Trauma is an event during which individuals are confronted with a threat to their own or to someone else’s integrity. If intense fear, horror and helplessness are experienced during the event there may be psychological traumatisation. However, individuals may experience physical trauma and require hospitalisation. The patients’ subjective experiences from the hospitalisations may precipitate further trauma. Although families of patients are not involved in the traumatic event, they may experience their own traumatisation. The individuals and their families experience the trauma on the biological, psychological and social levels. Medical literature is mostly positivistic and there is little qualitative research on the experience of hospitalisation, particularly of family experiences of the intensive care unit (ICU). There is also a paucity of research on psychological experiences in the medical world. The research that has been conducted in psychology is mostly with psychiatrists. The aim of this research is to explain the sense families make of physical trauma using narrative. Narrative is the sense individuals make of experiences across time through telling and re-telling stories. Qualitative research is most suited to explore these subjective experiences of individuals. Social constructionism is one form of qualitative research and a process exploring the world of individuals in the context of culture, history and social interaction. Individuals arrange these stories using myths, symbols and archetypes that will provide coherence to the lived experience. Languaging the experiences facilitates meaning attribution that informs behaviour. Data was collected through photographs taken by the participants and individual interviews were conducted. The co-construction of this text occurred in the context of the researcher as a counsellor, the researcher as a previous physical trauma patient and the family perspectives of the participants. The exploration of the photographs and their sequence are followed by a narrative analysis of the interview texts using storymaps. Narratives were co-created in this context. The participants selected the stories and created coherence by narrating and ordering the sequence of photographs. Since the family language this lived experience, the members explored various selves and their relationships with their worlds. The family was impacted biopsychosocially and is writing an alternate story in the discourse of the medical world that says further rehabilitation is difficult, if not impossible. They have made sense of the physical trauma by searching for unique outcomes and narrating on a temporal framework: stories of their self, relationships with others, their physical self and their physical environments. This will create space for their alternate story. / Dissertation (MA (Counselling Psychology))--University of Pretoria, 2008. / Psychology / unrestricted

Bakgrund: Suicid och suicidförsök är ett känt folkhälsoproblem både internationellt och nationellt. I Sverige är det ca 15 000 personers som utför suicidförsök varje år och över 150 000 personer lider av allvarliga suicidtankar. En del av dessa patienter kommer att behandlas inom intensivvården, vilket ställer stora krav på intensivvårdssjuksköterskans professionella och etiska förhållningssätt i interaktionen med patienten och anhöriga, för att bygga upp och säkerställa en god vårdande relation Syfte: Syftet med studien var att belysa intensivvårdssjuksköterskans upplevelse av att vårda patienter som utfört suicidförsök.  Metod: En kvalitativ intervjustudie med induktiv ansats användes. Tio intensivvårdssjuksköterskor inkluderades i studien. Datainsamling genomfördes med hjälp av semistrukturerade intervjuer som analyserades med hjälp av en kvalitativ innehållsanalys.  Resultat: Resultatet presenteras genom fyra kategorier; Upplevelsen av svårigheter i mötet med patienten, Upplevelsen av begränsningar i omvårdnadsarbetet, Upplevelsen av svåra tankar i omvårdnadsarbetet och Upplevelsen av otillräckligt stöd från olika professioner. Resultatet påvisar sjuksköterskornas upplevelse av bristande samarbete mellan professioner, bristande utbildning och känslomässigt engagemang. Vilket ger en känsla av frustration som leder till svårigheter i mötet med den nämnda patientgruppen. Slutsats: I den kliniska vården finns det flera centrala faktorer som kan gynna eller försvåra vårdandet av patienter som försökt begå suicid såsom kommunikationen i mötet med patienten, sjuksköterskans professionella roll och tvärprofessionell samverkan mellan kliniker samt utbildning och kompetens. Som blivande intensivvårdssjuksköterskor anser författarna att studien ger viktiga infallsvinklar i ämnet som kan vara användbara och stärka den kommande yrkesrollen. Det kan upplevas känslomässigt komplicerat att behandla patientgruppen, detta i sin tur är viktigt att följa upp och ses över av enhetschefer och ansvariga för yrkesgruppen.

Bakgrund: Intensivvård är en avancerad behandling med noggrann övervakning av kritiskt sjuka patienter. Patienterna är i ett utsatt läge och i beroendeställning av vårdpersonal såväl sina närstående. Tidigare studier tar upp vikten av delaktighet men utifrån ett patientperspektiv. Det har erfarits att närstående inte görs delaktiga i vården som de skulle kunnat vara. Det saknas även studier där närståendes delaktighet undersökts. Att vara närstående till en kritiskt sjuk person kan vara svårt och det är intensivvårdssjuksköterskans ansvar att göra de närstående delaktiga. Negativa effekter kan ske för de närstående som inte får vara delaktiga, så kallat “post-intensive care syndrom”. Syfte: Studiens syfte var att beskriva närståendes upplevelser av delaktighet i vården av en vuxen kritiskt sjuk person på intensivvårdsavdelningen. Metod: En systematisk litteraturstudie med kvalitativ ansats med 15 vetenskapliga artiklar. Artiklarna har analyserats med hjälp av Bettany-Saltikov och McSherrys metod. Resultat: I resultatet framkom tre huvudkategorier: Att finnas till för patienten, Involverad i kommunikationen med vårdpersonal samt Delta i den fysiska omvårdnaden. Slutsats: Närståendes upplevelse av delaktighet har en betydande roll för intensivvården. Närstående känner sig delaktiga genom att få vara med fysiskt i omvårdnaden men även att vara passiv. De uppskattar att få information, att få valmöjligheter och på så sätt känna sig delaktiga. Närståendes delaktighet speglades även när de var nära, uppmuntrade och förde patientens talan. Att ta vara på närstående och göra dem delaktiga på intensivvårdsavdelningen är något att ta lärdom av. / Background: Intensive care involves an advanced treatment and close monitoring of critically ill patients. Patients are in a vulnerable position that depends on both their next-of-kin as well as advanced health care. Previous studies address the importance of participation but from a patient perspective. Former experiences from intensive care have pinpointed that relatives are not as involved in the care as they could be. There currently are few studies where the participation of relatives has been investigated. Being close to a critically ill person can be difficult and it is the intensive care nurse´s responsibility to involve the relatives. Negative effects can occur for the relatives who are not allowed to participate, so called “post-intensive care syndrome”.  Aim: The aim of the study was to describe relatives' experiences of participation in the care of an adult critically ill person in the intensive care unit. Method: A systematic literature study with a qualitative approach from 15 scientific articles. The articles have been analyzed using Bettany-Saltikov and McSherry´s method. Results: The results showed three main headings: To be there for the patient, Part taking in the communicational aspects with the care givers and Participate in physical care. Conclusion: Relatives' experience of participation has a significant role for intensive care. Relatives feel involved by being physically engaged in the care, but also by being passively active. They appreciate recieving information, having choices and through that feeling more involved. The participation of relatives was also reflected when they were close, encouraged and brought the patient´s voice. Taking care of relatives and making them involved in the intensive care unit is something to learn from.

Esta investigación tiene como propósito principal desarrollar un proyecto de diseño interior para la renovación del pabellón de la Unidad de Cuidados Intensivos (UCI) del Hospital de la Policía Nacional del Perú Luis Nicasio Sáenz (Jesús María), de manera que se mejore su funcionalidad y confort. Como objetivos específicos, se plantearon proponer replanteamientos de distribución según las zonas negra, gris y blanca; proponer un diseño de iluminación que permita a los usuarios cumplir con las funciones habituales del área; y plantear un diseño que otorgue identidad, de manera que este pueda ser replicado en cada área del hospital. En esa línea, se desarrolla la problemática actual del entorno hospitalario, se conceptualiza qué es una UCI, sus características y tipos; asimismo, se expone cómo la arquitectura se articula con la humanización. En cuanto a la estrategia de diseño, esta incluye el diagnóstico, la intervención y aspectos específicos, como en el uso de colores, materiales e iluminación. Esta información se presenta mediante diversas figuras, que detallan el programa arquitectónico, el organigrama y la zonificación de espacios. Los desperfectos encontrados en el nosocomio sirven de partida para realizar la nueva propuesta de diseño. Las ideas se plantean de acuerdo con guías normativas para la implementación de una unidad tan crítica, de manera que el resultado sea un espacio que resulte funcional para el equipo del personal médico, así como confortable para los pacientes. / The main purpose of this research is to develop a project of interior design for the renovation in the pavilion of intensive care unit (ICU) of the National Police Hospital of Perú Luis Nicasio Sáenz (Jesús María), to improve its functionality and comfort. As specifics objectives, it is proposed a new distribution according to black, gray and white areas; also it is proposed a lighting design that allows users to acomplish with the usual functions of the area; and it is propose a design that give an identity, so that could be replied in different areas of the hospital. Therefore, the current problems of the hospitals are developed, the concept of a intensive care unit (ICU) is conceptualized, also its characteristics and types; additionally, it is exposed how the architecture articulates with humanization. For the design strategy, diagnostics, interventions and specific aspects, such as the use of colors, materials and lighting, are included. This information is presented in figures, which detail the architectural program, the organization chart and the zoning of the spaces. The problems found in the hospital serves as a starting point to carry out the new design proposal. The ideas are presented in accordance with normative guidelines for the implementation of a critical unit, so that result while be a space that is functional for the team of medical personnel, as well as comfortable for patients. / Tesis

Bakgrund: Intuberade patienter inom intensivvården har en hög risk för att erhålla en ventilator-associerad pneumoni (VAP). Det finns evidensbaserade riktlinjer för vuxna somförebygger VAP. För barn behövs det däremot mer forskning för att klargöra vilka omvårdnadsåtgärder som kan standardiseras. Syfte: Syftet är att beskriva vilka omvårdnadsåtgärder som förebygger VAP hos barn inom intensivvården, en litteraturöversikt. Metod: En deskriptiv litteraturstudie med kvantitativ induktiv ansats valdes. 16 kvantitativa studier analyserades med en innehållsanalys. Det samlade materialet kvalitetsgranskades med hjälp av GRADE. Resultat: Fem huvudteman identifierades utifrån studiernas resultat. Huvudteman var VAP-omvårdnadspaket, munvård med klorhexidin, skötsel av endotrakealtub, olika nutritionssonder, omvårdnadsutbildning. VAP-omvårdnadspaket och omvårdnadsutbildning visade sig statistiskt signifikant sänka VAP-prevalensen hos barn. Munvård med klorhexidin kunde inte sänka VAP-prevalensen. Slutsats: Med rätt evidensbaserad vård kan VAP-prevalensen sänkas. Forskning kring VAP-prevention till barn saknar evidens i nuläget och kan ej anses vara evidensbaserad vård. För att göra vården evidensbaserad, rekommenderas att globala riktlinjer för VAP-prevention till barn tas fram. / Background: Intubated patients admitted to an intensive care unit have a higher risk ofacquiring ventilator-associated pneumonia (VAP). There are evidence-based guidelines for adults that prevent VAP. For children there is a need for more research in this area to clarifywhich nursing methods can be standardized. Aim: The aim was to describe which nursing care measures prevent VAP in children admitted to the intensive care unit, a literature review. Method: A descriptive literature study with a quantitative inductive approach was used. A total of 16 quantitative studies was analysed with a content analysis. A GRADE system was used to assess the quality of the included studies. Results: Five main themes were identified from the study’s results. The main themes where VAP-care bundles, oral care with chlorhexidine, care of endotracheal tube, different nutritional catheters, and nursing care education. VAP-care bundles and nursing care education showed to have statistically and significantly lowered the prevalence of VAP in children. Oral care with Chlorhexidine did not lower the prevalence significantly of VAP. Conclusion: The prevalence of VAP can be lowered with the right evidence-based practice. At the current situation research on preventing VAP in children lack evidence and can’t be considered as evidence-based practice. To make the nursing care evidence based, it´s recommended to create global guidelines of VAP-prevention for children.

Bakgrund: Invasiv monitorering och behandling inom intensivvården ökar risken för VRI, vilket hotar patientsäkerheten. CVK-relaterad blodburen infektion utgör 20 % av infektionerna inom intensivvården och leder till ökad mortalitet. Dock anses dessa infektioner i hög grad vara undvikbara. Sjuksköterskor inom intensivvården hanterar CVK dagligen och ansvarar för att detta görs på ett patientsäkert sätt, om patientsäkerheten brister kan det leda till vårdlidande för patienten. En viktig del av patientsäkerhetsarbetet är att sammanställa kunskap om vilka åtgärder sjuksköterskor kan genomföra för att minska antalet CVK-relaterade blodburna infektioner.  Syfte: Beskriva de åtgärder som sjuksköterskor kan genomföra vid hantering av CVK för att minska frekvensen av CVK-relaterade blodburna infektioner hos vuxna patienter inom intensivvården.  Metod: Litteraturstudie med systematisk ansats av observations- och interventionsstudier. Artikelsökning genomfördes i PubMed och CINAHL. Kvalitetsgranskning genomfördes med mall från Willman, Stoltz och Bahtsevani (2011). Resultatet utformades genom narrativ syntes och presenteras i löpande text samt sammanfattande tabeller. Resultat: Baserat på 20 kvantitativa studier med fokus på vuxna patienter med CVK som vårdas på IVA beskrivs de sex kategorierna: förband, hudtvätt, hängtid, proppar och ventiler, utbildning samt åtgärdspaket. Inom alla dessa kategorier fanns studier som visade på åtgärder som ledde till minskning av CVK-relaterad blodburen infektion.  Slutsats: Denna studie tydliggör att sjuksköterskan vid CVK-hantering har möjlighet att arbeta infektionsförebyggande. Genom att använda desinfektionsproppar och injektionsventiler med desinfektionsbara membran, hudtvätt med klorhexidin, utbildning och åtgärdspaket kan sjuksköterskan således minska risken för patienters vårdlidande. Denna studie föreslår forskning av hur implementering ska ske för att öka följsamheten kring åtgärder för förebyggande av CVK-relaterad blodburen infektion. / Background: Invasive monitoring and treatment in intensive care increases the risk of healthcare associated infections, which is a threat for patient safety. Central line-associated bloodstream infection [CLABSI] accounts for 20 % of all infections in intensive care and leads to increased mortality. However, CLABSI is largely considered avoidable. Nurses in the ICU handle these devices on a daily basis and are responsible for ensuring that this is performed in a manner that complies with patient safety; lack of patient safety can cause suffering for the patient. An important part of improving patient safety is to compile knowledge about what measures nurses can implement to reduce the number of CLABSI. Aim: To describe the measures that nurses can implement when managing the central line to reduce the frequency of CLABSI in adult patients in intensive care. Method: Quantitative literature study with a systematic approach of observational and interventional studies. Search was performed in PubMed and CINAHL. Quality review was conducted using templates from Willman, Stoltz and Bahtsevani (2011). The results were developed through narrative synthesis and presented in text and summary tables. Results: Based on 20 quantitative studies focusing on adult patients with central lines cared for at the ICU, the six described categories are: dressings, bathing, hang time, port protectors and connectors, education and bundles. In all these categories, there were studies that showed measures that led to a reduction in CLABSI. Conclusion: This study clarifies that the nurse in central line-management has the opportunity to prevent infection. By using port protectors and connectors with disinfectable membranes, bathing with chlorhexidine, education and bundles, the nurse can therefore reduce the risk of patients suffering from care. This study proposes research on how implementation should take place to increase compliance with measures for the prevention of CLABSI.

Team collaboration is a fundamental part of Quality Management (QM), and working together successfully is an important part of improving an organization. Team collaboration is also essential for achieving quality of care, patient safety and care continuity, especially when handling critically ill patients. Transferring a patient from an intensive care unit (ICU) to a general ward demands planning, communication, competence, a system view, and a quality culture. This patient transfer process, called ICU transitional care, extends across hospital boundaries, which have different organizational cultures, technologies, and knowledge. It is a challenge to manage these differences in order for team collaboration to meet the needs of patients, relatives and co-workers. To achieve this, further research is required to understand how care teams, both within hospital units and between organizational boundaries, can collaborate more successfully and efficiently to achieve quality of care in the ICU transitional care process. The overall purpose of this thesis is to contribute to a deeper understanding of how to improve team collaboration within ICU transitional care aiming to increase quality of care. To achieve this, four research questions were formulated and three case studies conducted. In the first case, a systematic literature review was performed to explore the extent to which Quality Management and Nursing Science can offer complementary perspectives to provide better quality of care by looking at Quality Management core concepts and tools. Findings from this study revealed, among other things, a need for further research on team collaboration in ICU transitional care. The purpose of the second study was to develop and test a questionnaire aiming to measure the perception of team collaboration in the patient transfer process from the ICU to the general ward. This study also aimed to analyze the results to see how the questionnaire could help improve team collaboration within ICU transitional care. Empirical data were collected from two ICUs at two hospitals. Participants at the ICUs answered the developed questionnaire, and the results showed that it could be used for measuring perceived team collaboration in this patient transfer process. The results from the questionnaire also gave insights that might be useful for improving team collaboration in this ICU transitional care process. The purposes of the third study were, first, to describe how co-workers’, within a team, perceived team collaboration in patient transfers from ICU to general wards and, second, to describe co-workers’ suggestions for an improved future state of team collaboration. Focus group discussions (FGDs) were conducted at two hospitals to answer the two questions. There were several findings from the study, and the results indicated that team collaboration has an important role when creating prerequisites for a holistic view of the process, and that there was a perceived need among the co-workers to improve team collaboration over organizational boundaries. Co-workers also expressed a need for more involving patients and relatives when improving team collaboration.   Four overarching conclusions can be drawn from this research. Firstly, Quality Management is used in ICU transitional care to improve the quality of care. Secondly, multi-professional team collaboration is perceived to be easier and better developed within hospital units than between them. Collaborating in teams between hospital units is challenging for several reasons. Some reasons are unclarity in routines for communication and decision-making, for example who decides what.  A third conclusion is the importance of how teams and team collaboration are defined and structured in ICU transitional care. This involves roles and responsibilities of teams. Teams have specific characteristics that are important for their performance. A fourth conclusion is an expressed need to involve patients and relatives more when it comes to improve team collaboration in ICU transitional care. The main findings from the three studies presented in this thesis have given insight and deeper understanding of how co-workers perceive team collaboration within ICU transitional care at two hospitals located in Sweden, and co-workers’ suggestions for how team collaboration can be improved aiming to increase quality of care. / <p>Vid tidpunkten för framläggningen av avhandlingen var följande delarbete opublicerat: delarbete 3 (inskickat).</p><p>At the time of the defence the following paper was unpublished: paper 3 (submitted).</p>

The purpose of this study was to determine the effects of an atypical pattern of early acoustic stimulation on auditory development. Previous human research suggests that the acoustic environment of pre-term human infants in the Neonatal Intensive Care Unit (NICU) negatively affects some aspects of auditory development. Animal research suggests that premature auditory stimulation interrupts auditory development. Because mice are born before their auditory systems are developed, they make an excellent model for research on fetal and postnatal plasticity of the auditory system. The premature auditory state of newborn mice is similar to that of the NICU pre-term infant, albeit, natural for mice C57 mouse pups were exposed to an augmented acoustic environment (AAE) of a nightly 12-hour regiment of 70 dB SPL noise burst, beginning before age 12 days (onset of hearing) and lasting for one month. The prepulse inhibition (PPI) of mice exposed to the AAE was compared to that of non-exposed mice to observe short-term and long-term effects. Results showed that the prepulse inhibition of the AAE exposed mice did not differ significantly from that of the non-exposed mice. However, it is possible that the measurement used, PPI, may not have been appropriate or that the AAE may not have been an appropriate simulation of the NICU environment.

Bakgrund: Bristande kommunikationen kan vara en stor anledning till patientsäkerhetsrisker, ofta uppstår bristerna i övergången mellan olika team och där en snabb och effektiv hantering är av största vikt såsom på intensivvårdsavdelningar. SBAR rekommenderas av SKR och studier har visat att användandet av SBAR ökar patientsäkerheten i vissa aspekter. Motiv: Inga studier har hittats som undersöker vilka faktorer som kan påverka intensivvårdssjuksköterskans möjligheter att rapportera enligt SBAR. Kunskap om detta kan leda till utvecklandet av metoder som kan förbättra möjligheten till korrekt SBAR rapportering. Syftet: Syftet med studien var att kartlägga om olika faktorer kan påverka om intensivvårdssjuksköterskor rapporterar korrekt enligt SBAR eller inte vid överrapportering. Metod: Metoden som användes var en kvantitativ observationsstudie. Observationerna skedde på två olika intensivvårdsavdelningar på ett medelstort sjukhus i Norrland. 31 intensivvårdssjuksköterskor deltog. Efter observationen fick studiedeltagaren svara på ett frågeformulär. Resultat: Resultatet visade inga statistiskt signifikanta skillnader eller samband vilket delvis kan förklaras av ett litet stickprov. Resultatet visade dock på medelstora effekter som tyder på att intensivvårdssjuksköterskor som rapporterat felaktigt enligt SBAR var äldre, hade arbetat en längre tid som sjuksköterskor och längre tid på arbetsplatsen samt att en korrekt SBAR rapportering hade fler störningar och en högre ljudnivå. Konklusion: En förbättrad följsamhet till SBAR skulle kunna minska samhällskostnader och vårdskador. Utbildningsinsatser i form av rollspel eller simulering skulle kunna öka kunskapen om SBAR. Kontinuerlig fortbildning behövs för att upprätthålla kompetensen, detta kan göras genom instruktionssjuksköterskor och användandet av lättillgängliga flödesscheman samt att rapportering bör ske där det är en låg ljudnivå / Background: Inadequate communication can be a considerable reason for patient safety risks. Mistakes in communication often happen in the transition between different teams and when efficient and fast management is of importance, such as in an ICU. The use of SBAR (Situation, Background, Assessment, Recommendation) is recommended by SKR and studies have shown that it can improve patient safety in some aspects. Motive: Knowledge about factors that can affect the intensive care nurses' possibilities to do a correct SBAR handover can help create methods that can increase the possibility of a correct SBAR handover. Aim: The aim of the study was to map out whether varied factors can affect intensive care nurses to do a correct handover accordingly to SBAR or not. Method: The method used was a quantitative observational study. The observations took place on two different intensive care units in a medium sized hospital in northern Sweden. 31 intensive care nurses participated in the study. The participants then answered a questionnaire after the observation. Result: The result did not show any significant differences or relationships. The result did, however, show midsized effects that could indicate that the intensive care nurses who fail to do a handover accordingly to SBAR tend to be older, had worked a longer time at the workplace and as a registered nurse. Correct SBAR handovers had a higher sound level and more interruptions. Conclusion: A better compliance with SBAR could reduce iatrogenic harm and societal costs. Educational efforts could help increase knowledge about SBAR, roleplay and simulations have shown a good effect when implementing SBAR. Continuous education to uphold knowledge is needed, it can be done with instructional nurses and flowcharts. During handovers, the sound level should be reduced.

Bakgrund: Mekanisk respiratorbehandling är en den mest använda kortsiktiga livsuppehållande interventionen och den vanligaste behandlingsformen inom intensivvården och syftar till att understödja och stötta andningssvikt. Smärta är en vanlig upplevelse hos patienter som vårdas inom intensivvårdsavdelen och som behandlas med mekanisk ventilation, inte bara för själva respiratorbehandlingen utan även för de undersökningar och behandlingar som pågår samtidigt.  Motiv: Smärta är vanligt förekommande hos patienter som vårdas inom intensivvården relaterat till sjukdom, skada, behandling, procedurer och omvårdnad. När patienter vårdas i respirator försvinner förmågan att kunna uttrycka sig verbalt, det gör att de inte med ord kan förmedla sin smärta.   Metod: Kvalitativ innehållsanalys med individuella semistrukturerade intervjuer med induktiv ansats.   Syfte: Syftet var att belysa intensivvårdssjuksköterskors erfarenheter av att tolka smärta hos sederade patienter i respirator.   Resultat: Analysen av studien resulterade i två huvudkategorier med vardera tre subkategorier. Personliga aspekter med följande subkategorier; Individuella bedömningar, tolkning av patientens uttryck och komplexitet i bedömningar. Nästa huvudkategori var; Organisatoriska aspekter med följande subkategorier; sjuksköterskans framträdande roll i teamet, strukturerad informationsöverföring samt professionellt engagemang med kompetens  Konklusion: Resultatet visade att det finns hinder som påverkar bedömning av smärta hos respiratorvårdade patienter. Intensivvårdssjuksköterskan använder erfarenheter och tidigare kunskap istället för formella smärtskattningsinstrument. De uttryckte svårigheter i att bedöma skillnad på oro och smärta. Intensivvårdssjuksköterskorna upplever att det är deras ansvar att patienten får rätt smärtlindring och lyfta diskussionen kring smärta. De belyser även vikten av tydlig dokumentation och rapportering. / Background: Mechanical ventilator treatment is one of the most widely used short-term-life-sustaining interventions and the most common form of treatment in intensive care and aims to support respiratory failure. Pain is a common experience in patients who are cared for in the intensive care unit and who are treated with mechanical ventilation, not only for the respiratory treatment itself but also for the examinations and treatment that take place at the same time.   Motive: Pain is common symptom for intensive care patients, related to illness, injury, treatment, procedures and nursing. When patients are cared for in a ventilator, the ability to express themselves verbally disappears, which means that they cannot convey their pain with words.    Method: Qualitative content analysis with individual semi-structured interviews with an inductive approach.   Aim: The aim was to examine intensive care nurses' experience of interpreting pain in sedated patients on a ventilator.  Results: The analysis of the study resulted in two main categories with three subcategories each. The first main category was Personal aspects with the following subcategories; Individual assessments, interpretation of the patient's expression and complexity in assessments. The next main category was; Organizational aspects with the following subcategories; the nurse's prominent role in the team, structured information transfer and professional commitment with competence.  Conclusion: The results showed that there are obstacles that affect the assessment of pain in respiratory patients. The intensive care nurse uses experience and previous knowledge instead of formal pain assessment instruments. They expressed difficulty in distinguishing between anxiety and pain. The intensive care nurses feel that it’s their responsibility to get the patient the right pain relief and raise the discussion about pain. They also highlight the importance of clear documentation and reporting.