Introdução: Diversos estudos têm demonstrado que os cuidados paliativos (CP) melhoram o controle dos sintomas, a satisfação e o suporte psicológico dos pacientes com câncer e de seus familiares. Há evidências de que quanto mais precoce for o ingresso do paciente em CP menor será a utilização de tratamentos agressivos no último mês de vida. Além disso, a potencial redução nos custos do tratamento na fase final da vida associado a CP também tem sido relatada na literatura. No Brasil, não há estudo que estime o uso de recursos e os custos dos cuidados paliativos para pacientes com câncer. Objetivos: Estimar os custos diretos médicos de cuidados paliativos para pacientes com câncer na perspectiva do Instituto do Câncer do Estado de São Paulo (ICESP). Métodos: Estudo de descrição de custo retrospectivo para estimar a utilização de recursos e os custos diretos médicos associados ao serviço de cuidados paliativos, sob a perspectiva do serviço de saúde (ICESP). A amostra incluiu pacientes maiores de 18 anos com câncer, que foram a óbito de 2010 a 2013 e que receberam pelo menos dois atendimentos em cuidados paliativos e/ou fizeram uso do hospice. Os prontuários eletrônicos e as bases de dados administrativas do Instituto foram as fontes de dados. Utilizou-se das metodologias de microcusteio e macrocusteio para estimar os custos unitários. Realizou-se ainda análises de sensibilidade univariada e multivariada. Os fatores que impactam os custos foram identificados por meio de modelos lineares generalizados. A associação entre cuidados paliativos precoces e indicadores de tratamento agressivo foi avaliada pelo teste qui-quadrado de Pearson e pelo teste exato de Fisher. Resultados: Entre os 2.985 pacientes que fizeram parte do estudo, o intervalo de tempo entre o início em cuidados paliativos e o óbito apresentou mediana de 34 dias. Os pacientes que ingressaram até três meses antes do óbito realizaram menos visitas à emergência (p < 0,001). O custo total foi de R$ 67.372.455,91, com custo médio por paciente de R$ 22.570,34. Os pacientes com câncer de cérebro foram os que apresentaram maior custo (R$ 35.488,47). Não houve diferença no custo do último mês de vida entre os pacientes que ingressaram mais precocemente e os que ingressaram mais tardiamente em cuidados paliativos. Os fatores preditores do custo foram idade do paciente, localização do câncer, local do óbito, número de internações, número de visitas à emergência, dias em hospice e dias em cuidados paliativos. Conclusão: Este estudo permitiu conhecer as práticas de um serviço de cuidados paliativos, apresentou a utilização de recursos e os custos nas diversas localizações do câncer sob a perspectiva do provedor e poderá contribuir para a discussão sobre o cuidado paliativo no Brasil / Introduction: Several studies have shown that palliative care (PC) improves symptoms control, treatment satisfaction and psychological support of patients with cancer and their families. There are evidences that demonstrate that the sooner a patient enters into PC, the lower the need for aggressive treatment in the last month of life. In addition, a potential reduction in treatment costs at the end of life is associated with PC. In Brazil, there is no study to date that reports on the use of resources and the cost of palliative care for cancer patients. Objectives: To estimate the direct medical costs of PC for cancer patients from perspective of Cancer Institute of the State of São Paulo (ICESP). Methods: Retrospective cost description study to estimate the use of resources and direct medical costs associated with PC service from the perspective of ICESP. Eligible patients were older than 18 years of age, received at least 2 consultations in PC and/or made use of a hospice and died between 2010 and 2013. Data were collected from electronic medical records and administrative databases of ICESP. Unit costs were estimated using micro-costing and macro-costing methodologies. Univariate and multivariate sensitivity analyses were performed. The predictors of costs were identified through generalized linear models. The association between early palliative care and aggressive treatment indicators was assessed using Pearson\'s chi-square test and Fisher\'s exact test. Results: Among the 2985 patients in the study, the median time from entry into PC until death was 34 days. Patients who entered earlier into PC ( >- 3 months before death) had fewer emergency visits (p < 0.001). Total cost was R$67.372.455,91 with an average cost per patient of R$22.570,34. Patients with brain cancer presented the highest cost (R$35.488,47). There was no difference in cost in the last month of life between patients who entered earlier and those who entered later into PC. The predictor factors of cost were patient\'s age, cancer site, place of death, number of hospitalizations, number of emergency visits, number of days in hospice and number of days in PC. Conclusion: This study allowed to know the practices of a palliative care service, presented the use of resources and costs in the different locations of cancer from the perspective of the provider and can contribute to discussion about palliative care in Brazil

INTRODUÇÃO: O número de sobreviventes após um evento grave tem aumentado consideravelmente, e muitas vezes acarretando um maior tempo de internação na unidade de terapia intensiva (UTI) e hospitalar. Frequentemente esses pacientes evoluem com decréscimo da qualidade de vida e comprometimento das habilidades funcionais para realização de suas atividades de vida diária. Este estudo teve como objetivo avaliar a qualidade de vida relacionada à saúde (QVRS), as atividades básicas de vida diária (ABVD) e as atividades instrumentais de vida diária (AIVD) de pacientes críticos após a alta hospitalar. MÉTODO: Foi realizado um estudo observacional longitudinal, onde foram selecionados pacientes clínicos e/ou cirúrgicos, idade igual ou superior a 18 anos, submetidos a pelo menos 24 horas de ventilação mecânica. As avaliações foram feitas através de questionários direcionados para avaliar a QVRS (SF-36), as ABVD (Índice de Barthel e Índice de Katz) e AIVD (Health Assessement Questionaire Disability índex [HAQ-DI]). Os instrumentos foram aplicados através de entrevista telefônica nos primeiros 30 dias após a alta hospitalar e no terceiro e sexto meses subsequentes. RESULTADOS: Pelos critérios de inclusão foram selecionados 431 pacientes após a alta da UTI, destes 128 preencheram os critérios de exclusão e 142 perdidos antes da alta hospitalar. Dos 161 pacientes que receberam alta hospitalar e, portanto elegíveis para o estudo, foi possível realizar contato com 75, sendo esta a amostra inicial do estudo. Entre os 86 pacientes perdidos, a maioria (61) foi por impossibilidade de contato telefônico (número errado ou inexistente, mudança de cidade e/ou estado), os demais, por recusa, óbito e reinternação. Foram considerados idosos 29 pacientes (38,6 %). Houve melhora progressiva de todos os domínios do SF-36 ao longo do tempo de avaliação, sendo que os domínios mais comprometidos foram: aspecto físico, aspecto emocional e capacidade funcional. O componente físico do SF-36 e o índice de Katz mostraram-se influenciados pela idade (p=0,03) e (p=0,01) respectivamente. O Índice de Katz apresentou influência do Acute Physiology and Chronic Health Evaluation II (p=0,02). As ABVD e AIVD avaliadas pelos questionários Katz, Barthel e HAQ-DI ao longo do tempo, mostraram melhora progressiva nas atividades funcionais de acordo com a pontuação de cada instrumento e com diferenças significativas entre os períodos de avaliação (p<0,05). O HAQ-DI apresentou as atividades usuais como sendo as mais comprometidas. CONCLUSÕES: A QVRS e as ABVD e AIVD dos pacientes avaliados neste estudo apresentaram uma melhora progressiva no decorrer de seis meses após a alta hospitalar, mas ainda apresentando comprometimento até a última avaliação. Os idosos e os mais graves apresentaram maior comprometimento / INTRODUCTION: The number of surviving patients following a severe event has increased considerably, often leading to a longer intensive care unit (ICU) and hospital stay. Frequently, these patients evolve with decreased quality of life and impaired functional abilities to perform their activities of daily living. This study was aimed at evaluating the Health-Related Quality of Life (HRQoL), Basic Activities of Daily Living (BADL) and Instrumental Activities of Daily Living (IADL) for critical ill patients after hospital discharge. METHOD: A longitudinal observational study was conducted, and clinical and/or surgical patients aged 18 years-old who had been submitted to at least 24 hours of mechanical ventilation were screened. Assessments were conducted using targeted questionnaires to evaluate HRQoL (SF-36), BADL (Barthel Index and Katz Index), and IADL (Health Assessment Questionnaire Disability Index [HAQ-DI]). These instruments were applied via telephone interviews within the first 30 days following hospital discharge, and three and six months later. RESULTS: According to inclusion criteria, 431 patients were included following hospital discharge; of these, 128 met exclusion criteria, and 142 were lost to follow-up before hospital discharge. Of the 161 patients who had been discharged from hospital and therefore were considered eligible for the study, 75 patients could be contacted; this was the initial sample of the study. For the 86 lost to follow-up patients, most of them (61) could not be contacted by telephone (incorrect or nonexistent number, moved to other city and/or state) and the remaining due to refusal, death, and readmission. 29 patients were considered elderly (38.6%). All SF-36 domains progressively improved in the course of evaluation, and Role-Physical, Role-Emotional and Physical Functioning were the most impaired domains. The physical component of SF-36 and the Katz Index have been shown to be influenced by age (p=0.03 and p=0.01, respectively). Katz Index was also influenced by Acute Physiology and Chronic Health Evaluation II (p=0.02). It was shown that BADL and IADL assessed by Katz, Barthel and HAQ-DI questionnaires over time have progressively improved in terms of functional activities, according to each instrument scoring and significant differences between evaluation periods (p<0.05). HAQ-DI has shown that usual activities were the most impaired. CONCLUSIONS: HRQoL, BADL and IADL for patients evaluated in this study were progressively improved within 6 months after hospital discharge, but these patients were still impaired up to the last evaluation. Elderly and more severe patients demonstrated greater impairment

Diss. (sammanfattning) Stockholm : Karolinska institutet, 2005. / Härtill 4 uppsatser.

Introdução: Diversos estudos têm demonstrado que os cuidados paliativos (CP) melhoram o controle dos sintomas, a satisfação e o suporte psicológico dos pacientes com câncer e de seus familiares. Há evidências de que quanto mais precoce for o ingresso do paciente em CP menor será a utilização de tratamentos agressivos no último mês de vida. Além disso, a potencial redução nos custos do tratamento na fase final da vida associado a CP também tem sido relatada na literatura. No Brasil, não há estudo que estime o uso de recursos e os custos dos cuidados paliativos para pacientes com câncer. Objetivos: Estimar os custos diretos médicos de cuidados paliativos para pacientes com câncer na perspectiva do Instituto do Câncer do Estado de São Paulo (ICESP). Métodos: Estudo de descrição de custo retrospectivo para estimar a utilização de recursos e os custos diretos médicos associados ao serviço de cuidados paliativos, sob a perspectiva do serviço de saúde (ICESP). A amostra incluiu pacientes maiores de 18 anos com câncer, que foram a óbito de 2010 a 2013 e que receberam pelo menos dois atendimentos em cuidados paliativos e/ou fizeram uso do hospice. Os prontuários eletrônicos e as bases de dados administrativas do Instituto foram as fontes de dados. Utilizou-se das metodologias de microcusteio e macrocusteio para estimar os custos unitários. Realizou-se ainda análises de sensibilidade univariada e multivariada. Os fatores que impactam os custos foram identificados por meio de modelos lineares generalizados. A associação entre cuidados paliativos precoces e indicadores de tratamento agressivo foi avaliada pelo teste qui-quadrado de Pearson e pelo teste exato de Fisher. Resultados: Entre os 2.985 pacientes que fizeram parte do estudo, o intervalo de tempo entre o início em cuidados paliativos e o óbito apresentou mediana de 34 dias. Os pacientes que ingressaram até três meses antes do óbito realizaram menos visitas à emergência (p < 0,001). O custo total foi de R$ 67.372.455,91, com custo médio por paciente de R$ 22.570,34. Os pacientes com câncer de cérebro foram os que apresentaram maior custo (R$ 35.488,47). Não houve diferença no custo do último mês de vida entre os pacientes que ingressaram mais precocemente e os que ingressaram mais tardiamente em cuidados paliativos. Os fatores preditores do custo foram idade do paciente, localização do câncer, local do óbito, número de internações, número de visitas à emergência, dias em hospice e dias em cuidados paliativos. Conclusão: Este estudo permitiu conhecer as práticas de um serviço de cuidados paliativos, apresentou a utilização de recursos e os custos nas diversas localizações do câncer sob a perspectiva do provedor e poderá contribuir para a discussão sobre o cuidado paliativo no Brasil / Introduction: Several studies have shown that palliative care (PC) improves symptoms control, treatment satisfaction and psychological support of patients with cancer and their families. There are evidences that demonstrate that the sooner a patient enters into PC, the lower the need for aggressive treatment in the last month of life. In addition, a potential reduction in treatment costs at the end of life is associated with PC. In Brazil, there is no study to date that reports on the use of resources and the cost of palliative care for cancer patients. Objectives: To estimate the direct medical costs of PC for cancer patients from perspective of Cancer Institute of the State of São Paulo (ICESP). Methods: Retrospective cost description study to estimate the use of resources and direct medical costs associated with PC service from the perspective of ICESP. Eligible patients were older than 18 years of age, received at least 2 consultations in PC and/or made use of a hospice and died between 2010 and 2013. Data were collected from electronic medical records and administrative databases of ICESP. Unit costs were estimated using micro-costing and macro-costing methodologies. Univariate and multivariate sensitivity analyses were performed. The predictors of costs were identified through generalized linear models. The association between early palliative care and aggressive treatment indicators was assessed using Pearson\'s chi-square test and Fisher\'s exact test. Results: Among the 2985 patients in the study, the median time from entry into PC until death was 34 days. Patients who entered earlier into PC ( >- 3 months before death) had fewer emergency visits (p < 0.001). Total cost was R$67.372.455,91 with an average cost per patient of R$22.570,34. Patients with brain cancer presented the highest cost (R$35.488,47). There was no difference in cost in the last month of life between patients who entered earlier and those who entered later into PC. The predictor factors of cost were patient\'s age, cancer site, place of death, number of hospitalizations, number of emergency visits, number of days in hospice and number of days in PC. Conclusion: This study allowed to know the practices of a palliative care service, presented the use of resources and costs in the different locations of cancer from the perspective of the provider and can contribute to discussion about palliative care in Brazil

Bakgrund: När någon drabbas av sjukdom eller skada är det inte bara patienten som påverkas utan även de anhöriga. I kritiska lägen, när döden plötsligt blir ett verkligt hot, kastas både patient och anhöriga in i en krissituation. I familjefokuserad omvårdnad ses familjen som en helhet. Om något händer en individ påverkar det även de andra familjemedlemmarna. Även om det inte är den anhöriga som har drabbats av sjukdom kan de ändå ofta uppleva ohälsa och lidande. Syfte: Syftet var att beskriva anhörigas upplevelser när en närstående drabbas av plötslig, kritisk sjukdom. Metod: En litteraturbaserad studie med kvalitativ innehållsanalys.  Resultat: Resultatet består av tre huvudkategorier; behov av att få vara delaktig, känslor som tar över och en vilja att agera. Kategorierna definierar de anhörigas beskrivningar av sina upplevelser. Konklusion: Anhörigas upplevelser vid omhändertagandet när en närstående blivit kritiskt sjuk kan vara omtumlande. Vårdpersonal har möjlighet att påverka upplevelsen genom att möjliggöra och uppmuntra till delaktighet. Delaktighet minskar känslan av att vara avskärmad från verkligheten och underlättar för anhöriga att kunna ingripa och att föra patientens talan. / Background: Sudden illness affects not only the patient but also the patient’s close family. In critical situations both patient and relatives are thrown into a crisis situation. In addition to providing medical care to the patient, nurses must also be able to care for and support the patient’s family. Families’ reactions and needs, however, may look very different from one situation to another. Aim: The aim of the study was to describe family members’ experiences when a relative becomes critically ill. Method: A literature based study using a qualitative content analysis. Results: Three main categories were identified; a need to participate, emotions that take over, a desire to intervene. The categories describe the family members’ experiences. Conclusion: Experiencing critical illness of a family member can be overwhelming. Healthcare professionals can influence the experience by enabling and encouraging family members to participate in the care. Participation reduces the feeling of losing touch with reality and enables families to act.

The purpose of this qualitative study was to supply preliminary insights into improving the support of visiting families with children who are minors during the intensive care unit stay (ICU) of an adult family member. Hospitals often restrict children from visiting in ICUs; however, a review of the literature revealed that despite the prevalence of this policy, there has been little research into whether visiting is harmful or supportive (Liu et al., 2013; Manici & Ghillani, 2018). Although family-centred care (FCC) is considered beneficial for adult family members (Davidson et al., 2012; Eggenberger & Nelms, 2007), there is little evidence that policymakers have considered the involvement of children during an ICU stay (Knutsson & Bergbom, 2007). In this study, seven families shared their experiences of the critical illness of a loved one. Using a constructionist lens, this study explored the interaction between the gathered stories and the policies and practices associated with child and adult family members visiting adult critical care contexts in British Columbia (BC), Canada. This study found that the involvement of children in a family illness event is important and that tailoring involvement to the individual preferences of the child, and their family, is crucial. While navigating an ICU stay, families may benefit from a collaborative approach between the child, their caregiver/s, and a member of the ICU team. The goal of this research is that it will resonate with its readers and move people to deeper curiosity and further study. This exploratory study led to a list of seven preliminary recommendations that could inform the interdisciplinary policies and practices associated with supporting child and adult family members as visitors in an ICU. Further research is needed to explore the experiences of families with children more fully, and to understand the systems that need to be in place to support them during the critical illness of a loved one. / Graduate / 2021-12-16

Bakgrund: Barns besök inom intensivvården har tidigare varit förbjudet. En bristande kompetens beskrivs av sjuksköterskor kring att möta barn som närstående vilket resulterar i att sjuksköterskor lättare exkluderar barn. Barn upplever blandade känslor kring besök på IVA och uttrycker ett behov av involvering.  Syfte: Syftet var att beskriva barns besök på IVA ur barnets och sjuksköterskans perspektiv.  Metod: En systematisk litteraturstudie med kvalitativa, kvantitativa och semikvalitativa studier analyserades med en integrativ granskningsmodell. Databassökningarna i Pubmed och Cinahl resulterade i fjorton artiklar.  Resultat: Mötet med en betydelsefull person gav blandade känslor hos barn och skapade utrymme för fantasi. Fantasi var ett sätt att hantera situationen när allvaret kröp nära inpå. Mötet berörde barn på olika sätt och utgången av mötet var olika beroende på förutsättningarna. Barn beskrev vikten av involvering och hur bristande involvering påverkade och att ges plats var av vikt för barns välmående. Det fanns faktorer som styrde och påverkade tillgången till sin närstående vilket utmanade delaktigheten för barn. Vid en kris beskrev barn vikten av att få vara barn och vad det innebär, de beskrev samtidigt känslor av ansvar och vilket lidande det genererade. Barn eftersträvar en normal vardag när en närstående blir sjuk. Vid sjukdom och kris växer barns utsatthet, där mänskliga faktorer påverkar. Närvaro och delaktighet skapar en betydelsefullhet.  Slutsats: Det är viktigt för barn att få vara delaktiga när en närstående är kritiskt sjuk och vårdas på IVA. Barn som exkluderas lider och löper risk för en långsiktig psykisk ohälsa. Frustration ses hos barn när de inte blir sedda och respekterade som närstående och när sjuksköterskor uppvisar brister i bemötandet upplever barn känslor av minskad involvering och att inte bli sedda. Sjuksköterskor behöver och efterfrågar därför utbildning och stöd i att inkludera barn. Vidare finns ett stort behov av modern forskning då erfarenheter kring barn som närstående till patient på IVA saknas vilket utgör en risk för vidare utveckling av området. / Background: Children has historically been restricted to visit the intensive care unit. Nurses describe a lack of competence in meeting children as close relatives which results in nurses more easily excluding children. Children experience mixed feelings about visits to the ICU and express a need for involvement.  Aim: The aim was to examine child visits to the ICU from the child's and the nurse's perspective.  Method: A systematic literature study with qualitative, quantitative and semi-qualitative studies was analyzed with an integrative review model. The database searches were performed on Pubmed and Cinahl and resulted in fourteen articles.  Result: The meeting with a significant other gave mixed feelings in children and created space for imagination. Imagination was a way of dealing with the situation when the seriousness elevated. The meeting affected children in different ways and the outcome of the meeting was different depending on the conditions. Children described the importance of involvement and how lack of involvement affected them and being given space was important for children's well-being. There were factors that affected the children's access to their loved ones, which challenged the participation of the children. In a crisis, children described the importance of keeping their childhood intact, they also described feelings of responsibility and that it generates suffering. Children strive for a normal everyday life when a close relative becomes ill. In case of illness and crisis, children's vulnerability grows, and human factors affect the outcome. Attendance and participation create meaning.  Conclusion: It is important for children to be able to participate when a close relative is critically ill and cared for at ICU. Children who are excluded suffer and are at risk of long-term mental illness. Children experience frustration when they don't get any attention or respect as close relatives and when nurses show a lack om caring children experiences reduced involvement and not being seen. Nurses therefore need and demand education and support in including children. Furthermore, there is a large need for modern research on children’s experience as close relatives to a patient in ICU, which constitutes a development of the area.

Mechanically ventilated critically ill patients treated in the intensive care unit (ICU) require enteral feedings to maintain adequate nutrition during critical illness. Delivery of adequate enteral nutrition is also critical to the recovery of critically ill patients. Enteral nutrition has been shown to decrease length of time on the ventilator, decrease length of stay and ICU and decrease mortality. Despite all the evidence regarding the benefits of enteral nutrition, critically ill patients continue to receive less than their prescribed calories and protein. Nurses are in a unique position to influence the delivery of enteral nutrition. Nursing practices that contribute to underfeeding must be identified and corrected to ensure adequate delivery of nutrients is achieved. The purpose of the study was to describe the professional practice of critical care nurses regarding enteral feeding in mechanically ventilated critically ill patients. Several barriers were identified by the participants in the study that contributed to underfeeding including inconsistent practice regarding gastric residual volume, holding feeds when changing patient position and lack of a standardized protocol for enteral feeding. Also identified in the study was the idea that nurses do not see enteral feeding as a life-saving intervention. It is not the “sexy part” of what ICU nurses do. Enteral feeding guidelines need to be developed to include those interventions that are important to nursing practice in order to increase enteral feeding times and improve patient outcomes.

Bakgrund: Inom sjukvården förekommer ”utebliven omvårdnad”, vilket inkluderar all omvårdnad som uteblir. Detta påverkar patientens vårdupplevelse negativt och leder till ett vårdlidande för patienten. Mest förekommande är utebliven information och kommunikation med- och till patienterna, och skälet grundas i ett komplext samband av olika faktorer. Aktuell forskning inom området baseras framförallt på intrahospital vård och kunskapen om utebliven omvårdnad prehospitalt är begränsad. Syfte: Syftet med studien var att identifiera i vilka situationer utebliven omvårdnad sker vid vård av patienter som är kritiskt sjuka inom prehospital vård samt vilken omvårdnad som uteblir och varför. Metod: Studien har en kvalitativ design och bygger på data inhämtad från ambulanssjuksköterskor, genom semistrukturerade intervjuer med induktiv ansats som analyserats med Graneheim och Lundmans (2004) innehållsanalys. Resultat: Omvårdnad uteblir vid vård av kritiskt sjuka patienter prehospitalt. Främsta orsaken till att det sker var både en omedveten- och medveten prioritering av ambulanssjuksköterskan där direkt livräddande åtgärder prioriteras före omvårdnad ofta i kombination med tidsbrist och ett behov av att arbeta eller komma iväg till sjukhus snabbt. Den omvårdnad som uteblev var främst kommunikation och information till patienter och anhöriga, respekt för patientens autonomi och integritet samt hänsyn till patientens basala behov.  Slutsats: Omvårdnad uteblir vid kritiska patienter till följd av en prioritering av ambulanssjuksköterskan vilket skapar ett vårdlidande för patienten. Olika situationer och prehospitala förhållanden medförde att ytterligare faktorer behövde beaktas och omvårdnad uteslöts. Exempelvis uteslöts information och kommunikation till patienten. Ytterligare forskning från patient- eller anhörigperspektiv vore av intresse för att ytterligare belysa fenomenet. / Background: Missed nursing care is a problem in healthcare. Missed nursing care is all the care that is missed given to patients. This will negatively affect the patients’ health-care experience and lead to suffering. Most occurring missed nursing care is information and communication to the patient, the reason is a complex issue of various factors. Previous research on this subject lacks insight regarding missed nursing care in prehospital environment. Aim: Aim of the study was to identify in which situations missed nursing care occur within prehospital care of critically ill patients, and which care actions are left out and why. Method: This study has a qualitative design with an inductive approach. Data is collected from Swedish ambulance nurses through semi-structured interviews and analysed with content analysis in accordance with Graneheim and Lundman (2004).  Result: The cause for missed nursing care is an active prioritization by the ambulance nurse where lifesaving actions were prioritized before nursing care. This happened when caring for critically ill patients with simultaneous need for quick action and transport. There were also un subconscious prioritization as a reason for missed nursing care. The missed care was information for the patient and relatives, respect for integrity and autonomy and patient hygiene. Conclusion: Active and subconscious prioritization was the reason for missed nursing care. Suffering from given care is a result of missed nursing care. Example of missed nursing care was information and communication. Research from patient and relatives perspective would be of interest for further illuminate the phenomena.

Bakgrund: Allt fler patienter överlever tack vare medicinska framsteg kritisk sjukdom. Aktuell forskning visar att patienter ofta upplever den akuta sjukdomsfasen som känslomässigt jobbig med känslor såsom stress och ovisshet. Det är känt att kritisk sjukdom och intensivvård medför fysiska konsekvenser även långt efter sjukhusvistelsen och att detta påverkar patienters återhämtning negativt. Med kunskap om patienters upplevelse av psykisk hälsa efter kritisk sjukdom kan sjuksköterskan anpassa vården för att erbjuda dessa patienter stöd för att uppnå en god återhämtning. Syfte: Att belysa hur patienters upplevelse av den psykiska hälsan påverkas efter kritisk sjukdom. Metod: En litteraturstudie baserad på tolv artiklar med kvalitativ ansats analyserades med tematisk innehållsanalys. Resultat:Deltagarnas upplevelse av psykisk hälsa efter kritisk sjukdom presenteras under fem huvudkategorier: tacksamhet, utsatthet, oro och rädsla, fatigue samt identitetsförändringar. Konklusion: Deltagarnas upplevelse av psykisk hälsa påverkades av att de kände tacksamhet över att ha överlevt och de stöd de fått, men utsatthet, oro, fatigue och ett behov av att omforma sin identitet var vanliga upplevelser som fick deltagarna att ändra sin självbild och sina perspektiv på livet. Vikten av att patienter känner sig förstådda och erbjuds stöd från såväl vården som närstående har framkommit och personcentrerad vård och ett holistiskt förhållningssätt lyfts fram som viktiga faktorer för att tillgodose de komplexa behov som uppstår efter kritisk sjukdom. / Background: An increasing number of patients survive critical illness due to medical advancements. Current research indicates that patients often find the acute phase of illness emotionally challenging, experiencing stress and uncertainty. It is known that critical illness and intensive care lead to physical consequences long after hospitalization, negatively impacting patients' recovery. With knowledge of patients' post-critical illness health experiences, nurses can tailor care to provide support for optimal recovery. Aim: To illuminate how patients' experiences of mental health are affected after critical illness. Method: A literature review based on twelve articles with a qualitative approach was analyzed using thematic content analysis. Results: Participants' experiences of mental health after critical illness are presented in five main categories: gratitude, vulnerability, worry and fear, fatigue, and identity changes. Conclusion: Participants' mental health experiences were influenced by gratitude for survival and the support received. However, vulnerability, worry, fatigue, and a need to reshape identity were common experiences leading participants to alter their self-perception and life perspectives. The importance of patients feeling understood and offered support from both healthcare and relatives has emerged and person-centered care and a holistic approach are highlighted as important factors in meeting the complex needs that arise after critical illness.