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Nordin, A., Engström, Å., Strömbäck, U., Juuso, P. & Andersson, M. (2024). Close relatives' perspective of critical illness due to COVID-19: Keeping in touch at a distance. Nursing Open, 11(1), Article ID e2068.
Open this publication in new window or tab >>Close relatives' perspective of critical illness due to COVID-19: Keeping in touch at a distance
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2024 (English)In: Nursing Open, E-ISSN 2054-1058, Vol. 11, no 1, article id e2068Article in journal (Refereed) Published
Abstract [en]

Aim: To elucidate the meaning of being a close relative of a critically ill person cared for in intensive care during the initial phase of the COVID-19 pandemic.

Design: A narrative inquiry design following the COREQ guidelines.

Methods: Individual interviews with fifteen close relatives of patients critically ill with COVID-19 were analysed using phenomenological hermeneutics.

Results: The surreal existence of not being allowed to be near was emotionally difficult. While distancing due to restrictions was challenging, physicians' phone calls served as a connection to their relatives and brought a sense of security. Keeping notes helped them remember what happened and brought order to a chaotic situation.

Conclusion: Close relatives feel secure when they receive regular information about their critically ill relative, not just when their condition worsens. They wish to be physically near to their critically ill person; when this is impossible, digital technology can provide support, but further accessibility developments are needed.

Place, publisher, year, edition, pages
John Wiley & Sons, 2024
Keywords
COVID-19, critical care, nursing, person-centred care, relatives
National Category
Nursing Anesthesiology and Intensive Care
Research subject
Nursing
Identifiers
urn:nbn:se:ltu:diva-103518 (URN)10.1002/nop2.2068 (DOI)001127930300001 ()38268262 (PubMedID)2-s2.0-85180507390 (Scopus ID)
Note

Validerad;2024;Nivå 2;2024-02-09 (signyg);

Full text license: CC BY-NC-ND

Available from: 2024-01-08 Created: 2024-01-08 Last updated: 2024-02-09Bibliographically approved
Pesämaa, O., Engström, Å., Johansson, J. & Juuso, P. (2023). B2B procurement of alternative health services: An interview study of the ecosystem of key stakeholders. In: : . Paper presented at Online Center for Business and Industrial Marketing (CBIM) International Conference, Graz, Austria, [DIGITAL], June 12-13, 2023 (pp. 10-14).
Open this publication in new window or tab >>B2B procurement of alternative health services: An interview study of the ecosystem of key stakeholders
2023 (English)Conference paper, Oral presentation with published abstract (Refereed)
National Category
Business Administration
Research subject
Nursing; Entrepreneurship and Innovation; Accounting and Control
Identifiers
urn:nbn:se:ltu:diva-99661 (URN)
Conference
Online Center for Business and Industrial Marketing (CBIM) International Conference, Graz, Austria, [DIGITAL], June 12-13, 2023
Available from: 2023-08-14 Created: 2023-08-14 Last updated: 2023-12-21Bibliographically approved
Johansson, G., Engström, Å. & Juuso, P. (2023). Experiences of a nature-based intervention program in a northern natural setting: A longitudinal case study of two women with stress-related illness. International Journal of Qualitative Studies on Health and Well-being, 18(1), Article ID 2146857.
Open this publication in new window or tab >>Experiences of a nature-based intervention program in a northern natural setting: A longitudinal case study of two women with stress-related illness
2023 (English)In: International Journal of Qualitative Studies on Health and Well-being, ISSN 1748-2623, E-ISSN 1748-2631, Vol. 18, no 1, article id 2146857Article in journal (Refereed) Published
Abstract [en]

Purpose

This study explored the experiences of people with stress-related illness participating in a nature-based intervention programme in a northern natural setting.

Methods

A longitudinal case study was conducted with two women participating in a nature-based intervention programme on a farm. Data were collected by semi-structured interviews, diaries, rating scales, and self-assessment. Qualitative data were analysed by qualitative content analysis and quantitative data are presented descriptively.

Results

The theme of finding a source for recovery and well-being permeates all categories. The participants perceived the farm and nature to be a calming refuge; they learned to be in the present and could manage the tasks. In togetherness with each other and the facilitator on the farm they felt understood and confident, experienced joy, and found opportunities for change. They gained knowledge and positive memories and found new approaches in life. Self-assessment questionnaires indicated improvements of functioning in everyday life and reduced stress-related exhaustion at the end of the NBI programme.

Conclusions

Nature-based interventions lasting for a relatively short period seem to promote health and may be a complement to other treatments of stress-related illness. Further research is needed with a larger number of participants and in various natural settings.PurposeThis study explored the experiences of people with stress-related illness participating in a nature-based intervention programme in a northern natural setting.

Place, publisher, year, edition, pages
Taylor & Francis, 2023
Keywords
Case study, nature-based interventio, nnatural setting, recovery, stress-related illness, well-being
National Category
Nursing
Research subject
Nursing
Identifiers
urn:nbn:se:ltu:diva-94333 (URN)10.1080/17482631.2022.2146857 (DOI)000890913300001 ()36433841 (PubMedID)2-s2.0-85142856418 (Scopus ID)
Projects
New Nordic Nature Based Service Models
Funder
Interreg NordNorrbotten County CouncilLuleå University of Technology
Note

Validerad;2022;Nivå 2;2022-11-29 (sofila);

Funder: European Union

Available from: 2022-11-29 Created: 2022-11-29 Last updated: 2023-05-08Bibliographically approved
Nordin, A., Engström, Å., Andersson, M. & Fredholm, A. (2023). Intensive Care Managers' Experiences of the COVID-19 Pandemic: A Dramatic Change of the Intensive Care Landscape. Journal of Nursing Management, Article ID 3052994.
Open this publication in new window or tab >>Intensive Care Managers' Experiences of the COVID-19 Pandemic: A Dramatic Change of the Intensive Care Landscape
2023 (English)In: Journal of Nursing Management, ISSN 0966-0429, E-ISSN 1365-2834, article id 3052994Article in journal (Refereed) Published
Abstract [en]

Aim. To describe intensive care managers' experiences of premises and resources of care in intensive care units during the COVID-19 pandemic.

Background. Intensive care units (ICUs) were enormously pressured during the COVID-19 pandemic from many ill patients, requiring advanced care. Hospital and community volunteers increased staff strength. Obligatorily, recruitments were also conducted using transfer of staff from different hospital departments. However, there is little knowledge about intensive care managers' (ICMs) experiences of leadership during the COVID-19 pandemic.

Methods. A qualitative descriptive study was conducted from March to April 2022. Semistructured interviews were held with 12 ICMs who were purposively sampled from the ICU in ten Swedish hospitals. Data were analysed using qualitative content analysis.

Results. Two themes emerged: a dramatic change of the intensive care landscape and we could handle more than we thought, but at a steep price. Participants described that the ICUs had to perform extraordinary changes at a very fast pace, which initially created a sense of cohesion. Training and introduction to war-like conditions associated with uncertainty meant that ICMs had to support ICU staff in prioritising interventions. Participants described how ICUs stood strong against a pandemic, but stress, worries, and anxiety took a heavy toll on ICU staff and ICMs. The pandemic eroded the resilience in ICUs. Participants described a deterioration in health and said that sick leaves and resignations occurred.

Conclusion. Our findings show ICMs' experiences as a field of tension between resources and demands, whereby the changes created a heavy burden that left intensive care weakened.

Implications for Nursing Management. Findings emphasised the importance of creating working conditions using human resources and materials in order to rebuild resilience in intensive care with the ability to conduct safe patient care.

Place, publisher, year, edition, pages
Wiley-Hindawi, 2023
National Category
Nursing Anesthesiology and Intensive Care Health Care Service and Management, Health Policy and Services and Health Economy
Research subject
Nursing
Identifiers
urn:nbn:se:ltu:diva-102512 (URN)10.1155/2023/3052994 (DOI)2-s2.0-85174399328 (Scopus ID)
Funder
Karlstad UniversityRegion Värmland
Note

Validerad;2023;Nivå 2;2023-11-20 (hanlid);

Full text license: CC BY

Available from: 2023-11-20 Created: 2023-11-20 Last updated: 2023-11-20Bibliographically approved
Nordin, A., Engström, Å., Fredholm, A., Persenius, M. & Andersson, M. (2023). Measuring moral distress in Swedish intensive care: Psychometric and descriptive results. Intensive & Critical Care Nursing, 76, Article ID 103376.
Open this publication in new window or tab >>Measuring moral distress in Swedish intensive care: Psychometric and descriptive results
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2023 (English)In: Intensive & Critical Care Nursing, ISSN 0964-3397, E-ISSN 1532-4036, Vol. 76, article id 103376Article in journal (Refereed) Published
Abstract [en]

Objectives: To investigate the construct validity and psychometric properties of the Swedish version of the Moral Distress Scale–Revised and to describe moral distress in an intensive care context.

Research Methodology/Design: The Italian Moral Distress Scale–Revised was translated and semantically adjusted to the Swedish intensive care context. A web survey with 14 moral distress items, as well as three additional and eight background questions was answered by critical care nurses (N = 71) working in intensive care units during the second year of the coronavirus disease pandemic. Inferential and descriptive statistics were used to investigate the Italian four-factor model and to examine critical care nurses’ moral distress.

Results: The result shows a factor model of four components differing from the previous model. Critical care nurses demonstrated significant differences in moral distress regarding priorities compared to before the pandemic, type of household; experience as critical care nurses and whether they had supervised students during the pandemic.

Conclusion: The component structure might have originated from the specific situation critical care nurses perceived during the pandemic. The health care organisations’ role in preventing and healing the effects of moral distress is important for managers to understand.

Implications for clinical practice: Moral distress is common in intensive care and it is necessary to use valid instrument when measuring it. A psychometrical investigation of the Swedish version of the Moral Distress Scale–Revised, adapted for intensive care shows need for further semantic and cultural adaptation. Perceived priorities during the pandemic, household type, supervising during the pandemic and working experience were related to critical care nurses’ experience of moral distress and managers need to be aware of conditions that may trigger such a response.

Place, publisher, year, edition, pages
Elsevier, 2023
Keywords
Critical care nurses, Intensive care units, Moral distress, Psychometrics, Validity
National Category
Nursing
Research subject
Nursing
Identifiers
urn:nbn:se:ltu:diva-95611 (URN)10.1016/j.iccn.2022.103376 (DOI)000926137000001 ()36706495 (PubMedID)2-s2.0-85146903930 (Scopus ID)
Funder
Luleå University of TechnologyKarlstad UniversityLandstinget i Värmland
Note

Validerad;2023;Nivå 2;2023-02-13 (joosat);

Licens fulltext: CC BY License

Available from: 2023-02-13 Created: 2023-02-13 Last updated: 2023-04-21Bibliographically approved
Andersson, M., Fredholm, A., Nordin, A. & Engström, Å. (2023). Moral Distress, Health and Intention to Leave: Critical Care Nurses’ Perceptions During COVID-19 Pandemic. Sage Open Nursing, 9
Open this publication in new window or tab >>Moral Distress, Health and Intention to Leave: Critical Care Nurses’ Perceptions During COVID-19 Pandemic
2023 (English)In: Sage Open Nursing, E-ISSN 2377-9608, Vol. 9Article in journal (Refereed) Published
Abstract [en]

Introduction: Moral distress increases the risk that critical care nurses will lose the ability to provide quality nursing care.

Aims: To describe person-related conditions and perceptions of moral distress, health and intention to leave among critical care nurses in intensive care units, and to examine the relationship between person-related conditions, moral distress, health and intention to leave.

Method: Cross-sectional, with 220 critical care nurses in 15 Swedish ICUs, and data gathered via a self-reported questionnaire.

Results: Highest moral distress scores were reported in futile care and poor teamwork and 21% reported entertaining an intention to leave. Self-reported health was lower than before the COVID-19 pandemic and 4.1% reported pronounced exhaustion disorder. Self-reported health, reduced capacity to tolerate demands under time pressure, emotional instability or irritability, physical weakness, or being more easily fatigued and with decreased well-being were factors that had a relationship with futile care. Sleeping problems and intention to leave had a relationship with poor teamwork.

Conclusions: Different strategies are needed to reduce moral distress and the leadership is crucial for managing crises such as the COVID-19 pandemic.

Place, publisher, year, edition, pages
SAGE Publications Inc., 2023
Keywords
Covid-19 pandemic, critical care nurses, health, intensive care, moral distress
National Category
Nursing Public Health, Global Health, Social Medicine and Epidemiology
Research subject
Nursing
Identifiers
urn:nbn:se:ltu:diva-97282 (URN)10.1177/23779608231169218 (DOI)000973565200001 ()37089200 (PubMedID)2-s2.0-85153609241 (Scopus ID)
Funder
Luleå University of TechnologyRegion VärmlandKarlstad University
Note

Validerad;2023;Nivå 2;2023-05-23 (hanlid);

Licens full text: This article is distributed under the terms of the Creative Commons Attribution 4.0 License (https://creativecommons.org/licenses/by/4.0/) which permits any use, reproduction and distribution of the work without further permission provided the original work is attributed as specified on the SAGE and Open Access page (https://us.sagepub.com/en-us/nam/open-access-at-sage)

Available from: 2023-05-23 Created: 2023-05-23 Last updated: 2023-05-23Bibliographically approved
Bäckström, M., Leijon-Sundqvist, K., Lundvall, L., Jonsson, K. & Engström, Å. (2023). On the edge of decision-making in trauma care: A focus group study on radiographers’ experiences of interprofessional collaboration. Radiography, 29(6), 1123-1129
Open this publication in new window or tab >>On the edge of decision-making in trauma care: A focus group study on radiographers’ experiences of interprofessional collaboration
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2023 (English)In: Radiography, ISSN 1078-8174, E-ISSN 1532-2831, Vol. 29, no 6, p. 1123-1129Article in journal (Refereed) Published
Abstract [en]

Introduction: The temporary trauma teams in trauma alerts consist of a diverse group of unique professionals requiring interprofessional collaboration and coordination to achieve efficient, high-quality care. The uncertain situation and complex care environment impose high demands on team dynamics such as individual attitudes and team behaviours. Within interprofessional teams, interaction and coordination reflect the collective success of collaboration and the achievement of goals. Interactions with radiographers have increased in trauma teams given computed tomography's prominent role in providing crucial knowledge for decision-making in trauma care. This study aimed to explore radiographers' experiences of interprofessional collaboration during trauma alerts.

Method: The study was designed with focus group methodology, including 17 radiographers participating in five focus groups, analysed with an inductive focus group analysis.

Results: An overarching theme, “On the edge of decision-making”, emerged along with three sub-themes: “Feeling included requires acknowledgement”, “Exclusion precludes shared knowledge”, and “Experience and mutual awareness facilitate team interaction”.

Conclusions: Interprofessional collaboration from the radiographer's perspective within trauma teams requires a sense of inclusion and the ability to interact with the team. Exclusion from vital decision-making obstructs radiographers' comprehension of situations and thereby the interdependence in interprofessional collaboration. Implications for practice: Common platforms are needed for knowledge sharing and team practices, including radiographers’ areas of responsibility and relational coordination to foster interprofessional relationships. Through these means interdependence through awareness and shared knowledge can be facilitated on trauma teams.

Place, publisher, year, edition, pages
Elsevier, 2023
Keywords
Focus group, Interprofessional collaborative practice, Radiographer, Relational coordination, Shared decision-making, Shared mental model, Trauma team
National Category
Nursing
Research subject
Nursing
Identifiers
urn:nbn:se:ltu:diva-101861 (URN)10.1016/j.radi.2023.09.010 (DOI)37797480 (PubMedID)2-s2.0-85172993746 (Scopus ID)
Note

Validerad;2023;Nivå 2;2023-10-31 (hanlid);

Licens full text: CC BY

Available from: 2023-10-31 Created: 2023-10-31 Last updated: 2023-10-31Bibliographically approved
Larsson, F., Strömbäck, U., Gustafsson, S. R. & Engström, Å. (2023). Perception of feeling safe perioperatively: a concept analysis. International Journal of Qualitative Studies on Health and Well-being, 18(1), Article ID 2216018.
Open this publication in new window or tab >>Perception of feeling safe perioperatively: a concept analysis
2023 (English)In: International Journal of Qualitative Studies on Health and Well-being, ISSN 1748-2623, E-ISSN 1748-2631, Vol. 18, no 1, article id 2216018Article in journal (Refereed) Published
Abstract [en]

Purpose

The purpose of this study was to explore the concept of feeling safe, from the patient perspective, in a perioperative context.

Method

The eight-step concept analysis approach proposed by Walker and Avant was utilized to examine the attributes of feeling safe. Uses of the concept, defining attributes as well as antecedents, consequences and empirical referents are presented to describe the concept. Case examples are provided in order to assist the understanding of the defining attributes.

Results

Feeling safe is defined as: a person that does not feel worried or threatened. Three attributes were identified: Participation, Control and Presence. Knowledge and Relationship are the antecedents of feeling safe, while Feeling Acknowledged and Trust are the consequences. Empirical referents are explored in order to find a way to measuring the perceived feeling of safety.

Conclusion

This concept analysis underscores the importance of including patients’ perceptions in traditional patient safety work. Patients who feel safe perceive that they participate in their care, that they are in control, and that they feel the presence of both healthcare staff and relatives. The perceived feeling of security could, by extension, promote the postoperative recovery of patients undergoing surgery by positively affect the process of recovery.

Place, publisher, year, edition, pages
Taylor & Francis, 2023
Keywords
Feeling safe, perioperative, concept analysis, nursing, literature review
National Category
Nursing
Research subject
Nursing
Identifiers
urn:nbn:se:ltu:diva-97779 (URN)10.1080/17482631.2023.2216018 (DOI)000990265000001 ()37210740 (PubMedID)2-s2.0-85159760645 (Scopus ID)
Note

Validerad;2023;Nivå 2;2023-06-01 (joosat);

Licens fulltext: CC BY License

Available from: 2023-06-01 Created: 2023-06-01 Last updated: 2023-09-05Bibliographically approved
Bromfalk, Å., Hultin, M., Myrberg, T., Engström, Å. & Walldén, J. (2023). Postoperative recovery in preschool‐aged children: A secondary analysis of a randomized controlled trial comparing premedication with midazolam, clonidine, and dexmedetomidine. Pediatric Anaesthesia, 33(11), 962-972
Open this publication in new window or tab >>Postoperative recovery in preschool‐aged children: A secondary analysis of a randomized controlled trial comparing premedication with midazolam, clonidine, and dexmedetomidine
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2023 (English)In: Pediatric Anaesthesia, ISSN 1155-5645, E-ISSN 1460-9592, Vol. 33, no 11, p. 962-972Article in journal (Refereed) Published
Abstract [en]

Background

Preoperative anxiety in pediatric patients can worsen postoperative outcomes and delay discharge. Drugs aimed at reducing preoperative anxiety and facilitating postoperative recovery are available; however, their effects on postoperative recovery from propofol-remifentanil anesthesia have not been studied in preschool-aged children. Thus, we aimed to investigate the effects of three sedative premedications on postoperative recovery from total intravenous anesthesia in children aged 2–6 years.

Methods

In this prespecified secondary analysis of a double-blinded randomized trial, 90 children scheduled for ear, nose, and throat surgery were randomized (1:1:1) to receive sedative premedication: oral midazolam 0.5 mg/kg, oral clonidine 4 μg/kg, or intranasal dexmedetomidine 2 μg/kg. Using validated instruments, outcome measures including time for readiness to discharge from the postoperative care unit, postoperative sedation, emergence delirium, anxiety, pain, and nausea/vomiting were measured.

Results

After excluding eight children due to drug refusal or deviation from the protocol, 82 children were included in this study. No differences were found between the groups in terms of median time [interquartile range] to readiness for discharge (midazolam, 90 min [48]; clonidine, 80 min [46]; dexmedetomidine 100.5 min [42]). Compared to the midazolam group, logistic regression with a mixed model and repeated measures approach found no differences in sedation, less emergence delirium, and less pain in the dexmedetomidine group, and less anxiety in both clonidine and dexmedetomidine groups.

Conclusions

No statistical difference was observed in the postoperative recovery times between the premedication regimens. Compared with midazolam, dexmedetomidine was favorable in reducing both emergence delirium and pain in the postoperative care unit, and both clonidine and dexmedetomidine reduced anxiety in the postoperative care unit. Our results indicated that premedication with α2-agonists had a better recovery profile than short-acting benzodiazepines; although the overall recovery time in the postoperative care unit was not affected.

Place, publisher, year, edition, pages
John Wiley & Sons, 2023
National Category
Anesthesiology and Intensive Care Pediatrics
Research subject
Nursing
Identifiers
urn:nbn:se:ltu:diva-99413 (URN)10.1111/pan.14740 (DOI)001038648600001 ()37528645 (PubMedID)2-s2.0-85166673433 (Scopus ID)
Funder
Norrbotten County Council, NLL- 485451, NLL-486841, RN-785981Region Västerbotten, RV- 940554, RV-865681
Note

Validerad;2023;Nivå 2;2023-11-07 (hanlid);

Full text license: CC BY

Available from: 2023-08-09 Created: 2023-08-09 Last updated: 2023-11-09Bibliographically approved
Johansson, J., Pesämaa, O., Engström, Å. & Juuso, P. (2023). Strukturella förutsättningar för landsbygdens entreprenörskap: Institutionella logiker och naturbaserade sociala innovationer. In: : . Paper presented at Forskningskonferens - om social innovation i välfärd, hälsa och arbetsliv, Malmö, Sweden, November 22, 2023..
Open this publication in new window or tab >>Strukturella förutsättningar för landsbygdens entreprenörskap: Institutionella logiker och naturbaserade sociala innovationer
2023 (Swedish)Conference paper, Oral presentation only (Refereed)
National Category
Social Sciences Interdisciplinary
Research subject
Entrepreneurship and Innovation; Accounting and Control; Nursing
Identifiers
urn:nbn:se:ltu:diva-103380 (URN)
Conference
Forskningskonferens - om social innovation i välfärd, hälsa och arbetsliv, Malmö, Sweden, November 22, 2023.
Projects
Tur och retur i skogen
Funder
The Kamprad Family Foundation
Available from: 2023-12-21 Created: 2023-12-21 Last updated: 2023-12-21Bibliographically approved
Organisations
Identifiers
ORCID iD: ORCID iD iconorcid.org/0000-0001-6244-6401

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