Att flyttas från intensivvårdsavdelning (IVA) till vårdavdelningen kan ur patientens perspektiv leda till olika upplevelser, båda positiva och negativa. Själva överflyttningen kan ge ångest, oro och otrygghet till patienterna men kan också upplevas som positivt och oproblematiskt. Överflyttningen till vårdavdelningen kan vara abrupt eller välplanerat och detta kan påverka patienternas upplevelse och känsla. Studiens syfte var att beskriva patienters upplevelse av överflyttning från IVA till vårdavdelning. Kvalitativ metod användes med intervjuer som datainsamlingsmetod där nio patienter intervjuades. Som analysmetod valdes en kvalitativ innehållsanalys. Resultatet visar att överflyttningen upplevdes som ett steg i vårdprocessen. Patienterna i studien visade en positiv syn överlag men hade inte så stark upplevelse av själva överflyttningen. Skillnader hos de olika avdelningarna på sjukhuset var en stor del av det som kom fram under intervjuerna. Ingen negativ upplevelse har framkommit i studien angående själva överflyttningen utan patienterna tyckte att det var en del i själva vårdprocessen. / Program: Specialistsjuksköterskeutbildning med inriktning mot intensivvård

Inledning: Patienter som varit svårt sjuka och vårdats på intensivvårdsavdelning, upplever ofta oro och ångest, när de ska överflyttas till vårdavdelning. Dessa patienter har stort vårdbehov, eftersom flertalet inte återhämtat sig, från sitt svåra sjukdoms tillstånd. Patienterna är fortfarande mycket trötta, har nedsatt muskelkraft och svårt att klara sig själva. Målet med studien är, att med kunskap om hur patienter upplever överflyttningen, försöka finna former för hur vi ska kunna underlätta denna för patienten. Syftet med studien är att beskriva patienters upplevelser i samband med överflyttning från intensivvårdsavdelningen till vårdavdelningen. Metoden var systematisk litteraturstudie av vetenskapliga artiklar. Materialet granskades med kvalitativ innehållsanalys. Resultatet visar att flertalet patienter upplever överflyttningen positivt och de tolkar den, som att de blivit bättre. Ett antal patienter upplever överflyttningen med omedvetna känslor, antingen har de minnesluckor, eller ser de överflyttningen som en normal händelse i vårdkedjan. Ett fåtal patienter upplever överflyttningen som mycket traumatisk, de drabbas av oro och ångest, sk”flyttstress”. De oroar sig över hur de ska klara sig på vårdavdelning, känner sig enormt hjälplösa och har en rädsla över att bli ”glömda” på sitt rum och inte få den hjälp, de anser att de behöver. Slutsatsen av litteratur studien är att ett fåtal patienter upplever stor oro och ångest, när de ska lämna intensivvårdsavdelningen (IVA). Det är de patienter som varit svårast sjuka, oftast med multiorgansvikt och en lång vårdtid på IVA. Det är dessa patienter vi måste hjälpa till bättre livskvalitet vid en överflyttning till vårdavdelning. Förslagsvis utarbetas ett samarbete mellan mottagande vårdavdelning och intensivvårdsavdelning. Information upplever patienterna, som enormt viktig. En väl informerad patient är också en trygg patient. Anhöriga görs mer delaktiga i vården och är de välinformerade blir de ett stort stöd för patienten.

Bakgrund: Överföringen mellan en intensivvårdsavdelning till en vårdavdelning utgör en stor risk gentemot patientsäkerheten och är en stor utmaning då dessa patienter är de sjukaste i vårdkedjan. Förflyttningen innebär en stor förändring för patienten då de har skapat sig en trygghet i platsen på intensiven som de då kommer att fråntas. Brister i flytten kan orsaka ett lidande för patienten, öka risken för återinläggning på intensivvårdsavdelningen vilket innebär att patientsäkerheten äventyras. Patienters upplevelse av förflyttningen har därför stor betydelse för möjligheterna för förbättring.  Syfte: Syftet med studien var att beskriva patienters upplevelser av att flyttas från en intensivvårdsavdelning till en vårdavdelning. Metod: En litteraturstudie med systematiskt sökförfarande och kvalitativ ansats med 10 vetenskapliga artiklar som grund genomfördes. Analysen inspirerades av Bettany-Saltikov och McSherrys tolkning av innehållsanalys.  Resultat: Resultatet genererade fyra kategorier. Kategorierna var Skillnader i vårdmiljön, Rädsla inför det okända, Behovet av att ha en copingstrategi och Kommunikationens betydelse. Slutsats: Det framkom att patienterna upplevde att det fanns en stor brist i förberedelserna och informationen innan flytten. Vidare forskning skulle kunna öka förståelsen för eventuella kommunikationsbrister mellan patient och sjukvårdspersonal på intensiven vilket kan användas i förbättringsarbete mot en mer personcentrerad och patientsäker vård. / Background: The transfer between the intensive care unit and general ward is a big risk towards patient safety and a huge challenge since these patients are the sickest and most vulnerable in the care chain. The transfer means a major change for the patient since they’ve created a sense of security in the intensive care unit that they will be deprived of. Flaws in the transfer may cause a suffering for the patient and increase the risk of readmission in the intensive care unit, which means that patient safety is compromised. Therefore, patients experiences of the transfer process have a major importance for the opportunities for improvement. Aim: The aim of this study was to describe patients experiences of being transferred from an intensive care unit to the general ward. Method: A literature review with a systematic search procedure and a qualitative approach with 10 scientific articles has been made. The analysis is inspired by Bettany-Saltikov and McSherry’s interpretation of content analysis.  Result: Four categories emerged from the analysis: Differences in the care environment, Fear of the unknown, The need of having a coping strategy and The importance of communication. Conclusion: The patients experienced that the preparations and information were a huge flaw in the transfer process. Further research could increase the understanding of any communication deficits between the patient and the healthcare staff in the intensive care unit, which can be used in improvement work towards a more person-centered and patient-safe care.

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

The study investigated how patients in the general wards of the Avenues Clinic perceive the nursing care they received. The study objectives were to identify how nurses in the general wards of the Avenues Clinic respond to patients' needs and if the nursing care received from the nurses matched patients' expectations. The study further sought to determine if patients would return to use Avenues Clinic nursing services and recommend services to family and friends. Data was drawn from 87 respondents by randomly distributing 100 questionnaires to three thirty-four bedded general wards of the Avenues Clinic. Findings of the study indicated that the majority of patients who received nursing care that was in line with their expectations would also return to use Avenues Clinic nursing services as well as recommend the services to family and friends. The theme "optimal care" was used to consolidate patient satisfiers while "suboptimal care" was used to describe patient dissatisfiers. / Health Studies / (M.A.(Health Studies ))

The study investigated how patients in the general wards of the Avenues Clinic perceive the nursing care they received. The study objectives were to identify how nurses in the general wards of the Avenues Clinic respond to patients' needs and if the nursing care received from the nurses matched patients' expectations. The study further sought to determine if patients would return to use Avenues Clinic nursing services and recommend services to family and friends. Data was drawn from 87 respondents by randomly distributing 100 questionnaires to three thirty-four bedded general wards of the Avenues Clinic. Findings of the study indicated that the majority of patients who received nursing care that was in line with their expectations would also return to use Avenues Clinic nursing services as well as recommend the services to family and friends. The theme "optimal care" was used to consolidate patient satisfiers while "suboptimal care" was used to describe patient dissatisfiers. / Health Studies / (M.A.(Health Studies ))

Bakgrund: Med snabb start av hjärt- lungräddning (HLR) och tidig defibrillering ökar chansen för överlevnad då en patient drabbats av hjärtstopp. Intensivvårds- och anestesisjuksköterskan, som ingår i hjärtstoppsteamet, har en viktig roll när de lämnar sin ordinarie avdelning för att hjälpa till och stötta andra kollegor i den akuta situationen på en vårdavdelning. En situation som kan vara till grund för både positiva och negativa upplevelser. Syfte: Syftet med studien var att beskriva intensivvårds- och anestesisjuksköterskors upplevelser före, under och efter hjärtstoppslarm hos vuxna patienter på vårdavdelning. Metod: Kvalitativ ansats med deskriptiv design användes för att genomföra studien. Data samlades in via semistrukturerade intervjuer som transkriberades ordagrant. Sedan analyserades data med en kvalitativ innehållsanalys. Sju intensivvårdssjuksköterskor och fyra anestesisjuksköterskor som medverkat vid minst två hjärtstopp på vårdavdelning intervjuades. Huvudresultat: Resultatet sammanställdes i tre huvudkategorier: Känslomässiga upplevelser, Kommunikation och samarbetets betydelse i teamet samt Praktiska möjligheter och hinder. Huvudfynden var att specialistsjuksköterskorna upplevde olika typer av känslor före, under och efter ett hjärtstoppslarm på vårdavdelning. För mycket personal inne på salen försämrade upplevelsen av situationen. HLR-utbildning, en tydlig ledare i teamet samt tillgången till material var viktiga faktorer. Slutsats: Att arbeta som ett team vid ett hjärtstoppslarm på vårdavdelning var, enligt intensivvårds- och anestesisjuksköterskorna, ett meningsfullt och spännande uppdrag. Specialistsjuksköterskorna som ingick i hjärtstoppsteamet ställdes ofta inför nya utmaningar och påfrestande situationer där vikten av samarbete, kommunikation och utbildning var avgörande för de upplevelser som kunde uppstå. / Background: When a patient suffers a cardiac arrest at the general ward, the chance of survival increases with early initiation of cardiopulmonary resuscitation (CPR) and defibrillation. The intensive care nurse and nurse anesthetists, who is a part of the cardiac arrest team, has an important role when they leave their own ward to go and help and support other colleagues at the emergent situation at the general ward. A situation that can be perceived as both positive and negative. Aim: The purpose of this study was to describe the experiences of the intensive care nurses and nurse anesthetists before, during and after cardiac arrest alarms in adult patients at general wards. Method: A qualitative approach with a descriptive design was used to conduct the study. Data were collected via semi-structured interviews which were transcribed verbatim. Then the data were analyzed using a qualitative content analysis. Seven intensive care nurses and four nurse anesthetists who had participated in at least two cardiac arrests at the general ward were interviewed. Findings: Three significant main categories were identified: Emotional experiences, Communication and the importance of teamwork and Practical opportunities and obstacles. The main findings were that the nurse specialists experienced different kinds of emotions before, during and after a cardiac arrest alarm at the general ward. Too much staff in the room worsened the experience of the situation. CPR-training, a clear leader in the team and the availability of material were important factors. Conclusion: To work as a team on a cardiac arrest alarm at the general ward were, according to the intensive care nurse and nurse anesthetists, a meaningful and exciting assignment. The nurse specialists who were a part of the cardiac arrest team were often faced with new challenges and stressful situations where teamwork, communication and education were crucial for the experiences that could occur.

Introduction: Epidemiological studies have indicated that 5-38% of influenza like illnesses (ILI) develop into severe disease due to, among others, factors such as; underlying chronic diseases, age, pregnancy, and viral mutations. There are suggestions that dual or multiple virus infections may affect disease severity. This study investigated the association between co-infection between influenza A viruses and other respiratory viruses and disease severity. Methodology: Datum for samples from North West England tested between January 2007 and June 2012 was analysed for patterns of co-infection between influenza A viruses and ten respiratory viruses. Risk of hospitalization to a general ward ICU or death in single versus mixed infections was assessed using multiple logistic regression models. Results: One or more viruses were identified in 37.8% (11,715/30,975) of samples, of which 10.4% (1,214) were mixed infections and 89.6% (10,501) were single infections. Among patients with influenza A(H1N1)pdm09, co-infections occurred in 4.7% (137⁄2,879) vs. 6.5% (59⁄902) in those with seasonal influenza A virus infection. In general, patients with mixed respiratory virus infections had a higher risk of admission to a general ward (OR: 1.43, 95% CI: 1.2 – 1.7, p = <0.0001) than those with a single infection. Co-infection between seasonal influenza A viruses and influenza B virus was associated with a significant increase in the risk of admission to ICU/ death (OR: 22.0, 95% CI: 2.21 – 219.8 p = 0.008). RSV/seasonal influenza A viruses co-infection also associated with increased risk but this was not statistically significant. For the pandemic influenza A(H1N1)pdm09 virus, RSV and AdV co-infection increased risk of hospitalization to a general ward, whereas Flu B increased risk of admission to ICU/ death, but none of these were statistically significant. Considering only single infections, RSV and hPIV1-3 increased risk of admission to a general ward (OR: 1.49, 95% CI: 1.28 – 1.73, p = <0.0001 and OR: 1.34, 95% CI: 1.003 – 1.8, p = 0.05) and admission to ICU/ death (OR: 1.5, 95% CI: 1.20 – 2.0, p = <0.0001 and OR: 1.60, 95% CI: 1.02 – 2.40, p = 0.04). Conclusion: Co-infection is a significant predictor of disease outcome; there is insufficient public health data on this subject as not all samples sent for investigation of respiratory virus infection are tested for all respiratory viruses. Integration of testing for respiratory viruses’ co-infections into routine clinical practice and R&D on integrated drugs and vaccines for influenza A&B, RSV, and AdV, and development of multi-target diagnostic tests is encouraged.