The purpose of this study was to develop a theory to explain how nurses experience and respond to uncertainty arising from patient care-related situations and the influence of uncertainty on their information behaviour. Strauss and Corbin’s (1998) grounded theory approach guided the study. Semi-structured face-to-face interviews were conducted with 14 staff nurses working in an adult medical-surgical intensive care unit (MSICU) at one of two participating hospitals. The grounded theory recognizing and responding to uncertainty was developed from constant comparison analysis of transcribed interview data. The theory explicates recognizing, managing, and learning from uncertainty in patient care-related situations. Recognizing uncertainty involved a complex recursive process of assessing, reflecting, questioning and/or predicting, occurring concomitantly with facing uncertain aspects of patient care situations. Together, antecedent conditions and the process of recognizing uncertainty shaped the experience of uncertainty. Two main responses to uncertainty were physiological/affective responses and strategies used to manage uncertainty. Resolved uncertainty, unresolved uncertainty, and learning from uncertainty experiences were three consequences of managing uncertainty. The ten main categories of antecedent, actions and interactions, and consequences that comprised the theory were interrelated and connected through temporal and causal statements of relationship. Nurse, patient, and contextual factors were linked through patterns of conditions and intervening relational statements. Together, these conceptual relationships formed an explanatory theory of how MSICU nurses experienced and responded to uncertainty in their practice. This theory provides understanding of how nurses think through, act and interact in patient situations for which they are uncertain, and provides insight into the nature of the processes involved in recognizing and responding to uncertainty. Study implications for practice, nursing education, and further theory development and research are discussed.

Bakgrund: Patienter inlagda på sjukhus behöver näringstillförsel för att kunna återhämta sig. Enteral nutrition är troligen att föredra framför parenteral nutrition, och bör sättas in så tidigt som möjligt. Enteral nutrition kan administreras på olika sätt. Den kan ges intermittent och innehålla nattvila, eller ges kontinuerligt för att undvika plötsliga sänkningar i blodsockernivåer. En oönskad komplikation är lösa avföringar hos patienten. Frågan är om administrationsformen av enteral nutrition kan påverka frekvensen av diarré. Syfte: Att med hjälp av en registerstudie jämföra antal lösa avföringar per dygn mellan två olika administrationsformer av enteral nutrition: intermittent med nattvila jämfört med kontinuerlig tillförsel över hela dygnet. Metod: En kvantitativ retrospektiv registerstudie har genomförts på totalt 50 intensivvårdspatienter med traumatisk skallskada vid Norrlands Universitetssjukhus. Journaler från 2007 till 2012 har använts i studien. Resultat: Ingen signifikant skillnad kunde påvisas mellan grupperna i antal lösa avföringar per dygn, p=0.5. Däremot visade denna studie att de patienter som fick intermittent enteral nutrition fick signifikant större mängd enteral nutrition (699±249 ml) per dygn jämfört med patienter som fick sin enterala nutrition kontinuerligt (505±278 ml/dygn), p = 0.008. Slutsats: Resultatet från studien visar att antalet lösa avföringar inte verkar bero på administreringsformen av enteral nutrition. Mängden tillförd enteral nutrition skiljer sig dock statistiskt signifikant varav betydelsen av det borde studeras vidare för att avgöra vilken administreringsform som är att föredra. / Background: Patients admitted to hospital need nutrition to recover. Enteral nutrition is probably preferable to parenteral nutrition should be initiated as early as possible. Enteral nutrition may be administered in various ways, it can be intermittent and include night rest, or given continuously to avoid abrupt reductions in blood sugar levels. An unwanted complication is loose stools of the patient. The question is whether the form of administration of enteral nutrition can affect the frequency of diarrhea. Aim: With the help of a retrospective registry study comparing number of loose stools per day between two different forms of administration of enteral nutrition: intermittent with night sleep compared with continuous supply throughout the day. Method: A quantitative retrospective registry study has been carried out on a total of 50 ICU patients with traumatic head injury at Norrlands University Hospital. Records from 2007 to 2012 were used in the study. Results: No significant difference was detected between the groups in the number of diarrhea per day, p = 0.5. However, this study demonstrated that patients receiving intermittent enteral nutrition was significantly greater amount of enteral nutrition (699 ± 249 ml) per day compared with patients who received their enteral nutrition continuously (505 ± 278 mL / day), p = 0008. Conclusion: The results from the study show that the number of loose stools do not seem to depend on the form of administration of enteral nutrition. Quantities of enteral nutrition differ statistically significantly significance of which it should be further studied to determine which form of administration is preferred.

The purpose of this thesis was to examine the relationship between locus of control and the intensive care nurse's perception of job-related situations. It was hypothesized that intensive care nurses who evidenced an external locus of control would classify job-related situations as more stressful, more threatening, and less challenging than intensive care nurses who evidenced an internal locus of control. The instruments consisted of (1) a demographic questionnaire, (2) an instrument developed by this investigator to measure the degree of perceived stressful, threatening, and challenging aspects of certain job-related situations, and (3) Rotter's Internal-External Locus of Control Scale. The questionnaires were distributed to nurses working in intensive and coronary care units in one medium sized city in Indiana. An N of 75 was obtained.The hypotheses that external intensive care nurses would classify job-related situations as more stressful and more threatening were supported (F = 9.26, p<0.01, and F = 6.08, p<0.01 respectively). The hypothesis that internal nurses would classify more job-related situations as challenging was not supported by the data (F = 0.01, p = 0,91).Ball State UniversityMuncie, IN 47306

The purpose of this study was to develop a theory to explain how nurses experience and respond to uncertainty arising from patient care-related situations and the influence of uncertainty on their information behaviour. Strauss and Corbin’s (1998) grounded theory approach guided the study. Semi-structured face-to-face interviews were conducted with 14 staff nurses working in an adult medical-surgical intensive care unit (MSICU) at one of two participating hospitals. The grounded theory recognizing and responding to uncertainty was developed from constant comparison analysis of transcribed interview data. The theory explicates recognizing, managing, and learning from uncertainty in patient care-related situations. Recognizing uncertainty involved a complex recursive process of assessing, reflecting, questioning and/or predicting, occurring concomitantly with facing uncertain aspects of patient care situations. Together, antecedent conditions and the process of recognizing uncertainty shaped the experience of uncertainty. Two main responses to uncertainty were physiological/affective responses and strategies used to manage uncertainty. Resolved uncertainty, unresolved uncertainty, and learning from uncertainty experiences were three consequences of managing uncertainty. The ten main categories of antecedent, actions and interactions, and consequences that comprised the theory were interrelated and connected through temporal and causal statements of relationship. Nurse, patient, and contextual factors were linked through patterns of conditions and intervening relational statements. Together, these conceptual relationships formed an explanatory theory of how MSICU nurses experienced and responded to uncertainty in their practice. This theory provides understanding of how nurses think through, act and interact in patient situations for which they are uncertain, and provides insight into the nature of the processes involved in recognizing and responding to uncertainty. Study implications for practice, nursing education, and further theory development and research are discussed.

Background: Recent focus on quality and patient safety has underlined the need to involve patients in improving healthcare. “Experience-based Co-design” (EBCD) is an approach to capture and understand patient and staff (i. e. users) experiences, identifying so called “touch points” and then working together equally in improvement efforts. Purpose: This article elucidates patient (defined as the mother-newborn couple with next of kin) and staff experiences following improvement work carried out according to EBCD in a maternity ward and neonatal intensive care unit (NICU) in a small, acute hospital in Sweden. Method: An experience questionnaire, derived from the EBCD approach tool set, was used for continuously evaluating each event of the EBCD improvement project. Furthermore, a focus group interview with staff and in-depth interviews with mother-father couples were held in order to collect and understand the experiences of working together according to EBCD. The analysis and interpretation of the interview data was carried through using qualitative, problem-driven content analysis. Themes, categories and sub-categories presented in this study constitute the manifest and latent content of the participants’ experiences of Experience-based Co-design. Results: The analysis of the experience questionnaires, prior to the interviews, revealed mostly positive experiences of the participation. Both staff and patient participants stated generally happy, involved, safe, good and comfortable experiences following each event of the improvement project so far. Two themes emerged during the analysis of the interviews. For staff participants the improvement project was a matter of learning within the microsystem through managing practical issues, moving beyond assumptions of improvement work and gaining a new way of thinking. For patients, taking part of the improvement project was expressed as the experience of involvement in healthcare through their participation and through a sense of improving for the future. Discussion: This study confirms that, despite practical obstacles for participants, the EBCD approach to improvement work provided an opportunity for maternity ward /NICU care being explored respectfully at the experience level, by assuring the sincere sharing of useful information within the microsystem continuously, and by encouraging and supporting the equal involvement of both staff and patients. Staff and patients wanted and were able to contribute to the EBCD process of gathering information about their experiences, analyzing and responding to collected data, and engaging themselves in improving the same. Furthermore, the EBCD approach provided staff and patients the opportunity of learning within the microsystem. Nevertheless, the responsibility of the improvement work remained the responsibility of the healthcare professionals. Keywords: Quality Improvement, Maternity Care, Neonatal Intensive Care, Experience-based Co-design

Being a patient in intensive care can be experienced terrifying. Studies have demonstrated the link between unpleasant memories of hospitalization in the ICU and the development of posttraumatic stress disorder, depression, anxiety, and perception of quality of life in its aftermath. Placed on a ventilator, the patient is exposed to multiple invasive procedures. The aim was to describe critical care patients' experience of being intubated or tracheostomated. Method: Literature review using conventional content analysis. Searches were made in the databases Cinahl and Pubmed. Results: The study revealed four main categories: Discomfort, Vulnerability and Communication difficulties that were tied together by category Relief. It turned out that the patients experienced a discomfort caused by the endotracheal tube. Suctioning of airways remembered many of the patients in both discomfort and relief. Being dependent on a ventilator and equipment in order to survive, causing a feeling of vulnerability. Many patients lost hope when they could not communicate, make themselves understood and to be involved in their care. The medical staff has a significant impact on their experiences of intensive care. To find out the reason they were intubated / tracheostomated reduced their fear. This information helped them to bond with reality. The nurse has responsibility to act with compassion and empathy, theory and knowledge to reduce anxiety and facilitate hospital stay for patients.

Background: Recent focus on quality and patient safety has underlined the need to involve patients in improving healthcare. “Experience-based Co-design” (EBCD) is an approach to capture and understand patient and staff (i. e. users) experiences, identifying so called “touch points” and then working together equally in improvement efforts. Purpose:This article elucidates patient (defined as the mother-newborn couple with next of kin) and staff experiences following improvement work carried out according to EBCD in a maternity ward and neonatal intensive care unit (NICU) in a small, acute hospital in Sweden. Method: An experience questionnaire, derived from the EBCD approach tool set, was used for continuously evaluating each event of the EBCD improvement project. Furthermore, a focus group interview with staff and in-depth interviews with mother-father couples were held in order to collect and understand the experiences of working together according to EBCD. The analysis and interpretation of the interview data was carried through using qualitative, problem-driven content analysis. Themes, categories and sub-categories presented in this study constitute the manifest and latent content of the participants’ experiences of Experience-based Co-design. Results:The analysis of the experience questionnaires, prior to the interviews, revealed mostly positive experiences of the participation. Both staff and patient participants stated generally happy, involved, safe, good and comfortable experiences following each event of the improvement project so far. Two themes emerged during the analysis of the interviews. For staff participants the improvement project was a matter of learning within the microsystem through managing practical issues, moving beyond assumptions of improvement work and gaining a new way of thinking. For patients, taking part of the improvement project was expressed as the experience of involvement in healthcare through their participation and through a sense of improving for the future. Discussion: This study confirms that, despite practical obstacles for participants, the EBCD approach to improvement work provided an opportunity for maternity ward /NICU care being explored respectfully at the experience level, by assuring the sincere sharing of useful information within the microsystem continuously, and by encouraging and supporting the equal involvement of both staff and patients. Staff and patients wanted and were able to contribute to the EBCD process of gathering information about their experiences, analyzing and responding to collected data, and engaging themselves in improving the same. Furthermore, the EBCD approach provided staff and patients the opportunity of learning within the microsystem. Nevertheless, the responsibility of the improvement work remained the responsibility of the healthcare professionals.

Bakgrund: Att bli mamma till ett för tidigt fött barn (&lt;37 gestationsveckor) innebär en oväntad stress vilket påverkar hela familjen. Under de senaste årtionden har stora förbättringar skett inom perinatal vård och numera är chansen till överlevnad stor. Att barnet efter födseln vårdas på neonatal intensivvårdsavdelning (NICU) får konsekvenser för mamman både känslomässigt och i omvårdnaden av barnet. Syfte: Att undersöka föräldrastress och beskriva faktorer som påverkar tidig föräldrastress hos mammor till för tidigt födda barn när barnet är två månader i korrigerad ålder. Metod: Studien utfördes på fyra NICU i Sverige. Inklusionskriterierna för studien var att barnet var för tidigt fött samt vårdades på neonatalavdelning i minst 72 timmar. För att mäta upplevd föräldrastress fick mammorna (n=276) svara på enkäten Swedish Parental Stress Questionnaire (SPSQ) när barnet var två månader i korrigerad ålder. Resultat: Mammor vars barn inte vårdades på en samvårdsavdelning, som hade barn i kuvös, mammor till barn med äldre syskon, var äldre, rökte och/eller ammade helt upplevde mer föräldrastress än övriga mammor. Slutsats: Studien visar att faktorer i framför allt i miljön samt hos mamman har betydelse för upplevd föräldrastress. Våra resultat innebär att omhändertagandet bör bli bättre, både under tiden på neonatalavdelning men även efter utskrivning. Då studien också påvisar vikten av samvårdsavdelning bör förbättringar ske i den fysiska vårdmiljön för att minimera upplevelsen av föräldrastress. / Background: When an infant is born preterm (&lt;37 gestational weeks) unexpected stresses affect the whole family. Significant improvements in the perinatal care has been made in the recent decades and now the chance of survival is high. To become a mother in a Neonatal Intensive Care Unit (NICU) entail consequences for the mother emotionally and in her care for her infant. Aim: To investigate parental stress and describe factors associated to early parenting stress in mothers of preterm infants at two months of corrected age. Method: The study was conducted in four NICUs in Sweden. The inclusion criteria were that the infant was born prematurely and had a hospital stay for at least 72 hours. To measure perceived parental stress, the mothers (n=276) answered the Swedish Parental Stress Questionnaire (SPSQ) at two months of corrected age. Results: Mothers whose infants were not cared for in a NICU with co-care, whose infants were cared for in an incubator, who were multiparous, older, who smoked and/or who were breastfeeding exclusively, experienced more stress than their counterparts in various dimensions explored. Conclusion: The study shows that factors relating to the environment and the mother are associated to parental stress among mothers’ of preterm infants. These findings show the need for improved support, both during the NICU stay and after discharge. These findings also highlight the need for improvements in the physical environment of the NICUs to reduce the risk for parental stress.

År 2003 introducerades en checklista för patienters kliniska status och vårdplats på neurointensivvårdsavdelningen (NIVA) på ett universitetssjukhus i Mellansverige. Studiens syfte var att utvärdera denna checklista som verktyg i klinisk verksamhet med fokus på brister, åtgärder och användarvänlighet. Studien består av tre delar och är deskriptiv med kvantitativ ansats. En observationsstudie av tvärsnittskaraktär där funna brister och åtgärder studerats, en journalgranskning där användarvänlighet studerats och en enkätstudie avseende intensivvårdssjuksköterskornas erfarenheter och upplevelser. Resultatet visade att checklistan var användarvänlig med nyttjandefrekvens på 100 %. Intensivvårdssjuksköterskorna ansåg att checklistan inverkar positivt på arbetet, utgör ett stöd och bidrar till ökad patientsäkerhet. Den vanligast funna bristen var larmgränser. Totalt påträffades brister i 38 % av fallen och dessa gav en åtgärdsfrekvens på 77,5 %. En signifikant skillnad avseende åtgärdsfrekvensen påträffades mellan dag- och nattpass. Slutsatsen är att checklistan bidrar till att brister upptäcks och åtgärdas, den är användarvänlig och personalen är positivt inställd till den. En modifierad checklista skulle kunna användas inom intensivvårdsavdelningar generellt och säkerställa att personal arbetar på ett likvärdigt sätt och medföra en mer patientsäker vård där rätten till lika vård för alla efterlevs inom checklistans avsedda område. / This study aimed to evaluate a checklist, with regard to the workstation and the clinical status of the patient, used at the neuro-intensive care unit, NIVA, at a university hospital in central Sweden. The design of the study is descriptive with quantitative data and consists of three parts. An observational, cross-sectional study where flaws and measures where studied, a journal review where the usability where studied and a survey in which critical care nurses expressed their experiences and perceptions. The results showed that flaws where found in 38 % of all cases and these gave a measure frequency of 77,5 %. The checklist was user friendly with utilization of 100 %. According to the critical care nurses the checklist had a positive impact on their daily work, it provided support and contributed to increase patient safety. The conclusion is that the checklist contributes to detection and correction of flaws, it is user fiendly and the critical care nurses have a positive mindset about it. A modified checklist could be used in intensive care settings in general to ensure that staff are working on an equivalent basis and provide a more patient-safe care.

Sleep has a recreating, health promotive and regenerative function. Research shows that intensive care patients suffer from sleep deprivation and bad sleep quality with considerable negative consequences. The aim of the report was to examine how much nocturnal sleep patients without ventilator treatment get and to observe factors that may influence sleep. Methods: An observation chart was used to collect data. The staff’s observation of the patients’ night sleep and estimated nocturnal noise- and light levels in the patients’ rooms were documented. The patients’ answers to questions about pain and possible causes for their awakenings were noted. The staff documented also their own perception of what could have awakened the patient, plus the use of ear plugs, sleep medication and sedatives. Results: The results show that patients at CIVA have too short nocturnal sleep. Furthermore their sleep is fragmented and there are few sleep periods of 90 minutes or longer, which means that the sleep structure is disturbed. The results show also that there is room for improvement work at CIVA concerning factors which may influence the patients’ nocturnal sleep. Conclusions: Patients at CIVA have too short and fragmented night sleep. Efforts to promote the patients night sleep should be intensified. / Sömn har en rekreerande, hälsofrämjande och regenererande funktion. Forskning visar att intensivvårdspatienter har sömnbrist och dålig sömnkvalitet med betydande negativa konsekvenser. Rapportens syfte var att kartlägga hur mycket nattsömn icke- ventilatorbehandlade patienter på CIVA får och att observera faktorer som kan påverka sömnen. Metod: Ett formulär användes till datainsamling. Personalens observationer av patientens nattsömn samt skattade nattliga ljud- och ljusnivåer i patientsalen dokumenterades. Patientens svar på frågor om smärta och möjliga orsaker till uppvaknanden noterades. Personalen dokumenterade även sin egen uppfattning om vad som kunde ha väckt patienten samt användning av öronproppar, sömnmedicin och lugnande medicin. Resultat: Resultaten visar att patienterna på CIVA har för kort nattsömn. Dessutom är sömnen fragmenterad och det förekommer få sömnperioder à 90 minuter eller längre vilket betyder att sömnstrukturen är störd. Resultaten visar även att det finns utrymme för förbättringsarbete på CIVA angående faktorer som kan påverka patienternas nattsömn. Slutsats: Patienterna på CIVA har för kort och fragmenterad nattsömn. Kvalitetsutvecklingsarbetet för att främja patienternas nattsömn borde intensifieras.