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  • 1.
    Bazzi, M.
    et al.
    Institute of Health and Care Sciences, Sahlgrenska Academy at Gothenburg University, Gothenburg, Sweden.
    Fridh, Isabell
    University of Borås, Faculty of Caring Science, Work Life and Social Welfare. Department of Anesthesiology and Intensive Care, Sahlgrenska University Hospital, Gothenburg, Sweden.
    Ahlberg, K.
    Institute of Health and Care Sciences, Sahlgrenska Academy at Gothenburg University, Gothenburg, Sweden.
    Bergbom, I.
    Institute of Health and Care Sciences, Sahlgrenska Academy at Gothenburg University, Gothenburg, Sweden.
    Hellström, M.
    Department of Radiology, Sahlgrenska University Hospital and Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden.
    Lundèn, M.
    Institute of Health and Care Sciences, Sahlgrenska Academy at Gothenburg University, Gothenburg, Sweden.
    Collaboration in the Hybrid Operating Room: A Focus Group Study From the Perspective of the Nursing Staff2021In: Journal of Radiology Nursing, ISSN 1546-0843, E-ISSN 1555-9912Article in journal (Refereed)
    Abstract [en]

    Technical advancements in the operating room setting continue, and the concept of the hybrid operating room is promoted and accepted worldwide. The hybrid setting means inclusion of radiology in the already complex environment of a traditional operating room. Collaboration in this type of environment becomes essential and investigating how the nursing staff experiences this collaboration in the hybrid operating room is needed. The aim of the study was to investigate how the nursing staff from the specialties of surgery, anesthesiology, and radiology experienced collaborating in a hybrid operating room. Explorative qualitative design was used. Five focus groups consisting of operating room nurses, operating room assistant nurses, nurse anesthetists, assistant nurse anesthetists, and radiographers were included in the study. Interviews using semistructured questions were conducted. Directive content analysis was used for the data analysis. The following categories revealed: (1) different patient safety perspectives; (2) responsibilities being shared and divided; (3) collaboration becoming better over time; (4) uneven division of labor in a strained work situation and different terms of employment; (5) lack of education and joint meetings; and (6) environmental constraints for satisfying collaboration. The nursing staff in the hybrid operating room highlighted they worked toward a common goal but prioritized their own specific tasks rather than the procedure as a whole. This, together with the uneven task distribution and unclear responsibilities, could create tension between the different staff categories, impacting procedures negatively. The results revealed the importance of proper preparation of the staff to work in the hybrid operating room. Having team building activities, common meetings, relevant training to meet educational needs, and adjusting the team composition could improve hybrid operating room collaboration and improve patient safety and outcomes. 

  • 2.
    Bazzi, May
    et al.
    Gothenburg University.
    Bergbom, Ingegerd
    Gothenburg University.
    Hellström, Mikael
    Gothenburg University and Sahlgrenska University Hospital.
    Fridh, Isabell
    University of Borås, Faculty of Caring Science, Work Life and Social Welfare.
    Ahlberg, Karin
    Gothenburg University.
    Lundgren, Solveig M
    Gothenburg University.
    Team composition and staff roles in a hybrid operating room: A prospective study using video observations.2019In: Nursing Open, E-ISSN 2054-1058, Vol. 6, no 3, p. 1245-1253Article in journal (Refereed)
    Abstract [en]

    Aim: The aim of the study was to evaluate team composition and staff roles in a hybrid operating room during endovascular aortic repairs.

    Design: Quantitative descriptive design.

    Methods: Nine endovascular aortic repairs procedures were video-recorded between December 2014 and September 2015. The data analysis involved examining the work process, number of people in the room and categories of staff and their involvement in the procedure.

    Results: The procedures were divided into four phases. The hybrid operating room was most crowded in phase 3 when the skin wound was open. Some staff categories were in the room for the entire procedure even if they were not actively involved. The largest number of people simultaneously in the room was 14.

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  • 3.
    Bazzi, May
    et al.
    Gothenburg University.
    Lundgren, Solveig M
    Gothenburg University.
    Hellström, Mikael
    Gothenburg University and Sahlgrenska University Hospital.
    Fridh, Isabell
    University of Borås, Faculty of Caring Science, Work Life and Social Welfare.
    Ahlberg, Karin
    Gotehnburg University.
    Bergbom, Ingegerd
    Gothenburg University.
    The drama in the hybrid OR: video observations of work processes and staff collaboration during endovascular aortic repair.2019In: Journal of Multidisciplinary Healthcare, ISSN 1178-2390, E-ISSN 1178-2390, Vol. 12, p. 453-464Article in journal (Refereed)
    Abstract [en]

    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.

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  • 4.
    Bazzi, May
    et al.
    Institute of Health and Care Sciences, Sahlgrenska Academy at Gothenburg University, Gothenburg, Sweden..
    Lundèn, Maud
    Institute of Health and Care Sciences, Sahlgrenska Academy at Gothenburg University, Gothenburg, Sweden..
    Ahlberg, Karin
    Institute of Health and Care Sciences, Sahlgrenska Academy at Gothenburg University, Gothenburg, Sweden..
    Bergbom, Ingegerd
    Institute of Health and Care Sciences, Sahlgrenska Academy at Gothenburg University, Gothenburg, Sweden..
    Hellström, Mikael
    Institute of Health and Care Sciences, Sahlgrenska Academy at Gothenburg University, Gothenburg, Sweden..
    Lundgren, Solveig M
    Department of Radiology, Sahlgrenska University Hospital and Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden..
    Fridh, Isabell
    University of Borås, Faculty of Caring Science, Work Life and Social Welfare. Department of Anesthesiology and Intensive Care, Sahlgrenska University Hospital, Gothenburg, Sweden.
    Patients' lived experiences of waiting for and undergoing endovascular aortic repair in a hybrid operating room: A qualitative study.2020In: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702, Vol. 29, no 5-6, p. 810-820Article in journal (Refereed)
    Abstract [en]

    AIMS AND OBJECTIVES: The overall aim of the study was to illuminate the patients' lived experiences of waiting for and undergoing an endovascular aortic repair (EVAR) in a hybrid operating room (OR).

    BACKGROUND: The hybrid OR is an example of the technological advancements within hospitals. The environmental impact on humans is well recognised but is rarely taken into account when hospitals are designed or rebuilt. The patient's experience of a hybrid OR is not earlier described.

    DESIGN: A qualitative design based on hermeneutic phenomenology was implemented.

    METHODS: Interviews were conducted with 18 patients. A thematic interpretation based on van Manen's approach was then used to analyse the findings. The consolidated criteria for reporting qualitative studies (COREQ) were used (Data S1).

    RESULTS: The following three themes emerged from the interviews: (a) being scheduled for surgery induced both anxiety and hopefulness; (b) feeling watched over and surrendering to others in the technology intense environment and (c) feeling relief but unexpected exhaustion after surgery. In the discussion, the results were additionally reflected upon out from the four lifeworld existentials: lived body, lived space, lived time and lived others.

    CONCLUSIONS: The hybrid OR technology did not frighten the patients, but it was also not an environment that promoted or was conductive to having a dialogue with the staff. The disease and surgery brought feelings of anxiety, which was largely associated with the uncertainty of the situation. We suggest that continuity in contact with staff and patient-centred information could be solutions to further calm the patients.

    RELEVANCE TO CLINICAL PRACTICE: The hybrid OR environment itself did not seem to frighten the patient, but the way the high-tech environment increased the distance between the patient and the multiple staff members needs further investigation.

  • 5.
    Björk, Kristofer
    et al.
    University of Borås, Faculty of Caring Science, Work Life and Social Welfare. Department of Intensive Care Northern Älvsborg Hospital.
    Lindahl, Berit
    University of Borås, Faculty of Caring Science, Work Life and Social Welfare.
    Fridh, Isabell
    University of Borås, Faculty of Caring Science, Work Life and Social Welfare.
    Family members’ experiences of waiting in intensive care: a concept analysis2019In: Scandinavian Journal of Caring Sciences, ISSN 0283-9318, E-ISSN 1471-6712, p. 1-18Article in journal (Refereed)
    Abstract [en]

    AIM:

    The aim of this study was to explore the meaning of family members' experience of waiting in an intensive care context using Rodgers' evolutionary method of concept analysis.

    METHOD:

    Systematic searches in CINAHL and PubMed retrieved 38 articles which illustrated the waiting experienced by family members in an intensive care context. Rodgers' evolutionary method of concept analysis was applied to the data.

    FINDINGS:

    In total, five elements of the concept were identified in the analysis. These were as follows: living in limbo; feeling helpless and powerless; hoping; enduring; and fearing the worst. Family members' vigilance regarding their relative proved to be a related concept, but vigilance does not share the same set of attributes. The consequences of waiting were often negative for the relatives and caused them suffering. The references show that the concept was manifested in different situations and in intensive care units (ICUs) with various types of specialties.

    CONCLUSIONS:

    The application of concept analysis has brought a deeper understanding and meaning to the experience of waiting among family members in an intensive care context. This may provide professionals with an awareness of how to take care of family members in this situation. The waiting is inevitable, but improved communication between the ICU staff and family members is necessary to reduce stress and alleviate the suffering of family members. It is important to acknowledge that waiting cannot be eliminated but family-centred care, including a friendly and welcoming hospital environment, can ease the burden of family members with a loved one in an ICU.

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  • 6.
    Engwall, Marie
    et al.
    University of Borås, School of Health Science.
    Bergbom, Ingegerd
    University of Borås, School of Health Science.
    Fridh, Isabell
    University of Borås, School of Health Science. University of Borås, Faculty of Caring Science, Work Life and Social Welfare.
    Lindahl, Berit
    University of Borås, School of Health Science.
    Let there be light and darkness: findings from a prestudy concerning cycled light in the intensive care unit environment.2014In: Critical Care Nursing Quarterly, ISSN 0887-9303, E-ISSN 1550-5111, Vol. 37, no 3, p. 273-298Article in journal (Refereed)
    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.

  • 7.
    Engwall, Marie
    et al.
    University of Borås, Faculty of Caring Science, Work Life and Social Welfare.
    Fridh, Isabell
    University of Borås, Faculty of Caring Science, Work Life and Social Welfare.
    Johansson, Lotta
    Bergbom, Ingegerd
    University of Borås, Faculty of Caring Science, Work Life and Social Welfare.
    Lindahl, Berit
    University of Borås, Faculty of Caring Science, Work Life and Social Welfare.
    Lighting, sleep and circadian rhythm: An intervention study in the intensive care unit.2015In: Intensive & Critical Care Nursing, ISSN 0964-3397, E-ISSN 1532-4036, Vol. 31, no 6, p. 325-335Article in journal (Refereed)
    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.

  • 8.
    Engwall, Marie
    et al.
    University of Borås, Faculty of Caring Science, Work Life and Social Welfare. Sahlgrenska University Hospital.
    Fridh, Isabell
    University of Borås, Faculty of Caring Science, Work Life and Social Welfare.
    Jutengren, Göran
    University of Borås, Faculty of Caring Science, Work Life and Social Welfare.
    Bergbom, Ingegerd
    University of Borås, Faculty of Caring Science, Work Life and Social Welfare. Sahlgrenska University Hospital.
    Sterner, Anders
    University of Borås, Faculty of Caring Science, Work Life and Social Welfare.
    Lindahl, Berit
    University of Borås, Faculty of Caring Science, Work Life and Social Welfare. Sahlgrenska University Hospital.
    The effect of cycled lighting in the intensive care unit on sleep, activity and physiological parameters: A pilot study2017In: 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)
    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.

  • 9.
    Engwall, Marie
    et al.
    Högskolan Väst.
    Jutengren, Göran
    Østfold University College.
    Bergbom, Ingegerd
    Göteborgs universitet.
    Lindahl, Berit
    Lunds universitet.
    Fridh, Isabell
    University of Borås, Faculty of Caring Science, Work Life and Social Welfare.
    Patients' Self-Reported Recovery After an Environmental Intervention Aimed to Support Patient's Circadian Rhythm in Intensive Care2021In: Health Environments Research & Design Journal, ISSN 1937-5867, E-ISSN 2167-5112, Vol. 14, no 4, article id 19375867211001541Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Patients in intensive care units (ICUs) are among the most vulnerable, and they require support to start their recovery. The design of the patient area in the ICU can play a prominent role in both the quality of care and patients' recovery. The lighting environment has the opportunity to restore and strengthen the natural human circadian rhythm and health.

    AIM: To evaluate patients' self-reported recovery after being cared for in an ICU room rebuilt according to evidence-based design principles that promote recovery.

    METHOD: An intervention was set up in a two-bed patient room including a cycled lighting system. Self-reported recovery was reported at 6 and 12 months after discharge. Data were analyzed using a 2(mechanically ventilated, nonmechanically ventilated) × 2(intervention room, ordinary room) analysis of covariance (ANCOVA) and 2(male, women) × 2(intervention room, ordinary room) ANCOVA.

    RESULTS: Data from the different rooms showed no significant main effects for recovery after 6 months, p = .21; however, after 12 months, it become significant, p. < .05. This indicated that patient recovery was positively influenced for patients cared for in the intervention room (M = 8.88, SD = 4.07) compared to the ordinary room (M = 10.90, SD = 4.26). There were no interaction effects for gender or if the patients had been mechanically ventilated either at 6 or 12 months' postdischarge.

    CONCLUSIONS: A cycled lighting system may improve patient self-reported recovery after ICU care; however, more research on the topic is needed.

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  • 10.
    Falk, Hanna
    et al.
    The Sahlgrenska Academy, University of Gothenburg.
    Henoch, Ingela
    University of Gothenburg.
    Ozanne, Anneli
    The Sahlgrenska Academy, University of Gothenburg.
    Öhlen, Joakim
    The Sahlgrenska Academy, University of Gothenburg.
    Ung, Eva Jakobsson
    The Sahlgrenska Academy, University of Gothenburg.
    Fridh, Isabell
    University of Borås, Faculty of Caring Science, Work Life and Social Welfare.
    Sarenmalm, Elisabeth Kenne
    Skaraborg Hospital.
    Falk, Kristin
    University of Gothenburg.
    Differences in Symptom Distress Based on Gender and Palliative Care Designation Among Hospitalized Patients.2016In: Journal of Nursing Scholarship, ISSN 1527-6546, E-ISSN 1547-5069, Vol. 48, no 6, p. 569-576Article in journal (Refereed)
    Abstract [en]

    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 chi-square 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.

  • 11. Flodén, Anne
    et al.
    Lennerling, Annette
    Fridh, Isabell
    University of Borås, Faculty of Caring Science, Work Life and Social Welfare.
    Rizell, Magnus
    Forsberg, Anna
    Development and Psychometric Evaluation of the Instrument: Attitudes Towards Organ Donor Advocacy Scale (ATODAS).2011In: Open Nursing Journal, E-ISSN 1874-4346, Vol. 5, p. 65-73Article in journal (Refereed)
    Abstract [en]

    The consequences of advocacy in nursing are critical when caring for a potential organ donor. No specific instrument has been available to measure attitudes toward organ donor advocacy. The aim of this study was to develop and psychometrically evaluate an instrument for measuring intensive and critical care (ICU) nurses' attitudes toward organ donor advocacy. The study was conducted in two stages: instrument development and instrument evaluation and refinement. A questionnaire was developed (Attitude Toward Organ Donor Advocacy Scale (ATODAS)), which was sent to half of all nurses working in ICUs (general-, neuro-, thoracic- or paediatric-) in Sweden (n=1180). The final response rate was 42.5% (n=502). In order to explore validity and reliability, the expected scale dimensionality of the questionnaire was examined both by explorative principal component analysis (with oblique, varimax rotation) and by confirmatory multi-trait analysis. The confirmatory factor analysis indicated that the ATODAS could best be explained by five factors; Attitudes toward championing organ donation at a structural hospital level; Attitudes toward championing organ donation at a political and research level; Attitudes toward actively and personally safeguarding the will and wishes of the potential organ donor, Attitudes toward safeguarding the potential donor's will and wishes by a professional approach and Attitudes toward safeguarding the will and wishes of the relatives. This initial testing indicated that the ATODAS has good psychometric properties and can be used in future research to explore if interventions may influence attitudes and behaviors related to organ donor advocacy.

  • 12. Forsberg, Anna
    et al.
    Cavallini, Josefine
    Fridh, Isabell
    University of Borås, Faculty of Caring Science, Work Life and Social Welfare.
    Lennerling, Annette
    The core of social function after solid organ transplantation.2015In: Scandinavian Journal of Caring Sciences, ISSN 0283-9318, E-ISSN 1471-6712Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Social function is a key aspect of health-related quality of life after solid organ transplantation (SOT). The focus of this study was to report how solid organ-transplanted patients change their social function after transplantation.

    AIM: To investigate the main concerns associated with social function after SOT and how solid organ transplant recipients (SOTRs) deal with these concerns.

    METHOD: Twenty SOTRs, 13 men and 7 women, with a mean age of 54 years (range 22-75 years) and due for their first-year follow-up were included in this study. The informants had received various types of solid organs. Data were collected through in-depth interviews, which were recorded and transcribed verbatim for analysis by the method of grounded theory (GT) developed by Charmaz.

    RESULT: The GT of this study describes the efforts by the 20 SOTRs to adapt socially in order to maintain their social functioning and leading a normal life. The efforts summaries a process wherein the generated GT is present through three main categories: deconstruction, restriction and reconstruction, showing various ways to socially adapt. Through this process, a clear path of transition through adaptation is evident, starting before transplantation and continues beyond the first year after transplantation.

    CONCLUSION: Social functions improved through a process of adaptation during the first year after transplantation. Working and travelling were the two most important aspects of social function. All the informants emphasised the importance of regaining a normal life, which was the outcome of a successful adaptation.

  • 13. Forsberg, Anna
    et al.
    Flodén, Anne
    Lennerling, Annette
    Karlsson, Veronika
    Nilsson, Madeleine
    Fridh, Isabell
    University of Borås, School of Health Science.
    The core of after death in relation to organ donation: A grounded theory study2014In: Intensive & Critical Care Nursing, ISSN 0964-3397, E-ISSN 1532-4036, Vol. 30, no 5, p. 275-282Article in journal (Refereed)
    Abstract [en]

    OBJECTIVES: The aim of this study was to investigate how intensive and critical care nurses experience and deal with after death care i.e. the period from notification of a possible brain dead person, and thereby a possible organ donor, to the time of post-mortem farewell. RESEARCH METHODOLOGY: Grounded theory, based on Charmaz' framework, was used to explore what characterises the ICU-nurses concerns during the process of after death and how they handle it. Data was collected from open-ended interviews. FINDINGS: The core category: achieving a basis for organ donation through dignified and respectful care of the deceased person and the close relatives highlights the main concern of the 29 informants. This concern is categorised into four main areas: safeguarding the dignity of the deceased person, respecting the relatives, dignified and respectful care, enabling a dignified farewell. CONCLUSION: After death care requires the provision of intense, technical, medical and nursing interventions to enable organ donation from a deceased person. It is achieved by extensive nursing efforts to preserve and safeguard the dignity of and respect for the deceased person and the close relatives, within an atmosphere of peace and tranquillity.

  • 14. Forsberg, Anna
    et al.
    Lennerling, Annette
    Fridh, Isabell
    University of Borås, Faculty of Caring Science, Work Life and Social Welfare.
    Karlsson, Veronika
    Nilsson, Madeleine
    Understanding the Perceived Threat of the Risk of Graft Rejections: A Middle-Range Theory2015In: Global Qualitative Nursing Research, ISSN 2333-3936, Vol. 2Article in journal (Refereed)
    Abstract [en]

    From a clinical viewpoint, graft rejection is one of the greatest threats faced by an organ transplant recipient (OTR). We propose a middle-range theory (MRT) of Perceived Threat of the Risk of Graft Rejection (PTRGR) as a contribution to the practice of transplant nursing. It could also apply to the detection of risky protective behavior, that is, isolation, avoidance, or non-adherence. The proposed MRT covers the following concepts and the relationship between them: transplant care needs, threat reducing interventions, intervening variables, level of PTRGR, protective strategies, and evidence-based practice. Parts of this theory have been empirically tested and support the suggested relationship between some of the concepts. Further tests are needed to strengthen the theoretical links. The conceptual framework might serve as a guide for transplant nurses in their efforts to promote post-transplant health and reduce threat-induced emotions.

  • 15. Forsberg, Anna
    et al.
    Lennerling, Annette
    Fridh, Isabell
    University of Borås, Faculty of Caring Science, Work Life and Social Welfare.
    Rizell, Magnus
    Lovén, Charlotte
    Flodén, Anne
    Attitudes towards organ donor advocacy among Swedish intensive care nurses.2015In: Nursing in Critical Care, ISSN 1362-1017, E-ISSN 1478-5153, Vol. 20, no 3Article in journal (Refereed)
    Abstract [en]

    OBJECTIVES: To explore the attitudes of Swedish intensive care nurses towards organ donor advocacy.

    BACKGROUND: The concept of organ donor advocacy is critical to nurses who care for potential donors in order to facilitate organ donation (OD).

    DESIGN: A retrospective cross-sectional study was employed.

    METHODS: Inclusion criteria in this survey were to be a registered nurse and to work in a Swedish intensive care unit (ICU). Participants were identified by the Swedish association of health professionals. A number of 502 Swedish ICU nurses answered the 32-item questionnaire Attitudes Towards Organ Donor Advocacy Scale (ATODAS), covering the five dimensions of organ donor advocacy: attitudes towards championing organ donation at a structural hospital level, or at a political and research level, attitudes towards actively and personally safeguarding the will and wishes of the potential organ donor, or by using a more professional approach and finally to safeguard the will and wishes of the relatives. Data were analysed with the SPSS version 18·0 and the results were assessed by using Student's t-test and post hoc test, analysis of variance (ANOVA), χ(2) , Pearson's correlation and regression analysis.

    RESULTS: The most favoured advocacy action was safeguarding the POD's will and wishes by a professional approach, closely followed by actively and personally safeguarding the POD's will and wishes. Nurses at local hospitals reported a more positive attitude towards organ donor advocacy overall compared with nurses at larger regional or university hospitals. Important factors leading to positive attitudes were seniority, working experience, participating in conversations with relatives, caring for brain-dead persons and private experiences from OD or organ transplantation.

    CONCLUSIONS: Intensive and critical care nurses with short working experience in university hospitals showed the least positive attitude towards organ donor advocacy. This is problematic because many ODs and all transplantations are performed in university hospitals.

    RELEVANCE TO CLINICAL PRACTICE: This study emphasizes the importance of organizing the care of PODs and their relatives in a way that promotes advocacy.

  • 16.
    Fridh, Isabell
    University of Borås, School of Health Science.
    Caring for the dying patient in the ICU: The past, present and the future2014In: Intensive & Critical Care Nursing, ISSN 0964-3397, E-ISSN 1532-4036, Vol. 30, no 6, p. 306-311Article in journal (Refereed)
    Abstract [en]

    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 ones. It is therefore important that ICU nurses are aware of families' needs when a loved one is dying and that follow-up services are appreciated by bereaved family members. Ethical challenges are related to changed sedation practices, organ donation, globalisation and cultural sensitivity.

  • 17.
    Fridh, Isabell
    University of Borås, Faculty of Caring Science, Work Life and Social Welfare.
    Etik och palliativ vård inom intensivvård2021In: AnIva VENTILEN, Vol. 55, no 3, p. 6-9Article in journal (Other academic)
  • 18.
    Fridh, Isabell
    University of Borås, School of Health Science.
    Intensivvårdsmiljöer med plats för omtanke2014In: Vårdmiljöns betydelse / [ed] Helle Wijk, Studentlitteratur , 2014, p. 87-99Chapter in book (Other academic)
  • 19.
    Fridh, Isabell
    University of Borås, School of Health Science.
    Vaka2012In: Vårdvetenskapliga begrepp i teori och praktik / [ed] Lena Wiklund Gustin, Ingegerd Bergbom, Studentlitteratur , 2012, p. 449-459Chapter in book (Other academic)
  • 20.
    Fridh, Isabell
    University of Borås, Faculty of Caring Science, Work Life and Social Welfare.
    Vaka och vakandet2017In: Vårdvetenskapliga begrepp i teori och praktik / [ed] Lena Wiklund-Gustin, Ingegerd Bergbom, Lund: Studentlitteratur AB, 2017, 2, p. 427-435Chapter in book (Other academic)
  • 21.
    Fridh, Isabell
    et al.
    University of Borås, Faculty of Caring Science, Work Life and Social Welfare. Institutionen för vårdvetenskap och hälsa, Sahlgrenska akademin, Göteborgs universitet.
    Bergbom, Ingegerd
    University of Borås, Faculty of Caring Science, Work Life and Social Welfare.
    Att vaka — en begreppsanalytisk studie2006In: Nordic journal of nursing research, ISSN 2057-1585, E-ISSN 2057-1593, Vol. 26, no 1, p. 4-8Article in journal (Refereed)
  • 22.
    Fridh, Isabell
    et al.
    Institutionen för vårdvetenskap och hälsa, Sahlgrenska akademin, Göteborgs universitet.
    Forsberg, A
    Bergbom, Ingegerd
    University of Borås, Faculty of Caring Science, Work Life and Social Welfare.
    Family presence and environmental factors at the time of a patient's death in an ICU.2007In: Acta Anaesthesiologica Scandinavica, ISSN 0001-5172, E-ISSN 1399-6576, Vol. 51, no 4, p. 395-401Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: In an intensive care unit (ICU), privacy and proximity are reported to be important needs of dying patients and their family members. It is assumed that good communication between the ICU team and families about end-of-life decisions improves the possibilities of meeting families' needs, thus guaranteeing a dignified and peaceful death in accordance with end-of-life care guidelines. The aim of this study was to explore the circumstances under which patients die in Swedish ICUs by reporting on the presence of family and whether patients die in private or shared rooms. An additional aim was to investigate the frequency of end-of-life decisions and whether nurses and family members were informed about such decisions.

    METHODS: A questionnaire based on the research questions was completed when a patient died in the 10 ICUs included in the study. Data were collected on 192 deaths.

    RESULTS: Forty per cent of the patients died without a next of kin at the bedside and 46% of deaths occurred in a shared room. This number decreased to 37% if a family member was present. Patients without a family member at their bedside received less analgesics and sedatives. There was a significant relationship between family presence, expected death and end-of-life decisions.

    CONCLUSIONS: The results indicate the necessity of improving the ICU environment to promote the need for proximity and privacy for dying patients and their families. The study also highlights the risk of underestimating the needs of patients without a next of kin at their bedside at the time of death.

  • 23.
    Fridh, Isabell
    et al.
    University of Borås, Faculty of Caring Science, Work Life and Social Welfare.
    Forsberg, Anna
    Lund University.
    A new tool to assess relatives' experience of death and dying in the intensive care unit.2016In: Journal of Thoracic Disease, ISSN 2072-1439, E-ISSN 2077-6624, Vol. 8, no 8, p. 781-783Article in journal (Refereed)
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  • 24.
    Fridh, Isabell
    et al.
    Insitutionen för vårdvetenskap och hälsa, Sahlgrenska akademin, Göteborgs universitet.
    Forsberg, Anna
    Bergbom, Ingegerd
    Close relatives' experiences of caring and of the physical environment when a loved one dies in an ICU.2009In: Intensive & Critical Care Nursing, ISSN 0964-3397, E-ISSN 1532-4036, Vol. 25, no 3Article in journal (Refereed)
    Abstract [en]

    AIM: The aim of this study was to explore close relatives' experiences of caring and the physical environment when a loved one dies in an intensive care unit (ICU).

    METHOD: Interviews were conducted with 17 close relatives of 15 patients who had died in three adult ICUs. The interviews were analysed using a phenomenological-hermeneutic method.

    FINDINGS: The analysis resulted in seven themes; Being confronted with the threat of loss, Maintaining a vigil, Trusting the care, Adapting and trying to understand, Facing death, The need for privacy and togetherness and Experiencing reconciliation. The experience of a caring relationship was central, which meant that the carers piloted the close relatives past the hidden reefs and through the dark waters of the strange environment, unfamiliar technology, distressing information and waiting characterised by uncertainty. Not being piloted meant not being invited to enter into a caring relationship, not being allowed access to the dying loved one and not being assisted in interpreting information.

    CONCLUSION: The participants showed forbearance with the ICU-environment. Their dying loved one's serious condition and his or her dependence on the medical-technical equipment were experienced as more frightening than the equipment as such. Returning for a follow-up-visit provided an opportunity for reconciliation and relief from guilt.

  • 25.
    Fridh, Isabell
    et al.
    Instiutionen för vårdvetenskap och hälsa,Sahlgrenska akademin, Göteborgs universitet.
    Forsberg, Anna
    Bergbom, Ingegerd
    University of Borås, Faculty of Caring Science, Work Life and Social Welfare.
    Doing one's utmost: nurses' descriptions of caring for dying patients in an intensive care environment.2009In: Intensive & Critical Care Nursing, ISSN 0964-3397, E-ISSN 1532-4036, Vol. 25, no 5, p. 233-241Article in journal (Refereed)
    Abstract [en]

    AIM: The aim of this study was to explore nurses' experiences and perceptions of caring for dying patients in an intensive care unit (ICU) with focus on unaccompanied patients, the proximity of family members and environmental aspects.

    METHOD: Interviews were conducted with nine experienced ICU nurses. A qualitative descriptive approach was employed. The analysis was performed by means of conventional content analysis [Hsieh HF, Shannon SE. Three approaches to qualitative content analysis. Qual Health Res 2005;15:1277-88] following the steps described by e.g. Elo and Kyngas [Elo S, Kyngas H. The qualitative content analysis process. J Adv Nurs 2008;62:107-15].

    FINDINGS: The analysis resulted in a main category; Doing one's utmost, described by four generic categories and 15 sub-categories, comprising a common vision of the patients' last hours and dying process. This description was dominated by the nurses' endeavour to provide dignified end-of-life care (EOLC) and, when relatives were present, to give them an enduring memory of their loved one's death as a calm and dignified event despite his/her previous suffering and death in a high-technological environment.

    CONCLUSION: This study contributes new knowledge about what ICU nurses focus on when providing EOLC to unaccompanied patients but also to those whose relatives were present. Nurses' EOLC was mainly described as their relationship and interaction with the dying patient's relatives, while patients who died alone were considered tragic but left a lesser impression in the nurses' memory.

  • 26.
    Fridh, Isabell
    et al.
    [external].
    Forsberg, Anna
    Bergbom, Ingegerd
    End-of-life care in intensive care units: family routines and environmental factors2007In: Scandinavian Journal of Caring Sciences, ISSN 0283-9318, E-ISSN 1471-6712, Vol. 21, no 1, p. 25-31Article in journal (Refereed)
    Abstract [en]

    The purpose of this study was to describe family care routines and to explore environmental factors when patients die in Swedish intensive care units (ICUs). The main research questions were: what are the physical environmental circumstances and facilities when caring for patients in end-of-life and are there any routines or guidelines when caring for dying patients and their families? A questionnaire was sent to 79 eligible Swedish ICUs in December 2003, addressed to the unit managers. The response rate was 94% (n = 74 units). The findings show that, despite recommendations highlighting the importance of privacy for dying ICU patients and their families, only 11% of the respondents stated that patients never died in shared rooms in their ICU. If a patient dies in a shared room, nurses strive to ensure a dignified goodbye by moving the body to an empty room or to one specially designated for this purpose. The majority (76%) of the units had waiting rooms within the ICU. The study also revealed that there is a need for improvements in the follow-up routines for bereaved families. Many units reported (51%) that they often or almost always offer a follow-up visit, although in most cases the bereaved family had to initiate the follow-up by contacting the ICU. Guidelines in the area of end-of-life care were used by 25% of the ICUs. Further research is necessary to acquire a deeper knowledge of the circumstances under which patients die in ICUs and what impact the ICU environment has on bereaved families.

  • 27.
    Fridh, Isabell
    et al.
    Institutionen för vårdvetenskap och hälsa, Sahlgrenska akademin, Göteborgs universitet.
    Forsberg, Anna
    Bergbom, Ingegerd
    University of Borås, Faculty of Caring Science, Work Life and Social Welfare.
    End-of-life care in intensive care units: family routines and environmental factors.2007In: Scandinavian Journal of Caring Sciences, ISSN 0283-9318, E-ISSN 1471-6712, Vol. 21, no 1, p. 25-31Article in journal (Refereed)
    Abstract [en]

    The purpose of this study was to describe family care routines and to explore environmental factors when patients die in Swedish intensive care units (ICUs). The main research questions were: what are the physical environmental circumstances and facilities when caring for patients in end-of-life and are there any routines or guidelines when caring for dying patients and their families? A questionnaire was sent to 79 eligible Swedish ICUs in December 2003, addressed to the unit managers. The response rate was 94% (n = 74 units). The findings show that, despite recommendations highlighting the importance of privacy for dying ICU patients and their families, only 11% of the respondents stated that patients never died in shared rooms in their ICU. If a patient dies in a shared room, nurses strive to ensure a dignified goodbye by moving the body to an empty room or to one specially designated for this purpose. The majority (76%) of the units had waiting rooms within the ICU. The study also revealed that there is a need for improvements in the follow-up routines for bereaved families. Many units reported (51%) that they often or almost always offer a follow-up visit, although in most cases the bereaved family had to initiate the follow-up by contacting the ICU. Guidelines in the area of end-of-life care were used by 25% of the ICUs. Further research is necessary to acquire a deeper knowledge of the circumstances under which patients die in ICUs and what impact the ICU environment has on bereaved families.

  • 28.
    Fridh, Isabell
    et al.
    University of Borås, School of Health Science.
    Kenne Sarenmalm, Elisabeth
    University of Borås, School of Health Science.
    Falk, Kristin
    University of Borås, School of Health Science.
    Henoch, Ingela
    University of Borås, School of Health Science.
    Öhlén, Joakin
    University of Borås, School of Health Science.
    Ozanne, Anneli
    University of Borås, School of Health Science.
    Jakobsson Ung, Eva
    University of Borås, School of Health Science.
    Extensive human suffering: a point prevalence survey of patients´most distressing concerns2014In: Scandinavian Journal of Caring Sciences, ISSN 0283-9318, E-ISSN 1471-6712, Vol. 29, no 3, p. 1-10Article in journal (Refereed)
    Abstract [en]

    AIM: To explore patients' most distressing concerns during a hospital stay. BACKGROUND: The characteristics of hospitalised patients have changed. Care is provided at a higher age, lengths of stay have fallen and the nursing workload is increasing. It is presumed that hospitalised patients are more seriously ill and have more palliative needs than previously. Studies show that inpatients suffer from more distress than similar outpatients although there is a lack of overall knowledge about inpatients' distress and major concerns, regardless of age, diagnosis or care setting. METHODS: This study was part of a point prevalence survey (PPS) concerning symptom prevalence. Of the 710 patients who participated in the PPS, 678 (95%) answered an open-ended question in a questionnaire: What is your main concern or what is most distressing or troublesome for you at present? Using a life-world approach, the text was analysed qualitatively and patients' concerns were interpreted in two main dimensions, an intersubjective dimension and a temporal dimension. FINDINGS: The patients reported extensive suffering due to illness, symptoms and failing health. Patients were concerned about family members, existential issues and the future. Three aspects of the patients' most distressing concerns were interpreted: The suffering self, The suffering person in close relations and The suffering person in a threatening world. CONCLUSION: Hospitalised patients are affected by severe illness, distressing symptoms and existential quandaries, revealing extensive human suffering in the midst of the demanding activities that take place during an ordinary day in a hospital. To support patients and alleviate suffering, hospital staff need to be more sensitive to patients' most distressing concerns. This presupposes a hospital environment in which the value system supports caring and comforting behaviour.

  • 29.
    Fridh, Isabell
    et al.
    University of Borås, Faculty of Caring Science, Work Life and Social Welfare. Department of Anesthesiology and Intensive Care, Sahlgrenska University Hospital .
    Åkerman, Eva
    Karolinska university hospital, Stockholm.
    Family-centred end-of-life care and bereavement services in Swedish intensive care units: A cross-sectional study.2019In: Nursing in Critical Care, ISSN 1362-1017, E-ISSN 1478-5153Article in journal (Refereed)
    Abstract [en]

    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.

  • 30.
    Galazzi, A.
    et al.
    Department of Healthcare Professions, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy.
    Adamini, I.
    Department of Healthcare Professions, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy.
    Bazzano, G.
    Department of Healthcare Professions, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy.
    Cancelli, L.
    Department of Healthcare Professions, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy.
    Fridh, Isabell
    University of Borås, Faculty of Caring Science, Work Life and Social Welfare. Department of Anesthesiology and Intensive Care, Sahlgrenska University Hospital, Gothenburg, Sweden.
    Laquintana, D.
    Department of Healthcare Professions, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy.
    Lusignani, M.
    Department of Biomedical Sciences for Health, University of Milan, Milan, Italy.
    Rasero, L.
    Department of Health Sciences, University of Florence, Florence, Italy.
    Intensive care unit diaries to help bereaved family members in their grieving process: a systematic review2021In: Intensive & Critical Care Nursing, ISSN 0964-3397, E-ISSN 1532-4036, article id 103121Article, review/survey (Refereed)
    Abstract [en]

    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. 

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  • 31. Henoch, Ingela
    et al.
    Jakobsson Ung, Eva
    Ozanne, Anneli
    Falk, Hanna
    Falk, Kristin
    Kenne Sarenmalm, Elisabeth
    Öhlén, Joakim
    Fridh, Isabell
    University of Borås, School of Health Science. Institutionen för vårdvetenskap och hälsa, Sahlgrenska akademin, Göteborgs universitet.
    Nursing students' experiences of involvement in clinical research: An exploratory study2014In: Nurse Education in Practice, ISSN 1471-5953, E-ISSN 1873-5223, Vol. 14, no 2, p. 188-194Article in journal (Refereed)
    Abstract [en]

    Background Nursing education can positively affect nurses' attitudes toward nursing research, resulting in better patient outcomes. Experiential learning theory was the basis for this study. Objectives To explore nursing students' experiences of involvement in clinical research, their approach to learning and their interest in nursing research. Design Cross-sectional. Methods One hundred and twenty-six nursing students were invited to be involved as data collectors in a research project as part of their training in research methodology. The students completed an evaluation form and the Revised Study Process Questionnaire. The questionnaires were analyzed quantitatively and one open-ended question was analyzed qualitatively. Results On the whole, the students were happy to be involved in the data collection although a minority felt uncertain and exposed. Students with a deeper approach to learning felt that their involvement had increased their interest in nursing research and they stated that data collection should be a regular feature of the course. Conclusions Participation as data collectors in research has the potential to increase interest in nursing research among students with higher levels of deep learning. Further studies are needed to examine ways to increase interest in research among students with lower levels of deep learning.

  • 32. Henoch, Ingela
    et al.
    Sawatzky, Richard
    Falk, Hanna
    Fridh, Isabell
    University of Borås, Faculty of Caring Science, Work Life and Social Welfare.
    Jakobsson Ung, Eva
    Sarenmalm, Elisabeth Kenne
    Ozanne, Anneli
    Öhlén, Joakim
    Falk, Kristin
    Symptom distress profiles in hospitalized patients in Sweden: a cross-sectional study.2014In: Research in Nursing & Health, ISSN 0160-6891, E-ISSN 1098-240X, Vol. 37, no 6, p. 512-523Article in journal (Refereed)
    Abstract [en]

    Symptom distress profiles of patients with a variety of diagnoses at two hospitals in Sweden were examined using a point-prevalence cross-sectional survey design. The sample included 710 patients present on internal medicine, surgery, geriatric, and oncology acute care hospital wards of each hospital on a single day. Symptom distress data were collected via structured interviews using a 0-10 numeric rating scale (NRS). Fatigue was the most prevalent symptom, experienced by 76.2% of the patients, followed by pain (65.2%) and sleeping difficulties (52.8%). Symptoms were fairly distressing (median NRS 5-6). Patients experiencing high distress from fatigue and pain were more likely to be female, living alone, and to have more symptoms. Latent class analysis revealed three symptom distress profiles that differed with respect to the degree of distress and number of symptoms. The profiles were not substantially differentiated by diagnoses. Symptom distress needs to be assessed and treated on an individual basis, rather than predicting distress levels based on diagnosis alone.

  • 33.
    Jensen, Hanne Irene
    et al.
    Department of Anaesthesiology and Intensive Care, Vejle and Middelfart Hospitals, Vejle, Denmark, and the University of Southern Denmark, Odense, Denmark.
    Halvorsen, Kristin
    Oslo Metropolitan University, Faculty of Health Sciences, Oslo, Norway..
    Jerpseth, Heidi
    Oslo Metropolitan University, Faculty of Health Sciences, Oslo, Norway..
    Fridh, Isabell
    University of Borås, Faculty of Caring Science, Work Life and Social Welfare.
    Lind, Ranveig
    University Hospital of North Norway, Tromsø, Norway..
    Practice Recommendations for End-of-Life Care in the Intensive Care Unit.2020In: Critical care nurse, ISSN 1940-8250, Vol. 40, no 3, p. 14-22Article in journal (Refereed)
    Abstract [en]

    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.

  • 34.
    Jensen, Hanne Irene
    et al.
    University Hospital of Southern Denmark.
    Åkerman, Eva
    Karolinska Institutet.
    Lind, Raneveig
    UiT The Arctic University of Norway.
    Alfheim, Hanne Birgit
    VID Specialized University, Norway.
    Frivold, Gro
    University of Agder, Norway.
    Fridh, Isabell
    University of Borås, Faculty of Caring Science, Work Life and Social Welfare.
    Ågård, Anne Sophie
    Aarhus University, Denmark.
    Conditions and strategies to meet the challenges imposed by the COVID-19-related visiting restrictions in the intensive care unit: A Scandinavian cross-sectional study2021In: Intensive & Critical Care Nursing, ISSN 0964-3397, E-ISSN 1532-4036, article id 103116Article in journal (Refereed)
    Abstract [en]

    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. © 2021 The Authors

  • 35.
    Karlsson, Jonas
    et al.
    University of Borås, Faculty of Caring Science, Work Life and Social Welfare.
    Eriksson, Thomas
    University of Borås, Faculty of Caring Science, Work Life and Social Welfare.
    Lindahl, Berit
    University of Borås, Faculty of Caring Science, Work Life and Social Welfare. Department of Health Sciences, Lund University, Lund, Sweden.
    Fridh, Isabell
    University of Borås, Faculty of Caring Science, Work Life and Social Welfare. Department of Anesthesiology and Intensive Care, Sahlgrenska University Hospital, Gothenburg, Sweden.
    Family members' lived experiences when a loved one undergoes an interhospital intensive care unit‐to‐unit transfer: A phenomenological hermeneutical study2020In: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702Article in journal (Refereed)
    Abstract [en]

    Aims and objectives

    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 (ICUs). 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 ICUs. Data were generated through individual in‐depth interviews with seven family members and analysed using a phenomenological hermeneutical approach. The Criteria for Reporting Qualitative Research 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.

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  • 36.
    Karlsson, Jonas
    et al.
    University of Borås, Faculty of Caring Science, Work Life and Social Welfare.
    Eriksson, Thomas
    University of Borås, Faculty of Caring Science, Work Life and Social Welfare.
    Lindahl, Berit
    University of Borås, Faculty of Caring Science, Work Life and Social Welfare.
    Fridh, Isabell
    University of Borås, Faculty of Caring Science, Work Life and Social Welfare.
    The Patient’s Situation During Interhospital Intensive Care Unit-to-Unit Transfers: A Hermeneutical Observational Study2019In: Qualitative Health Research, ISSN 1049-7323, E-ISSN 1552-7557, p. 1-12Article in journal (Refereed)
    Abstract [en]

    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 caring atmosphere around these patients.

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    The Patient’s Situation During Interhospital Intensive Care Unit to Unit Transfers A Hermeneutical Observational Study
  • 37.
    Karlsson, Jonas
    et al.
    University of Borås, Faculty of Caring Science, Work Life and Social Welfare.
    Eriksson, Thomas
    University of Borås, Faculty of Caring Science, Work Life and Social Welfare.
    Lindahl, Berit
    University of Borås, Faculty of Caring Science, Work Life and Social Welfare. Department of Health Sciences, Lund University, Lund, Sweden..
    Schildmeijer, Kristina
    School of Health and Caring Sciences, Faculty of Health and Life Sciences, Linnaeus University, 391 82 Kalmar, Sweden.
    Fridh, Isabell
    University of Borås, Faculty of Caring Science, Work Life and Social Welfare. Department of Anesthesiology and Intensive Care, Sahlgrenska University Hospital, Blå Stråket 5, 413 45 Gothenburg, Sweden.
    Critical care nurses’ lived experiences of interhospital intensive care unit-to-unit transfers: A phenomenological hermeneutical study2020In: Intensive & Critical Care Nursing, ISSN 0964-3397, E-ISSN 1532-4036Article in journal (Refereed)
    Abstract [en]

    Objective

    To explore critical care nurses’ lived experiences of transferring intensive care patients between hospitals.

    Methods

    A phenomenological hermeneutic approach using data generated through individual interviews with 11 critical care registered nurses.

    Setting

    Two general intensive care units in Sweden.

    Findings

    Five themes were identified: it depends on me; your care makes a difference; being exposed; depending on interprofessional relationships; and sensing professional growth. These themes were synthesised into a comprehensive understanding showing how transferring intensive care patients between hospitals meant being on an ambivalent journey together with the patient but also on a journey within yourself in your own development and growth, where you, as a nurse, constantly are torn between contradictory feelings and experiences.

    Conclusion

    Interhospital intensive care unit-to-unit transfers can be a challenging task for critical care nurses but also an important opportunity for professional growth. During the transfer, nurses become responsible for the patient, their colleagues and the entire transfer process. In a time of an increasing number of interhospital intensive care unit-to-unit transfers, this study illuminates the risk for missed nursing care, showing that the critical care nurse has an important role in protecting the patient from harm and safeguarding dignified care.

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    table 1
  • 38.
    Karlsson, Jonas
    et al.
    University of Borås, Faculty of Caring Science, Work Life and Social Welfare.
    Fridh, Isabell
    University of Borås, Faculty of Caring Science, Work Life and Social Welfare.
    Eriksson, Thomas
    Designing and Conducting Observational Research on the Move Within High-Tech Environments2017Conference paper (Refereed)
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    fulltext
  • 39.
    Karlsson, Jonas
    et al.
    University of Borås, Faculty of Caring Science, Work Life and Social Welfare.
    Fridh, Isabell
    University of Borås, Faculty of Caring Science, Work Life and Social Welfare.
    Schildmeijer, Kristina
    Faculty of Health and Life Sciences, Linnaeus University, Sweden.
    Andersson Hagiwara, Magnus
    University of Borås, Faculty of Caring Science, Work Life and Social Welfare.
    Missed nursing care in intensive care patients subjected to interhospital capacity transfers: a retrospective matched case–control chart reviewManuscript (preprint) (Other academic)
  • 40.
    Kisch, Annika
    et al.
    Institute of Health Sciences, Lund University.
    Forsberg, Anna
    Institute of Health Sciences, Lund University.
    Fridh, Isabell
    University of Borås, Faculty of Caring Science, Work Life and Social Welfare.
    Almgren, Matilda
    Institute of Health Sciences, Lund University.
    Lundmark, Martina
    Institute of Health Sciences, Lund University.
    Lovén, Charlotte
    Transplant Unit, Department of Surgery and Gastroenterology, Skåne University Hospital.
    Flodén, Anne
    University of Borås, Faculty of Caring Science, Work Life and Social Welfare. Department of Anaesthesiology, Södra Älvsborg Hospital.
    Nilsson, Madeleine
    Department of Neurology, Psychiatry and Habilitation, Queen Silvia's Children's Hospital, Sahlgrenska University Hospital.
    Karlsson, Veronika
    Department of Health Sciences, University West.
    Lennerling, Annette
    Institute of Health and Care Sciences, University of Gothenburg.
    The meaning of being a living kidney, liver, or stam cell donor - A meta-ethnogrphy2018In: Transplantation, ISSN 0041-1337, E-ISSN 1534-6080, Transplantation, Vol. 102, no 5, p. 744-765Article in journal (Refereed)
    Abstract [en]

    BACKGROUND:

    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 to deepen understanding of the meaning of being a living donor for the purpose of saving or extending someone's life.

    METHODS:

    The meta-ethnography steps presented by Noblit and Hare in 1988 were used.

    RESULTS:

    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 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 themes; A sense of responsibility, loneliness and abandonment, suffering, pride and gratitude, a sense of togetherness, and a life changing event.

    CONCLUSIONS:

    The main issue is that one donates irrespective of what one donates. The relationship to the recipient determines the motives for donation. The deeper insight into the donors' experiences provides implications for their psychological care.

  • 41.
    Lindahl, Berit
    et al.
    University of Borås, Faculty of Caring Science, Work Life and Social Welfare.
    Fridh, Isabell
    University of Borås, Faculty of Caring Science, Work Life and Social Welfare.
    Andersson, Morgan
    Chalmers University of Technology.
    Can an ICU-patient roompromote wellbeing and improve healthcare quality?2019Conference paper (Refereed)
    Abstract [en]

    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 area in that other hospital staff and visitors have no immediate access to such environment. The ICU environment often appears frightening to patients and their loved ones due to presence of technology and advanced treatments. There is evidence that sounds, light, sleep deprivation and ICU delirium impact on patients’ health and recovery. Research has described negative effects of ICU environment to staff concerning noise, high work-load, heavy responsibilities and a complex psychological proximity to patients and their loved ones. A health care environment and patient room should be safe and attractive to staff so that they continue to contribute to caring processes. However, research about ICU’s physical environment and ICU-patient room design are sparse and thus evidence about how to design such areas is weak. Recommendations: Recommendations based on evaluation of a research program concerning evidence-based design in ICU-patient rooms will be shared. Components like light, sound environment, shape, colours, decoration and view to nature will be presented, pros and con with single rooms and the concepts privacy and control will be articulated. The research program was performed within a caring science perspective and so far it has generated three PhD theses with a forth on its way. Directions for further research such as interdisciplinary collaboration, the need for development of the meta-paradigm concept environment will be suggested. The latter needs to be theorized, problematized and practically explored. ICU-nurses, nursing researchers and former patients should collaborate with architects, building planners and economists in planning of new ICUs. Concepts like enriching and healing environments should be a part of ICU-nurses education curricula.

  • 42.
    Lindberg, Elisabeth
    et al.
    University of Borås, Faculty of Caring Science, Work Life and Social Welfare.
    Fridh, Isabell
    University of Borås, Faculty of Caring Science, Work Life and Social Welfare.
    Postgraduate nursing students' experiences of simulation training and reflection in end-of-life communication with intensive care patients and their families2021In: Nursing and Health Sciences, ISSN 1441-0745, E-ISSN 1442-2018, Nursing & Health Sciences, E-ISSN 1442-2018Article in journal (Refereed)
    Abstract [en]

    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 toward preparing students to be attuned to what it can be like to be a family member in this situation. The scenarios contributed toward preparing the students to engage in end-of-life conversations during clinical placements.

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  • 43.
    Listerfeldt, Stephanie
    et al.
    Södra Älvsborgs Hospital.
    Fridh, Isabell
    University of Borås, Faculty of Caring Science, Work Life and Social Welfare.
    Lindahl, Berit
    University of Borås, Faculty of Caring Science, Work Life and Social Welfare.
    Facing the unfamiliar: Nurses' transcultural care in intensive care - A focus group study.2019In: Intensive & Critical Care Nursing, ISSN 0964-3397, E-ISSN 1532-4036, article id 102752Article in journal (Refereed)
    Abstract [en]

    INTRODUCTION: Western Europe today is a culturally diverse society and expected to become more so in the future. When patients from unfamiliar cultures become critically ill and require intensive care, this places considerable demands on the cultural and linguistic competencies of the intensive care staff. Existing research regarding the transcultural aspects of intensive care is scarce and, in Sweden, non-existent.

    OBJECTIVE: To explore the experiences of critical care nurses and enrolled nurses in caring for culturally diverse patients in intensive care units.

    METHOD: Four focus group interviews were conducted with a total of 15 interviewees. The collected data were subjected to qualitative content analysis.

    FINDINGS: The findings mostly concerned the nursing staff's experiences of caring for relatives. Caring for the relatives of culturally diverse patients was described as challenging due to linguistic and cultural barriers.

    CONCLUSIONS: To overcome linguistic and cultural barriers, intensive care units should be reorganised and restructured to create a more welcoming environment for relatives. Alternative communication methods should be developed and traditional ways of using support from interpreters support must be re-evaluated. Education to ensure cultural competence and the promotion of an intercultural approach is key and the development of research programmes is recommended.

  • 44.
    Palmér, Lina
    et al.
    University of Borås, Faculty of Caring Science, Work Life and Social Welfare.
    Nyström, Maria
    University of Borås, Faculty of Caring Science, Work Life and Social Welfare.
    Carlsson, Gunilla
    University of Borås, Faculty of Caring Science, Work Life and Social Welfare.
    Ekebergh, Margaretha
    University of Borås, Faculty of Caring Science, Work Life and Social Welfare.
    Fridh, Isabell
    University of Borås, Faculty of Caring Science, Work Life and Social Welfare.
    Lindberg, Elisabeth
    University of Borås, Faculty of Caring Science, Work Life and Social Welfare.
    Wireklint Sundström, Birgitta
    University of Borås, Faculty of Caring Science, Work Life and Social Welfare.
    Caring Science With a Focus on Existential Issues in a Caring Context: A Research Area Inspired by Existential Philosophy2022In: International journal for human caring, ISSN 1091-5710, Vol. 26, no 3, p. 1-11Article in journal (Refereed)
    Abstract [en]

    This article examines and exemplifies how existential philosophy can provide a 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 of existential caring science is suggested as a research area for research on existential and meaning-oriented phenomena.

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  • 45.
    Sepideh, Olausson
    et al.
    Göteborgs Universitet.
    Fridh, Isabell
    University of Borås, Faculty of Caring Science, Work Life and Social Welfare.
    Lindahl, Berit
    University of Borås, Faculty of Caring Science, Work Life and Social Welfare.
    Torkildsby, Anne-Britt
    Norges Naturvetenskapliga och Tekniska Universitet (NTNU).
    The meanings of comfort in intensive care settings: the fusion of care and interior design revealed through a lexical and content analysis2019In: Intensive and Critical Care Nursing Quarterly, ISSN 0887-9303, Vol. 42, no 3, p. 329-341Article in journal (Refereed)
    Abstract [en]

    Providing comfort in an ICU setting is often related to pain relief and end-of-life care; environmental factors are often neglected, despite the major role of the environment on the patients’ wellbeing and comfort. The aim of this paper is to explore the meanings of comfort from a theoretical and empirical perspective to increase the understanding of what comfort means in ICU settings. A lexical analysis and serials of workshops were performed, and data were analysed using a qualitative content analysis. The findings from the theoretical analysis show that comfort has a broad range of synonyms related both to subjective experiences and objective and physical qualities. The findings from the empirical part reveal four themes: comfort in relation to nature, comfort in relation to situation and people, comfort in relation to place and comfort in relation to objects and material. Materiality, functionality, memory, culture and history stipulate comfort. It is challenging to discern what comfort is when it comes to an individual’s function and emotions. We also found that comfort is closely linked to nature and wellbeing.

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  • 46.
    Sundberg, Fredrika
    et al.
    University of Borås, Faculty of Caring Science, Work Life and Social Welfare.
    Fridh, Isabell
    University of Borås, Faculty of Caring Science, Work Life and Social Welfare.
    Lindahl, Berit
    University of Borås, Faculty of Caring Science, Work Life and Social Welfare.
    Abstracts, Poster Presentation for Qualitative Health Research Conference, 20172018In: International Journal of Qualitative Methods, E-ISSN 1609-4069, Vol. 17, no 1, p. 1-31Article in journal (Refereed)
  • 47.
    Sundberg, Fredrika
    et al.
    University of Borås, Faculty of Caring Science, Work Life and Social Welfare.
    Fridh, Isabell
    University of Borås, Faculty of Caring Science, Work Life and Social Welfare.
    Lindahl, Berit
    University of Borås, Faculty of Caring Science, Work Life and Social Welfare.
    Ingemar, Kåreholt
    Jönköping University.
    Associations between healthcare environment design and adverse events in intensive care unit2020In: Nursing in Critical Care, ISSN 1362-1017, E-ISSN 1478-5153Article in journal (Refereed)
    Abstract [en]

    Background: Healthcare environment can affect health. Adverse events (AEs) are common because rapid changes in the patients' status can suddenly arise, and have serious consequences, especially in intensive care. The relationship between the design of intensive care units (ICUs) and AEs has not been fully explored. Hence, an intensive care room was refurbished with cyclic lightning, sound absorbents and unique interior, and exterior design to promote health.

    Aims: The aim of this study was to evaluate the differences between a regular and a refurbished intensive care room in risk for AEs among critically ill patients.

    Design: This study retrospectively evaluated associations of AEs and compared the incidence of AEs in patients who were assigned to a multidisciplinary ICU in a refurbished two-bed patient room with patients in the control rooms between 2011 and 2018.

    Methods: There were 1938 patients included in this study (1382 in control rooms; 556 in the intervention room). Descriptive statistics were used to present the experi-enced AEs. Binary logistic regressions were conducted to estimate the relationship between the intervention/control rooms and variables concerning AEs. Statistical significance was set at P < 0.05.

    Results: For the frequency of AEs, there were no significant differences between the intervention room and the control rooms (10.6% vs 11%, respectively, P < 0.805). No findings indicated the intervention room (the refurbished room) had a significant influence on decreasing the number of experienced AEs in critically ill patients.

    Conclusions: The findings revealed a low incident of AEs in both the intervention room as well as in the control rooms, lower than previously described. However, our study did not find any decreases in the AEs due to the design of the rooms.

    Relevance to clinical practice: Further research is needed to determine the relation-ship between the physical environment and AEs in critically ill patients.

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  • 48.
    Sundberg, Fredrika
    et al.
    University of Borås, Faculty of Caring Science, Work Life and Social Welfare.
    Fridh, Isabell
    University of Borås, Faculty of Caring Science, Work Life and Social Welfare.
    Lindahl, Berit
    University of Borås, Faculty of Caring Science, Work Life and Social Welfare.
    Kåreholt, Ingemar
    Jönköping University.
    Associations between healthcare environment design and adverse events in intensive care unit2021In: Nursing in Critical Care, ISSN 1362-1017, E-ISSN 1478-5153, Vol. 26, no 2, p. 86-93Article in journal (Refereed)
    Abstract [en]

    Background

    Healthcare environment can affect health. Adverse events (AEs) are common because rapid changes in the patients' status can suddenly arise, and have serious consequences, especially in intensive care. The relationship between the design of intensive care units (ICUs) and AEs has not been fully explored. Hence, an intensive care room was refurbished with cyclic lightning, sound absorbents and unique interior, and exterior design to promote health.

    Aims

    The aim of this study was to evaluate the differences between a regular and a refurbished intensive care room in risk for AEs among critically ill patients.

    Design

    This study retrospectively evaluated associations of AEs and compared the incidence of AEs in patients who were assigned to a multidisciplinary ICU in a refurbished two‐bed patient room with patients in the control rooms between 2011 and 2018.

    Methods

    There were 1938 patients included in this study (1382 in control rooms; 556 in the intervention room). Descriptive statistics were used to present the experienced AEs. Binary logistic regressions were conducted to estimate the relationship between the intervention/control rooms and variables concerning AEs. Statistical significance was set at P < 0.05.

    Results

    For the frequency of AEs, there were no significant differences between the intervention room and the control rooms (10.6% vs 11%, respectively, P < 0.805). No findings indicated the intervention room (the refurbished room) had a significant influence on decreasing the number of experienced AEs in critically ill patients.

    Conclusions

    The findings revealed a low incident of AEs in both the intervention room as well as in the control rooms, lower than previously described. However, our study did not find any decreases in the AEs due to the design of the rooms.

    Relevance to clinical practice

    Further research is needed to determine the relationship between the physical environment and AEs in critically ill patients.

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    fulltext
  • 49.
    Sundberg, Fredrika
    et al.
    University of Borås, Faculty of Caring Science, Work Life and Social Welfare.
    Fridh, Isabell
    University of Borås, Faculty of Caring Science, Work Life and Social Welfare.
    Lindahl, Berit
    University of Borås, Faculty of Caring Science, Work Life and Social Welfare.
    Kåreholt, Ingemar
    Jönköping University.
    Visitor’s Experiences of an Evidence-Based Designed Healthcare Environment in an Intensive Care Unit2021In: Health Environments Research & Design Journal, ISSN 1937-5867, E-ISSN 2167-5112, Vol. 14, no 2, p. 178-191Article in journal (Refereed)
    Abstract [en]

    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 ClimateQuestionnaire—Family version (PCQ-F) or the semantic environment description (SMB) in the ICUsetting.

    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 interventionroom.

    Results: For the dimension of everydayness in the PCQ-F, a significantly better experience was expressed for the intervention room (p<.030); the dimension regarding the ward climate general was also perceived as higher in the intervention room (p<.004). The factors of pleasantness (p<.019), and complexity (p<0.049), showed significant differences favoring the intervention room in the SMB, with borderline significance on the modern factor (p<.061).

    Conclusion: Designing and implementing an enriched healthcare environment in the ICU setting increases person-centered care in relation to the patients’ visitors. This could lead to better outcomes for the visitors, for example, decreasing post-traumatic stress disorder symptoms, but this needs further investigations

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  • 50.
    Sundberg, Fredrika
    et al.
    University of Borås, Faculty of Caring Science, Work Life and Social Welfare.
    Fridh, Isabell
    University of Borås, Faculty of Caring Science, Work Life and Social Welfare.
    Olausson, Sepideh
    Lindahl, Berit
    University of Borås, Faculty of Caring Science, Work Life and Social Welfare.
    Room Design - A Phenomenological-Hermeneutical Study: A Factor in Creating a Caring Environment.2019In: Critical Care Nursing Quarterly, ISSN 0887-9303, E-ISSN 1550-5111, Vol. 42, no 3, p. 265-277, article id 31135477Article in journal (Refereed)
    Abstract [en]

    Medical technology has progressed tremendously over the last few decades, but the same development cannot be seen in the design of these intensive care unit environments. Authors report results of a study of evidence-based room design, emphasizing the impact on conveying a caring attitude to patients. Ten nonparticipant observations were conducted in patient rooms with 2 different designs, followed by interviews. The data were analyzed using a phenomenological-hermeneutical approach. The results did not reveal that it was obvious that redesigned spaces resulted in a more caring attitude. The meanings of caring displayed during nursing activities were interpreted by interpreting gazes. Some of the nursing staff had an instrumental gaze, interpreted as caring with a task-orientated approach, while others communicated their caring with an attentive and attuned gaze, where the needs of the patients regulated the working shift. The study findings indicated that caring may not be perceived when nurses use a task-oriented approach. However, when nurses practice a person-centered approach, using an attentive and attuned gaze, caring is conveyed. Caring in intensive care contexts needs to be assisted by a supportive environment design that cultivates the caring approach.

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