Att smärtlindra sederade intensivvårdspatienter vid procedurer är något som intensivvårdssjuksköterskor utför dagligen på sina arbetsplatser. Att behandla smärta är viktigt för patientens välmående samtidigt som att bedöma smärta hos en sederad patient upplevs svårare än att bedöma smärta hos en vaken patient. Syfte: Studiens syfte är att beskriva intensivvårdssjuksköterskors erfarenheter av att smärtlindra sederade intensivvårdspatienter vid procedurrelaterad smärta. Metod: En kvalitativ intervjustudie med ett induktivt förhållningssätt. Nio legitimerade sjuksköterskor med specialistutbildning inom intenssivsjukvård intervjuades till studien. Intervjuerna analyserades med kvalitativ innehållsanalys. Urval: Inklusionskriterierna var legitimerad sjuksköterska med specialistutbildning inom intensivsjukvård och en arbetslivserfarenhet av minst tre år vid en intensivvårdsavdelning samt en vilja att berätta sina erfarenheter. Resultat: Analysprocessen gav fyra kategorier: Utmaningen att bedöma smärta, Att förebygga smärta inför procedurer,  Att smärtlindra den sederade patienten vid procedurer, Samarbete och kommunikation. Slutsats: Intensivvårdssjuksköterskor använder sig av observation av patienten och sina tidigare erfarenheter för att tolka och bedöma smärta hos patienten. Studien betonar även vikten av att samarbeta i teamet runt patienten för att förebygga smärta vid olika procedurer. / <p>Presentation skett via Zoom 9/6</p>

Introduktion: I dagens intensivvård hålls patienter som vårdas i respirator mer ytligt sederade. Patienterna blir berövade sitt verbala tal och behandlas i en miljö som kan upplevas som skrämmande. Detta ställer högre krav på sjuksköterskan, att bemöta patientens psykosociala behov på ett bra sätt och etablera en vårdande relation. Syfte: Att belysa sjuksköterskors erfarenheter av att skapa en vårdande relation med en vaken eller lätt sederad patient som vårdas i respirator på en intensivvårdsavdelning. Metod: En kvalitativ induktiv design användes och data insamlades med hjälp av fyra fokusgruppsintervjuer, med totalt 14 kvinnliga sjuksköterskor med minst två års yrkeserfarenhet av intensivvård. Studien utgick från tre intensivvårdsenheter i västra Sverige. Den insamlade datan analyserades med hjälp av kvalitativ innehållsanalys. Resultat: Sjuksköterskors erfarenheter av att skapa en vårdande relation med en vaken eller lätt sederad patient som vårdas i respirator, tolkades utifrån följande teman för att belysa olika faktorer som är av vikt: kommunikation i mötet, att lyfta fram personen bakom patienten, det vårdande rummet och när relationen försvåras. Slutsats: Att med hjälp av kommunikation skapa en gemensam förståelse, att lära känna patienten och orientera patienten i nuet, att vårda med respekt och trygghet och slutligen att sträva efter att lösa eventuella hinder som uppstår på vägen, var alla centrala faktorer i skapandet av en vårdande relation. Som blivande intensivvårdssjuksköterskor anser författarna att studien ger viktiga infallsvinklar i problemområdet som kan vara användbara i deras kommande yrkesroll. / Introduction: In today's intensive care, patients who are mechanically ventilated are more often lightly sedated. Patients are deprived of their verbal communication and treated in an environment that they can find frightening. This puts greater demands on the nurse, in order to respond to the patient's psychosocial needs in a positive way and establish a caring relationship. Aim: To illuminate nurses’ experience of creating a caring relationship with an awake or lightly sedated patient undergoing mechanical ventilation in an intensive care unit. Method: A qualitative inductive design was used and data was collected with four focus groups, with a total of 14 female registered nurses with at least two years professional experience of intensive care. The study was conducted at three intensive care units in western Sweden. Data was analysed with a qualitative content analysis.   Result: Nurses' experience of creating a caring relationship with an awake or lightly sedated patient undergoing mechanical ventilation, was interpreted on the basis of the following themes to highlight the various factors that are of importance; communication in the meeting, to highlight the person behind the patient, the room of caring and when the relationship is complicated. Conclusion: Using communication to create a common understanding, to get to know the patient and orient the patient in the present, to provide care with respect and impart a sense of comfort, and finally strive to resolve any challenges that may arise along the way, were all key factors in creating a caring relationship. As future intensive care nurses, the authors consider that the study provides important insights into the problem area that may be useful in their future profession.

The use of wraps in the care of newborns and infants. The thesis deals with the use of wraps suitable for newborns and infants. Wraps are used particulary to calm down children. Because swaddling of a child imitates the strength and tightness of their mother's womb, children are mostly feeling calmly and safely. There are many wraps on the market, like blankets, classic lace-wraps, cocoons and wraps specially developed for restless and teary children. The goal of the thesis was to find out what knowledge have parents of children about swaddling, which wraps do they use and effect of swaddling on children. We have tried to verify the effects of swaddling in practice. In this thesis, we used a combination of qualitative and quantitative methods, interview techniques, and action research. The qualitative part of the research took the form of an unstructured interview. The sample for this interview was 33 mothers who had to answer open questions. The results of the interview were manually written to the printed record sheets. The interviewed responders were individually asked in their homes, in cafes and children's clubs. At first was completed the basic respondents information like their age, education level, place of residence and number of children and their age during their first pregnancy. Then we proceeded to talk about swaddling children to varienty types of wraps. We asked questions related to the type used wraps, swaddling style, usage time of wraps. We also asked about what for effect had swaddling on a child, whether the child calmed down, slept or remained teary. The collected personal information we processed statistically to help us to determine the answer to our hypothesis. Action research was applied on 4 children and one pair of twins in their home environment. Prior to that, their parents agreed with the research. We agreed that during the research will be present at least one parent. Parents received a record sheet on which they could write down when the child had trouble sleeping, or falling asleep and how much did the child cry. Based on their statements and notes we have devised a way to help the child to fall asleep or calm down. Parents got recommended specialized literature on swaddling, which they could later study. For swaddling we had the opportunity to use more types of wraps, according to the wish of parents, especially with best regards for the child, because each individual requires a specific type of swaddling and different wraps. Together with parents, we chose a wrap for the day or night and we wrapped the baby up and observed how it goes. Parents then following days wrapped up the children themselves and told us about how the child behaves during swaddling and whether was there a desired effect. After a month, we met parents again and personally summarized the effects of wraps on their baby and the changes that occurred after swaddling. Results: In the qualitative survey, we found out that most parents use wraps to calm down and soothe the child. Most mothers reported using quick wraps, classic lace wraps or a combination of both. Half of the surveyed mothers said that after using wraps were their children calmer. The remaining third of the mothers said that swaddling helped to let their children to sleep better. Children of the remaining respondents did not feel well during swaddling and they were more teary and restless. Questions regarding age, education and place of residence showed that more than half of respondents have completed education with graduation, a third of mothers have an university degree. The youngest mother was at the time of our research 21 years old, the oldest was aged 38 years, the average age of mothers was 28.2 years. In the question regarding the residence, we found out that 19 of the interviewed mothers were living in a town and the remaining number, 14, were living in the smaller village.

Bakgrund: Tidigare forskning visar att invasiv ventilation varit obehagligt för patienterna, därav har de varit djupt sederade. Rutinerna har ändrats och numera är patienterna ofta lätt sederade under invasiv ventilation på IVA. Lätt sedering har visats ge positiva fysiologiska effekter. Därför är det av stor vikt att belysa patienternas upplevelser av att vara lätt sederade under invasiv ventilation. Syfte: Syftet var att beskriva lätt sederade patienters upplevelser under invasiv ventilation på IVA. Metod: En strukturerad litteraturstudie med systematisk datainsamling har genomförts. 13 resultatartiklar inkluderades efter kvalitetsgranskning. Det kvalitativa innehållet analyserades med hjälp av dataextraktion. Resultat: Följande tre huvudkategorier, med subkategorier, utgjorde resultatet: Upplevelser av sitt tillstånd, Upplevelser av att bli sedd och hörd och Upplevelser av längtan. Patienterna hade både positiva och negativa upplevelser av att vara lätt sederade. Upplevelser av maktlöshet och förlorad värdighet var centralt i resultatet. Majoriteten av patienterna ville trots allt vara lätt sederade. Flera förbättringsområden framkom ur resultatet baserat på patienternas upplevelser. Slutsats: Resultatet kan ge ökad kunskap hos IVA-sjuksköterskan för att förbättra patienternas vårdupplevelse genom förbättringsarbeten inom verksamheten. Patienternas vårdvistelse kan underlättas med hjälp av hälsofrämjande åtgärder med minskad risk för vårdlidande. Sjuksköterske-patient ratio 1:1 tror författarna kan ge ökad patientfokuserad vård. Litteraturstudien har kartlagt befintlig forskning och även förslag på vidare forskning inom ämnet. / Background: Earlier research show that invasive ventilation has been uncomfortable for the patients. Therefore the patients have been deeply sedated. Routines have changed and the patients are nowadays often lightly sedated during invasive ventilation in the ICU. Light sedation results in positive physical effects. It's important to illuminate the patients'  experiences by light sedation during invasive ventilation. Aim: The aim of the study was to describe lightly sedated patients experiences during invasive ventilation in the ICU.  Method: A structured literature study with systematic data collection was implemented. 13 articles was included after quality control. The qualitative content were analyzed with data extraction.  Result: The result were constituted by the following three main categories with subcategories: Experiences of the condition, Experiences of being seen and heard, and Experiences by yearning. The patients expressed both positive and negative experiences associated with light sedation. Experiences of powerlessness and lost dignity were central parts of the result. Nevertheless, the majority of patients wanted to be lightly sedated. Several areas of improvement emerged from the result based on the patients' experiences. Conclusion: The result can provide the ICU-nurse with increased knowledge about the patients experiences of care during improvement within the intensive care. Patients hospital stay could be facilitated by health-promoted actions and reduced risk of suffering in care. The authors believe that nurse-patient ratio 1:1 can provide increased patient-focused care. The literature study has also illustrated the existing research and ideas for further research.