M.Cur. / In the cardiothoracic critical care unit, the respiratory management, post-extubation forms an important component of the total nursing care of the patient. To ensure optimal respiratory management the critical care nurse needs guidelines through which quality and continuity of nursing care can be ensured. Through the effective management of the respiratory system of the patient the critical care nurse contributes to maintaining, promoting and restoring health. In this way the critical care nurse facilitates the patient's strive towards reaching his/her objective of obtaining wholeness and he/she obtains his/her objective of quality nursing. The aim of this study is to formulate guidelines for the respiratory mangement of the cardiothoracic patient, post-extubation. A qualitative-descriptive contextual spesific reseach was followed in which a focus group interview, the opinions of field specialists and the deductive analysis of a literture study were used to formulate guidelines for the respiratory management of the cardiothoracic patient, post-extubation. An analysis was done through which the focus group interview was coded and categories were formulated. These main categories and subcategories were then further explored and described by the literature and by die opinions of the field specialists. The guidelines which were formulated must relieve the uncertainty that exists among different critical care nurses and it must ensure continuity of nursing care. After the guideliness have been established to promote the nursing practice recommendations were made for nursing practice, nursing education and for further research.

M.Cur. / From out the researchers experience of the critical care nursing practice, a need for clinical learning outcomes was identified. There are no listed guidelines or outcomes of what the critical care learner should be able to do at the end of the program, to function as a competent critical care-nursing practitioner. From the above mentioned problemstatement the following question were asked namely: Which knowledge's, skills, attitudes and values do the critical care learner need to function as a compatend critical care nursing practitioner? The main aim of this study was to compile a manual with clinical learning outcomes for the following disciplines within the critical care practice + Cardiology and cardio-thorasic surgery + General surgery and Pulmonary + Neuro-surgery and trauma From out the constructivistic learning approach a contextual, qualitative and describing study was done.The first objective namely the formulation of clinical learning outcomes from out the literature was done by means of a extensive literature survey. The second and third objective of the study namely the formulation of clinical learning outcomes for the different disciplines within the critical care practices. And compiling a manual for the preceptor in the critical care practice was done simultaneously. The clinical learning outcomes was written directly into the format of a manual. Eighty questioners was handed out to critical care trained registered nurses. The data gathered from out the questioners was used in identifying learning outcomes. There are generic clinical learning outcomes, these outcomes are universal for al the disciplines within the critical care practice. Specific clinical learning outcomes where identified for • Coronary and thoracic surgery • Neuro-surgery and • Trauma Specific learning outcomes are outcomes that are only applicable within that specific discipline. If effective clinical guidance are facilitated by means of the clinical learning outcomes and the learner has reached al the outcomes, he/she should be able to function as a competend critical nursing practitioner.

M.Cur. (Intensive Care Nursing) / The problem of intensive care nurses leaving the profession due to non-conducive working environments and uncompetitive conditions of employment is becoming more alarming and is therefore as relevant as ever. The researcher is concerned about the quality of nurse-awareness nurses create in order to practice quality nurse care. Confusion among nurses about their professional rights and responsibilities adds fuel to the fire. The management of health care services is at times not sensitive to the needs of nurses, and nurses are not always recognized for their inherent professional worth. In the adult intensive care unit at which the researcher practices as unit manager she perceived her colleagues to be experiencing some sort of emotional and spiritual discomfort in going about their daily activities. As the researcher felt responsible for the well-being of the staff in the unit she decided to investigate the phenomenon via a formal research study. The objectives of the study were two-fold: Firstly to explore and describe the registered nurse's experience of nursing in the intensive care unit and then to use the information obtained to describe guidelines for the compilation of a support programme for the nurses nursing in the unit The research questions that were generated are: How do registered nurses in the intensive care unit experience nursing there and how can the information be utilized to describe guidelines to support these nurses? The researcher used an exploratory, descriptive, contextual and phenomenological qualitative design to answer these research questions. Phenomenological interviews were conducted with five interviewees who had been possessively selected.

Bakgrund: Intensivvårdssjuksköterskor upplever intensivvårdsavdelningen som en stressfylld arbetsplats. Patienterna är svårt sjuka och akuta situationer kan hastigt uppstå. Miljön är högteknologisk och har stundvis ett högt tempo. Tidigare stressforskning har visat att en ökad stressnivå har en negativ inverkan på hälsan. Stresshantering utgår ifrån problemfokuserade – eller känslofokuserade copingstrategier. Syfte: Att beskriva de faktorer som stressar intensivvårdssjuksköterskor, samt hur de upplever och hanterar denna stress. Metod: En kvalitativ ansats med fokusgruppsintervjuer. Fem intensivvårdssjuksköterskor deltog. Intervjun var ostrukturerad med två öppna frågor. Materialet analyserades med hjälp av kvalitativ innehållsanalys. Resultat: Tre huvudkategorier och tio subkategorier framkom. Huvudkategorierna bestod av; Upplevda stressorer, Känslor och upplevelser av stress och Förmåga att hantera stress. Under intervjun framkom att stress framkallades under vissa arbetssituationer och i viss arbetsmiljö. Detta väckte känslor av frustration och maktlöshet hos intensivvårdssjuksköterskorna. Intensivvårdssjuksköterskorna använde en rad olika copingstrategier såsom till exempel att söka stöd samt planera och organisera sitt arbete, för att hantera stressfulla situationer. Slutsats: Det framkomna resultatet visade att intensivvårdssjuksköterskorna upplevde känslan av att varken räcka till eller kunna påverka sin arbetssituation. Detta ledde i sin tur till frustration och stress hos intensivvårdssjuksköterskorna. Trots detta fanns en hög nivå av trivsel. För att hantera den uppkomna stressen valde intensivvårdssjuksköterskorna att söka stöd hos varandra som den främsta copingstrategin Klinisk betydelse: Framkommen kunskap ur denna uppsats kan vara av betydelse för yrkesverksamma intensivvårdssjuksköterskor och deras arbetsmiljö. Även chefer kan ha användning av denna kunskap för att kunna organisera och ge intensivvårdssjuksköterskor stöd. / Background: Intensive care nurses perceive the Intensive Care Unit (ICU) as a stressful workplace. Patients are critically ill and emergency situations can occur quickly. The environment is high-tech and occasionally a high tempo. Previous stress research has shown that increased levels of stress have a negative impact on health. Stress management is based on problem-focused - or emotion-focused coping strategies. The Aim: To describe the factors that stress critical care nurses, and how they experience and cope with this stress. Method: A qualitative approach with focus group interviews. Five critical care nurses participated. The interview was unstructured with two open questions. The material was analyzed using qualitative content analysis. Results: Three main categories and ten subcategories emerged. The main categories consisted of: Perceived stressors, feelings and experiences of stress and ability to handle stress. During the interview revealed that stress was induced in certain work situations and in particular working environment. This caused feelings of frustration and powerlessness in ICU nurses. Critical care nurses used a variety of coping strategies such as seeking support and plan and organize their work, to cope with stressful situations. Conclusion: It originated results showed that intensive care nurses experienced the feeling of not enough or able to influence their work situation. This in turn led to frustration and stress among critical care nurses. Although this was a high level of comfort. To cope with the present stress chose critical care nurses to seek support from each other as the primary coping strategy Clinical significance: Arrived knowledge from this study may be important for professional’s intensive care nurses and their work environment. Although managers could use this knowledge to organize and provide critical care nurses support.

Critical care nursing is a vital and significant part of health care provision to critically ill patients. It is a specialty area of nursing that requires registered nurses who are highly motivated, knowledgeable and skilled to provide optimal care to critically ill patients. These patients are nursed in a complex environment consisting of specialised equipment (such as ventilators, defibrillators, intravenous pumps, and cardiac monitors) that is not found in any other field of nursing. Collegial support and an adequate registered nurse: patient ratio is vital in critical care units in order to provide optimal quality care to critically ill patients. However, an understaffed work environment, the demands of critical care nursing and other work-related problems, such as conflict with physicians, inadequate remuneration packages and an increased workload can cause serious distress and dissatisfaction amongst registered nurses in this specific environment (Carayon & Gürses, 2005:287). The objectives of this study therefore are to explore and describe the experiences of registered nurses of their work environment in a critical care unit and to make recommendations that will assist registered nurses working in a critical care unit. A qualitative, explorative, descriptive and contextual research design will be utilised. Data will be collected by means of semi-structured interviews and analysed according to the framework provided by Tesch (in Cresswell, 2003:192). Purposive sampling will be used to select a sample of registered nurses working in a critical care environment. Guba’s model (in Krefting, 1991) will be utilised to verify data and to ensure trustworthiness of the study. Ethical considerations will be adhered to throughout the study. Once data has been analysed, recommendations will be made that will assist registered nurses working in a critical care unit.

This descriptive comparative and correlational study was designed to determine the degree of environmental stress perceived by mothers and fathers during the first week of their infant's admission to a Special Care Nursery (SCN) and to determine the differences in their perceptions. In addition, the variables of gestational age, birth weight and paternal attitude toward caregiving were investigated for their relationship to the perceived degree of environmental stress. A convenience sample of 31 sets of parents was selected from a tertiary level SCN in a large urban children's hospital. Both parents completed the Neonatal Intensive Care Unit Parental Stress Scale and an information sheet; fathers also completed the Paternal Attitude Scale. Overall, mothers and fathers perceived the SCN environment as a low source of stress. Mothers were moderately stressed by their altered parental role. In addition, mothers were significantly more stressed by the environmental aspects of SCN and the total SCN experience than were fathers. Environmental stress arising from staff communications and relations was significantly negatively related to birth weight and gestational age. No significant relationship was found between paternal attitude toward care giving and the fathers' perception of environmental stress. / Applied Science, Faculty of / Nursing, School of / Graduate

Bakgrund: Fetma är ett globalt och regionalt växande problem. Patienter med fetma är överrepresenterade på intensivvårdsavdelningar (IVA) och det finns risker och komplikationer associerade till fetma på IVA. Att vårda patienter med fetma på IVA kan vara emotionellt påfrestande. Syfte: Att beskriva intensivvårdssjuksköterskors (IVA-sjuksköterskors) erfarenheter av att vårda patienter med fetma på IVA. Metod: Studien har en kvalitativ metod med induktiv ansats. Datainsamling har skett genom semi-strukturerade intervjuer med åtta intensivvårdssjuksköterskor som jobbar på en IVA i norra Sverige. Data analyserades med hjälp av kvalitativ innehållsanalys enligt Elo och Kyngäs. Resultat: Två huvudkategorier, att värna om patienten och förutsättningar för att ge ett bra vårdande framkom med fem underkategorier. Att prata om fetma, att tillgodose patientens unika behov, att ge lika vård, att behöva vara fler och vikten av utrustningen Slutsats: Att vårda patienter med fetma på IVA kan skilja sig åt jämfört med normalviktiga och förutsättningarna för att vårda patienterna kan inte alltid tillgodoses. Det kan vara utmanande att tillgodose patientens unika omvårdnadsbehov som att hjälpa patienten att andas, att lägesändra och mobilisera patienter på ett säkert sätt och att hålla en god hygien. Vården kan ytterligare begränsas genom ett ökat behov av personal som inte alltid är möjligt, att patienter inte kan genomföra vissa undersökningar och att de finns ett behov av speciellt anpassad utrustning. / Background: Obesity is a regional and global growing problem. There is a higher prevalence of obesity in the intensive care unit (ICU), compared to the general population and obesity is associated with certain risks at the intensive care unit. To care for obese patients in the ICU can be emotionally demanding. Aim: To explore intensive care nurses’ (ICU-nurses’) experiences caring for obese patients. Method: The study is a qualitative design with inductive approach. Data was collected using semi-structured interviews. Eight intensive care nurses working at an ICU in the north of Sweden participated. Data was analyzed using qualitative content analysis according to Elo and Kyngäs. Results: Two main categories derived from the analysis: safeguarding the patient and pre-requisites needed to provide good care. Sub-categories that emerged were talking about obesity, meeting the patient’s unique needs, to give equal care, the need for extra staff and the importance of equipment. Conclusion: The care for obese patients on the ICU can be different compared to normal weight patients and pre-requisites for care cannot always be met. It can be a challenge to meet the patient’s unique needs by helping the patient to breathe, to reposition and mobilize patients in a safe manner and to keep a good hygiene. The care can further be limited by a need for extra staff that cannot always be met, the incapability to perform certain examinations and a need for specialized equipment.

Bakgrund: Barn behöver få information anpassad för sin ålder. Enligt barnkonventionen har barn rätt att säga sin åsikt och att bli hörda. Om barn får besöka en svårt sjuk familjemedlem kan det påverka den sjuke positivt genom att hen känner mer hopp. Även barn kan påverkas genom att de känner mindre hopplöshet och skuldkänslor. Syfte: Att undersöka hur intensivvårdssjuksköterskan bemöter barn som är anhörig på en intensivvårdsavdelning. Metod: En integrativ litteraturstudie, sökningar gjorda i PubMed och CINAHL. Resultat: Utifrån syftet identifierades tre huvudteman: stöd till barn som besöker, anpassa mötet efter barns behov och intensivvårdssjuksköterskans attityder till barn som anhörig. Sex studier ingår i resultatet, studierna är av kvantitativ, kvalitativ och mixad metod. Konklusion: Intensivvårdssjuksköterskan behöver i bemötandet av barn engagera och bekräfta barnet genom att se till barnets individuella behov. Det kan göras genom att i mötet med barn informera, visa och engagera. Intensivvårdssjuksköterskans attityd till att bemöta barn kan påverka barns möjligheter att få komma på besök. Det finns attityder som underlättar för barn att få komma på besök medan andra attityder kan hindra barn som besökare.

SAMMANFATTNING (Svensk)  Titel: Intensivvårdssjuksköterskors erfarenheter av överrapportering Fakultet: Hälsa, natur – och teknikvetenskap Kurs: Examensarbete – omvårdnad, 15 HP Författare: Josefin Axelsson & Mathilda Blomberg Handledare: Anders Sidenblad Examinerande lärare: Cecilia Olsson Examinator: Jan Nilsson Sidor: 24 Datum för examination: 2022-06-20 Svenska nyckelord: Intensivvårdssjuksköterskor, Erfarenheter, Överrapportering, Intensivvårdsavdelning Introduktion: Intensivvårdssjuksköterskors profession kännetecknas av arbete inom avancerad vård och i en högteknologisk miljö kombinerat med komplex omvårdnad vilket ställer höga krav på intensivvårdssjuksköterskors kompetens. Intensivvårdssjuksköterskor har ansvaret att både ge och ta emot överrapporteringar avseende patientens tillstånd och är ett moment som om det brister kan äventyra patientsäkerheten. Syfte: Intensivvårdssjuksköterskors erfarenheter av överrapportering inom slutenvården. Metod: Kvalitativ litteraturstudie, där åtta artiklar inkluderades och analyserades med manifest innehållsanalys. Resultat: Intensivvårdssjuksköterskorna erfarenheter resulterade i kategorin: Faktorer som påverkar överrapportering och tre underkategorier: Förberedelser och metoder, Kommunikationsverktyg och struktur, Att bemöta och att bli bemött. Konklusion: Överrapportering är komplex arbetsuppgift och det finns faktorer vid överrapportering som påverkar kvaliteten av rapporten. Kommunikationsverktyg och hur vårdpersonal uppträder mot varandra kan minska att patientinformation missas och risk för vårdskada blir lägre. Utbildning, klinisk träning och utvärdering av modeller för överrapportering kan öka patientsäkerheten. / ABSTRACT (English)  Title: Intensive care nurses' experiences of handover Faculty: Health, Science and Technology Course: Degree project – nursing, 15 ECTS Authors: Josefin Axelsson & Mathilda Blomberg Supervisor: Anders Sidenblad Examiner: Cecilia Olsson Examiner: Jan Nilsson Pages: 24 Date for the examination: 2022-06-20 Key words: Intensive care nurses, Experiences, Handover, Intensive care units Introduction: The profession of intensive care is characterized by work in advanced care and in a high-tech environment combined with complex nursing, wich places high demands on the competence of intensive care nurses. Intensive care nurses are responsible for both giving and receiving handover regarding the patients condition and are a moment that, if there are shortcomings, can jeopardize patient safety. Aim: Intensive care nurses' experiences of handover in inpatient care. Method: Qualitative literature study, where eight articles were included and analyzed with manifest content analysis. Results: The intensive care nurses experiences resulted in the category: Factors that affect handover and three subcategories: Preparations and methods, Communication tools and structure, To interact. Conclusion: Handover is a complex task and there are factors in handover that affect the quality of the report. Communication tools and how care staff behave towards each other can reduce that patient information is missed and the risk of care injury is lover. Education, clinical training and evaluation of models for handover can increase patient safety.

Bakgrund: Att ha ett barn som vårdas på en intensivvårdsavdelning innebär att föräldrar tvingas lämna sitt barn i händerna hos vårdpersonal och detta är för de flesta föräldrar en ny situation som är förenad med upplevelser av stress och oro. En ökad kunskap om föräldrarnas upplevelse av tiden barnet vårdas på en intensivvårdsavdelning kan bidra till ett bättre omhändertagande av föräldrarna. Syfte: Att beskriva föräldrars upplevelse av att ha ett barn som vårdas inom intensivvård. Metod: En systematisk litteraturstudie med kvalitativ ansats och ett induktivt förhållningssätt där 13 artiklar inkluderades till resultatpresentationen. Resultat: Resultatet visar att föräldrar upplevde oro och stress i samband med att barnet lades in på intensivvårdsavdelningen. Intensivvårdsavdelningen, som är en högteknologisk miljö med mycket personal runt barnet, beskrevs som en ny och okänd miljö av föräldrarna och upplevdes föra dem längre ifrån barnet. Rädsla för barnets framtid och oro för att barnet skulle dö beskrevs av föräldrarna. Föräldrar upplevde att stöd från vårdpersonal i form av kontinuerlig information, en god kommunikation och att tillåtas vara delaktiga var betydelsefullt. Slutsats: Att vårdteamet inkluderade och involverade föräldrarna i vården var viktigt och hade betydelse för att minska föräldrarnas stress och oro. Det ökade även föräldrarnas känsla av trygghet och  säkerhet i sin roll som förälder vilket har betydelse för föräldrarnas upplevelse av delaktighet samt för föräldrarnas förmåga att finnas där för sitt barn. Med ett familjeperspektiv och familjecentrering i vården av barnet ses familjen som en helhet och vidare forskning skulle kunna öka förståelsen för föräldrar i en utsatt situation och studera vad implementeringen av den familjecentrerade vården skulle innebära för föräldrarnas upplevelse. / Background: Having a child in an intensive care unit means that parents are forced to leave their child in the arms of the healthcare staff and for most parents this is a new situation and is associated with experiences of stress and anxiety. An increased knowledge of the parents' experience of the time their child is admitted to an intensive care unit can contribute to better care for the parents. Aim: To describe the parents’ experience of when their child is being admitted to an intensive care unit. Method: A systematic literature study with a qualitative approach and an inductive approach where 13 articles was included in the presentation of the result. Results: The result shows that parents’ experienced anxiety and stress when their child was admitted to the intensive care unit. The intensive care unit, which is a highly technical environment (with high technology) and a lot of people surrounding the child, was described by the parents as an new and unknown environment that separated them from their child. A fear of the future on the child's behalf and anxiety for the childs’ death was described by the parents. Parents’ experienced support from healthcare staff in the form of continuous information, good communication and being involved was meaningful. Conclusion: The healthcare teams’ ability to include and involve the parents in caring was important and of significance for reducing the parents’ stress and anxiety. It also increased the parents’ sense of comfort and security in their role as parents which is of significance in the parents’ experience of involvement and their ability to be there for their child. With a family-perspective and family-centered care in the care for the child the family was seen as an entirety och further research could increase the understanding of parents in a vulnerable situation and study what the implementation of family-centered care would mean for the parents’ experience