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  • 1.
    Engström, Åsa
    et al.
    Luleå University of Technology, Department of Health Sciences, Nursing Care.
    Forsberg, Angelica
    Luleå University of Technology, Department of Health Sciences, Nursing Care.
    Peripheral intravenous catheter difficulty: A clinical survey of registered nurse and critical care nurse performance2019In: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702, Vol. 28, no 3-4, p. 686-694, article id 15960276Article in journal (Refereed)
    Abstract [en]

    Objectives To describe the characteristics, problems and interventions associated with performing peripheral intravenous catheterisation in difficult situations when registered nurses need support from critical care nurses. Background Only a few studies have focused on peripheral intravenous catheterisation problems or interventions to promote success. There is limited research on the education, knowledge, confidence and skills of registered nurses associated with successful peripheral intravenous catheterisations. Design A descriptive cross‐sectional survey design was used. Results A total of 101 questionnaires were completed by critical care nurses (n = 32) and 92 by registered nurses (n = 83); the total number of participants was 115. The same critical care nurses and registered nurses could participate several times on different occasions. Statistical analyses were performed using descriptive statistics. The patterns differed in part between the registered nurses who needed support and the critical care nurses who provided the support. Both registered nurses and critical care nurses used ultrasound to a very low extent (2.2% vs. 1.0%). The registered nurses indicated to a significantly higher extent (p = 0.02) that the veins were invisible and that they had performed the optional interventions. The success rate for critical care nurses was considerably high (86.1%). The most common place for successful insertion was the wrist. Critical care nurses performed fewer interventions, and they informed the patients and assessed that the veins were fragile to a higher extent. Conclusions Superior nursing skills are required in order to adapt and assess specific situations related to peripheral intravenous catheterisation difficulties and to choose the adequate interventions. Young and newly graduated registered nurses should be offered individualised training during the post‐educational period on how to assess problems and perform peripheral intravenous catheterisations in specific difficult situations. Relevance to Clinical Practice Simulation is suggested for practical training in order to increase patient safety related to the performance of technical skills such as peripheral intravenous catheterisation.

  • 2.
    Forsberg, Angelica
    et al.
    Luleå University of Technology, Department of Health Sciences, Nursing Care.
    Engström, Åsa
    Luleå University of Technology, Department of Health Sciences, Nursing Care.
    Critical care nurses'  experiences of performing successful peripheral intravenous catherisation i difficult situations2018In: Journal of Vascular Nursing, ISSN 1062-0303, E-ISSN 1532-6578, Vol. 36, no 2, p. 64-70Article in journal (Refereed)
    Abstract [en]

    he aim of this study is to describe the experiences of critical care nurses (CCNs) when performing successful peripheral intravenous catheterization (PIVC) on adult inpatients in difficult situations. This study uses a descriptive design with a qualitative approach. Semistructured interviews were given to CCNs (n = 22) at a general central county hospital in northern Sweden. The interview text was analyzed with qualitative thematic content analysis. Three themes emerged: “releasing time and creating peace,” “feeling self-confidence in the role of expert nurse,” and “technical interventions promoting success.” CCNs stated that apart from experience, releasing enough time is the most crucial factor for a successful PIVC. They emphasized the importance of identifying the kinds of difficulties that may occur during the procedure, for example, fragile or/and invisible veins. CCNs explained that compared to when they were newly graduated, the difference in their approach nowadays has changed to using their hands more than their eyes and that they feel comfortable with bodily palpations. To further optimize PIVC performing skills, continued possibilities to train and learn in hospital settings are necessary, even after formal education has been completed.

  • 3.
    Forsberg, Angelica
    et al.
    Luleå University of Technology, Department of Health Sciences, Nursing Care. ICU 57, Sunderby Hospital.
    Vikman, Irene
    Luleå University of Technology, Department of Health Sciences, Health and Rehabilitation.
    Välivaara, Britt-Marie
    Luleå University of Technology, Department of Health Sciences, Nursing Care.
    Rattray, Janice
    chool of Nursing and Health Sciences, University of Dundee.
    Engström, Åsa
    Luleå University of Technology, Department of Health Sciences, Nursing Care.
    Patient's perceptions of perioperative quality of care in relation to self-rated health2018In: Journal of Perianesthesia Nursing, ISSN 1089-9472, E-ISSN 1532-8473, Vol. 33, no 6, p. 834-843Article in journal (Refereed)
    Abstract [en]

    Purpose: To explore (1) associations between patient and perioperativefactors and dimensions of quality of care and (2) perioperative patients’self-rated physical health in relation to information, encouragement, andparticipation.Design: A nonexperimental descriptive exploratory design (n 5 170participants).Methods: Analyses were performed using quantitative techniques;collected data were quantitative in nature. Multiple logistic regressionand Mann-Whitney U tests were used to analyze the data.Findings: The factor associatedwith patients’ satisfaction within the dimensionof ‘‘identity-oriented approach of the caregivers,’’ including the qualityof information, encouragement, and participation, was self-estimated physicalhealth. Those who estimated their physical health as being good weregenerally more satisfied. Patients who rated their physical health as beingless thangoodwere significantly less satisfiedwith the informationprovidedbefore surgery about their stay in the postanesthesia care unit (PACU).Conclusions: Nurses should chart patients’ estimations of their physicalhealth initially in care to provide reinforced support for patients who estimatetheir physical health is less than good. Before surgery, patients whohave estimated their physical health as being less than good should begiven realistic information about their stay in the PACU—that they willbe in a PACU after surgery, what that stay means, and why it is necessary.

  • 4.
    Forsberg, Angelica
    et al.
    Luleå University of Technology, Department of Health Sciences, Nursing Care.
    Vikman, Irene
    Luleå University of Technology, Department of Health Sciences, Health and Rehabilitation.
    Välivaara, Britt-Marie
    Luleå University of Technology, Department of Health Sciences, Nursing Care.
    Engström, Åsa
    Luleå University of Technology, Department of Health Sciences, Nursing Care.
    Patterns of changes in patients' postoperative recovery from a short-term perspective2018In: Journal of Perianesthesia Nursing, ISSN 1089-9472, E-ISSN 1532-8473, Vol. 33, no 2, p. 188-199Article in journal (Refereed)
    Abstract [en]

    Purpose

    To explore patterns of changes in patients' postoperative recovery over 1 month within different surgery groups.

    Design

    A quantitative longitudinal survey design was used.

    Methods

    A standardized questionnaire was used (N = 167 patients); the postoperative recovery profile for self-assessment of recovery. The postoperative recovery profile developed for hospitalized patients contains 17 items distributed over five dimensions: physical symptoms, physical function, psychological function, social function, and activity.

    Findings

    Overall, orthopaedic patients perceived a lower recovery than general surgery patients. All major surgery groups and subgroups except for joint replacement patients indicated significant systematic changes toward lower levels of problems. The orthopaedic patients assessed their psychological functioning as impaired, and the gastric bypass group was the most recovered.

    Conclusions

    The patients' expectations should be charted initially, and patients should be given realistic information to achieve a realistic hope for a good life in the future. A patient's recovery trajectory may not start after the surgery is completed. Rather, it has already commenced before surgery.

  • 5.
    Sandström, Linda
    et al.
    Luleå University of Technology, Department of Health Sciences, Nursing Care.
    Forsberg, Angelica
    Luleå University of Technology, Department of Health Sciences, Nursing Care. Intensive Care Unit 57, Sunderby Hospital, Luleå, Sweden.
    Problems associated with performance of peripheral intravenous catheterization in relation to working experience2018In: Journal of Vascular Nursing, ISSN 1062-0303, E-ISSN 1532-6578, Vol. 36, no 4, p. 196-202Article in journal (Refereed)
    Abstract [en]

    The aim of this study was to explore general registered nurses’ (RNs) assessments of problems associated with difficult peripheral intravenous catheterization (PIVC) depending on their years of working experience, that is, those who had worked 3 years or less and those who had worked more than 3 years. The design was a quantitative, nonexperimental, descriptive, and analytic survey. The participating RNs (n = 83) were divided into two groups according to the length of their working experience, and the analysis was performed using the SPSS, version 24, software. The RNs also had the opportunity to answer a free-text question related to the aim. The results showed that less experienced RNs assessed to a significantly higher extent that they lacked time, experience, and ability and that there was no blood return; however, they assessed that the peripheral venous catheters were in the vein. If critical care nurses had been requested for support earlier, this request was seen as a reason not to try PIVC at all because critical care nurses were assessed as more experienced and skilled. To develop the kind of effective problem-solving and clinical reasoning needed for practice, a supportive setting must be created throughout nursing education as well as after graduation. Further research should focus on the education needs associated with PIVC and seek to understand to what extent learning in clinical skill simulation laboratories is transferred to actions in the clinical setting.

  • 6.
    Forsberg, Angelica
    et al.
    Luleå University of Technology, Department of Health Sciences, Nursing Care.
    Vikman, Irene
    Luleå University of Technology, Department of Health Sciences, Health and Rehabilitation.
    Välivaara, Britt-Marie
    Luleå University of Technology, Department of Health Sciences, Nursing Care.
    Engström, Åsa
    Luleå University of Technology, Department of Health Sciences, Nursing Care.
    Patients' perceptions of quality of care during the perioperative procedure2017In: ACORN: The Journal of Perioperative Nursing in Australia, ISSN 1448-7535, Vol. 30, no 3, p. 13-22Article in journal (Refereed)
    Abstract [en]

    Purpose: To describe patients' perceptions of quality of care during the perioperative period and to identify areas for quality improvement. Design: A cross-sectional descriptive survey design was used. Method: The data was collected (N=170) using a questionnaire for perioperative care. The methods were descriptive statistics, reported as percentages, and a manifest content analysis of the free text. Finding: The areas identified for improvement were information and participation. The participants lacked knowledge, preferred to hand over decision making to the hospital staff, and indicated that having personalised information about the surgery and perioperative period was important. However, too detailed information before surgery could cause increased anxiety. Conclusions: This study indicates that participation and information needs in perioperative settings seem to be situation specific. In addition, these needs seem to be personal and surgery specific. Further studies are required to clarify the differences in the satisfaction and quality of care between groups of patients in the perioperative context.

  • 7.
    Forsberg, Angelica
    Luleå University of Technology, Department of Health Sciences, Nursing Care.
    Patients' experiences of undergoing surgery: From vulnerability towards recovery -including a new, altered life2015Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    The overall aim of this thesis was to explore patients’ experiences of undergoing surgery, including their perceptions of quality of care and recovery. A mixed methods design was used, and studies with qualitativemethods (I, II) and quantitative methods (III, IV, V) were performed. Data were collected through interviews with ten patients after gastric bypass surgery (I) and nine patients after lower limb fracture surgery (II) and weresubjected to qualitative content analysis. Data were also collected using two standardized questionnaires; The Quality from Patient’s Perspective (III) and Postoperative Recovery Profile (IV, V). A total of 170 orthopedicand general surgery patients participated in study III. In study IV and V, 180 patients participated. Accordingly, 170 of patients were the same in study III, IV and V. Data were analyzed by descriptive statistics (III, IV, V)and a manifest content analysis of the free-text answers (III) as well as with analytical statistics (IV, V). Prior to surgery, patients undergoing gastric bypass surgery (I) described a sense of inferiority related to their obesity. In the post-anesthesia care unit, patients felt both omitted and safe in the unknown environment and expressed needs to have the staff close by. Despite the information provided prior to surgery it was difficult toimagine one’s situation after homecoming, thus it was worth it so far and visions of a new life were described. Patients undergoing lower limb surgery (II) described feelings of helplessness when realizing the seriousness oftheir injury. The wait prior to surgery was strain, and patients needed orientation for the future. They remained awake during surgery and expressed feelings of vulnerability during this procedure. In the post-anesthesia careunit, patients expressed a need to have control and to feel safe in their new environment. Mobilizing and regaining their autonomy were struggles, and patients stated that their recovery was extended. The quality of theperioperative care was assessed as quite good (III). While undergoing a surgical procedure (III), the areas identified for improvement were information and participation. Patients preferred to hand over the decisionmakingto staff and indicated that having personalized information about their surgery was important. However, too detailed information before surgery could cause increased anxiety (III). After surgery, orthopedic patientswere substantially less recovered than general surgery patients (IV, V). Approximately two-thirds of orthopedic patients and half of general surgery patients perceived severe or moderate pain in the first occasion (day 1-4after surgery) (IV). Both the orthopedic and general surgery group showed a significant systematic change at a group level towards higher levels of recovery after one month compared with day 1-4 after surgery. The same patterns occurred regarding acute and elective surgery (V). Patients overall recovered better (IV, V) after a gastric bypass, than after other surgeries. Compared with the period prior to surgery; certain Gastric bypass patients felt after one month that they had improved (IV). The orthopedic groups assessed their psychologicalfunction as being impaired after one month compared with the first occasion (IV, V). The overall view of patients’ experiences of undergoing surgery (I-V) can be understood as a trajectory, from vulnerability towards recovery, including a new, altered life. Patients’ experiences and perceptions of the caregiven (I, II, III) are embedded within this trajectory. As a thread in this thesis, through all studies, patients expressed vulnerability in numerous ways. A progress towards recovery with regards to regaining preoperativelevels of dependence/independence could be concluded. Thus, for patients undergoing gastric bypass surgery, a view of a new, altered life after surgery was also discernible. While undergoing surgery, satisfaction with theprovision of information not necessarily include receiving as much and the most detailed information as possible; nevertheless, the need for information to a great extent is personal. The recovery-period for orthopedic patients is strain, and the support must be improved. In conclusion, the perioperative support may contain a standardized part, made-to-order to the general procedure commonly for all patients, such as information about the stay in the post anesthesia care unit. Moreover, the support should be person-centered, accounting for the patients’ expectations about the future but also tailored to the specific surgical procedure; with its limitations and possibilities. Then, patients in a realistic way would be strengthened towards recovery, including a new, altered life.

  • 8.
    Forsberg, Angelica
    et al.
    Luleå University of Technology, Department of Health Sciences, Nursing Care.
    Vikman, Irene
    Luleå University of Technology, Department of Health Sciences, Health and Rehab.
    Wälivaara, Britt-Marie
    Luleå University of Technology, Department of Health Sciences, Nursing Care.
    Engström, Åsa
    Luleå University of Technology, Department of Health Sciences, Nursing Care.
    Patients' perceptions of quality of care during the perioperative procedure2015In: Journal of Perianesthesia Nursing, ISSN 1089-9472, E-ISSN 1532-8473, Vol. 30, no 4, p. 280-289Article in journal (Refereed)
    Abstract [en]

    To describe patients' perceptions of quality of care during the perioperative period and to identify areas for quality improvement. Design: A cross-sectional descriptive survey design was used. Methods: The data were collected (N = 170) using a questionnaire for perioperative care. The methods were descriptive statistics, reported as percentages, and a manifest content analysis of the free text. Finding: The areas identified for improvement were information and participation. The participants lacked knowledge, preferred to hand over decision making to the hospital staff, and indicated that having personalized information about the surgery and perioperative period was important. However, too detailed information before surgery could cause increased anxiety. Conclusions: This study indicates that participation and information needs in perioperative settings seem to be situation specific. In addition, these needs seem to be personal and surgery specific. Further studies are required to clarify the differences in the satisfaction and quality of care between groups of patients in the perioperative context

  • 9.
    Forsberg, Angelica
    et al.
    Luleå University of Technology, Department of Health Sciences, Nursing Care.
    Vikman, Irene
    Luleå University of Technology, Department of Health Sciences, Health and Rehab.
    Wälivaara, Britt-Marie
    Luleå University of Technology, Department of Health Sciences, Nursing Care.
    Engström, Åsa
    Luleå University of Technology, Department of Health Sciences, Nursing Care.
    Patients' perceptions of their postoperative recovery for one month2015In: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702, Vol. 24, no 13-14, p. 1825-1836Article in journal (Refereed)
    Abstract [en]

    Aims and objectivesTo explore orthopaedic and general surgery patients' perceptions of their postoperative recovery for one month.BackgroundIn general, nursing research in the postoperative context has been directed towards a single symptom or area, which is valuable. However, there is a lack of studies of orthopaedic and general surgery patients' perceptions of postoperative recovery from a short-term perspective.DesignA quantitative approach with a longitudinal design was used.MethodsA total of 180 patients participated in the study. Data were collected using a standardised questionnaire, the Postoperative Recovery Profile, for self-assessment of recovery. Descriptive statistics reported as proportions were used for the categorical variables. Analytic statistics were used to identify statistically significant differences. Mean values and t-tests were used for quantity variables, and Mann–Whitney U-tests and Chi-squared tests were used for nonparametric variables.ResultsOverall, the orthopaedic patients were substantially less recovered than the general surgery patients. Two-thirds of the orthopaedic patients and half of the general surgery patients perceived severe or moderate pain in the acute recovery phase. Within the general surgery group, there were significant differences in the recovery between the Gastric Bypass patients and colon/ileum surgery patients. The gastric bypass patients were overall more recovered than the other groups of patients. The Gastric Bypass patients reported that they had improved after one month compared to their own status prior to surgery.Conclusions and relevance to clinical practiceNursing support for orthopaedic patients must be improved, especially after they are discharged from the hospital. To structure and monitor individual recovery, a top-five priority profile of the most important problems should be used during follow-up calls after the patient is discharged from the hospital. Postoperative pain continues to represent a clinical problem that requires attention. Heterogeneity in the perceptions of recovery within the general surgery group was indicated, which may depend on the surgical procedure as well as the patients' expectations and comparisons with their lives before surgery. Rather than return to their preoperative levels, certain patients tend to continue towards a new or different life postoperatively.

  • 10.
    Forsberg, Angelica
    et al.
    Luleå University of Technology, Department of Health Sciences, Nursing Care.
    Engström, Åsa
    Luleå University of Technology, Department of Health Sciences, Nursing Care.
    Söderberg, Siv
    Luleå University of Technology, Department of Health Sciences, Nursing Care.
    From reaching the end of the road to a new lighter life: People's experiences of undergoing Gastric Bypass surgery2014In: Intensive & Critical Care Nursing, ISSN 0964-3397, E-ISSN 1532-4036, Vol. 30, no 2, p. 93-100Article in journal (Refereed)
    Abstract [en]

    ObjectivesIt is limited research that focuses on people's experiences from prior to surgery to the postoperative period after a gastric bypass. The aim of this retrospective study was to describe people's experiences of undergoing gastric bypass surgery.MethodA qualitative approach was used. Interviews with ten participants were subjected to qualitative content analysis.ResultsThe analysis of the interviews resulted in one theme: from reaching the end of the road to a new lighter life. Prior to surgery participants described a sense of inferiority and that they were not able to ‘take any more’. Shortly after surgery participants felt both vulnerable and safe in the unknown environment and expressed needs of orientation and to have the staff close. Despite information prior to surgery it was difficult to imagine ones’ situation after homecoming, thus it was worth it so far.ConclusionThe care given in the acute postoperative phase for people who undergo gastric bypass surgery, should aim to provide predictability and management based on individual needs. Being treated with respect, receiving closeness, and that the information received prior to surgery complies with what then happens may facilitate postoperative recovery after a gastric bypass surgery.

  • 11.
    Forsberg, Angelica
    et al.
    Luleå University of Technology, Department of Health Sciences, Nursing Care.
    Söderberg, Siv
    Luleå University of Technology, Department of Health Sciences, Nursing Care.
    Engström, Åsa
    Luleå University of Technology, Department of Health Sciences, Nursing Care.
    People's experiences of suffering a lower limb fracture and undergoing surgery2014In: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702, Vol. 23, no 1-2, p. 191-200Article in journal (Refereed)
    Abstract [en]

    AIMS AND OBJECTIVES: To describe people's experiences of suffering a lower limb fracture and undergoing surgery, from the time of injury through to the care given at the hospital and recovery following discharge.BACKGROUND: There is a lack of research on people's experiences of suffering a lower limb fracture and undergoing surgery - from injury to recovery.DESIGN: A qualitative approach was used.METHODS: Interviews with nine participants were subjected to thematic content analysis.RESULTS: One theme was expressed: from realising the seriousness of the injury to regaining autonomy. Participants described feelings of frustration and helplessness when realising the seriousness of their injury. The wait prior to surgery was a strain and painful experience, and participants needed orientation for the future. They expressed feelings of vulnerability about being in the hands of staff during surgery. After surgery, in the postanaesthesia unit, participants expressed a need to have control and to feel safe in their new situation. To mobilise and regain their autonomy was a struggle, and participants stated that their recovery was extended.CONCLUSIONS AND RELEVANCE TO CLINICAL PRACTICE: Participants found themselves in a new and unexpected situation and experienced pain, vulnerability and a striving for control during the process, that is, 'from realising the seriousness of the injury to regaining autonomy'. How this is managed depends on how the patient's needs are met by nurses. The nursing care received while suffering a lower limb fracture and undergoing surgery should be situation specific as well as individual specific. The safe performance of technical interventions and the nurse's comprehensive explanations of medical terms may help the patient to feel secure during the process.

  • 12.
    Forsberg, Angelica
    et al.
    Luleå University of Technology, Department of Health Sciences, Nursing Care.
    Lindgren, Elenor
    Department of Intensive Care, Sunderby Hospital.
    Engström, Åsa
    Luleå University of Technology, Department of Health Sciences, Nursing Care.
    Being transferred from an intensive care unit to a ward: searching for the known in the unknown2011In: International Journal of Nursing Practice, ISSN 1322-7114, E-ISSN 1440-172X, Vol. 17, no 2, p. 110-116Article in journal (Refereed)
    Abstract [en]

    People who have been cared for in intensive care units (ICUs) are transferred between different levels of care and hospitals. The aim with this study was to describe peoples’ experiences of being cared for in an ICU and transferred to a ward. An inductive, descriptive qualitative study was performed with qualitative individual interviews with 10 participants. The interviews were transcribed verbatim and subjected to qualitative thematic content analysis which resulted in one theme; searching for the known in the unknown, and five categories. The findings showed the importance of being prepared for the transfer and knowing what was going to happen. Some participants felt secure in the ICU and excluded on the ward, others appreciated leaving the stressful environment in the ICU for a more peaceful ward. Feelings of anxiety and exposure were experienced during the transfer and it was helpful if staff involved were known to the participants. Better information and patients’ involvement concerning the transfer from ICUs to general wards are suggested as means of improving nursing care. Further studies are needed to improve continuity of care for critically ill people

  • 13.
    Sandström, Linda
    et al.
    Luleå University of Technology, Department of Health Sciences, Nursing Care.
    Engström, Åsa
    Luleå University of Technology, Department of Health Sciences, Nursing Care.
    Juuso, Päivi
    Luleå University of Technology, Department of Health Sciences, Nursing Care.
    Nilsson, Carina
    Luleå University of Technology, Department of Health Sciences, Nursing Care.
    Forsberg, Angelica
    Luleå University of Technology, Department of Health Sciences, Nursing Care.
    Patients’ health-related quality of life and perceptions of care: A longitudinal study based on data from the Swedish Trauma RegistryManuscript (preprint) (Other academic)
1 - 13 of 13
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