Isabell Fridh - Academia.edu (original) (raw)
Papers by Isabell Fridh
To present novel reflections on environment regarding the design of the patient room in intensive... more To present novel reflections on environment regarding the design of the patient room in intensive care units(ICUs).Introduction: An ICU and the patient room in particular, is a protected and closed ...
Intensive and Critical Care Nursing, 2021
BACKGROUND Intensive care unit diaries are often used to support patients during their psychologi... more BACKGROUND Intensive care unit diaries are often used to support patients during their psychological recovery. The intensive care unit stay can be upsetting, disturbing and traumatic for both patients and their families especially when the patient does not survive. AIM To investigate the connection between intensive care unit diaries and the grieving process experienced by family members of adult patients deceased in the intensive care unit. METHODS Systematic literature review according to PRISMA guidelines: PubMed, CINAHL and Cochrane Library were consulted. The Caldwell's framework was used for the quality appraisal. RESULTS Only six studies examine this topic. The potential benefits of intensive care unit diaries in family members' bereavement process may be an aid to realise how extremely ill their loved one was, may provide comfort and may help relatives to cope with their loss. CONCLUSION The use of intensive care unit diaries to help family members' bereavement process may be a useful tool but further research is necessary to better understand their role and benefits.
Journal of Nursing Scholarship, 2016
Purpose: To explore patient-reported symptom distress in relation to documentation of symptoms an... more Purpose: To explore patient-reported symptom distress in relation to documentation of symptoms and palliative care designation in hospital inpatients. Design: This cross-sectional study analyzed data from 710 inpatients at two large hospitals in Sweden using the Edmonton Symptom Assessment Scale and the Memorial Symptom Assessment Scale. Chart reviews focused on nurses' and physicians' symptom documentation and palliative turning point. Methods: Descriptive statistics were calculated for all variables and provided summaries about the sample. Patients were grouped according to gender, age, palliative care designation, and symptom documentation. The t test and chisquare test were used to calculate whether symptom distress varied between groups. A two-way analysis of variance was conducted for multiple comparisons to explore the impact of gender and age on mean symptom distress. Findings: Females reported higher levels of symptom distress than did males related to pain, fatigue, and nausea. When comparing symptom distress between males and females with documentation pertaining to symptoms, there were significant differences implying that females had to report higher levels of symptom distress than males in order to have their symptoms documented. Conclusions: Females need to report higher levels of symptom distress than do males for healthcare professionals to identify and document their symptoms. It can be hypothesized that females are not receiving the same attention and symptom alleviation as men. If so, this highlights a serious inequality in care that requires further exploration. Clinical Relevance: Considering that common reasons why people seek health care are troublesome symptoms of illness, and that the clinical and demographic characteristics of inpatients are changing towards more advanced ages with serious illnesses, inadequate symptom assessment and management are a serious threat to the care quality. The most common reasons why people seek health care are troublesome symptoms of illness (Kris & Dodd, 2004;
Den plotsliga doden kommer alltid ovantat och utan forberedelsetid for de narmaste. Detta staller... more Den plotsliga doden kommer alltid ovantat och utan forberedelsetid for de narmaste. Detta staller speciella krav pa sjukskoterskans omvardnad saval prehospitlat,pa akutmottagningen som pa olika var ...
Admission to an intensive care unit (ICU) is in most cases preceded by a sudden illness or trauma... more Admission to an intensive care unit (ICU) is in most cases preceded by a sudden illness or trauma, without an opportunity for either the patient or his or her family to prepare themselves for, or influence the location of, a patient’s death. An assumption of this thesis was that the place and the environment in which people die are important both for the person dying and his or her close relatives. The overall aim of the thesis was to explore and describe end-of-life care (EOLC) in the ICU environment from the perspective of close relatives and nurses. Study I was a survey concerning Swedish ICUs physical environment and routines when caring for dying patients. Study II was a study of the circumstances in conjunction with 192 patients’ death in 10 ICUs. In Study III, interviews were conducted with 17 close relatives of 15 patients who died in three ICUs. The interviews were analysed using a phenomenological-hermeneutic method. In Study IV, nine intensive care nurses were interviewed...
Intensive & critical care nursing : the official journal of the British Association of Critical Care Nurses, 2014
The aim of this paper is to present the state of the science concerning issues in end-of-life (EO... more The aim of this paper is to present the state of the science concerning issues in end-of-life (EOL) care which have an impact on intensive care nurses possibilities to provide nursing care for dying patients and their families. The perspective of families is also illuminated and finally ethical challenges in the present and for the future are discussed. The literature review revealed that the problem areas nurses report concerning EOL care have been the same over three decades. Most problems are related to inter-disciplinary collaboration and communication with the medical profession about the transition from cure to comfort care. Nurses need enhanced communication skills in their role as the patient's advocate. Education in EOL care and a supportive environment are prerequisites for providing EOL care. Losing a loved one in the ICU is a stressful experience for close relatives and nursing care has a profound impact on families' memories of the EOL care given to their loved ...
International Journal for Human Caring
This article examines and exemplifies how existential philosophy can provide deeper understanding... more This article examines and exemplifies how existential philosophy can provide deeper understanding of existential issues in a caring context. Existential philosophy, including lifeworld theory, is treated both as an epistemology for the development of research methods and inspiration for analysis and discussions in caring science research. The significance of the lifeworld is also highlighted as a guide to perform and enable caring and caring didactics, along with short descriptions where existential philosophy has previously influenced the development of caring science. The concept existential caring science is suggested as a research area for research on existential and meaning-oriented phenomena.
HERD: Health Environments Research & Design Journal, 2020
Objectives: The objective of the research was to study the visitors’ experiences of different hea... more Objectives: The objective of the research was to study the visitors’ experiences of different healthcare environment designs of intensive care unit (ICU) patient rooms. Background: The healthcare environment may seem frightening and overwhelming in times when life-threatening conditions affect a family member or close friend and individuals visit the patient in an ICU. A two-bed patient room was refurbished to enhance the well-being of patients and their families according to the principles of evidence-based design (EBD). No prior research has used the Person-centred Climate Questionnaire—Family version (PCQ-F) or the semantic environment description (SMB) in the ICU setting. Methods: A sample of 99 visitors to critically ill patients admitted to a multidisciplinary ICU completed a questionnaire; 69 visited one of the two control rooms, while 30 visited the intervention room. Results: For the dimension of everydayness in the PCQ-F, a significantly better experience was expressed for...
Nursing & Health Sciences, 2021
Losing a loved one in the intensive care unit relates to a risk of developing stress and complica... more Losing a loved one in the intensive care unit relates to a risk of developing stress and complicated grief. Education in intensive care nursing should cover end-of-life care, and the use of simulation in nursing education is a powerful instrument to develop confidence in end-of-life care. The aim of this study was to explore postgraduate nursing students' experiences with simulation training in end-of-life communication with intensive care patients and their families. Twenty-nine students answered a questionnaire and nine students participated in an interview. Analyses were conducted according to the principles of phenomenography. The result is presented in four categories including the following: the design of the scenario affects learning, uncertainty overshadows learning, intertwining theory and practice contributes to learning, and learning to encounter existential dimensions. The conclusion is that high-fidelity simulation training contributes towards preparing students to be attuned to what it can be like to be a family member in this situation. The scenarios contributed towards preparing the students to engage in end-of-life conversations during clinical placements.
Intensive and Critical Care Nursing, 2021
Objectives: To examine conditions and strategies to meet the challenges imposed by the coronaviru... more Objectives: To examine conditions and strategies to meet the challenges imposed by the coronavirus disease 2019 (COVID-19)-related visiting restrictions in Scandinavian intensive care units. Research methodology/design: A cross-sectional survey. Setting: Adult intensive care units in Denmark, Norway and Sweden. Main outcome measures: Likert scale responses and free-text comments within six areas: capacity and staffing, visiting policies and access to the unit, information and conferences with relatives, written information, children as relatives and follow-up initiatives. Results: The overall response rate was 53% (74/140 participating units). All intensive care units had planned for capacity extensions; the majority ranging between 11 and 30 extra beds. From March-June 2020, units had a mean maximum of 9.4 COVID-19 patients simultaneously. Allowing restricted visiting was more common in Denmark (52%) and Norway (61%) than in Sweden where visiting was mostly denied except for dying patients (68%), due to a particular increased number of COVID-19 patients. The restrictions forced nurses to compromise on their usual standards of family care. Numerous models for maintaining contact between relatives and patients were described. Conclusion: Visitation restrictions compromised the quality of family care and entailed dilemmas for healthcare professionals but also spurred initiatives to developing new ways of providing family care.
Intensive and Critical Care Nursing, 2020
Critical care nurses' lived experiences of interhospital intensive care unit-to-unit transfers: a... more Critical care nurses' lived experiences of interhospital intensive care unit-to-unit transfers: a phenomenological hermeneutical study.
Journal of Clinical Nursing, 2020
AIMS AND OBJECTIVES The aim of the study was to reveal meanings of family members' lived expe... more AIMS AND OBJECTIVES The aim of the study was to reveal meanings of family members' lived experiences when a loved one undergoes an interhospital intensive care unit-to-unit transfer. BACKGROUND Interhospital intensive care unit-to-unit transfers take place between different hospitals and their respective intensive care units. These types of transfers are an increasing phenomenon but are sparsely studied from the family members' perspective. Indeed, the patient's critical illness and care can have a major impact on family members. During the transfer process, there is a demand for the involved intensive care health personnel to make family members feel safe and cared for. DESIGN A qualitative design based on phenomenological hermeneutics. METHODS The study was conducted at two Swedish general intensive care units. Data were generated through individual in-depth interviews with seven family members and analysed using a phenomenological hermeneutical approach. The COREQ principles were applied in the conduct and reporting of this study. RESULTS Four themes that reveal meanings of family members' lived experiences were developed: losing your safe haven, dealing with uncertainty, carrying your own and others' burdens and a wish to be close. CONCLUSIONS The study reveals that an interhospital intensive care unit-to-unit transfer affects the whole family and is characterised by family members experiencing many negative feelings. The findings also illustrate that being a family member when a loved one is transferred means being exposed to the core existential elements of being human, such as loneliness and searching for meaning. RELEVANCE TO CLINICAL PRACTICE The study highlights the importance of maintaining a family-centred approach during the transfer process. Our findings can provide deeper knowledge for intensive care health personnel, better preparing them for the delicate task of providing family-centred care during the interhospital intensive care unit-to-unit transfer process.
Critical Care Nurse, 2020
Topic A substantial number of patients die in the intensive care unit, so high-quality end-of-lif... more Topic A substantial number of patients die in the intensive care unit, so high-quality end-of-life care is an important part of intensive care unit work. However, end-of-life care varies because of lack of knowledge of best practices. Clinical Relevance Research shows that high-quality end-of-life care is possible in an intensive care unit. This article encourages nurses to be imaginative and take an individual approach to provide the best possible end-of-life care for patients and their family members. Purpose of Paper To provide recommendations for high-quality end-of-life care for patients and family members. Content Covered This article touches on the following domains: end-of-life decision-making, place to die, patient comfort, family presence in the intensive care unit, visiting children, family needs, preparing the family, staff presence, when the patient dies, after-death care of the family, and caring for staff.
Nursing in Critical Care, 2019
Background: Post-intensive care syndrome-family is a common problem in relatives of patients who ... more Background: Post-intensive care syndrome-family is a common problem in relatives of patients who die in an intensive care unit. Family-centred end-of-life care with support for the family during and after the death is supposed to prevent suffering and avoid illness. Aims and objectives: This study aimed to investigate family-centred end-of-life care and bereavement follow-up services offered to family members of patients who die in Swedish intensive care units. Design, Methods: A cross-sectional study using a 16-question survey based on family-centred end-of-life care was sent to all 81 adult intensive care units. Data were analysed by descriptive statistics and chi-square. Respondents were able to add individual comments to the questionnaire. Results: Although the majority (76.7%) offered some kind of follow up, this service was not always offered. Modes for invitation, timing, and contents in the follow up varied between the units. The staff tried to individualize the follow-up service according to the family's needs. Nurses and social workers were the only professionals who provided follow-up conversations on their own. Most of the intensive care units (97.3%) kept diaries that were handed over to the family when they left the unit after the patient's death or at a follow-up visit. Only 8.8% reported that they always offer the family the opportunity to be present during resuscitation. Most respondents reported that patients (60.6%) died in a private room. Conclusions: Family-centred end-of-life care varied among the intensive care units, and some families were not offered any follow up at all. Timing, invitation, and elements in the follow up differ between the units. Diaries were commonly kept and usually given to the family. Few units offered the family to be present during resuscitation. Relevance to clinical practice: There is a need for national guidelines to ensure that all bereaved families receive equal and individual family-centred end-of-life care.
Nursing Open, 2019
Operating rooms (OR) represent a complex environment that includes highly advanced technology and... more Operating rooms (OR) represent a complex environment that includes highly advanced technology and a need of various specialist competencies. To ensure patient safety, staff in an OR must both have specific individual skills and work as a cohesive team (Cassera, Zheng, Martinec, Dunst, & Swanstrom, 2009). Working as a team in the OR has proven to be challenging and deficiencies in patient safety, procedure efficiency and well-being of the staff caused by communication failures are highlighted in the literature (Lingard et al., 2004). A hybrid OR can be described as an OR integrated with advanced radiological imaging equipment under strictly controlled aseptic conditions. Staff requirements in a hybrid OR during endovascular aortic repair (EVAR) go beyond ordinary OR staffing and usually include radiology staff, including radiologists and radiographers, due to the use of radiological equipment and the image-guided aspect of the procedure. Despite the growing number of hybrid ORs worldwide, the optimal composition and function of an OR team where radiology staff is included are an unevaluated research area and are the aim of this study. 1.1 | Literature review Being able to perform both open surgery and percutaneous imageguided interventions in the same room, with no need to move the patient between different rooms for each procedure, is the main advantage with a hybrid OR (Nollert et al., 2012). A hybrid OR, thus, allows for easy and immediate conversion from an EVAR to open surgery in the same setting, if medically necessary. This improves patient safety and this flexibility can also result in shortened hospital
Journal of Multidisciplinary Healthcare, 2019
Introduction: A hybrid operating room (OR) is a surgical OR with integrated imaging equipment and... more Introduction: A hybrid operating room (OR) is a surgical OR with integrated imaging equipment and the possibility to serve both open surgery and image-guided interventions. Aim: This study aimed to investigate the work processes and types of collaboration in a hybrid OR during endovascular aortic repair (EVAR). Methods: Data consisted of video recordings from nine procedures, with a total recording time of 48 hrs 39 mins. The procedures were divided into four episodes (Acts). A qualitative cross-case analysis was conducted, resulting in a typical case. The type of collaboration during specific tasks was discussed and determined based on Thylefors´team typology. Results: An extensive amount of safety activities occurred in the preparation phase (Acts 1 and 2), involving a number of staff categories. After the skin incision (Act 3), the main activities were performed by fewer staff categories, while some persons had a standby position and there were persons who were not at all involved in the procedure. Discussion: The different specialist staff in the hybrid OR worked through different types of collaboration: multi-, inter-and transprofessional. The level of needed collaboration depended on the activity performed, but it was largely multiprofessional and took place largely in separate groups of specialties: anesthesiology, surgery and radiology. Waiting time and overlapping tasks indicate that the procedures could be more efficient and safe for the patient. Conclusion: This study highlights that the three expertise specialties were required for safe treatment in the hybrid OR, but the extent of interprofessional activities was limited. Our results provide a basis for the development of more effective procedures with closer and more efficient interprofessional collaboration and reduction of overlapping roles. Considerable waiting times, traffic flow and presence of people who were not involved in the patient care are areas of further investigation.
Qualitative Health Research, 2019
Interhospital intensive care unit-to-unit transfers are an increasing phenomenon, earlier mainly ... more Interhospital intensive care unit-to-unit transfers are an increasing phenomenon, earlier mainly studied from a patient safety perspective. Using data from video recordings and participant observations, the aim was to explore and interpret the observed nature of the patient’s situation during interhospital intensive care unit-to-unit transfers. Data collection from eight transfers resulted in over 7 hours of video material and field notes. Using a hermeneutical approach, three themes emerged: being visible and invisible; being in a constantly changing space; and being a fettered body in constant motion. The patient’s situation can be viewed as an involuntary journey, one where the patient exists in a constantly changing space drifting in and out of the health personnel’s attention and where movements from the journey become part of the patient’s body. Interhospital transfers of vulnerable patients emerge as a complex task, challenging the health personnel’s ability to maintain a car...
Transplantation, Jan 2, 2018
Studies on living donors from the donors' perspective show that the donation process involves... more Studies on living donors from the donors' perspective show that the donation process involves both positive and negative feelings involving vulnerability. Qualitative studies of living kidney, liver, and allogeneic hematopoietic stem cell donors have not previously been merged in the same analysis. Therefore, our aim was to synthesize current knowledge of these donors' experiences in order to deepen understanding of the meaning of being a living donor for the purpose of saving or extending someone's life. The meta-ethnography steps presented by Noblit & Hare in 1988 were used. Forty-one qualitative studies from 1968 to 2016 that fulfilled the inclusion criteria were analyzed. The studies comprised experiences of over 670 donors. The time since donation varied from 2 days to 29 years. A majority of the studies, 25 out of 41, were on living kidney donors. The synthesis revealed that the essential meaning of being a donor is doing what one feels one has to do, involving 6 t...
To present novel reflections on environment regarding the design of the patient room in intensive... more To present novel reflections on environment regarding the design of the patient room in intensive care units(ICUs).Introduction: An ICU and the patient room in particular, is a protected and closed ...
Intensive and Critical Care Nursing, 2021
BACKGROUND Intensive care unit diaries are often used to support patients during their psychologi... more BACKGROUND Intensive care unit diaries are often used to support patients during their psychological recovery. The intensive care unit stay can be upsetting, disturbing and traumatic for both patients and their families especially when the patient does not survive. AIM To investigate the connection between intensive care unit diaries and the grieving process experienced by family members of adult patients deceased in the intensive care unit. METHODS Systematic literature review according to PRISMA guidelines: PubMed, CINAHL and Cochrane Library were consulted. The Caldwell's framework was used for the quality appraisal. RESULTS Only six studies examine this topic. The potential benefits of intensive care unit diaries in family members' bereavement process may be an aid to realise how extremely ill their loved one was, may provide comfort and may help relatives to cope with their loss. CONCLUSION The use of intensive care unit diaries to help family members' bereavement process may be a useful tool but further research is necessary to better understand their role and benefits.
Journal of Nursing Scholarship, 2016
Purpose: To explore patient-reported symptom distress in relation to documentation of symptoms an... more Purpose: To explore patient-reported symptom distress in relation to documentation of symptoms and palliative care designation in hospital inpatients. Design: This cross-sectional study analyzed data from 710 inpatients at two large hospitals in Sweden using the Edmonton Symptom Assessment Scale and the Memorial Symptom Assessment Scale. Chart reviews focused on nurses' and physicians' symptom documentation and palliative turning point. Methods: Descriptive statistics were calculated for all variables and provided summaries about the sample. Patients were grouped according to gender, age, palliative care designation, and symptom documentation. The t test and chisquare test were used to calculate whether symptom distress varied between groups. A two-way analysis of variance was conducted for multiple comparisons to explore the impact of gender and age on mean symptom distress. Findings: Females reported higher levels of symptom distress than did males related to pain, fatigue, and nausea. When comparing symptom distress between males and females with documentation pertaining to symptoms, there were significant differences implying that females had to report higher levels of symptom distress than males in order to have their symptoms documented. Conclusions: Females need to report higher levels of symptom distress than do males for healthcare professionals to identify and document their symptoms. It can be hypothesized that females are not receiving the same attention and symptom alleviation as men. If so, this highlights a serious inequality in care that requires further exploration. Clinical Relevance: Considering that common reasons why people seek health care are troublesome symptoms of illness, and that the clinical and demographic characteristics of inpatients are changing towards more advanced ages with serious illnesses, inadequate symptom assessment and management are a serious threat to the care quality. The most common reasons why people seek health care are troublesome symptoms of illness (Kris & Dodd, 2004;
Den plotsliga doden kommer alltid ovantat och utan forberedelsetid for de narmaste. Detta staller... more Den plotsliga doden kommer alltid ovantat och utan forberedelsetid for de narmaste. Detta staller speciella krav pa sjukskoterskans omvardnad saval prehospitlat,pa akutmottagningen som pa olika var ...
Admission to an intensive care unit (ICU) is in most cases preceded by a sudden illness or trauma... more Admission to an intensive care unit (ICU) is in most cases preceded by a sudden illness or trauma, without an opportunity for either the patient or his or her family to prepare themselves for, or influence the location of, a patient’s death. An assumption of this thesis was that the place and the environment in which people die are important both for the person dying and his or her close relatives. The overall aim of the thesis was to explore and describe end-of-life care (EOLC) in the ICU environment from the perspective of close relatives and nurses. Study I was a survey concerning Swedish ICUs physical environment and routines when caring for dying patients. Study II was a study of the circumstances in conjunction with 192 patients’ death in 10 ICUs. In Study III, interviews were conducted with 17 close relatives of 15 patients who died in three ICUs. The interviews were analysed using a phenomenological-hermeneutic method. In Study IV, nine intensive care nurses were interviewed...
Intensive & critical care nursing : the official journal of the British Association of Critical Care Nurses, 2014
The aim of this paper is to present the state of the science concerning issues in end-of-life (EO... more The aim of this paper is to present the state of the science concerning issues in end-of-life (EOL) care which have an impact on intensive care nurses possibilities to provide nursing care for dying patients and their families. The perspective of families is also illuminated and finally ethical challenges in the present and for the future are discussed. The literature review revealed that the problem areas nurses report concerning EOL care have been the same over three decades. Most problems are related to inter-disciplinary collaboration and communication with the medical profession about the transition from cure to comfort care. Nurses need enhanced communication skills in their role as the patient's advocate. Education in EOL care and a supportive environment are prerequisites for providing EOL care. Losing a loved one in the ICU is a stressful experience for close relatives and nursing care has a profound impact on families' memories of the EOL care given to their loved ...
International Journal for Human Caring
This article examines and exemplifies how existential philosophy can provide deeper understanding... more This article examines and exemplifies how existential philosophy can provide deeper understanding of existential issues in a caring context. Existential philosophy, including lifeworld theory, is treated both as an epistemology for the development of research methods and inspiration for analysis and discussions in caring science research. The significance of the lifeworld is also highlighted as a guide to perform and enable caring and caring didactics, along with short descriptions where existential philosophy has previously influenced the development of caring science. The concept existential caring science is suggested as a research area for research on existential and meaning-oriented phenomena.
HERD: Health Environments Research & Design Journal, 2020
Objectives: The objective of the research was to study the visitors’ experiences of different hea... more Objectives: The objective of the research was to study the visitors’ experiences of different healthcare environment designs of intensive care unit (ICU) patient rooms. Background: The healthcare environment may seem frightening and overwhelming in times when life-threatening conditions affect a family member or close friend and individuals visit the patient in an ICU. A two-bed patient room was refurbished to enhance the well-being of patients and their families according to the principles of evidence-based design (EBD). No prior research has used the Person-centred Climate Questionnaire—Family version (PCQ-F) or the semantic environment description (SMB) in the ICU setting. Methods: A sample of 99 visitors to critically ill patients admitted to a multidisciplinary ICU completed a questionnaire; 69 visited one of the two control rooms, while 30 visited the intervention room. Results: For the dimension of everydayness in the PCQ-F, a significantly better experience was expressed for...
Nursing & Health Sciences, 2021
Losing a loved one in the intensive care unit relates to a risk of developing stress and complica... more Losing a loved one in the intensive care unit relates to a risk of developing stress and complicated grief. Education in intensive care nursing should cover end-of-life care, and the use of simulation in nursing education is a powerful instrument to develop confidence in end-of-life care. The aim of this study was to explore postgraduate nursing students' experiences with simulation training in end-of-life communication with intensive care patients and their families. Twenty-nine students answered a questionnaire and nine students participated in an interview. Analyses were conducted according to the principles of phenomenography. The result is presented in four categories including the following: the design of the scenario affects learning, uncertainty overshadows learning, intertwining theory and practice contributes to learning, and learning to encounter existential dimensions. The conclusion is that high-fidelity simulation training contributes towards preparing students to be attuned to what it can be like to be a family member in this situation. The scenarios contributed towards preparing the students to engage in end-of-life conversations during clinical placements.
Intensive and Critical Care Nursing, 2021
Objectives: To examine conditions and strategies to meet the challenges imposed by the coronaviru... more Objectives: To examine conditions and strategies to meet the challenges imposed by the coronavirus disease 2019 (COVID-19)-related visiting restrictions in Scandinavian intensive care units. Research methodology/design: A cross-sectional survey. Setting: Adult intensive care units in Denmark, Norway and Sweden. Main outcome measures: Likert scale responses and free-text comments within six areas: capacity and staffing, visiting policies and access to the unit, information and conferences with relatives, written information, children as relatives and follow-up initiatives. Results: The overall response rate was 53% (74/140 participating units). All intensive care units had planned for capacity extensions; the majority ranging between 11 and 30 extra beds. From March-June 2020, units had a mean maximum of 9.4 COVID-19 patients simultaneously. Allowing restricted visiting was more common in Denmark (52%) and Norway (61%) than in Sweden where visiting was mostly denied except for dying patients (68%), due to a particular increased number of COVID-19 patients. The restrictions forced nurses to compromise on their usual standards of family care. Numerous models for maintaining contact between relatives and patients were described. Conclusion: Visitation restrictions compromised the quality of family care and entailed dilemmas for healthcare professionals but also spurred initiatives to developing new ways of providing family care.
Intensive and Critical Care Nursing, 2020
Critical care nurses' lived experiences of interhospital intensive care unit-to-unit transfers: a... more Critical care nurses' lived experiences of interhospital intensive care unit-to-unit transfers: a phenomenological hermeneutical study.
Journal of Clinical Nursing, 2020
AIMS AND OBJECTIVES The aim of the study was to reveal meanings of family members' lived expe... more AIMS AND OBJECTIVES The aim of the study was to reveal meanings of family members' lived experiences when a loved one undergoes an interhospital intensive care unit-to-unit transfer. BACKGROUND Interhospital intensive care unit-to-unit transfers take place between different hospitals and their respective intensive care units. These types of transfers are an increasing phenomenon but are sparsely studied from the family members' perspective. Indeed, the patient's critical illness and care can have a major impact on family members. During the transfer process, there is a demand for the involved intensive care health personnel to make family members feel safe and cared for. DESIGN A qualitative design based on phenomenological hermeneutics. METHODS The study was conducted at two Swedish general intensive care units. Data were generated through individual in-depth interviews with seven family members and analysed using a phenomenological hermeneutical approach. The COREQ principles were applied in the conduct and reporting of this study. RESULTS Four themes that reveal meanings of family members' lived experiences were developed: losing your safe haven, dealing with uncertainty, carrying your own and others' burdens and a wish to be close. CONCLUSIONS The study reveals that an interhospital intensive care unit-to-unit transfer affects the whole family and is characterised by family members experiencing many negative feelings. The findings also illustrate that being a family member when a loved one is transferred means being exposed to the core existential elements of being human, such as loneliness and searching for meaning. RELEVANCE TO CLINICAL PRACTICE The study highlights the importance of maintaining a family-centred approach during the transfer process. Our findings can provide deeper knowledge for intensive care health personnel, better preparing them for the delicate task of providing family-centred care during the interhospital intensive care unit-to-unit transfer process.
Critical Care Nurse, 2020
Topic A substantial number of patients die in the intensive care unit, so high-quality end-of-lif... more Topic A substantial number of patients die in the intensive care unit, so high-quality end-of-life care is an important part of intensive care unit work. However, end-of-life care varies because of lack of knowledge of best practices. Clinical Relevance Research shows that high-quality end-of-life care is possible in an intensive care unit. This article encourages nurses to be imaginative and take an individual approach to provide the best possible end-of-life care for patients and their family members. Purpose of Paper To provide recommendations for high-quality end-of-life care for patients and family members. Content Covered This article touches on the following domains: end-of-life decision-making, place to die, patient comfort, family presence in the intensive care unit, visiting children, family needs, preparing the family, staff presence, when the patient dies, after-death care of the family, and caring for staff.
Nursing in Critical Care, 2019
Background: Post-intensive care syndrome-family is a common problem in relatives of patients who ... more Background: Post-intensive care syndrome-family is a common problem in relatives of patients who die in an intensive care unit. Family-centred end-of-life care with support for the family during and after the death is supposed to prevent suffering and avoid illness. Aims and objectives: This study aimed to investigate family-centred end-of-life care and bereavement follow-up services offered to family members of patients who die in Swedish intensive care units. Design, Methods: A cross-sectional study using a 16-question survey based on family-centred end-of-life care was sent to all 81 adult intensive care units. Data were analysed by descriptive statistics and chi-square. Respondents were able to add individual comments to the questionnaire. Results: Although the majority (76.7%) offered some kind of follow up, this service was not always offered. Modes for invitation, timing, and contents in the follow up varied between the units. The staff tried to individualize the follow-up service according to the family's needs. Nurses and social workers were the only professionals who provided follow-up conversations on their own. Most of the intensive care units (97.3%) kept diaries that were handed over to the family when they left the unit after the patient's death or at a follow-up visit. Only 8.8% reported that they always offer the family the opportunity to be present during resuscitation. Most respondents reported that patients (60.6%) died in a private room. Conclusions: Family-centred end-of-life care varied among the intensive care units, and some families were not offered any follow up at all. Timing, invitation, and elements in the follow up differ between the units. Diaries were commonly kept and usually given to the family. Few units offered the family to be present during resuscitation. Relevance to clinical practice: There is a need for national guidelines to ensure that all bereaved families receive equal and individual family-centred end-of-life care.
Nursing Open, 2019
Operating rooms (OR) represent a complex environment that includes highly advanced technology and... more Operating rooms (OR) represent a complex environment that includes highly advanced technology and a need of various specialist competencies. To ensure patient safety, staff in an OR must both have specific individual skills and work as a cohesive team (Cassera, Zheng, Martinec, Dunst, & Swanstrom, 2009). Working as a team in the OR has proven to be challenging and deficiencies in patient safety, procedure efficiency and well-being of the staff caused by communication failures are highlighted in the literature (Lingard et al., 2004). A hybrid OR can be described as an OR integrated with advanced radiological imaging equipment under strictly controlled aseptic conditions. Staff requirements in a hybrid OR during endovascular aortic repair (EVAR) go beyond ordinary OR staffing and usually include radiology staff, including radiologists and radiographers, due to the use of radiological equipment and the image-guided aspect of the procedure. Despite the growing number of hybrid ORs worldwide, the optimal composition and function of an OR team where radiology staff is included are an unevaluated research area and are the aim of this study. 1.1 | Literature review Being able to perform both open surgery and percutaneous imageguided interventions in the same room, with no need to move the patient between different rooms for each procedure, is the main advantage with a hybrid OR (Nollert et al., 2012). A hybrid OR, thus, allows for easy and immediate conversion from an EVAR to open surgery in the same setting, if medically necessary. This improves patient safety and this flexibility can also result in shortened hospital
Journal of Multidisciplinary Healthcare, 2019
Introduction: A hybrid operating room (OR) is a surgical OR with integrated imaging equipment and... more Introduction: A hybrid operating room (OR) is a surgical OR with integrated imaging equipment and the possibility to serve both open surgery and image-guided interventions. Aim: This study aimed to investigate the work processes and types of collaboration in a hybrid OR during endovascular aortic repair (EVAR). Methods: Data consisted of video recordings from nine procedures, with a total recording time of 48 hrs 39 mins. The procedures were divided into four episodes (Acts). A qualitative cross-case analysis was conducted, resulting in a typical case. The type of collaboration during specific tasks was discussed and determined based on Thylefors´team typology. Results: An extensive amount of safety activities occurred in the preparation phase (Acts 1 and 2), involving a number of staff categories. After the skin incision (Act 3), the main activities were performed by fewer staff categories, while some persons had a standby position and there were persons who were not at all involved in the procedure. Discussion: The different specialist staff in the hybrid OR worked through different types of collaboration: multi-, inter-and transprofessional. The level of needed collaboration depended on the activity performed, but it was largely multiprofessional and took place largely in separate groups of specialties: anesthesiology, surgery and radiology. Waiting time and overlapping tasks indicate that the procedures could be more efficient and safe for the patient. Conclusion: This study highlights that the three expertise specialties were required for safe treatment in the hybrid OR, but the extent of interprofessional activities was limited. Our results provide a basis for the development of more effective procedures with closer and more efficient interprofessional collaboration and reduction of overlapping roles. Considerable waiting times, traffic flow and presence of people who were not involved in the patient care are areas of further investigation.
Qualitative Health Research, 2019
Interhospital intensive care unit-to-unit transfers are an increasing phenomenon, earlier mainly ... more Interhospital intensive care unit-to-unit transfers are an increasing phenomenon, earlier mainly studied from a patient safety perspective. Using data from video recordings and participant observations, the aim was to explore and interpret the observed nature of the patient’s situation during interhospital intensive care unit-to-unit transfers. Data collection from eight transfers resulted in over 7 hours of video material and field notes. Using a hermeneutical approach, three themes emerged: being visible and invisible; being in a constantly changing space; and being a fettered body in constant motion. The patient’s situation can be viewed as an involuntary journey, one where the patient exists in a constantly changing space drifting in and out of the health personnel’s attention and where movements from the journey become part of the patient’s body. Interhospital transfers of vulnerable patients emerge as a complex task, challenging the health personnel’s ability to maintain a car...
Transplantation, Jan 2, 2018
Studies on living donors from the donors' perspective show that the donation process involves... more Studies on living donors from the donors' perspective show that the donation process involves both positive and negative feelings involving vulnerability. Qualitative studies of living kidney, liver, and allogeneic hematopoietic stem cell donors have not previously been merged in the same analysis. Therefore, our aim was to synthesize current knowledge of these donors' experiences in order to deepen understanding of the meaning of being a living donor for the purpose of saving or extending someone's life. The meta-ethnography steps presented by Noblit & Hare in 1988 were used. Forty-one qualitative studies from 1968 to 2016 that fulfilled the inclusion criteria were analyzed. The studies comprised experiences of over 670 donors. The time since donation varied from 2 days to 29 years. A majority of the studies, 25 out of 41, were on living kidney donors. The synthesis revealed that the essential meaning of being a donor is doing what one feels one has to do, involving 6 t...