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Israelsson-Skogsberg, Å., Hedén, L. E., Lindahl, B. & Laakso, K. (2018). 'I'm almost never sick': Everyday life experiences of children and young people with home mechanical ventilation.. Journal of Child Health Care, 1(13)
Open this publication in new window or tab >>'I'm almost never sick': Everyday life experiences of children and young people with home mechanical ventilation.
2018 (English)In: Journal of Child Health Care, ISSN 1367-4935, E-ISSN 1741-2889, Vol. 1, no 13Article in journal (Refereed) Published
Abstract [en]

Developments in medical technology and treatment have increased the survival rates of children with serious illnesses or injuries, including those receiving home mechanical ventilation, which is a small but growing group. The aim of this study was to explore everyday life experiences of children and young people living with home mechanical ventilation (HMV). Data were obtained through interviews with nine participants. The interviews were supported by photovoice methodology: photographs taken by the participants before or during the interviews were used to facilitate conversation. Interview data were analyzed using qualitative content analysis. The findings revealed that everyday life on a ventilator can be described as including power but simultaneously as characterized by vulnerability to the outside world, comparable to balancing on a tightrope. Various types of technology, both information and communication technology (ICT) and vital medical technology, enabled the participants to engage with the world around them. This study contributes knowledge about the experiences of children and young people with HMV, who depict their lives as good and valuable. The study also underscores, when designing plans and home support, it is necessary to take a sensible approach to personal experiences of what a good life is and what resources are needed to attain and maintain health.

National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:hb:diva-13611 (URN)10.1177/1367493517749328 (DOI)000429864300002 ()29298495 (PubMedID)2-s2.0-85042497737 (Scopus ID)
Available from: 2018-02-01 Created: 2018-02-01 Last updated: 2018-12-21Bibliographically approved
Sundler, A. J., Johansson, E., Johansson, L. & Hedén, L. E. (2018). Incidents reported by nurse anesthetists in the operating room. Journal of Interprofessional Care
Open this publication in new window or tab >>Incidents reported by nurse anesthetists in the operating room
2018 (English)In: Journal of Interprofessional Care, ISSN 1356-1820, E-ISSN 1469-9567Article in journal (Refereed) Published
Abstract [en]

The quality of health care and patient safety in the operating room is a major concern for nurse anaesthetists. However, few studies have focused on the experiences of nurse anaesthetists’ and their contributions to safety in this setting. Therefore, this study aims to explore the content and frequency of incidents reported by nurse anaesthetists in the operating room and the risks involved in these incidents. A retrospective study with a descriptive design was conduct. Data were gathered concerning 220 incidents reported by nurse anaesthetists from 2012 to 2015 in operating rooms at a middle-sized hospital in Sweden. These were analysed with a method for qualitative and quantitative content analysis. The findings are presented in five categories: communication and teamwork; routines and guidelines; patient care; nurses’ work environment; devices, materials and technologies. In 184 (73%) of the incidents, there was either a risk of harm or there was an actual harm to patients or nurses. Of all incidents only 23 (10%) had harmed patients or nurses. Few of these incidents involved patient harm (= 6), while a greater number involved harm to nurses (= 17). The findings reveal lack of communication and interprofessional teamwork as the two most common areas for the reported incidents, followed by problems related to lack of compliance with guidelines and routines. The findings suggest that strategies are needed to improve these areas. Patient safety reporting systems may be important to identify risk in preventing patients and health care professionals from being harmed. In addition, the findings indicate that the nurses sought to prevent harm to patients rather than to themselves. Consequently, increased attention to the work environments of nurses, and most likely other professionals, in the operating room may be needed to prevent health care professionals from being harmed.

Keywords
incidents, patient safety, quality improvement, nurses, operating room, content analysis
National Category
Nursing
Research subject
Människan i vården
Identifiers
urn:nbn:se:hb:diva-15143 (URN)10.1080/13561820.2018.1500452 (DOI)30040519 (PubMedID)2-s2.0-85050536779 (Scopus ID)
Available from: 2018-10-04 Created: 2018-10-04 Last updated: 2018-10-05Bibliographically approved
Berglund, M., Nässén, K., Hedén, L. & Gillsjö, C. (2016). Older Adults' Experiences of Reflective STRENGTH-Giving Dialogues: An Interview Study.. Journal of Gerontology & Geriatric Research
Open this publication in new window or tab >>Older Adults' Experiences of Reflective STRENGTH-Giving Dialogues: An Interview Study.
2016 (English)In: Journal of Gerontology & Geriatric Research, ISSN 2167-7182Article in journal (Refereed) Published
Abstract [en]

Background: A major health problem that frequently accompanies old age is long-term pain, but pain must be acknowledged by older adults and health care providers. Interventions are needed to alleviate pain and suffering while holistically providing health care that promotes wellbeing. The intervention project, Reflective STRENGTHGiving Dialogues© (STRENGTH) was implemented to increase health and wellbeing among community dwelling older adults living with long-term musculoskeletal pain at home. Aim: The aim of this study was to describe the older adults' experiences of the intervention Reflective STRENGTH-Giving Dialogue. Method: A life world hermeneutic approach was used in collection and analysis of data. Twenty community dwelling older adults participated were interviewed in their homes after the intervention. Findings: The findings consisted of five themes and showed that the older adults experienced the Reflective STRENGTH-Giving Dialogues as a continuous and trusting relationship that alleviates the pain and breaks the loneliness. They expressed it as a new way to talk about life with pain. The dialogues supported reflection and memory and resulted in a transition in orientation in life. Conclusion: The Reflective STRENGTH-Giving Dialogues helped the older adults to increase their intellectual, emotional, and physical engagement in daily living. The dialogues facilitated a transition in orientation from past to present, to the future, and from obstacles to opportunities. The dialogues were oriented towards enjoyments, meaning, courage and strength in life as a whole which promoted the older adults’ sense of well-being and vitality. The dialogues also facilitated carrying out small and large life projects. The Reflective STRENGTH-Giving Dialogues created a deepened caring relationship that contributed to an increased sense of security, strength and courage, all of which enhanced the potential for better health and wellbeing.

Keywords
Older adults, Long-term musculoskeletal pain, Home experience, Qualitative research
National Category
Medical and Health Sciences
Research subject
Människan i vården
Identifiers
urn:nbn:se:hb:diva-11872 (URN)10.4172/2167-7182.1000304 (DOI)
Available from: 2017-01-31 Created: 2017-01-31 Last updated: 2017-05-04Bibliographically approved
Hedén, L. & Åhlström, L. (2015). Individual response technology to promote active learning within the caring sciences: An experimental research study.. Nurse Education Today
Open this publication in new window or tab >>Individual response technology to promote active learning within the caring sciences: An experimental research study.
2015 (English)In: Nurse Education Today, ISSN 0260-6917, E-ISSN 1532-2793Article in journal (Refereed) Epub ahead of print
Abstract [en]

BACKGROUND: One major challenge in delivering lectures to large and diverse classes is the maintenance of a high standard of lecturing in order to engage students and increase their participation and involvement. The lecturer's assignment is to arrange and prepare the lecture before teaching, hence enabling students' enhanced learning. Individual response technology could encourage students' active learning and activate higher cognitive levels.

OBJECTIVES: The aim of this study was to evaluate individual response technology as a complement during lectures for students in higher education, in terms of the students' experiences of participation, engagement, and active learning. Also of interest was whether this technology can be considered a supportive technical system.

DESIGN: Data were collected through a questionnaire where levels of each condition were reported on a numeric rating scale (0-10) at baseline and after the introduction of individual response technology. To get a broader perspective, two types of lectures (pediatric and statistical) were included, giving a total of four assessment times.

PARTICIPANTS: The participants comprised 59 students in Bachelor of Nursing program at a Swedish metropolitan university.

RESULTS: Overall, when individual response technology was used, students reported increased experience of engagement (n=82, mean 6.1 vs. n=65, mean 7.3, p<0.001), participation (n=92, mean 6.1 vs. n=79, mean 7.7, p<0.001), and active learning (n=92, mean 7.3 vs. n=79, mean 8.2 p<0.001). Additionally, the students experienced this technology as a supportive technical system during lectures (mean 6.6 vs. mean 8.1, p<0.001).

CONCLUSIONS: The use of individual response technology during teaching is one way to enhance students' experiences of engagement, participation, and learning within the caring sciences.

National Category
Nursing Pedagogy
Research subject
Människan i vården
Identifiers
urn:nbn:se:hb:diva-4074 (URN)10.1016/j.nedt.2015.10.010 (DOI)000367117000034 ()26515492 (PubMedID)2-s2.0-84949933596 (Scopus ID)
Available from: 2016-01-08 Created: 2015-12-15 Last updated: 2018-12-21Bibliographically approved
Hedén, L., von Essen, L. & Ljungman, G. (2015). The relationship between fear and pain levels during needle procedures in children from the parents' perspective.. European Journal of Pain
Open this publication in new window or tab >>The relationship between fear and pain levels during needle procedures in children from the parents' perspective.
2015 (English)In: European Journal of Pain, ISSN 1090-3801, E-ISSN 1532-2149Article in journal (Refereed) Epub ahead of print
Abstract [en]

BACKGROUND: The primary objective was to determine the levels of and potential relationships between procedure-related fear and pain in children. Secondary objectives were to determine if there are associations between the child's age and sex, diagnostic group, time since diagnosis, time since last needle insertion, cortisol levels and the parent's fear level in relation to fear and pain.

METHODS: The child's level of pain and fear was reported by parents on 0-100 mm visual analogue scales (VAS). One hundred and fifty-one children were included consecutively when undergoing routine needle insertion into a subcutaneously implanted intravenous port. All children were subjected to one needle insertion following topical anaesthesia (EMLA) application. The effect of the child's age and sex, diagnostic group, time since diagnosis, time since last needle insertion, cortisol change levels and the parent's fear level, on fear and pain levels was investigated with multiple regression analysis.

RESULTS: The needle-related fear level (VAS mean 28 mm) was higher than the needle-related pain level (VAS mean 17 mm) when topical anaesthesia is used according to parents' reports (n = 151, p < 0.001). With fear as the dependent variable, age and pain were significantly associated and explained 33% of the variance, and with pain as the dependent variable, fear, parents' fear and change in cortisol level were significantly associated and explained 38% of the variance.

CONCLUSIONS: According to parents, children experienced more fear than pain during needle insertion when topical anaesthesia is used. Therefore, in addition to pain management, an extended focus on fear-reducing interventions is suggested for needle procedures.

National Category
Pediatrics Cancer and Oncology
Research subject
Människan i vården
Identifiers
urn:nbn:se:hb:diva-4073 (URN)10.1002/ejp.711 (DOI)000368819500008 ()25845466 (PubMedID)2-s2.0-84957839319 (Scopus ID)
Available from: 2016-01-08 Created: 2015-12-15 Last updated: 2018-12-07Bibliographically approved
Hedén, L., von Essen, L. & Ljungman, G. (2014). Effect of high-dose paracetamol on needle procedures in children with cancer: a RCT. Acta Paediatrica, 103(3), 314-319
Open this publication in new window or tab >>Effect of high-dose paracetamol on needle procedures in children with cancer: a RCT
2014 (English)In: Acta Paediatrica, ISSN 0803-5253, E-ISSN 1651-2227, Vol. 103, no 3, p. 314-319Article in journal (Refereed) Published
Abstract [en]

AIM: The aim was to investigate whether children experience less pain, fear and/or distress when they receive high-dose paracetamol compared with placebo, using a needle insertion in a subcutaneously implanted intravenous port as a model. METHODS: Fifty-one children ranging from 1 to 18 years of age being treated in a paediatric oncology setting were included consecutively when undergoing routine needle insertion into a subcutaneously implanted intravenous port. All children were subjected to one needle insertion following topical anaesthetic (EMLA) application in this double-blind, placebo-controlled RCT, comparing orally administered paracetamol (n = 24) 40 mg/kg body weight (max 2000 mg) with placebo (n = 27). The patients' pain, fear and distress were reported by parents, nurses and children (≥7 years of age) using 0- to 100-mm visual analogue scales (VAS). In addition, pain observation, procedure time and cortisol reduction were assessed. RESULTS: No differences between the paracetamol and the placebo group were found with respect to demographic characteristics. According to VAS reports, paracetamol did not reduce pain, fear and distress compared with placebo. Pain observation, cortisol reduction and procedure time did not differ between the study groups. CONCLUSION: Paracetamol provides no additive effect in reducing pain, fear and distress when combined with topical anaesthesia in children undergoing port needle insertion.

Place, publisher, year, edition, pages
Wiley-Blackwell Publishing Ltd., 2014
National Category
Cancer and Oncology Medical and Health Sciences
Research subject
Integrated Caring Science
Identifiers
urn:nbn:se:hb:diva-2046 (URN)10.1111/apa.12509 (DOI)24219618 (PubMedID)2320/14674 (Local ID)2320/14674 (Archive number)2320/14674 (OAI)
Available from: 2015-11-13 Created: 2015-11-13 Last updated: 2017-12-01Bibliographically approved
Hedén, L., Pöder, U., von Essen, L. & Ljungman, G. (2013). Parents' perceptions of their child's symptom burden during and after cancer treatment.. Journal of Pain and Symptom Management, 46(3)
Open this publication in new window or tab >>Parents' perceptions of their child's symptom burden during and after cancer treatment.
2013 (English)In: Journal of Pain and Symptom Management, ISSN 0885-3924, E-ISSN 1873-6513, Vol. 46, no 3Article in journal (Refereed) Published
Abstract [en]

CONTEXT: Previously reported studies of children with cancer mostly provide cross-sectional knowledge of the prevalence of symptoms but do not show when during the disease trajectory and after the end of successful treatment certain symptoms are most prevalent and/or distressing.

OBJECTIVES: The aim was to describe parents' perceptions of their child's symptom burden longitudinally during and after cancer treatment and to investigate whether parents' perceptions vary with child characteristics and parent gender.

METHODS: One hundred sixty parents (49% fathers) of 89 children answered a modified version of the Memorial Symptom Assessment Scale (MSAS) 10-18 at six different time points from one week after the child's diagnosis (T1) to 12-18 months after the end of successful treatment (T6).

RESULTS: Feeling drowsy, pain, and lack of energy are initially the most prevalent symptoms. During treatment, the most prevalent symptom is less hair than usual. Pain, feeling sad, and nausea are initially the most distressing symptoms. Pain is both prevalent and distressing throughout the treatment. The child's symptom burden decreases over time. There is no difference regarding the reported symptom burden between the parents of a daughter or a son, or parents of a child older or younger than seven years of age. Mothers' and fathers' assessments of the symptom number, total MSAS and the subscales, are associated, but mothers' assessments are often higher than fathers' assessments.

CONCLUSION: The prevalence and distress of symptoms and symptom burden decrease over time. However, even though the cancer is cured, feeling sad is reported as being prevalent and psychological distress is an issue. A dialogue between staff and the family about distressing symptoms and when they can be expected may increase acceptance and adaptation in children and parents during the disease trajectory.

National Category
Cancer and Oncology Pediatrics
Identifiers
urn:nbn:se:hb:diva-4072 (URN)10.1016/j.jpainsymman.2012.09.012 (DOI)000324026700006 ()23498966 (PubMedID)2-s2.0-84888643928 (Scopus ID)
Available from: 2016-01-08 Created: 2015-12-15 Last updated: 2018-04-20Bibliographically approved
Hedén, L. E., von Essen, L. & Ljungman, G. (2011). Effect of morphine in needle procedures in children with cancer.. European Journal of Pain, 15(10)
Open this publication in new window or tab >>Effect of morphine in needle procedures in children with cancer.
2011 (English)In: European Journal of Pain, ISSN 1090-3801, E-ISSN 1532-2149, Vol. 15, no 10Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: The aim was to investigate whether children experience less fear, distress, and/or pain when they receive oral morphine vs. placebo before a needle is inserted in a subcutaneously implanted intravenous port when combined with topical anesthesia.

METHOD: Fifty children 1-18 years of age who were treated in a pediatric oncology and hematology setting were included consecutively when undergoing routine needle insertion into an intravenous port. All children were subjected to one needle insertion following topical anesthetic (EMLA) application in this randomized, triple-blind, placebo-controlled study comparing orally administered morphine (n=26) 0.25 mg/kg body weight with placebo (n=24). The patients' fear, distress, and pain were reported by parents, nurses and the children themselves (if ≥ 7 years of age) on 0-100 mm Visual Analogue Scales. In addition, observational methods were used to measure distress and procedure pain.

RESULTS: No differences between the morphine and the placebo group were found with respect to age, weight, height, physical status, sex, weeks from diagnosis, or weeks from latest needle insertion. According to, parents, nurses, and children, oral morphine at a dose of 0.25 mg/kg body weight did not reduce fear, distress or pain compared with placebo.

CONCLUSION: We could not reject the null hypothesis that there is no difference between the oral morphine and placebo groups assuming an effect size of 15 mm on VAS. Therefore it seems that oral morphine at 0.25 mg/kg does not give any additional reduction of fear, distress or pain compared with placebo when combined with topical anesthesia in pediatric patients undergoing subcutaneous port needle insertion, and would not be expected to be of any advantage for similar procedures such as venipuncture and venous cannulation when topical anesthesia is used.

National Category
Cancer and Oncology Pediatrics
Identifiers
urn:nbn:se:hb:diva-4070 (URN)10.1016/j.ejpain.2011.05.010 (DOI)21680210 (PubMedID)
Available from: 2016-01-08 Created: 2015-12-15 Last updated: 2018-04-20Bibliographically approved
Hedén, L. E., von Essen, L., Frykholm, P. & Ljungman, G. (2009). Low-dose oral midazolam reduces fear and distress during needle procedures in children with cancer. Pediatric Blood & Cancer
Open this publication in new window or tab >>Low-dose oral midazolam reduces fear and distress during needle procedures in children with cancer
2009 (English)In: Pediatric Blood & Cancer, ISSN 1545-5009, E-ISSN 1545-5017Article in journal (Refereed) Published
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:hb:diva-13612 (URN)10.1002/pbc.22233 (DOI)000271363800006000271363800006 ()19688837 (PubMedID)2-s2.0-70449729869 (Scopus ID)
Available from: 2018-02-01 Created: 2018-02-01 Last updated: 2018-05-04Bibliographically approved
Hedén, L. E., von Essen, L. & Ljungman, G. (2009). Randomized interventions for needle procedures in children with cancer. European Journal of Cancer Care
Open this publication in new window or tab >>Randomized interventions for needle procedures in children with cancer
2009 (English)In: European Journal of Cancer Care, ISSN 0961-5423, E-ISSN 1365-2354Article in journal (Refereed) Published
Abstract [en]

Twenty-eight children, 2-7 years, cared for at a paediatric oncology unit, undergoing a routine needle insertion in an intravenous port were included consecutively. All children were subjected to two needle insertions; at the first they received standard care, and at the second standard care + a randomized intervention. Parents and nurses assessed children's fear, distress and pain on 0-100 mm visual analogue scales. According to parents' report, children experienced less fear when subjected to intervention vs. standard care reported by parents (P < 0.001). Children also experienced less fear (P < 0.05) and distress (P < 0.05) when subjected to standard care + blowing soap bubbles vs. standard care (n = 14), and less fear when subjected to standard care + heated pillow vs. standard care (P < 0.05). Nurses' reports did not show any differences for standard care + intervention vs. standard care. Blowing soap bubbles or having a heated pillow is more effective than standard care in reducing children's fear and distress in needle procedures, according to parents' report.

National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:hb:diva-13613 (URN)10.1111/j.1365-2354.2008.00939.x (DOI)000267538700006 ()19040458 (PubMedID)2-s2.0-68149163240 (Scopus ID)
Available from: 2018-02-01 Created: 2018-02-01 Last updated: 2018-05-04Bibliographically approved
Organisations
Identifiers
ORCID iD: ORCID iD iconorcid.org/0000-0001-7067-2687

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