Kaety Plos | Göteborg University (original) (raw)

Papers by Kaety Plos

Critical Care Medicine, 2010

The overall aim of this study was to describe changes in health-related quality of life, anxiety,... more The overall aim of this study was to describe changes in health-related quality of life, anxiety, depression, and return to work from 0.5-1.5 yrs to 4.5-5.5 yrs after injury in patients with and without delusional memories during their intensive care unit stay. A secondary aim was to explore factors that were related to healthrelated quality of life and to compare trauma patients' health-related quality of life 4.5 to 5.5 yrs after injury with a reference group. Design: Longitudinal, prospective. Settings: Multicentre study. Patients: Trauma patients treated in the intensive care unit. Interventions: None. Measurements and main results: A follow-up study was conducted with 153 consenting adults. Each patient answered a postal questionnaire twice, 0.5-1.5 yrs to 4.5-5.5 yrs after the injury. Health-related quality of life was assessed by Short Form-36 and anxiety and depression by the Hospital Anxiety and Depression Scale. Delusional memories and other clinical variables were assessed in a previous study and used in this study as possible precipitants of poor health-related quality of life. Seventy-five percent were males and mean Injury Severity Scores were 10.7 ؎ 7.1. When comparing health-related quality of life over time, there was significant improvement in five domains of health-related quality of life for patients with delusional memories compared with 4 yrs previously. Significantly more patients with delusions had anxiety and depression (Hospital Anxiety and Depression Scale >8). Patients with delusional memories were still significantly separated from the other patients in all health-related quality-of-life domains except for general health. Seventy-five percent of all patients had returned to work. Despite a poorer health-related quality of life, patients with delusions had returned to work to the same degree. Patients with trauma still scored significantly lower in all domains 4.5 to 5.5 yrs after the injury compared with the Swedish population in the reference group (p < .001). Two factors, delusional memories during intensive care unit stay and preexisting disease prior the trauma, had the most influence on a poorer health-related quality of life. Conclusions: From a long-term perspective, health-related quality of life has improved but not reached the reference sample scores in Short Form-36. Seventy-five percent had returned to work. Patients with delusional memories still experienced poorer health-related quality of life and more patients had anxiety and depression compared with patients without those memories. (Crit Care Med 2010; 38:38-44) KEY WORDS: follow-up; health-related quality of life; intensive care unit; injury; memories; trauma LEARNING OBJECTIVES After participating in this activity, the participant should be better able to: 1. Explain how to measure quality of life after intensive care in a trauma unit. 2. Describe effect of delusional thoughts on post-intensive care unit quality of life. 3. Use this information in a clinical setting. Unless otherwise noted below, each faculty or staff's spouse/life partner (if any) has nothing to disclose. The authors have disclosed that they have no financial relationships with or interests in any commercial companies pertaining to this educational activity. All faculty and staff in a position to control the content of this CME activity have disclosed that they have no financial relationship with, or financial interests in, any commercial companies pertaining to this educational activity. Visit the Critical Care Medicine Web site (www.ccmjournal.org) for information on obtaining continuing medical education credit.

Scandinavian Journal of Caring Sciences, Sep 1, 2009

Nordic journal of nursing research, Jun 1, 2001

En inventering av förekommande arbetsmoment och tidsåtgången för dessa gjordes vid en operationsa... more En inventering av förekommande arbetsmoment och tidsåtgången för dessa gjordes vid en operationsavdelningen med 4 operationssalar, som vardera bemannas med en sjuksköterska och en undersköterska. Sjuksköterskorna och undersköterskorna registrerade efterhand arbetet de utförde under några dagar. Baserat på dessa uppgifter kunde det dagliga arbetet uppdelas i specifka välavgränsade arbetsmoment som inordnades i verksamhetskategorier. Ett registreringsprotokoll skapades där utförda arbetsmoment och tids åtgång efterhand registrerades av operationslagens medlemmar under 10 arbetsdagar. Avdelningens maximala operations kapacitet definierades som; antal operationssalar × operationslagets faktiska arbetstid och benämndes Total Bemannad Operationssalstid = TBO-ptid. Resultaten visade att sjuksköterskorna utförde 20 och undersköterskorna 18 specifika arbetsmoment. Mest tid krävde arbetsmomenten «Assistera/Lägga förband» respektive «assistera på sal» som tog 40% av TBOp-tiden. «Patientrelaterad verksamhet» utgjorde ungefär 70% av TBOptiden. Operationssalarna utnyttjades under drygt 60 % av TBOp-tiden «Väntan» och oplanerad «Resttid» utgjorde 10 respektive 15% av TBOp-tiden. Konklusion: Operationslagen är effektiva. Rationaliseringar, som är nödvändigaför att skapa bättre och lugnare arbetsförhållanden kan ernås om vid tidsplaneringen av operationsprogrammet hänsyn tas till alla arbetsmoment, som operationslagen skall utföra i anslutning till varje operation. Improduktiv väntetid måste identifieras och minimeras. Den framtagna metoden för identifiering och analys av de dagliga arbetsuppgifterna och tidsåtgången för dessa uppfyllde våra ställda krav avseende användbarhet och tillförlitlighet. Sökord: Operationssal Operationssals-personal Arbetsuppgifter Mätteknik

Creative Education, 2012

In this study, e-learning based on authentic situations was used as a pedagogic method to stimula... more In this study, e-learning based on authentic situations was used as a pedagogic method to stimulate medical students to reflect over their own learning styles and to prepare them for dealing with medical insurance issues in their future profession. The aim was to explore the learning styles used by the students in a Social medicine course when e-learning, based on authentic situations was used as a pedagogical approach. A learning style questionnaire by Kember, Biggs and Leung, and a course evaluation questionnaire designed by the authors were used. Seventy-seven students answered the questionnaires and the questionnaires were analysed by Mann-Whitney U-test, and Fisher's test was used as a pair comparison. One hundred forty comments made by the students were analysed using content analysis. The results showed that: 69% of the students regarded e-learning as a very good/good pedagogical method to study medical insurance. Men had a significantly higher rate of surface learning than women. A majority of the students thought that it was positive to take part of peer students' assignments but they highlighted the risk of plagiarism and cheating. The students made use of the flexibility in this type of learning which suited their lifestyle.

Nursing Research and Practice, 2011

Patient participation is an important basis for nursing care and medical treatment and is a legal... more Patient participation is an important basis for nursing care and medical treatment and is a legal right in many Western countries. Studies have established that patients consider participation to be both obvious and important, but there are also findings showing the opposite and patients often prefer a passive recipient role. Knowledge of what may influence patients' participation is thus of great importance. The aim was to identify incidents and nurses' behaviours that influence patients' participation in nursing care based on patients' experiences from inpatient somatic care. The Critical Incident Technique (CIT) was employed. Interviews were performed with patients (n = 17), recruited from somatic inpatient care at an internal medical clinic in West Sweden. This study provided a picture of incidents, nurses' behaviours that stimulate or inhibit patients' participation, and patient reactions on nurses' behaviours. Incidents took place during medical ward round, nursing ward round, information session, nursing documentation, drug administration, and meal.

Journal of Further and Higher Education, Feb 1, 2008

Scandinavian Journal of Caring Sciences, Sep 1, 2007

The study's rationale: Patients' active participation in their own care is expected to contribute... more The study's rationale: Patients' active participation in their own care is expected to contribute to increased motivation to improve their own condition, better treatment results and greater satisfaction with received care. Knowledge of patients' understanding of participation is of great importance for nurses in their efforts to meet patient expectations and for quality of nursing care. Aim: The aim was to explore the meaning of patient participation in nursing care from a patient point of view. Methodological design and justification: Six tape-recorded focus group interviews with 26 Swedish informants described opinions on and experiences of patient participation. The informants consisted of patients in somatic inpatient care as well as discharged patients from such a setting. The Grounded Theory method was used and the data were analysed using constant comparative analysis. Ethical issues and approval: The ethics of scientific work was followed. Each study participant gave informed consent after verbal and written information. The Ethics Committee of Gö teborg University approved the study. Findings: The patients emphasised the importance of collaboration to improve participation. The core category, Insight through consideration, was generated from four interrelated categories: (i) Obliging atmosphere; (ii) Emotional response; (iii) Concordance; and (iv) Rights and their 15 subcategories. Conclusions: The meaning structures of patient participation in nursing care revealed from a patient point of view, seemed to mainly consist of not only external factors presented by the institutions-by the professionals-but also internal patient factors. The patients' view of participation should be considered to a greater degree in nursing practice and education, as should also further development of nursing care policy programmes, evaluation and quality assurance criteria. For further development, studies are needed in similar and other settings.

Nursing in critical care, May 9, 2014

Background: For most critically ill patients requiring mechanical ventilation in the intensive ca... more Background: For most critically ill patients requiring mechanical ventilation in the intensive care unit (ICU) weaning is uncomplicated. For the remainder, weaning is a challenge and may result in further complications and increased risk of mortality. Critical care nurses (CCNs) require substantial knowledge and experience to manage patients experiencing prolonged weaning. Aim: The aim of this study was to explore CCNs approach for management of patients experiencing prolonged weaning in the ICU. Design: A descriptive qualitative design. Methods: Semi-structured interviews with 19 experienced CCNs were conducted. Data were analysed using content analysis. Results: Participants used various strategies for weaning that were grouped into four categories: individualized planning for the weaning process, assessing patient's capacity, managing the process and team interaction. The overall theme that emerged was: CCNs drive the weaning process using both a patient centred and targeted approach. Conclusion: CCNs in these ICUs performed weaning using a patient centred approach to plan, initiate, assess and establish a holistic weaning process. Team collaboration among all health care practitioners was important. CCNs have a key role in prioritizing weaning and driving the process forward. Relevance to clinical practice: Closeness to the patient and a key role in management of the mechanical ventilated patient in ICU gives the CCN unique potential to develop and create models and tools for prolonged weaning. These tools, specially designed for patients undergoing prolonged weaning, would give focus on continuous planning, collaborating, managing and evaluation in the process of liberating patients from mechanical ventilation.

BMC Nursing, Jun 17, 2008

Background: The purpose of this study was to acquire a deeper understanding of patients' memories... more Background: The purpose of this study was to acquire a deeper understanding of patients' memories of being injured and the trajectory of care before, during and after their Intensive Care Unit (ICU) stay. Methods: Interviews were conducted with eighteen informants who after physical trauma had been cared for in the ICU. The interviews were analyzed by using a phenomenological hermeneutical method. Results: The memories of injury during the trajectory of care are illustrated in a figure in which the injured informants have memories from five scenes; the scene of the accident, emergency unit, ICU, nursing ward and of coming home. Twelve subthemes were abstracted and four themes emerged; a surrealistic world, an injured body, care, and gratitude for life. After the accident, a "surrealistic world" appeared along with bad memories of being in a floating existence where plans had to be changed. This world was unfamiliar, sometimes including delusional and fragmentary memories from the ICU, and it was experienced as uncontrollable. They felt connected to an "injured body", experiencing bad memories from the ICU of being injured, from the nursing ward of simply enduring and of being in a No Man's Land when coming home; their lives had become limited. At the same time they were "connected to care" with good memories of receiving attention from others at the scene of the accident, being taken cared of at the emergency unit and cared for in the ICU. This care made them realise that people are responsible for each other, and they felt comforted but also vulnerable. Finally, they experienced "gratitude for life". This included good memories of being loved together with support from their families at the ICU, wanting to win life back at the nursing ward and acceptance when returning home. The support from their families made them realise that they fit in just as they are. Conclusion: When bad memories of a surrealistic world and of being injured are balanced by good ones of care and love with a gratitude for life, there are more possibilities to move on despite an uncertain future following the injury.

Intensive and Critical Care Nursing, Jun 1, 2012

Introduction: In connection with the care received in the intensive care unit (ICU), the patient ... more Introduction: In connection with the care received in the intensive care unit (ICU), the patient can experience discomfort and frustration. Earlier studies have shown mechanical ventilation (MV) to be a factor that increases patients' delusional memories in the ICU. The patients who need MV after a physical trauma constitute a vulnerable group who so far has attracted little attention from a long-term perspective. Aim: The aim for this study is to describe mechanically ventilated trauma patients over time regarding their memories, psychological recovery and health related quality of life (HRQoL). Methods: In a multicentre study, 41 patients who had received MV, answered a questionnaire with the SF-36, HAD and ICUM tool on two occasions about one and five years after the injury and care in the ICU. Results: The patients' memories were stable over time and significantly more patients remembered panic and anxiety. 37% remembered pain one year after the trauma and 46% five years thereafter. The majority of the patients remembered the family's presence from their ICU stay. Half of the patients had thoughts regarding why they had so few recollections. One fourth of the patients experienced clear symptoms of anxiety and the same amount had symptoms of depression one year after the injury. In seven of the patients the symptoms of probable anxiety persisted after five years. In six of the patients the symptoms of probable depression persisted after five years. Two of eight dimensions in HRQoL, the physical and emotional role functions, had improved significantly five years after the injury. Conclusions: Five years after the trauma, the memories from the ICU were still the same and the HRQoL improved in only two out of eight dimensions. A smaller group of patients had remaining symptoms of psychological ill-health. MV in connection with trauma may result in continued reduced health in the long term.

Scandinavian Journal of Caring Sciences, Sep 1, 2005

Hindrance for patient participation in nursing care The study's rationale: Patients' influence in... more Hindrance for patient participation in nursing care The study's rationale: Patients' influence in health care through participation, freedom of choice and information, is laid down in laws, national and local directives. In nursing care situations, the degree to which a patient participates depends on the nursing staff. Accordingly, hindrances for patient's participation during nursing care is an important question for the nursing profession. Aims and objectives: The aim was to focus on Swedish Registered Nurses opinion of hindrances for patient participation in nursing care and to uncover the informants' perspectives in depth. Methodological design and justification: The study was limited to inpatient somatic care and has a qualitative approach. Data were collected through seven focus group interviews with 31 Registered Nurses from five hospitals. An analysis of the tape-recorded interview material was made, combining elements of content analysis with aspects of the Grounded Theory approach. Ethical issues and approval: The ethics of scientific work was followed. The participants gave informed consent. Verbal and written information was given as a guarantee that all information would be treated confidentially outside the focus group. Formal approval by ethical committee was not required according to national and local directives. Results: Hindrance for patient participation in nursing care comprised three themes: Competence, Influence of significant others and Organization and work environment, and their seven underlying subthemes. Conclusions: The study clarified factors, which individually or combined may be hindrance for patient participation in nursing practice. Professional nurses must be able to find a balance for their patients' participation in nursing care activities through identification and coping with the hindrances. The three themes and seven subthemes here identified, can be used in patient care and its' evaluation, like also quality assurance of care and work organization and in nursing education. For further development replication studies are needed, like additional studies of patients and significant others.

Scandinavian Journal of Caring Sciences, Jan 17, 2011

Patients' perceptions of barriers for participation in nursing care Background: In many Western c... more Patients' perceptions of barriers for participation in nursing care Background: In many Western countries as in Sweden, patients have legal right to participate in own care individually adjusted to each patient's wishes and abilities. There are still few empirical studies of patients' perceptions of barriers for participation. Accordingly, there is a need to identify what may prevent patients from playing an active role in own nursing care. Such knowledge is highly valuable for the nursing profession when it comes to implementation of individual patient participation. Aim and objective: To explore barriers for patient participation in nursing care with a special focus on adult patients with experience of inpatient physical care. Methodological design and justification: Data were collected through 6 focus groups with 26 Swedish informants recruited from physical inpatient care as well as discharged patients from such a setting. A content analysis with qualitative approach of the tape-recorded interview material was made. Ethical issues and approval: The ethics of scientific work was adhered to. Each study participant gave informed consent after verbal and written information. The Ethics Committee of Gö teborg University approved the study. Results: The barriers for patient participation were identified as four categories: Facing own inability, meeting lack of empathy, meeting a paternalistic attitude and sensing structural barriers, and their 10 underlying subcategories. Conclusions: Our study contributes knowledge and understanding of patients' experiences of barriers for participation. The findings point to remaining structures and nurse attitudes that are of disadvantage for patients' participation. The findings may increase the understanding of patient participation and may serve as an incentive in practice and nursing education to meet and eliminate these barriers, in quality assurance of care, work organization and further research.

Nursing Forum, 2008

The concept of patient participation has an array of interpretations and lacks clarity. The purpo... more The concept of patient participation has an array of interpretations and lacks clarity. The purpose of this article is to explore the concept of patient participation within the context of nursing practice. The method described by Walker and Avant (1995) is used. The critical attributes of the concept are identified. Formation of model, borderline, and contrary cases exemplifies key characteristics. Antecedents, consequences, and empirical referents presented allow for further refinement of the key attributes defining the concept. Patient participation in nursing practice can be defined as an established relationship between nurse and patient, a surrendering of some power or control by the nurse, shared information and knowledge, and active engagement together in intellectual and/or physical activities.

Scandinavian Journal of Caring Sciences, Mar 1, 1989

The questionnaire CIC1:PQ for measuring needs, concerns and coping of parents of chronically ill ... more The questionnaire CIC1:PQ for measuring needs, concerns and coping of parents of chronically ill children was mailed to 85 families with children with cystic fibrosis (CF). Some questions about the parents' experiences of the health care system were also included. Fifty-four per cent responded-in all cases but two the mothers. More than half of the mothers wanted help with or opportunities to discuss the state of health and the emotional development of the child and dietary issues. Many of them were concerned about the child's future. Shortage of time was another problem. The coping strategies used when having problems with the child were partly different from those used when problems arose with the spouse. Most mothers were satisfied with the hospital care and the CF paediatrician. They wanted further support from the physiotherapist and many of them missed a CF nurse. The project illuminated many areas for further investigation.

Medical Teacher, 2008

Background: How students are introduced to their studies will affect the quality of learning. Thi... more Background: How students are introduced to their studies will affect the quality of learning. This project deals with tools for lifelong learning to increase students' awareness of learning how to learn. In parallel to an introductory course for students, a course for teachers was given with a focus on tutoring students. Aims: To evaluate an interprofessional transition course for first-year health science students, the LearnAble project, and a teachers' course aiming to support students to be successful in their learning. Method: The project was followed up by a computer-based course evaluation, reflective journals, the Learning Process Questionnaire and the Approaches to Teaching Inventory. The questionnaires were distributed before and after the courses. Teachers (n ¼ 31) and students (n ¼ 270) in two courses from different health educations participated. Results: Students' approaches to the course and to learning could be described as technical/reproductive, seeking for an identity or as reflective/transformative. The evaluation indicates that a deep approach to the studies among the students was related to higher age and female gender. Teachers with earlier pedagogical education supported students more in the attempts to question their own understanding. Conclusion: The most obvious result was the positive impact of being a tutor for a group of students in parallel to studying pedagogy.

Nordic Journal of Nursing Research, 2001

The Journal of Trauma Injury Infection and Critical Care, Apr 1, 2009

Background: To examine the relationship between delusional memories from the Intensive Care Unit ... more Background: To examine the relationship between delusional memories from the Intensive Care Unit (ICU) stay, health related quality of life (HRQoL), anxiety, and symptoms of depression in patients with physical trauma, 6 months to 18 months after their ICU stay.