Det övergripande syftet med avhandlingen var att beskriva och undersöka patienters - vårdade inom intensivvård - upplevelser och effekter av en cyklisk belysningsintervention utifrån hälsa, välbefinnande och återhämtning. Metod: En intervention bestående av ett automatiskt styrt belysningssystem var installerat på ett intensivvårdsrum. Belysningsinterventionens mål var att efterlikna dagsljuset i styrka, kvalitet, och lokalisation. Ett ordinarie intensivvårdsrum fungerade som kontrollmiljö. I studie I eftersöktes i en systematisk litteratursammanställning tidigare forskningsresultat rörande cykliska belysningsinterventioner inom intensivvård. Belysningsmiljöerna i intervention- och kontrollmiljön bedömdes i studie I av besökare och i studie II av patienter samt jämfördes och analyserades statistiskt. Ljus och belysningsmätningar utfördes i både forsknings- och kontrollmiljön. I studie II undersöktes patienters upplevelser av den cykliska belysningsmiljön genom kvalitativa intervjuer vilka analyserade med innehållsanalys. I studie II mättes och jämfördes patienters sömn, dygnsrytm samt fysiologiska parametrar och analyserades statistiskt. I studie IV undersöktes och jämfördes patienternas självskattade återhämtning efter sex och tolv månader. Resultat: Cykliska belysningsinterventioner exponerade för vuxna patienter var få. Resultatet visade dock att interventioner med cykliskt ljus inom neonatal intensivvård kunde inverka positivt på förtidigt födda barns hälsa. Den cykliska interventionsmiljön bedömdes som mer trivsam och mätningar av belysningen utförda i interventionsmiljön visade på samstämmighet med europeiska rekommendationer. Belysningsnivåerna i kontrolmiljön var manuellt styrda och mätningarna visade på antingen för låga eller för höga belysningsnivåer under dagtid jämfört med europeiska rekommendationer. Patienterna bedömde den cykliska belysningsmiljön som starkare dagtid och under nattetid bedömdes belysningen i kontrolmiljön som mer varierande. Patienters individuella upplevelser av den cykliska belysningsinterventionen presenterades i fyra kategorier: en dynamisk belysningsmiljö, belysningens påverkan på patientens sömn, ljus/belysnings påverkan på dygnsrytm samt en lugnande belysning. Patienternas dygnsrytm stärktes inte av den cykliska belysningsmiljön under deras sista 24-timmarsperiod. Patienternas självrapporterade återhämtning efter intensivvård var bättre efter 12-månader efter utskrivning hos de som vårdats i interventionsmiljön. Slutsatser: Genom att studera de båda forskningsområdena vårdvetenskap och ljus/belysning tillsammans skapades ny kunskap till vårdvetenskapen. Trots svår sjukdom eller skada kunde patienterna bedöma och reflektera kring belysningsmiljön. Ämnesområdet lämpar sig väl för att undersökas med både kvantitativa och kvalitativa metoder. / Aim: The overall aim of this thesis was to describe and evaluate patients’, who were cared for in the intensive care unit (ICU), experiences and effects concerning a cycled lighting intervention based on health, wellbeing and recovery. Methods: An automatically controlled cycled lighting intervention aimed to mimic natural light levels, quality and position throughout the day was evaluated. An ordinary lit room was used as a control. A multiple-method approach was used. In study I, there were three aspects: a systematic review of the previous research concerning cycled lighting interventions in the intensive care; visitor evaluations of the lighting environments in the intervention and ordinary room; and measurements of illuminance, luminance and irradiance in both conditions. In study II, the patients evaluated the lighting environment in the two rooms. Data were compared and analysed. Furthermore, patients’ experiences regarding the cycled lighting environment were investigated through qualitative interviews, which were subsequently analysed by content analysis. In study III, patients’ sleep, activity and physiological parameters were measured and compared. Study IV consisted of statistical analysis of a questionnaire concerning patients’ self-reported recovery six and 12 months after their ICU treatments. Results: The literature review on cycled lighting interventions in adult ICUs was rare but more common in the neonatal ICU (NICU). Findings showed that cycled lighting interventions improved health in preterm infants, but there were also non-significant results reported. The visitors reported the cycled lighting environment as more pleasant, and based on measurements, the lighting levels were at equivalent levels with European recommendations for hospitals. The lighting levels in the ordinary room were manually controlled and were reported as being either too low or too bright during the daytime. Patients evaluated the cycled lighting environment as brighter in daytime, and this was in coherence with the results from the measurements of illumination. Patients’ individual experiences concerning the cycled lighting environment were reported in four categories: a dynamic lighting environment, the impact of lighting on patients’ sleep, the impact of light/lighting on the circadian rhythm and the degree to which the lighting calmed them. Patients’ circadian rhythms were not further strengthened by the cycled lighting intervention during their final 24-period in the ICU. Twelve months after their ICU treatments, patients cared for in the intervention environment self-reported their recovery as significantly better than those who received treatment in the ordinary room. Conclusions: A multiple methodology was used to explore theresearch field from a wider perspective. Combining knowledge from both the lighting research field and caring science has brought new knowledge to both and especially to the practice of nursing. Despite their severe illnesses or injuries, patients were able to assess their experiences with the lighting environment and reflect on how the lighting was able to support their health. This thesis reports findings that indicate that environmental/lighting interventions may improvepatients’ health. Lighting interventions are harmless, safe, sustainable and, in comparison to technical and medical interventions, considerably cheaper. With this knowledge, we believe all vulnerable patients in the ICU should be surrounded by a lighting environment around the clock to support their health, wellbeing and recovery.
| Identifer | oai:union.ndltd.org:UPSALLA1/oai:DiVA.org:hb-11911 |
| Date | January 2017 |
| Creators | Engwall, Marie |
| Publisher | Högskolan i Borås, Akademin för vård, arbetsliv och välfärd, Göteborg |
| Source Sets | DiVA Archive at Upsalla University |
| Language | Swedish |
| Detected Language | English |
| Type | Doctoral thesis, comprehensive summary, info:eu-repo/semantics/doctoralThesis, text |
| Format | application/pdf |
| Rights | info:eu-repo/semantics/openAccess |
Page generated in 0.0031 seconds