents as a multidimensional phenomenon, which is somehow difficult to identify. It appears in contrast to the absence of fear. The comprehensive understanding of the results reveals that the parents experience their children's fear as both a suffering and an ethical demand for the parents to answer.

  • 3. Benbenishty, Julie
    et al.
    DeKeyser Ganz, Freda
    Lippert, Anne
    Bulow, Hans-Henrik
    Wennberg, Elisabeth
    Henderson, Beverly
    Svantesson, Mia
    Örebro University, Department of Clinical Medicine.
    Baras, Mario
    Phelan, Dermot
    Maia, Paulo
    Sprung, Charles L.
    Nurse involvement in end-of-life decision making: the ETHICUS Study2006In: Intensive Care Medicine, ISSN 0342-4642, E-ISSN 1432-1238, Vol. 32, no 1, p. 129-132Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: The purpose was to investigate physicians' perceptions of the role of European intensive care nurses in end-of-life decision making. DESIGN: This study was part of a larger study sponsored by the Ethics Section of the European Society of Intensive Care Medicine, the ETHICUS Study. Physicians described whether they thought nurses were involved in such decisions, whether nurses initiated such a discussion and whether there was agreement between physicians and nurses. The items were analyzed and comparisons were made between different regions within Europe. SETTING: The study took place in 37 intensive care units in 17 European countries. PATIENTS AND PARTICIPANTS: Physician investigators reported data related to patients from 37 centers in 17 European countries. INTERVENTIONS: None. MEASUREMENTS AND RESULTS: Physicians perceived nurses as involved in 2,412 (78.3%) of the 3,086 end-of-life decisions (EOLD) made. Nurses were thought to initiate the discussion in 66 cases (2.1%), while ICU physicians were cited in 2,438 cases (79.3%), the primary physician in 328 cases (10.7%), the consulting physician in 105 cases (3.4%), the family in 119 cases (3.9%) and the patient in 19 cases (0.6%). In only 20 responses (0.6%) did physicians report disagreement between physicians and nurses related to EOLD. A significant association was found between the region and responses to the items related to nursing. Physicians in more northern regions reported more nurse involvement. CONCLUSIONS: Physicians perceive nurses as involved to a large extent in EOLDs, but not as initiating the discussion. Once a decision is made, there is a sense of agreement. The level of perceived participation is different for different regions.

  • 4.
    Bulow, Hans-Henrik
    et al.
    Intensive Care, Holbaek Hospital, Holbaek, Denmark.
    Sprung, Charles L.
    Department of Anesthesiology and Critical Care Medicine, Medical Center, Hadassah Hebrew University, Jerusalem, Israel.
    Baras, Mario
    Hadassah School of Public Health, Hadassah Medical Center, Hebrew University, Jerusalem, Israel.
    Carmel, Sara
    Centre for Multidisciplinary Research in Aging, Ben-Gurion University of the Negev, Negev, Israel.
    Svantesson, Mia
    Örebro University Hospital. Örebro University, School of Health Sciences. Centre for Health Care Research.
    Benbenishty, Julie
    Department of Anesthesiology and Critical Care Medicine, Hadassah Hebrew University Medical Center, Jerusalem, Israel.
    Maia, Paulo A.
    Department of Intensive Care, Centro Hospitalar, Hospital S. Antonio, Porto, Portugal.
    Beishuizen, Albertus
    Medical Center, Vrije Universiteit, Amsterdam, The Netherlands.
    Cohen, Simon
    Intensive Care Unit, University College Hospital, London, United Kingdom.
    Nalos, Daniel
    Krajská Zdravotní A.s., ARO Masarykova Nemocnice Ústí Nad, Labem, Czech Republic.
    Are religion and religiosity important to end-of-life decisions and patient autonomy in the ICU?: The Ethicatt study2012In: Intensive Care Medicine, ISSN 0342-4642, E-ISSN 1432-1238, Vol. 38, no 7, p. 1126-1133Article in journal (Refereed)
    Abstract [en]

    This study explored differences in end-of-life (EOL) decisions and respect for patient autonomy of religious members versus those only affiliated to that particular religion (affiliated is a member without strong religious feelings).

    In 2005 structured questionnaires regarding EOL decisions were distributed in six European countries to ICUs in 142 hospital ICUs. This sub-study of the original data analyzed answers from Protestants, Catholics and Jews.

    A total of 304 physicians, 386 nurses, 248 patients and 330 family members were included in the study. Professionals wanted less treatment (ICU admission, CPR, ventilator treatment) than patients and family members. Religious respondents wanted more treatment and were more in favor of life prolongation, and they were less likely to want active euthanasia than those affiliated. Southern nurses and doctors favored euthanasia more than their Northern colleagues. Three quarters of doctors and nurses would respect a competent patient's refusal of a potentially life-saving treatment. No differences were found between religious and affiliated professionals regarding patient's autonomy. Inter-religious differences were detected, with Protestants most likely to follow competent patients' wishes and the Jewish respondents least likely to do so, and Jewish professionals more frequently accepting patients' wishes for futile treatment. However, these findings on autonomy were due to regional differences, not religious ones.

    Health-care professionals, families and patients who are religious will frequently want more extensive treatment than affiliated individuals. Views on active euthanasia are influenced by both religion and region, whereas views on patient autonomy are apparently more influenced by region.

  • 5.
    Carlsson, Eva
    et al.
    Örebro University, School of Health Sciences.
    Anderzén Carlsson, Agneta
    Örebro University, School of Health Sciences.
    Prenkert, Malin
    Örebro University, School of Health Sciences.
    Svantesson, Mia
    Örebro University, School of Health Sciences.
    Ways of understanding being a healthcare professional in the role of family member of a patient admitted to hospital: A phenomenographic study2016In: International Journal of Nursing Studies, ISSN 0020-7489, E-ISSN 1873-491X, Vol. 53, p. 50-60Article in journal (Refereed)
    Abstract [en]

    Healthcare professionals' experience of being family member of a patient can contribute to knowledge development and organizational learning in further ways than the experiences of general family members. However, there is little research on healthcare professionals' experience being on 'the other side of the bed'.

    Objective: To describe how healthcare professionals understand the role of being a healthcare professional and a family member of a patient admitted to hospital.

    Design: Qualitative with a phenomenographic approach.

    Setting: Three Swedish hospitals.

    Participants: All healthcare professionals in three hospitals were invited. Twenty-one volunteered for the study and 18 met the inclusion criteria; to have one year of professional experience and to have visited the family member in hospital daily during hospitalization. Family members in maternity or psychiatric care were excluded.

    Methods: Semi-structured interviews were used for data collection. Transcripts were analyzed with a phenomenographic method to describe variation and commonality in the ways of understanding the phenomenon under study.

    Results: Four dominant ways of understanding the phenomenon were identified; the informed bystander, the supervisor, the advocate and the carer. The four ways of understanding were hierarchically related with "The informed bystander" being least involved in the care of the family member and "The carer" more or less taking over the patient's care because of inappropriate, unsafe or omitted care. Common for all ways of understanding the phenomenon, except "The informed bystander", was the difficult balance between their loyalty toward the family member and their colleagues among the staff. "The informed bystander" and "The supervisor" are ways of understanding the phenomenon under study that, to our knowledge, has not been described before.

    Conclusions: This study describes how being a family member of a patient can be understood in four different ways when the family member is a healthcare professional. The findings show similarities to previous studies on general family members as well as nurse-family members of patients in critical care. The need for professional communication, support and coordination will be substantially different if the family member understands his/her role as an informed bystander compared to if they perceive themselves as a carer. The role conflict and ambivalence toward building relationships described are aspects that need further exploration, as does the experience of being forced to care for a family member. Our findings contribute with new knowledge developing patient- and family-centered care.

  • 6.
    de Snoo-Trimp, Janine
    et al.
    VU University Medical Centre, Department of Medical Humanities and the Amsterdam Public Health Research Institute, Amsterdam, Netherlands.
    Widdershoven, Guy
    VU University Medical Centre, Department of Medical Humanities and the Amsterdam Public Health Research Institute, Amsterdam, Netherlands.
    Svantesson, Mia
    Örebro University, School of Health Sciences. Örebro University Hospital. University Health Care Research Center, Region Örebro County, Örebro, Sweden; Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, UK.
    de Vet, Riekie
    Department of Medical Humanities, VU University Medical Centre, Amsterdam, Netherlands; Amsterdam Public Health Research Institute, Amsterdam, Netherlands.
    Molewijk, Bert
    Department of Medical Humanities, VU University Medical Centre, Amsterdam, Netherlands; Amsterdam Public Health Research Institute, Amsterdam, Netherlands.
    What Outcomes do Dutch Healthcare Professionals Perceive as Important Before Participation in Moral Case Deliberation?2017In: Bioethics, ISSN 0269-9702, E-ISSN 1467-8519, Vol. 31, no 4, p. 246-257Article in journal (Refereed)
    Abstract [en]

    Background: There has been little attention paid to research on the outcomes of clinical ethics support (CES) or critical reflection on what constitutes a good CES outcome. Understanding how CES users perceive the importance of CES outcomes can contribute to a better understanding, use of and normative reflection on CES outcomes.

    Objective: To describe the perceptions of Dutch healthcare professionals on important outcomes of moral case deliberation (MCD), prior to MCD participation, and to compare results between respondents.

    Methods: This mixed-methods study used both the Euro-MCD instrument and semi-structured interviews. Healthcare professionals who were about to implement MCD were recruited from nursing homes, hospitals, psychiatry and mentally disabled care institutions.

    Results: 331 healthcare professionals completed the Euro-MCD instrument, 13 healthcare professionals were interviewed. The outcomes perceived as most important were more open communication', better mutual understanding', concrete actions', see the situation from different perspectives', consensus on how to manage the situation' and find more courses of action'. Interviewees also perceived improving quality of care, professionalism and the organization as important. Women, nurses, managers and professionals in mentally disabled care rated outcomes more highly than other respondents.

    Conclusions: Dutch healthcare professionals perceived the MCD outcomes related to collaboration as most important. The empirical findings can contribute to shared ownership of MCD and a more specific use of MCD in different contexts. They can inform international comparative research on different CES types and contribute to normative discussions concerning CES outcomes. Future studies should reflect upon important MCD outcomes after having experienced MCD.

  • 7.
    Heidenreich, Kaja
    et al.
    Örebro University, School of Medical Sciences. University Health Care Research Center, Region Örebro County, Örebro, Sweden.
    Bremer, Anders
    Department of Health and Caring Sciences, Faculty of Health and Life Sciences, Linnaeus University, Växjö, Sweden; PreHospen - Centre for Prehospital Research, University of Borås, Borås, Sweden.
    Materstvedt, Lars Johan
    Department of Philosophy and Religious Studies, Faculty of Humanities, Norwegian University of Science and Technology (NTNU), Trondheim, Norway; Glasgow End of Life Studies Group, School of Interdisciplinary Studies, University of Glasgow, Dumfries, UK.
    Tidefelt, Ulf
    University Health Care Research Center, Region Örebro County, Örebro, Sweden.
    Svantesson, Mia
    Örebro University, School of Health Sciences. Örebro University Hospital. University Health Care Research Center, Region Örebro County, Örebro, Sweden.
    Relational autonomy in the care of the vulnerable: health care professionals' reasoning in Moral Case Deliberation (MCD)2018In: Medicine, Health care and Philosophy, ISSN 1386-7423, E-ISSN 1572-8633, Vol. 21, no 4, p. 467-477Article in journal (Refereed)
    Abstract [en]

    In Moral Case Deliberation (MCD), healthcare professionals discuss ethically difficult patient situations in their daily practice. There is a lack of knowledge regarding the content of MCD and there is a need to shed light on this ethical reflection in the midst of clinical practice. Thus, the aim of the study was to describe the content of healthcare professionals' moral reasoning during MCD. The design was qualitative and descriptive, and data consisted of 22 audio-recorded inter-professional MCDs, analysed with content analysis. The moral reasoning centred on how to strike the balance between personal convictions about what constitutes good care, and the perceived dissonant care preferences held by the patient. The healthcare professionals deliberated about good care in relation to demands considered to be unrealistic, justifications for influencing the patient, the incapacitated patient's nebulous interests, and coping with the conflict between using coercion to achieve good while protecting human dignity. Furthermore, as a basis for the reasoning, the healthcare professionals reflected on how to establish a responsible relationship with the vulnerable person. This comprised acknowledging the patient as a susceptible human being, protecting dignity and integrity, defining their own moral responsibility, and having patience to give the patient and family time to come to terms with illness and declining health. The profound struggle to respect the patient's autonomy in clinical practice can be understood through the concept of relational autonomy, to try to secure both patients' influence and at the same time take responsibility for their needs as vulnerable humans.

  • 8.
    Nilsson, Christina
    et al.
    Örebro University, School of Health Sciences. University Health Care Research Center.
    Bremer, Anders
    Department of Acute and Prehospital Care and Medical Technology and PreHospen – Centre for Prehospital Research Academy, University of Borås, Borås, Sweden; Division of Emergency Medical Services, Kalmar County Hospital, Kalmar, Sweden.
    Blomberg, Karin
    Örebro University, School of Health Sciences.
    Svantesson, Mia
    Örebro University, School of Health Sciences. Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, UK.
    Responsibility and compassion in prehospital support to survivors of suicide victim - Professionals' experiences2017In: International Emergency Nursing, ISSN 1755-599X, E-ISSN 1878-013X, Vol. 35, p. 37-42Article in journal (Refereed)
  • 9.
    Prenkert, Malin
    et al.
    Örebro University, School of Health Sciences.
    Carlsson, Eva
    Örebro University, School of Health Sciences.
    Svantesson, Mia
    Örebro University, School of Health Sciences.
    Anderzén-Carlsson, Agneta
    Örebro University, School of Health Sciences.
    Healthcare-professional patients’ conceptions of being ill and hospitalised: a phenomenographic study2017In: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702, Vol. 26, no 11-12, p. 1725-1736Article in journal (Refereed)
    Abstract [en]

    Aims and Objectives: To describe the variation of conceptions of being ill and hospitalised, from the perspective of health-care-professional-patients.

    Background: Previous literature focuses on either physicians' or nurses' experiences of being a patient, without aiming at determining a variation of ways of understanding that phenomena. Nor have we been able to identify any study reporting other health-care-professionals' experiences.

    Design: This study has an inductive descriptive design.

    Methods: Qualitative interviews with health care professionals (n=16), who had been hospitalised for at least two days. Phenomenographic data analysis was conducted.

    Results: The feelings of security were based on knowledge, insight and trust, and acceptance of the health care system. Being exposed and totally dependent due to illness provoked feelings of vulnerability and insecurity. The patients used their knowledge to achieve participation in the care. The more severe they perceived their illness to be, the less they wanted to participate and the more they expressed a need for being allowed to surrender control. The patients' ideal picture of care was sometimes disrupted and based on their experience they criticised care and made suggestions that could contribute to general care improvements.

    Conclusions: Health-care-professional patients' have various conceptions of being ill and hospitalised. Based on the general nature of the many needs expressed, we believe that the some insights provided in this study can be transferred so as to also be valid for lay patients. Possibly, an overhaul of routines for discharge planning and follow-up, and adopting a person-centred approach to care, can resolve some of the identified shortcomings. Finally, the results can be used for the purpose of developing knowledge for health-care professions and for educational purposes.

    Relevance to clinical practice: The results can be used for the purpose of develop-ing knowledge for healthcare professions and for educational purposes.

  • 10.
    Rasoal, Dara
    et al.
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    Kihlgren, Annica
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    James, Inger
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    Svantesson, Mia
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    What healthcare teams find ethically difficult: Captured in 70 moral case deliberations2016In: Nursing Ethics, ISSN 0969-7330, E-ISSN 1477-0989, Vol. 23, no 8, p. 825-837Article in journal (Refereed)
    Abstract [en]

    Background: Ethically difficult situations are frequently encountered by healthcare professionals. Moral case deliberation is one form of clinical ethics support, which has the goal to support staff to manage ethical difficulties. However, little is known which difficult situations healthcare teams need to discuss.

    Aim: To explore which kinds of ethically difficult situations interprofessional healthcare teams raise during moral case deliberation.

    Research design: A series of 70 moral case deliberation sessions were audio-recorded in 10 Swedish workplaces. A descriptive, qualitative approach was applied, using thematic content analysis.

    Ethical considerations: An advisory statement specifying no objections to the study was provided from an Ethical Review Board, and consent to be recorded was assumed by virtue of participation in the moral case deliberation.

    Findings: Three themes emerged: powerlessness over managing difficult interactions with patients and next-of-kin, unease over unsafe and unequal care, and uncertainty over who should have power over care decisions. The powerlessness comprised feelings of insufficiency, difficulties to respond or manage patient's/next-of-kin's emotional needs or emotional outbursts and discouragement over motivating patients not taking responsibility for themselves. They could be uncertain over the patient's autonomy, who should have power over life and death, disclosing the truth or how much power next-of-kin should have.

    Discussion: The findings suggest that the nature of the ethically difficult situations brought to moral case deliberations contained more relational-oriented ethics than principle-based ethics, were permeated by emotions and the uncertainties were pervaded by power aspects between stakeholders.

    Conclusion: MCD can be useful in understanding the connection between ethical issues and emotions from a team perspective.

  • 11.
    Rasoal, Dara
    et al.
    Örebro University, School of Health Sciences.
    Kihlgren, Annica
    Örebro University, School of Health Sciences.
    Svantesson, Mia
    Örebro University, School of Health Sciences. Örebro University Hospital. Centre for Health Care Sciences, Örebro University Hospital, Örebro, Sweden.
    ‘It’s like sailing’: experiences of the role as facilitator during moral case deliberation2017In: Clinical Ethics, ISSN 1477-7509, E-ISSN 1758-101X, Vol. 12, no 3, p. 1-8Article in journal (Refereed)
    Abstract [en]

    Moral case deliberation is one form of clinical ethics support, and there seems to be different ways of facilitating thedialogue. This paper aimed to explore the personal experiences of Swedish facilitators of their role in moral casedeliberations. Being a facilitator was understood through the metaphor of sailing: against the wind or with it. Therole was likened to a sailor’s set of skills: to promote security and well-being of the crew, to help crew navigate theirmoral reflections, to sail a course into the wind against homogeneity, to accommodate the crew’s needs and just sail withthe wind, and to steer towards a harbour with authority and expertise. Balancing the disparate roles of being accom-modative and challenging may create a free space for emotions and ideas, including self-reflection and consideration ofmoral demands. This research opens the question of whether all these skills can be taught through systematic training orwhether facilitators need to possess the characteristics of being therapeutic, pedagogical, provocative, sensitive andauthoritarian.

  • 12.
    Rasoal, Dara
    et al.
    Örebro University, School of Health Sciences.
    Svantesson, Mia
    Örebro University, School of Health Sciences.
    Kihlgren, Annica
    Örebro University, School of Health Sciences.
    ‘It’s like sailing’- experiences of the role as facilitator during moral case deliberationManuscript (preprint) (Other academic)
  • 13. Silén, Marit
    et al.
    Svantesson, Mia
    Örebro University, School of Health and Medical Sciences.
    Ahlström, Gerd
    Nurses' conceptions of decision making concerning life-sustaining treatment2008In: Nursing Ethics, ISSN 0969-7330, E-ISSN 1477-0989, Vol. 15, no 2, p. 160-173Article in journal (Refereed)
    Abstract [en]

    The aim of this study was to describe nurses' conceptions of decision making with regard to life-sustaining treatment for dialysis patients. Semistructured interviews were conducted with 13 nurses caring for such patients at three hospitals. The interview material was subjected to qualitative content analysis. The nurses saw decision making as being characterized by uncertainty and by lack of communication and collaboration among all concerned. They described different ways of handling decision making, as well as insufficiency of physician-nurse collaboration, lack of confidence in physicians, hindrances to patient participation, and ambivalence about the role of patients' next of kin. Future research should test models for facilitating communication and decision making so that decisions will emerge from collaboration of all concerned. Nurses' role in decision making also needs to be discussed.

  • 14. Sprung, Charles L.
    et al.
    Carmel, Sara
    Sjokvist, Peter
    Baras, Mario
    Cohen, Simon L.
    Maia, Paulo
    Beishuizen, Albertus
    Nalos, Daniel
    Novak, Ivan
    Svantesson, Mia
    Örebro University, School of Health and Medical Sciences.
    Benbenishty, Julie
    Henderson, Beverly
    Attitudes of European physicians, nurses, patients, and families regarding end-of-life decisions: the ETHICATT study2007In: Intensive Care Medicine, ISSN 0342-4642, E-ISSN 1432-1238, Vol. 33, no 1, p. 104-110Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: To evaluate attitudes of Europeans regarding end-of-life decisions. DESIGN AND SETTING: Responses to a questionnaire by physicians and nurses working in ICUs, patients who survived ICU, and families of ICU patients in six European countries were compared for attitudes regarding quality and value of life, ICU treatments, active euthanasia, and place of treatment. MEASUREMENTS AND RESULTS: Questionnaires were distributed to 4,389 individuals and completed by 1,899 (43%). Physicians (88%) and nurses (87%) found quality of life more important and value of life less important in their decisions for themselves than patients (51%) and families (63%). If diagnosed with a terminal illness, health professionals wanted fewer ICU admissions, uses of CPR, and ventilators (21%, 8%, 10%, respectively) than patients and families (58%, 49%, 44%, respectively). More physicians (79%) and nurses (61%) than patients (58%) and families (48%) preferred being home or in a hospice if they had a terminal illness with only a short time to live. CONCLUSIONS: Quality of life was more important for physicians and nurses than patients and families. More medical professionals want fewer ICU treatments and prefer being home or in a hospice for a terminal illness than patients and families.

  • 15.
    Svantesson, Mia
    Örebro University, School of Health and Medical Sciences.
    Postpone death?: Nurse-physician perspectives on life-sustaining treatment and ethics rounds2008Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    The starting point of the present thesis is nurses’ reported experiences of disagreements with physicians for pushing life sustaining treatment too far. The overall aim was to describe and compare nurses’ and physicians’ perspectives on the boundaries for life-sustaining treatment and to evaluate whether ethics rounds could promote mutual understanding and stimulate ethical reflection. A mixed methods design with qualitative and quantitative data was used, including interviews and questionnaires. The health professionals’ experiences/perceptions were based on known patients foremost from general wards, but also intensive care units, at four Swedish hospitals. The first two studies treated the perspective on boundaries for life-sustaining treatment and the last two evaluated philosopher- ethicist led ethics rounds. Analysis of data was performed using a phenomenological approach and content analysis as well as comparative and descriptive non-parametric statistics.

    In the first study, the essence of the physicians’ decision-making process to limit life-sustaining treatment for ICU patients, was a process of principally medical considerations in discussions with other physicians. In the second study, there were more similarities than differences between nurses’ and physicians’ opinions regarding the 714 patients studied. The physicians considered limited treatment as often as the nurses did. The ethics rounds studies generated mixed experiences/perceptions. It seemed that more progress was made toward the goal of promoting mutual understanding than toward the goal of stimulating ethical reflection. Above all, the rounds seemed to meet the need for a forum for crossing over professional boundaries. The most salient finding was the insight to enhance team collaboration, that the interprofessional dialogue was sure to continue. Predominating new insights after rounds were interpreted as corresponding to a hermeneutic approach. One of nurses’ negative experiences of the ethics rounds was associated with the lack of solutions. Based on the present findings, one suggestion for improvement of the model of ethics rounds is made with regard to achieving a balance between ethical analyses, conflict resolution and problem solving. In conclusion, the present thesis provides strong evidence that differences in opinions regarding boundaries for life-sustaining treatment are not associated with professional status. The findings support the notion of a collaborative team approach to end-of-life decision-making for patients with diminished decisionmaking capacity. There is an indication that stimulation of ethical reflection in relation to known patients may foremost yield psychosocial insights. This could imply that social conflicts may overshadow ethical analysis or that ethical conflicts and social conflicts are impossible to distinguish.

    List of papers
    1. End-of-life decisions in Swedish ICUs: how do physicians from the admitting department reason?
    Open this publication in new window or tab >>End-of-life decisions in Swedish ICUs: how do physicians from the admitting department reason?
    2003 (English)In: Intensive & Critical Care Nursing, ISSN 0964-3397, E-ISSN 1532-4036, Vol. 19, no 4, p. 241-251Article in journal (Refereed) Published
    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.

    National Category
    Nursing
    Research subject
    Caring sciences
    Identifiers
    urn:nbn:se:oru:diva-2974 (URN)10.1016/S0964-3397(03)00055-7 (DOI)
    Available from: 2008-04-22 Created: 2008-04-22 Last updated: 2017-12-14Bibliographically approved
    2. Nurses’ and physicians’ opinions on aggressiveness of treatment for general ward patients
    Open this publication in new window or tab >>Nurses’ and physicians’ opinions on aggressiveness of treatment for general ward patients
    2006 (English)In: Nursing Ethics, ISSN 0969-7330, E-ISSN 1477-0989, Vol. 13, no 2, p. 147-162Article in journal (Refereed) Published
    Abstract [en]

    The aim of this study was to evaluate agreement between nurses’ and physicians’ opinions regarding aggressiveness of treatment and to investigate and compare the rationales on which their opinions were based. Structured interviews regarding 714 patients were performed on seven general wards of a university hospital. The data gathered were then subjected to qualitative and quantitative analyses. There was 86% agreement between nurses’ and physicians’ opinions regarding full or limited treatment when the answers given as ‘uncertain’ were excluded. Agreement was less (77%) for patients with a life expectancy of less than one year. Disagreements were not associated with professional status because the physicians considered limiting life-sustaining treatment as often as the nurses. A broad spectrum of rationales was given but the results focus mostly on those for full treatment. The nurses and the physicians had similar bases for their opinions. For the majority of the patients, medical rationales were used, but age and quality of life were also expressed as important determinants. When considering full treatment, nurses used quality-of-life rationales for significantly more patients than the physicians. Respect for patients’ wishes had a minor influence.

    National Category
    Social Sciences Interdisciplinary Nursing Humanities and the Arts Religious Studies
    Research subject
    Nursing Science
    Identifiers
    urn:nbn:se:oru:diva-2975 (URN)10.1191/0969733006ne861oa (DOI)
    Available from: 2008-04-22 Created: 2008-04-22 Last updated: 2018-01-13Bibliographically approved
    3. Learning a way through ethical problems: Swedish nurses’ and doctors’ experiences from one model of ethics rounds
    Open this publication in new window or tab >>Learning a way through ethical problems: Swedish nurses’ and doctors’ experiences from one model of ethics rounds
    Show others...
    2008 (English)In: Journal of Medical Ethics, ISSN 0306-6800, E-ISSN 1473-4257, Vol. 34, no 5, p. 399-406Article in journal (Refereed) Published
    Abstract [en]

    OBJECTIVE: To evaluate one ethics rounds model by describing nurses' and doctors' experiences of the rounds.

    METHODS: Philosopher-ethicist-led interprofessional team ethics rounds concerning dialysis patient care problems were applied at three Swedish hospitals. The philosophers were instructed to promote mutual understanding and stimulate ethical reflection, without giving any recommendations or solutions. Interviews with seven doctors and 11 nurses were conducted regarding their experiences from the rounds, which were then analysed using content analysis. Findings: The goal of the rounds was partly fulfilled. Participants described both positive and negative experiences. Good rounds included stimulation to broadened thinking, a sense of connecting, strengthened confidence to act, insight into moral responsibility and emotional relief. Negative experiences were associated with a sense of unconcern and alienation, as well as frustration with the lack of solutions and a sense of resignation that change is not possible. The findings suggest that the ethics rounds above all met the need of a forum for crossing over professional boundaries. The philosophers seemed to play an important role in structuring and stimulating reasoned arguments. The nurses' expectation that solutions to the ethical problems would be sought despite explicit instructions to the contrary was conspicuous.

    CONCLUSION: When assisting healthcare professionals to learn a way through ethical problems in patient care, a balance should be found between ethical analyses, conflict resolution and problem solving. A model based on the findings is presented.

    National Category
    Humanities and the Arts Religious Studies Social Sciences Interdisciplinary Nursing
    Research subject
    Nursing Science
    Identifiers
    urn:nbn:se:oru:diva-2976 (URN)10.1136/jme.2006.019810 (DOI)
    Available from: 2008-04-22 Created: 2008-04-22 Last updated: 2018-01-13Bibliographically approved
    4. Interprofessional ethics rounds concerning dialysis patients: staff's ethical reflections before and after rounds
    Open this publication in new window or tab >>Interprofessional ethics rounds concerning dialysis patients: staff's ethical reflections before and after rounds
    Show others...
    2008 (English)In: Journal of Medical Ethics, ISSN 0306-6800, E-ISSN 1473-4257, Vol. 34, no 5, p. 407-413Article in journal (Refereed) Published
    Abstract [en]

    OBJECTIVE: To evaluate whether ethics rounds stimulated ethical reflection. METHODS: Philosopher-ethicist-led interprofessional team ethics rounds concerning dialysis patient care problems were applied at three Swedish hospitals. The philosophers were instructed to stimulate ethical reflection and promote mutual understanding between professions but not to offer solutions. Questionnaires directly before and after rounds were answered by 194 respondents. The analyses were primarily content analysis with Boyd's framework but were also statistical in nature. FINDINGS: Seventy-six per cent of the respondents reported a moderate to high rating regarding new insights on ethical problem identification, but the ethics rounds did not seem to stimulate the ethical reflection that the respondents had expected (p < 0.001). Dominant new insights did not seem to fit into traditional normative ethics but were instead interpreted as hermeneutic ethics. This was illustrated in the extended perspective on the patient and increased awareness of relations to other professions. Regarding insights into how to solve ethical problems, the request for further interprofessional dialogue dominated both before and after rounds. CONCLUSION: The findings show the need for interprofessional reflective ethical practice but a balance between ethical reflection and problem solving is suggested if known patients are discussed. Further research is needed to explore the most effective leadership for reflective ethical practice.

    Place, publisher, year, edition, pages
    London: BMJ Publ. Group, 2008
    National Category
    Nursing Social Sciences Interdisciplinary Humanities and the Arts
    Research subject
    vårdvetenskap
    Identifiers
    urn:nbn:se:oru:diva-5376 (URN)10.1136/jme.2007.023572 (DOI)
    Available from: 2009-02-06 Created: 2009-02-06 Last updated: 2018-01-13Bibliographically approved
  • 16.
    Svantesson, Mia
    et al.
    Örebro University, School of Health and Medical Sciences.
    Anderzén-Carlsson, Agneta
    Örebro University, School of Health and Medical Sciences.
    Thorsén, Håkan
    Örebro University, School of Health and Medical Sciences.
    Kallenberg, Kjell
    Ahlström, Gerd
    Hälsohögskolan i Jönköping.
    Interprofessional ethics rounds concerning dialysis patients: staff's ethical reflections before and after rounds2008In: Journal of Medical Ethics, ISSN 0306-6800, E-ISSN 1473-4257, Vol. 34, no 5, p. 407-413Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: To evaluate whether ethics rounds stimulated ethical reflection. METHODS: Philosopher-ethicist-led interprofessional team ethics rounds concerning dialysis patient care problems were applied at three Swedish hospitals. The philosophers were instructed to stimulate ethical reflection and promote mutual understanding between professions but not to offer solutions. Questionnaires directly before and after rounds were answered by 194 respondents. The analyses were primarily content analysis with Boyd's framework but were also statistical in nature. FINDINGS: Seventy-six per cent of the respondents reported a moderate to high rating regarding new insights on ethical problem identification, but the ethics rounds did not seem to stimulate the ethical reflection that the respondents had expected (p < 0.001). Dominant new insights did not seem to fit into traditional normative ethics but were instead interpreted as hermeneutic ethics. This was illustrated in the extended perspective on the patient and increased awareness of relations to other professions. Regarding insights into how to solve ethical problems, the request for further interprofessional dialogue dominated both before and after rounds. CONCLUSION: The findings show the need for interprofessional reflective ethical practice but a balance between ethical reflection and problem solving is suggested if known patients are discussed. Further research is needed to explore the most effective leadership for reflective ethical practice.

  • 17.
    Svantesson, Mia
    et al.
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    Carlsson, Eva
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    Prenkert, Malin
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    Anderzen-Carlsson, Agneta
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    'Just so you know, the patient is staff': healthcare professionals' perceptions of caring for healthcare professional-patients2016In: BMJ Open, ISSN 2044-6055, E-ISSN 2044-6055, Vol. 6, no 1, article id e008507Article in journal (Refereed)
    Abstract [en]

    Objective: To explore healthcare professionals' conceptions of the care of patients who are also healthcare professionals.

    Design: Explorative, with a qualitative, phenomenographic approach.

    Participants and setting: 16 healthcare personnel within different professions (doctors, nurses, assistant nurses, physiotherapists, occupational therapists) were interviewed about the care of 32 patients who were themselves members of different healthcare professions, in one healthcare organisation in Sweden.

    Results: The care of patients who are healthcare professionals was conceived in five different ways, as: usual, dutiful, prioritised and secure, insecure and responsive. An initial conception was that their care was usual, just as for any other patient, and also a perceived duty to treat them and to protect their right to be a patient-as any other patient. Exploring further, informants described that these patients did receive secure and prioritised care, as the informants experienced making a greater commitment, especially doctors giving privileges to doctor-patients. A conception of insecure care infused the informants' descriptions. This comprised of them feeling intimidated in their professional role, feeling affected by colleagues' stressful behaviour and ambiguity whether the healthcare professional-patient could be regarded as a competent professional. The deepest way of understanding care seemed to be responsive care, such as acknowledging and respecting the patient's identity and responding to their wishes of how treatment was to be met.

    Conclusions: Caring for healthcare professionals seems to trigger different ethical approaches, such as deontology and ethics of care. According to ethics of care, the findings may indeed suggest that these patients should be cared for just as any other patients would be, but only if this means that they are cared for as persons, that is, they are given 'person-centred care'. This would imply balancing between acknowledging the vulnerable patient in the colleague and acknowledging the identity of the colleague in the patient.

  • 18.
    Svantesson, Mia
    et al.
    Örebro University Hospital. Centre for Health Care Sciences, Örebro University Hospital, Örebro University, Örebro, Sweden; Karlskoga Hospital, Karlskoga, Sweden.
    Karlsson, Jan
    Örebro University Hospital. Centre for Health Care Sciences, Örebro University Hospital, Örebro, Sweden; Department of Medicine, Örebro University Hospital, Örebro, Sweden.
    Boitte, Pierre
    Dept Eth, Ctr Med Eth, Catholic Univ, Lille, France.
    Schildman, Jan
    NRW Jr Res Grp Med Eth End Life Norm & Empiricism, Inst Med Eth & Hist Med, Ruhr Univ Bochum, Bochum, Germany.
    Dauwerse, Linda
    Med Ctr, Inst Hlth & Care Res, Vrije Univ, Amsterdam, Netherlands; Dept Sociol, Vrije Univ, Amsterdam, Netherlands.
    Widdershoven, Guy
    Med Ctr, Inst Hlth & Care Res, Vrije Univ, Amsterdam, Netherlands; Dept Sociol, Vrije Univ, Amsterdam, Netherlands.
    Pedersen, Reidar
    Inst Hlth & Soc, Ctr Med Eth, Univ Oslo, Oslo, Norway.
    Huisman, Martijn
    Dept Epidemiol & Biostat, Vumc & Emgo, Amsterdam, Netherlands; Dep Med Humanities, Vumc & Emgo, Amsterdam, Netherlands .
    Molewijk, Bert
    Med Ctr, Inst Hlth & Care Res, Vrije Univ, Amsterdam, Netherlands; Dept Sociol, Vrije Univ, Amsterdam, Netherlands; nst Hlth & Soc, Ctr Med Eth, Univ Oslo, Oslo, Norway .
    Outcomes of Moral Case Deliberation: the development of an evaluation instrument for clinical ethics support (the Euro-MCD)2014In: BMC Medical Ethics, ISSN 1472-6939, E-ISSN 1472-6939, Vol. 15, article id 30Article in journal (Refereed)
    Abstract [en]

    Background: Clinical ethics support, in particular Moral Case Deliberation, aims to support health care providers to manage ethically difficult situations. However, there is a lack of evaluation instruments regarding outcomes of clinical ethics support in general and regarding Moral Case Deliberation (MCD) in particular. There also is a lack of clarity and consensuses regarding which MCD outcomes are beneficial. In addition, MCD outcomes might be context-sensitive. Against this background, there is a need for a standardised but flexible outcome evaluation instrument. The aim of this study was to develop a multi-contextual evaluation instrument measuring health care providers' experiences and perceived importance of outcomes of Moral Case Deliberation.

    Methods: A multi-item instrument for assessing outcomes of Moral Case Deliberation (MCD) was constructed through an iterative process, founded on a literature review and modified through a multistep review by ethicists and health care providers. The instrument measures perceived importance of outcomes before and after MCD, as well as experienced outcomes during MCD and in daily work. A purposeful sample of 86 European participants contributed to a Delphi panel and content validity testing. The Delphi panel (n = 13), consisting of ethicists and ethics researchers, participated in three Delphi-rounds. Health care providers (n = 73) participated in the content validity testing through `think-aloud' interviews and a method using Content Validity Index.

    Results: The development process resulted in the European Moral Case Deliberation Outcomes Instrument (Euro-MCD), which consists of two sections, one to be completed before a participant's first MCD and the other after completing multiple MCDs. The instrument contains a few open-ended questions and 26 specific items with a corresponding rating/response scale representing various MCD outcomes. The items were categorised into the following six domains: Enhanced emotional support, Enhanced collaboration, Improved moral reflexivity, Improved moral attitude, Improvement on organizational level and Concrete results.

    Conclusions: A tentative instrument has been developed that seems to cover main outcomes of Moral Case Deliberation. The next step will be to test the Euro-MCD in a field study.

  • 19.
    Svantesson, Mia
    et al.
    Örebro University, School of Health and Medical Sciences.
    Löfmark, Rurik
    Thorsén, Håkan
    Kallenberg, Kjell
    Ahlström, Gerd
    Learning a way through ethical problems: Swedish nurses’ and doctors’ experiences from one model of ethics rounds2008In: Journal of Medical Ethics, ISSN 0306-6800, E-ISSN 1473-4257, Vol. 34, no 5, p. 399-406Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: To evaluate one ethics rounds model by describing nurses' and doctors' experiences of the rounds.

    METHODS: Philosopher-ethicist-led interprofessional team ethics rounds concerning dialysis patient care problems were applied at three Swedish hospitals. The philosophers were instructed to promote mutual understanding and stimulate ethical reflection, without giving any recommendations or solutions. Interviews with seven doctors and 11 nurses were conducted regarding their experiences from the rounds, which were then analysed using content analysis. Findings: The goal of the rounds was partly fulfilled. Participants described both positive and negative experiences. Good rounds included stimulation to broadened thinking, a sense of connecting, strengthened confidence to act, insight into moral responsibility and emotional relief. Negative experiences were associated with a sense of unconcern and alienation, as well as frustration with the lack of solutions and a sense of resignation that change is not possible. The findings suggest that the ethics rounds above all met the need of a forum for crossing over professional boundaries. The philosophers seemed to play an important role in structuring and stimulating reasoned arguments. The nurses' expectation that solutions to the ethical problems would be sought despite explicit instructions to the contrary was conspicuous.

    CONCLUSION: When assisting healthcare professionals to learn a way through ethical problems in patient care, a balance should be found between ethical analyses, conflict resolution and problem solving. A model based on the findings is presented.

  • 20.
    Svantesson, Mia
    et al.
    Örebro University, School of Health Sciences. University of Warwick, Coventry, UK.
    Silén, Marit
    University of Gävle, Gävle, Sweden; Uppsala University, Uppsala, Sweden.
    James, Inger
    Örebro University, School of Health Sciences.
    It's not all about moral reasoning: Understanding the content of Moral Case Deliberation2018In: Nursing Ethics, ISSN 0969-7330, E-ISSN 1477-0989, Vol. 25, no 2, p. 212-229Article in journal (Refereed)
    Abstract [en]

    Background: Moral Case Deliberation is one form of clinical ethics support described as a facilitator-led collective moral reasoning by healthcare professionals on a concrete moral question connected to their practice. Evaluation research is needed, but, as human interaction is difficult to standardise, there is a need to capture the content beyond moral reasoning. This allows for a better understanding of Moral Case Deliberation, which may contribute to further development of valid outcome criteria and stimulate the normative discussion of what Moral Case Deliberation should contain.

    Objective: To explore and compare the content beyond moral reasoning in the dialogue in Moral Case Deliberation at Swedish workplaces.

    Methods: A mixed-methods approach was applied for analysing audio-recordings of 70 periodic Moral Case Deliberation meetings at 10 Swedish workplaces. Moral Case Deliberation facilitators and various healthcare professions participated, with registered nurses comprising the majority.

    Ethical considerations: No objection to the study was made by an Ethical Review Board. After oral and written information was provided, consent to be recorded was assumed by virtue of participation.

    Findings: Other than ‘moral reasoning’ (median (md): 45% of the spoken time), the Moral Case Deliberations consisted of ‘reflections on the psychosocial work environment’ to a varying extent (md: 29%). Additional content comprised ‘assumptions about the patient’s psychosocial situation’ (md: 6%), ‘facts about the patient’s situation’ (md: 5%), ‘concrete problem-solving’ (md: 6%) and ‘process’ (md: 3%).

    Conclusion: The findings suggest that a restorative function of staff’s wellbeing in Moral Case Deliberation is needed, as this might contribute to good patient care. This supports outcome criteria of improved emotional support, which may include relief of moral distress. However, facilitators need a strategy for how to proceed from the participants’ own emotional needs and to develop the use of their emotional knowing to focus on the ethically difficult patient situation.

  • 21.
    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.

  • 22.
    Svantesson, Mia
    et al.
    Örebro University, Department of Clinical Medicine.
    Sjökvist, Peter
    Thorsén, Håkan
    Örebro University, Department of Health Sciences.
    Ahlström, Gerd
    Nurses’ and physicians’ opinions on aggressiveness of treatment for general ward patients2006In: Nursing Ethics, ISSN 0969-7330, E-ISSN 1477-0989, Vol. 13, no 2, p. 147-162Article in journal (Refereed)
    Abstract [en]

    The aim of this study was to evaluate agreement between nurses’ and physicians’ opinions regarding aggressiveness of treatment and to investigate and compare the rationales on which their opinions were based. Structured interviews regarding 714 patients were performed on seven general wards of a university hospital. The data gathered were then subjected to qualitative and quantitative analyses. There was 86% agreement between nurses’ and physicians’ opinions regarding full or limited treatment when the answers given as ‘uncertain’ were excluded. Agreement was less (77%) for patients with a life expectancy of less than one year. Disagreements were not associated with professional status because the physicians considered limiting life-sustaining treatment as often as the nurses. A broad spectrum of rationales was given but the results focus mostly on those for full treatment. The nurses and the physicians had similar bases for their opinions. For the majority of the patients, medical rationales were used, but age and quality of life were also expressed as important determinants. When considering full treatment, nurses used quality-of-life rationales for significantly more patients than the physicians. Respect for patients’ wishes had a minor influence.

  • 23.
    Svantesson Sandberg, Mia
    et al.
    Örebro University, School of Health Sciences. Örebro University Hospital.
    Heidenreich, Kaja
    Örebro University, School of Medical Sciences.
    Do analysis methods need to be altered when using software program?2018Conference paper (Other academic)
    Abstract [en]

    Background: Do analysis methods need to be altered when using software program? Software program facilitating qualitative data analysis are here to stay, but data analysis methods may not be adapted for this aid.

    Objective: To reflect on the feasibility to follow qualitative data analysis methods when using data analysis software in a basic way.

    Method: Presentation of three different analysis of data, using different data analysis methods, aided by QSR NVivo©.

    Results: On the conference we report on own experiences of using QSR NVivo© when following the methods of content analysis according to Graneheim and Lundman [1], framework method according to Gale et. al [2] and phenomenological hermeneutical method according to Lindseth and Norberg [3]. Furthermore, we will discuss how NVivo may facilitate analysis, but also how it may threaten the sense of the whole and impede co-assessment.

  • 24.
    Svantesson-Sandberg, Mia
    et al.
    Örebro University, School of Health Sciences. Örebro University Hospital. University of Warwick, Coventry, UK.
    Griffiths, Frances
    University of Warwick, Coventry, UK.
    Bassford, Chris
    University of Warwick, Coventry, UK.
    Slowther, Anne
    University of Warwick, Coventry, UK.
    Values in conict during the decision making process surrounding admission to intensive care: Ethnographic study in six British hospitals2017Conference paper (Refereed)
  • 25.
    Svensson, Margita
    et al.
    Örebro University, School of Health Sciences.
    Nilsson, Ulrica
    Örebro University, School of Health Sciences.
    Svantesson, Mia
    Örebro University, School of Health Sciences. Faculty of Medicine and Health, University Health Care Research Center, Region Örebro County, Örebro, Sweden.
    Patients’ experience of mood while waiting for day surgery2016In: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702, Vol. 25, no 17-18, p. 2600-2608Article in journal (Refereed)
    Abstract [en]

    Aims and objectives: The aim was to describe the moods experienced by people waiting for day surgery.

    Background: Except for anxiety, there is a lack of knowledge about the moods experienced by patients while waiting for day surgery, as well as the impact of mood during the perioperative period. Preoperative anxiety is common and has multiple negative effects. A deeper knowledge of preoperative moods and how they are experienced is needed and may be useful for improving perioperative care.

    Design: Qualitative descriptive design.

    Methods: Qualitative semi-structured interviews (n = 20) with adults waiting for day surgery in a Swedish university hospital. Data were analysed with inductive content analysis.

    Results: The informants described a variety of moods and mood-influencing reasons. The main category that emerged was, ‘feeling hope about regaining health as a help to balance mood’ regardless of mood. This category was abstracted from the generic categories ‘experiencing a harmonious mood’ and ‘experiencing a shifting mood’. The subcategories were ‘feeling calm and at ease despite concerns and fear’, ‘experiencing expectation’, ‘feeling trust and confidence’, ‘shifting between expectancy and anxiety’, ‘feeling vulnerable and exposed, and ‘feeling uncertainty’.

    Conclusions: The findings contribute to the knowledge about that regardless of mood, feeling hope about regaining health may help patients to balance their mood during the waiting period.

    Relevance to clinical practice: The results can have implications with respect to developing and improving preoperative care, such as having clinicians extend offers of individual assistance and information during the waiting period to patients experiencing shifting mood. Instilling hopefulness in patients who are waiting for day surgery by means of clinical staff attitudes and interactions may help patients to develop healthy coping strategies and thereby improve their physical and emotional well-being.

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