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Bakgrund: Varje år föds det 15 miljoner prematura barn i världen. Prematura barn behöver vårdas på en neonatalavdelning, tills de är friska nog att lämna avdelningen. I familjecentrerad omvårdnad betraktas familjen som en helhet. Familjecentrering är ett relativt nytt forskningsområde, med perspektiv från både föräldrar och vårdpersonal. Tidigare forskning inom familjecentrerad omvårdnad på en neonatalavdelning visar på positiva effekter hos både förälder och barn. Syfte: Syftet var att belysa föräldrars upplevelse av familjecentrerad omvårdnad på en neonatalavdelning. Metod: Studien var en litteraturöversikt som inkluderade 15 vetenskapliga artiklar på engelska som var publicerade mellan år 2010 och 2020. Både kvalitativa och kvantitativa artiklar inkluderades i studien. Databassökningen skedde i databaserna CINAHL och PubMed och artiklarna analyserades i enlighet med Kristenssons (2014) integrerade analys. Resultat: Resultatet visade att många föräldrar upplever tiden på neonatalavdelningen som en känslomässig berg- och dalbana. Många föräldrar längtade efter närhet med deras barn, oftast var hindret till närhet en rädsla för att barnets hälsa skulle försämras. Vägledning visade sig ge föräldrarna modet att delta i omvårdanden med deras barn, och även möjlighet till att knyta an till barnet. Sjuksköterskan var ett stort stöd enligt föräldrarna, även bara att vara i närheten gav familjen en möjlighet till att slappna av. Slutsats: Föräldrar som får ett prematurt barn överväldigas av många olika känslor. Vårdpersonalen på neonatalavdelningen bidrar till stöd och vägledning. Upplevelser som var återkommande hos föräldrarna var att deras stress minskade när de fick vara med sitt barn samt vara delaktig i vården. Som sjuksköterska är kunskap om hur man ska stötta och bemöta föräldrar i denna sårbara situation betydelsefull för att kunna möjliggöra en så bra och individanpassad vård som möjligt. / Background: Every year 15 million premature children are born. Premature children are in need of care in a neonatal intensive care unit, until they are strong enough to be discharged. In family centered care (FCC) the family is viewed as an ensemble. FCC is a relatively new research area, with perspectives both from parents and health personnel. Research has shown that FCC had positive effects on both parents and child in a neonatal intensive care unit (NICU). Aim: The aim was to describe parent’s experiences of FCC in NICU.  Method: The study was a literature review that included 15 scientific articles in English, which were published between the years 2010 and 2020. Both qualitative and quantitative articles were included. The database search was made in CINAHL and PubMed and the articles were analysed according to Kristensson’s (2014) integrated analysis. Results: The results showed that many parents experience the time in NICU as an emotional roller-coaster. Many parents long for a physical contact with their child, often the fear of the child's health is an obstacle. Guidance showed that parents had the courage to participate in their child's care and got the opportunity of getting an emotional connection. The nurse was a big support for the parents, to be nearby gave the family the opportunity to relax more. Conclusions: Parents that give birth to a premature child gets overwhelmed with different feelings. The health personnel in the NICU contributes to support and guidance. Experiences that was repetitive were that parents stress decreased when they were able to be with their child and to participate in the care of their child. As a nurse knowledge of how you are going to support and meet parents in this vulnerable situation is significant to make it possible for a good and an individualized care.

SAMMANFATTNINGBakgrund: Specialistsjuksköterskor anser att extubation är svårare och mer komplext än intubation. Extubation kräver mycket fokus på patientens fysiska behov vilket kan försvåra för vårdpersonal att uppfylla patientens psykosociala behov. Forskning visar att patienter har obehagliga minnen från att vara intuberade och bli extuberade. Syftet: Syftet var att undersöka hur patienten görs delaktig vid extubation på intensivvårdsavdelning. Metod: Designen var en fokuserad etnografiskt observationsstudie med deduktiv ansats. Urvalet var patienter som opererades elektivt och vårdades postoperativt på Thoraxintensivvårdsavdelning vid ett universitetssjukhus. Tio patienter observerades när de blev extuberade av intensivvårdspersonalen. Sedan utfördes en semistrukturerad intervju om patientens erfarenhet av att bli extuberad och om de kände sig delaktiga.  Resultat: För att göra patienten delaktig gav personalen information, var stöttande, närvarande och respekterade patientens värdighet och integritet. Detta gjorde personalen genom fysisk beröring, att benämna patienten med namn, samt att utföra extubation avskilt. Resultatet kan inte säkerställa att det går att etablera en vårdrelation under extubation då en vårdrelation endast etablerades vid två av tio tillfällen. Majoriteten av patienterna hade inga minnen av att bli extuberade. Slutsats: Personalen gjorde patienterna delaktiga under extubation genom att ge information, vara närvarande och stöttande samt genom att visa patienten värdighet och respekt. Patienterna kunde göras delaktiga utan att en vårdrelation etablerades, detta tyder på att begreppet vårdrelation behöver en tydligare definition. Trots att majoriteten av deltagarna inte hade minnen från extubationen bör de göras delaktiga. / ABSTRACT. Background: Specialist nurses consider extubation more difficult and complext than intubation. Extubation requires a lot of focus on the patient's physical needs, which can prove it difficult for specialist nurses to fulfill the patient's psychosocial needs. Research shows that patients have unpleasant memories of being intubated and being extubated. Aim: The aim was to investigate how patient participation was fulfilled during extubation in a intensive care unit. Method: The design was a focused ethnographic observational study with a deductive approach. The sample was patients who underwent elective surgery and received postoperative care in the thoracic intensive care unit in a university hospital. Ten patients were observed as they were extubated by the intensive care personnel. A semi-structured interview was then conducted about the patient's experience of being extubated and whether they felt involved. Main result: To increase the patience participation, the staff were informative and supportive, present and respected the patient's dignity and privacy. Staff did this through physical touch, calling the patient by name, and performing extubation separately. The results cannot ensure that it is possible to establish a care relationship during extubation as a care relationship was only established on two out of ten occasions. The majority of patients had no memory of being extubated.  Conclusion: Patient participation during extubation can be achieved through information, staff presence and support. It’s possible to achieve patientparticipant without establishing a caring relationship. The majority of participants did not have memories of extubation, however, patient participation should still be achieved.

Bakgrund Tidigt föräldraskap redan på neonatalvårdsavdelning med aktivt deltagande och hud-mothudkontakt påvisar positiva effekter hos det prematura barnet och främjar en sund anknytning. För att främja deltagande behövs ett respektfullt samarbete mellan sjuksköterska och familj enligt familjecentrerad vård (FCC). Syfte Syftet var att sammanställa tidigare forskning för att beskriva föräldrars upplevelser av delaktighet i omvårdnaden av prematura barn. Metod Litteraturstudien inkluderade 15 studier med kvalitativ design och utformades som en strukturerad litteraturstudie. Datainsamlingen utfördes i databaserna PubMed och CINAHL. Inför inklusion lästes artiklarna av båda författarna och kvalitetsgranskades enligt Fribergs granskningsfrågor för kvalitativa studier. Dataanalys utfördes strukturerat utifrån Fribergs fyra steg för att analysera och sammanställa resultatet. Resultat Två kategorier med respektive sex underkategorier identifierades där främjande respektive hindrande faktorer av föräldrars upplevelser av delaktighet speglas. Att vara närvarande i omvårdnaden samt hud-mot-hudkontakt med barnet fick föräldrarna att känna sig delaktiga. Stöd och vägledning från vårdpersonal hade stor betydelse och upplevdes underlättade för föräldrarna. Det fanns känslomässiga hinder för anknytningen samt svårigheter med miljöns utformning. Slutsats Delaktigheten i omvårdnaden var viktigt för att gynna amningen, stärka föräldrarollen samt öka självförtroendet och kan uppnås med implementering av FFC. / Background Early parenthood already in the neonatal care unit with active participation and skin-to-skin contact demonstrates positive effects in the premature baby and promotes a healthy bonding. To promote participation, a respectful collaboration between nurse and family is needed according to family-centered care (FCC). Aim The aim of this study was to compile previous research to describe parents' experiences of participation in the care of premature infants. Method The literature review included 15 studies with qualitative design and was designed as a structured literature review. The data collection was performed in the databases PubMed and CINAHL. Prior to inclusion, the articles were read by both authors and quality reviewed according to Friberg's review questions for qualitative studies. Data analysis was performed in a structured way based on Friberg's four steps to analyze and set the results. Results Two categories with six subcategories were identified where promoting and barrier factors of parents' experiences of participation are reflected. Being present in the care and skin-to-skin contact with the child made the parents feel involved. Support and guidance from healthcare professionals was of great importance and was perceived as easier for the parents. There were emotional barriers to the connection as well as difficulties with the design of the environment. Conclusions Participation in nursing was important to promote breastfeeding, strengthen the parental role and increase self-confidence and can be achieved with the implementation of FCC.

Males have a higher risk for an adverse outcome of COVID-19. The aim of the study was to analyze sex differences in the clinical course with focus on patients who received intensive care. Research was conducted as an observational retrospective cohort study. A group of 23,235 patients from 83 hospitals with PCR-confirmed infection with SARS-CoV-2 between 4 February 2020 and 22 March 2021 were included. Data on symptoms were retrieved from a separate registry, which served as a routine infection control system. Males accounted for 51.4% of all included patients. Males received more intensive care (ratio OR = 1.61, 95% CI = 1.51–1.71) and mechanical ventilation (invasive or noninvasive, OR = 1.87, 95% CI = 1.73–2.01). A model for the prediction of mortality showed that until the age 60 y, mortality increased with age with no substantial difference between sexes. After 60 y, the risk of death increased more in males than in females. At 90 y, females had a predicted mortality risk of 31%, corresponding to males of 84 y. In the intensive care unit (ICU) cohort, females of 90 y had a mortality risk of 46%, equivalent to males of 72 y. Seventy-five percent of males over 90 died, but only 46% of females of the same age. In conclusion, the sex gap was most evident among the oldest in the ICU. Understanding sex-determined differences in COVID-19 can be useful to facilitate individualized treatments.

Kritiskt sjuka spädbarn och deras föräldrar som vårdas inom barnintensivvården löper risk att få en otrygg anknytning till varandra, då det saknas etablerade omvårdnadsåtgärder för att främja anknytningen. Utebliven anknytning kan leda till oönskade långsiktiga fysiska samt kognitiva konsekvenser för föräldrar och spädbarn. Magisteruppsatsens syfte var att med hjälp av publicerade forskningsresultat beskriva ett vårdande som främjar anknytning mellan föräldrar och deras kritiskt sjuka spädbarn under vårdtiden på barnintensivvården. Vald metod är en systematisk integrativ litteraturöversikt. Bestående av 12 artiklar med kvalitativ ansats, tre artiklar med kvantitativ ansats och två med mixad metod. Totalt 17 artiklar. Litteratursökningen gjordes i databaserna Cinahl och PubMed. Efter att en systematisk urvalsprocess och kvalitetsgranskning gjorts ingick totalt 17 artiklar i datamaterialet. Magisteruppsatsen resulterade i tre huvudteman; Intensivvårdens inverkan på anknytningsprocessen, ett vårdande med inverkan på anknytningsprocessen samt en familjecentrerad vård- utgångspunkten för att främja anknytning. Resultatet presenterar vårdande metoder som kan främja anknytningsprocessen. Intensivvårdssjuksköterskan behöver vara lyhörd inför att familjer har olika behov i anknytningsprocessen och arbeta familjecentrerat, personcentrerat samt anpassa miljön för att möta dessa behov. Vårdande metoder som intensivvårdssjuksköterskan kan arbeta med är hud mot hud kontakt, kamerateknik och musikterapi. Hud mot hud kontakt visar sig i resultatet vara en avgörande faktor, men det kräver fysiskt närvarande föräldrar. Vid fysiskt frånvarande föräldrar kan kamerateknik och musikterapi fungera som en brygga i kommunikationen mellan föräldrar och spädbarn. Resultatet i magisteruppsatsen speglar vården i sin komplexa helhet, där varje liten pusselbit är viktig för att kunna nå ett optimalt resultat både kortsiktigt och långsiktigt. / There is a risk of insecure attachment developing between parents and critically ill infants where the infant is cared for in the pediatric intensive care unit as there is a lack of established nursing measures to promote attachment. Failure to bond can lead to unwanted long-term physical and cognitive consequences for parents and babies. The purpose of the master's thesis was to use published research results to describe care that promotes attachment between parents and their critically ill infants during the period of care in the pediatric intensive care unit. The chosen method is a systematic integrative literature review consisting of a total of 17 articles. 12 articles with a qualitative approach, three articles with a quantitative approach and two with a mixed method. The literature search was done in the databases Cinahl and PubMed. After a systematic selection process and quality review, a total of 17 articles were included in the data material. The Master's thesis resulted in three main themes; The impact of intensive care on the attachment process, care with an impact on the attachment process and a family-centered care starting point to promote attachment. The result presents nurturing methods that can promote the attachment process. The intensive care nurse needs to be sensitive to the fact that families have different needs in the attachment process and work family-centred, person-centred and adapt the environment to meet these needs. Caring methods that the intensive care nurse can work with are skin-to-skin contact, camera technology and music therapy. Skin-to-skin is a decisive factor in the results, but it requires physically present parents. In the case of physically absent parents, camera technology and music therapy can act as a bridge in the communication between parents and babies. The result in the master's thesis reflects the complexity of overall care, where every small piece of the puzzle is important to be able to achieve an optimal result both in the short term and in the long term.

Bakgrund: Suicid är ett globalt folkhälsoproblem. I Sverige vårdades 2021 cirka 11 000 patienter som försökt begå suicid. Intensivvårdssjuksköterskor har en betydelsefull roll i vården och mötet med patienten som utfört ett suicidförsök. Människor som försökt begå suicid har ett lidande och behöver bemötas utifrån en helhet av kropp, själ och ande. Syfte: Att beskriva intensivvårdssjuksköterskors erfarenheter av att på en intensivvårdsavdelning vårda patienter som försökt begå suicid. Metod: Kvalitativ innehållsanalys med induktiv ansats. Tio intensivvårdssjuksköterskor med erfarenhet av att vårda patient efter suicidförsök intervjuades. Resultat: Analysen resulterade i fyra kategorier, Väcker känslor, Vårda både kropp och själ, Att skapa en trygg miljö och Att bemöta anhöriga. De fyra kategorierna är sedan uppdelade i nio subkategorier. Konklusion: Studiens resultat visar att intensivvårdssjuksköterskor erfar att omvårdnaden av patienter som försökt begå suicid är komplex. Olika uppfattningar framkommer angående om det ingår i intensivvårdssjuksköterskans roll att prata med patienten om suicidförsöket. Att intensivvårdssjuksköterskor har olika syn på detta kan eventuellt leda till att patienter inte får jämlik vård. Vidare forskning av ämnet behövs för att skapa riktlinjer och tydliggöra om det är intensivvårdssjuksköterskans uppgift att initiera samtal om suicidförsöket. / Background: Suicide is a global public health problem. In Sweden, approximately 11,000 patients who attempted suicide were treated in 2021. Intensive care nurses have an important role in the care and meeting with the patient who has attempted suicide. People who have attempted to commit suicide are suffering and the whole person needs to be treated, body, soul and spirit. Aim: To describe intensive care nurses' experiences of caring for patients who have attempted suicide in an intensive care unit. Method: A qualitative content analyses with an inductive approach. Ten intensive care nurses with experience from caring for patients after suicide attempt, where interviewed. Result: The analysis resulted in four categories, Evokes emotions, Caring for both body and soul, Creating a safe environment and Dealing with relatives. Conclusion: Intensive care nurses experience that the care of patients who have attempted suicide is complex. Different opinions emerge regarding whether it is part of the intensive care nurse's role to talk to the patient about the suicide attempt. Different views on this could potentially lead to patients not receiving equal care. Further research on the subject is needed to create guidelines and clarify whether it is the intensive care nurse's task to initiate conversations about the suicide attempt.

Preterm birth disrupts the development of the brain and other critical organs of the infant body. Since the brain is one of the last organs to finish developing during pregnancy, the risk for substantial neurological deficits increases as the gestational age decreases. One way to combat these deficits is to reconnect the preterm infant with the mother via skin-to-skin contact, also known as kangaroo care (KC). This intimate touch helps to replicate aspects of the environment that the preterm infant experienced in utero. The purpose of this literature review was to analyze the current literature to better understand the effects that KC may have on facilitating neurodevelopment of preterm infants in Neonatal Intensive Care Units (NICUs). Emphasis was placed on neurophysiologic functioning, autonomic functioning, and neurobehavioral functioning. A database search of CINAHL Plus with Full Text, PsycINFO, MEDLINE, Cochrane Central Register of Controlled Trials, and Health Source: Nursing/Academic Edition was conducted, and a total of six articles were reviewed based on their relevance and application towards this thesis. KC is a low-cost, relatively easy intervention to initiate that can have positive impacts on many aspects of preterm infant growth and maturation. There is limited research regarding the use of KC as an intervention to support neurodevelopment, especially with regards to long-term effects. Existing research supports the use of KC as an intervention to facilitate neurodevelopment in preterm infants in the NICU.

The purpose of this study was to conduct an integrated review of the literature examining the use of non-pharmacologic pain management strategies in premature neonates and to explore the relationship between health outcomes and time to discharge from the neonatal intensive care unit (NICU). Non-pharmacologic pain management strategies include human touch, facilitated tucking, non-nutritive sucking, and kangaroo care. A systematic review of the literature was conducted from multiple online databases. Peer reviewed, English-language articles containing the keywords ‘pain management’, ‘neonatal intensive care unit’, and ‘non-pharmacologic’ were included for synthesis. Exclusion criteria included articles with a focus on infants not admitted to the NICU and infants with a gestational age greater than 37 weeks. Results revealed positive outcomes when alternative pain-relieving methods, rather than drug therapy, were used in the NICU. A majority of articles suggest facilitated tucking is very successful in lowering a preterm infant’s pain. However, facilitated tucking alone was significantly less effective in relieving procedural pain compared to facilitated tucking in combination with oral sucrose administration. Kangaroo care and gentle human touch also proved to reduce physiologic and behavioral signs of pain in neonates. The literature reveled an overall positive outcome when non-pharmacologic pain interventions are used in the NICU, with some behavioral interventions showing better efficacy than others at relieving neonatal pain. None of the reviewed articles explored the relationship between reduced length of stay and parameters assessing health outcomes based on pain control in neonates. The literature indicated nurses play a significant role in the use of pain-relieving methods in neonatal populations. Implications for future research that focuses on successful behavioral based pain management strategies that assists in refining neonatal pain relief would be of great benefit to improving health outcomes related to infant survival after discharge from the NICU.

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