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Engwall, Marie
Publications (5 of 5) Show all publications
Engwall, M. (2017). En vårdande ljusmiljö inom intensivvård: Patienters upplevelser och effekter av en cyklisk belysningsintervention. (Doctoral dissertation). Göteborg: Göteborgs universitet
Open this publication in new window or tab >>En vårdande ljusmiljö inom intensivvård: Patienters upplevelser och effekter av en cyklisk belysningsintervention
2017 (Swedish)Doctoral thesis, comprehensive summary (Other academic)
Abstract [sv]

Det övergripande syftet med avhandlingen var att beskriva och undersöka patienters - vårdade inom intensivvård - upplevelser och effekter av en cyklisk belysningsintervention utifrån hälsa, välbefinnande och återhämtning.

Metod: En intervention bestående av ett automatiskt styrt belysningssystem var installerat på ett intensivvårdsrum. Belysningsinterventionens mål var att efterlikna dagsljuset i styrka, kvalitet, och lokalisation. Ett ordinarie intensivvårdsrum fungerade som kontrollmiljö. I studie I eftersöktes i en systematisk litteratursammanställning tidigare forskningsresultat rörande cykliska belysningsinterventioner inom intensivvård. Belysningsmiljöerna i intervention- och kontrollmiljön bedömdes i studie I av besökare och i studie II av patienter samt jämfördes och analyserades statistiskt. Ljus och belysningsmätningar utfördes i både forsknings- och kontrollmiljön. I studie II undersöktes patienters upplevelser av den cykliska belysningsmiljön genom kvalitativa intervjuer vilka analyserade med innehållsanalys. I studie II mättes och jämfördes patienters sömn, dygnsrytm samt fysiologiska parametrar och analyserades statistiskt. I studie IV undersöktes och jämfördes patienternas självskattade återhämtning efter sex och tolv månader.

Resultat: Cykliska belysningsinterventioner exponerade för vuxna patienter var få. Resultatet visade dock att interventioner med cykliskt ljus inom neonatal intensivvård kunde inverka positivt på förtidigt födda barns hälsa. Den cykliska interventionsmiljön bedömdes som mer trivsam och mätningar av belysningen utförda i interventionsmiljön visade på samstämmighet med europeiska rekommendationer. Belysningsnivåerna i kontrolmiljön var manuellt styrda och mätningarna visade på antingen för låga eller för höga belysningsnivåer under dagtid jämfört med europeiska rekommendationer. Patienterna bedömde den cykliska belysningsmiljön som starkare dagtid och under nattetid bedömdes belysningen i kontrolmiljön som mer varierande. Patienters individuella upplevelser av den cykliska belysningsinterventionen presenterades i fyra kategorier: en dynamisk belysningsmiljö, belysningens påverkan på patientens sömn, ljus/belysnings påverkan på dygnsrytm samt en lugnande belysning. Patienternas dygnsrytm stärktes inte av den cykliska belysningsmiljön under deras sista 24-timmarsperiod. Patienternas självrapporterade återhämtning efter intensivvård var bättre efter 12-månader efter utskrivning hos de som vårdats i interventionsmiljön.

Slutsatser: Genom att studera de båda forskningsområdena vårdvetenskap och ljus/belysning tillsammans skapades ny kunskap till vårdvetenskapen. Trots svår sjukdom eller skada kunde patienterna bedöma och reflektera kring belysningsmiljön. Ämnesområdet lämpar sig väl för att undersökas med både kvantitativa och kvalitativa metoder.

Abstract [en]

Aim: The overall aim of this thesis was to describe and evaluate patients’, who were cared for in the intensive care unit (ICU), experiences and effects concerning a cycled lighting intervention based on health, wellbeing and recovery. Methods: An automatically controlled cycled lighting intervention aimed to mimic natural light levels, quality and position throughout the day was evaluated. An ordinary lit room was used as a control. A multiple-method approach was used. In study I, there were three aspects: a systematic review of the previous research concerning cycled lighting interventions in the intensive care; visitor evaluations of the lighting environments in the intervention and ordinary room; and measurements of illuminance, luminance and irradiance in both conditions. In study II, the patients evaluated the lighting environment in the two rooms. Data were compared and analysed. Furthermore, patients’ experiences regarding the cycled lighting environment were investigated through qualitative interviews, which were subsequently analysed by content analysis. In study III, patients’ sleep, activity and physiological parameters were measured and compared. Study IV consisted of statistical analysis of a questionnaire concerning patients’ self-reported recovery six and 12 months after their ICU treatments. Results: The literature review on cycled lighting interventions in adult ICUs was rare but more common in the neonatal ICU (NICU). Findings showed that cycled lighting interventions improved health in preterm infants, but there were also non-significant results reported. The visitors reported the cycled lighting environment as more pleasant, and based on measurements, the lighting levels were at equivalent levels with European recommendations for hospitals. The lighting levels in the ordinary room were manually controlled and were reported as being either too low or too bright during the daytime. Patients evaluated the cycled lighting environment as brighter in daytime, and this was in coherence with the results from the measurements of illumination. Patients’ individual experiences concerning the cycled lighting environment were reported in four categories: a dynamic lighting environment, the impact of lighting on patients’ sleep, the impact of light/lighting on the circadian rhythm and the degree to which the lighting calmed them. Patients’ circadian rhythms were not further strengthened by the cycled lighting intervention during their final 24-period in the ICU. Twelve months after their ICU treatments, patients cared for in the intervention environment self-reported their recovery as significantly better than those who received treatment in the ordinary room. Conclusions: A multiple methodology was used to explore theresearch field from a wider perspective. Combining knowledge from both the lighting research field and caring science has brought new knowledge to both and especially to the practice of nursing. Despite their severe illnesses or injuries, patients were able to assess their experiences with the lighting environment and reflect on how the lighting was able to support their health. This thesis reports findings that indicate that environmental/lighting interventions may improvepatients’ health. Lighting interventions are harmless, safe, sustainable and, in comparison to technical and medical interventions, considerably cheaper. With this knowledge, we believe all vulnerable patients in the ICU should be surrounded by a lighting environment around the clock to support their health, wellbeing and recovery.

Place, publisher, year, edition, pages
Göteborg: Göteborgs universitet, 2017
Keywords
care environment, circadian rhythm, health, intensive and critical care, lighting, sleep, recovery, wellbeing
National Category
Medical and Health Sciences Nursing
Research subject
Människan i vården
Identifiers
urn:nbn:se:hb:diva-11911 (URN)978-91-629-0101-1 (ISBN)978-91-629-0102-8 (ISBN)
Opponent
Available from: 2017-02-20 Created: 2017-02-16 Last updated: 2017-03-01Bibliographically approved
Engwall, M., Fridh, I., Jutengren, G., Bergbom, I., Sterner, A. & Lindahl, B. (2017). The effect of cycled lighting in the intensive care unit on sleep, activity and physiological parameters: A pilot study. Intensive & Critical Care Nursing, 41, 26-32, Article ID S0964-3397(17)30032-0.
Open this publication in new window or tab >>The effect of cycled lighting in the intensive care unit on sleep, activity and physiological parameters: A pilot study
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2017 (English)In: Intensive & Critical Care Nursing, ISSN 0964-3397, E-ISSN 1532-4036, Vol. 41, p. 26-32, article id S0964-3397(17)30032-0Article in journal (Refereed) Published
Abstract [en]

Patients in intensive care suffer from severe illnesses or injuries and from symptoms related to care and treatments. Environmental factors, such as lighting at night, can disturb patients' circadian rhythms. The aim was to investigate whether patients displayed circadian rhythms and whether a cycled lighting intervention would impact it. In this pilot study (N=60), a cycled lighting intervention in a two-bed patient room was conducted. An ordinary hospital room functioned as the control. Patient activity, heart rate, mean arterial pressure and body temperature were recorded. All data were collected during the patients' final 24h in the intensive care unit. There was a significant difference between day and night patient activity within but not between conditions. Heart rates differed between day and night significantly for patients in the ordinary room but not in the intervention room or between conditions. Body temperature was lowest at night for all patients with no significant difference between conditions. Patients in both conditions had a natural circadian rhythm; and the cycled lighting intervention showed no significant impact. As the sample size was small, a larger repeated measures study should be conducted to determine if other types of lighting or environmental factors can impact patients' well-being.

Keywords
Body temperature, Circadian rhythm, Critical care, Heart rate, Intensive care unit, Light, Mean arterial pressure, Motor activity, Sleep
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:hb:diva-12870 (URN)10.1016/j.iccn.2017.01.009 (DOI)000405251200006 ()28268055 (PubMedID)2-s2.0-85014263045 (Scopus ID)
Available from: 2017-10-16 Created: 2017-10-16 Last updated: 2017-12-13Bibliographically approved
Engwall, M., Fridh, I., Johansson, L., Bergbom, I. & Lindahl, B. (2015). Lighting, sleep and circadian rhythm: An intervention study in the intensive care unit.. Intensive & Critical Care Nursing, 31(6), 325-335
Open this publication in new window or tab >>Lighting, sleep and circadian rhythm: An intervention study in the intensive care unit.
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2015 (English)In: Intensive & Critical Care Nursing, ISSN 0964-3397, E-ISSN 1532-4036, Vol. 31, no 6, p. 325-335Article in journal (Refereed) Published
Abstract [en]

Patients in an intensive care unit (ICU) may risk disruption of their circadian rhythm. In an intervention research project a cycled lighting system was set up in an ICU room to support patients' circadian rhythm. Part I aimed to compare experiences of the lighting environment in two rooms with different lighting environments by lighting experiences questionnaire. The results indicated differences in advantage for the patients in the intervention room (n=48), in perception of daytime brightness (p=0.004). In nighttime, greater lighting variation (p=0.005) was found in the ordinary room (n=52). Part II aimed to describe experiences of lighting in the room equipped with the cycled lighting environment. Patients (n=19) were interviewed and the results were presented in categories: "A dynamic lighting environment", "Impact of lighting on patients' sleep", "The impact of lighting/lights on circadian rhythm" and "The lighting calms". Most had experiences from sleep disorders and half had nightmares/sights and circadian rhythm disruption. Nearly all were pleased with the cycled lighting environment, which together with daylight supported their circadian rhythm. In night's actual lighting levels helped patients and staff to connect which engendered feelings of calm.

Keywords
Circadian rhythm, Content analysis, Critical care, Cycled light, Intensive care unit, Interview, Lighting, Mann-Whitney-test, Nursing, Sleep
National Category
Nursing
Research subject
Människan i vården
Identifiers
urn:nbn:se:hb:diva-4012 (URN)10.1016/j.iccn.2015.07.001 (DOI)000365185500001 ()26215384 (PubMedID)2-s2.0-84946495465 (Scopus ID)
Available from: 2015-12-11 Created: 2015-12-11 Last updated: 2017-12-01Bibliographically approved
Engwall, M., Bergbom, I., Fridh, I. & Lindahl, B. (2014). Let there be light and darkness: findings from a prestudy concerning cycled light in the intensive care unit environment.. Critical Care Nursing Quarterly, 37(3), 273-298
Open this publication in new window or tab >>Let there be light and darkness: findings from a prestudy concerning cycled light in the intensive care unit environment.
2014 (English)In: Critical Care Nursing Quarterly, ISSN 0887-9303, E-ISSN 1550-5111, Vol. 37, no 3, p. 273-298Article in journal (Refereed) Published
Abstract [en]

The present study reports findings concerning light in an intensive care unit setting presented from 3 aspects, giving a wide view. The first part is a systematic review of intervention studies concerning cycled light compared with dim light/noncycled light. The findings showed that cycled light may be beneficial to preterm infant health. Second, a lighting intervention in the intensive care unit is presented, comparing and assessing experience of this lighting environment with that of an ordinary room. Significant differences were shown in hedonic tone, favoring the intervention environment. In the third part, measured illuminance, luminance, and irradiance values achieved in the lighting intervention room and ordinary room lighting are reported.

Place, publisher, year, edition, pages
Wolters Kluwer Health Lippincott Williams & Wilkins, 2014
Keywords
cycled light, Intensive care, high-tech environment
National Category
Medical and Health Sciences Nursing
Research subject
Människan i vården
Identifiers
urn:nbn:se:hb:diva-1916 (URN)10.1097/CNQ.0000000000000031 (DOI)24896559 (PubMedID)2320/14271 (Local ID)2320/14271 (Archive number)2320/14271 (OAI)
Available from: 2015-11-13 Created: 2015-11-13 Last updated: 2017-12-01Bibliographically approved
Olausson, S., Engwall, M. & Johansson, L. (2012). Evidenced-based and sustainable design in a high tech hospital environment: a challenge for the future. In: : . Paper presented at Chalmers Conferences, ARCH12, Gothenburg, Swweden, 14-15 November 2012.
Open this publication in new window or tab >>Evidenced-based and sustainable design in a high tech hospital environment: a challenge for the future
2012 (English)Conference paper, Published paper (Refereed)
Abstract [en]

The Intensive care unit (ICU) is the place of care for the most critically ill patients in hospitals. According to previous research the ICU environment can have a negative impact on the patients’ recovery process. Critical illness together with constant nursing activities, strong lightning and noise especially in patient’s room are believed to affect patients’ physiological parameters and wellbeing negatively. Research has addressed the role of the environment in relation to the development of the most common side-effect of care in ICU, namely ICU delirium. In addition, there is a limited access to single rooms in Swedish ICUs. This means that patients with various diagnoses, gender and age are treated together in the same room. Moreover, as many ICUs in Sweden are aged and in need of renewals, in order to meet the demand of contemporary intensive care, several restoration projects are planned in the following years. Aspects mentioned above have raised questions about how an intervention of the physical environment in an ICU could benefit the patients and their families. A literature search showed that there is little research about the impact of the physical environment on patients’ health in this context and that there is a lack of reliable long term studies focusing on the relationship between the physical environment, health and recovery. Therefore this project was initiated by two experienced researchers, Professor I, Bergbom at the University of Gothenburg and Associate professor B, Lindahl at the University College of Borås, with the purpose to investigate if an intervention in the physical environment in an ICU patient room can improve patients’ recovery process and wellbeing. The project has an exploratory and descriptive design. The intervention is located at an ICU, in Western Sweden and implicates a rebuilt patient room. The refurbished room (experimental room) is equipped with sound absorbents behind the walls and ceiling, a cycled lighting system and a new interior decoration. An identical room has remained intact (control room), which makes it possible to compare data from two different environments. All research questions will be related to the sound environment, the light environment and the esthetic layout. The results from this project will be useful in the context of ICU, but also in other high tech environments. The aim of this paper is to provide a description of the intervention project and present findings generated from a sound environment study.

National Category
Medical and Health Sciences
Research subject
Integrated Caring Science
Identifiers
urn:nbn:se:hb:diva-6919 (URN)2320/11837 (Local ID)2320/11837 (Archive number)2320/11837 (OAI)
Conference
Chalmers Conferences, ARCH12, Gothenburg, Swweden, 14-15 November 2012
Available from: 2015-12-22 Created: 2015-12-22 Last updated: 2017-10-12Bibliographically approved
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