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  • 1.
    Carnesten, Hillewi
    et al.
    Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare.
    von Heideken Wågert, Petra
    Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare.
    Wiklund Gustin, Lena
    Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare. The Arctic University of Norway Narvik Norway.
    Toivanen, Susanna
    Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare.
    Skoglund, Karin
    Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare.
    Jaarsma, Tiny
    Department of Health, Medicine and Caring Sciences Linköping University Linköping Sweden;Julius Center University Medical Center Utrecht Utrecht Netherlands.
    Andreae, Christina
    Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare. Centre for Clinical Research Sörmland Uppsala University Eskilstuna Sweden.
    Struggling in the dehumanized world of COVID—An exploratory mixed‐methods study of frontline healthcare workers' experiences2024In: Journal of Advanced Nursing, ISSN 0309-2402, E-ISSN 1365-2648, p. 1-15Article in journal (Refereed)
    Abstract [en]

    Aim

    To explore healthcare workers' experiences of the changed caring reality during the COVID-19 pandemic in Sweden.DesignAn online fully mixed-methods design.MethodsA web-based self-reported questionnaire with fixed and open-ended answers collected data from March to April 2021, analysed in three steps. First, free-text questions were analysed by qualitative content analysis. Then quantitative linear regression analyses using models covering stress and coping mechanisms were conducted. Finally, a meta-inference of qualitative and quantitative data emerged a new comprehensive understanding. The COREQ guidelines were used for reporting.

    Results

    Meta-inferenced results of quantitative and qualitative findings show the pandemic was a traumatic experience for healthcare workers. Main theme; When work became a frightening experience in a dehumanized reality, comprised four themes: Entering unprepared into a frightful, incomprehensible world; Sacrificing moral values and harbouring dilemmas in isolation; Lack of clear management; and Reorient in togetherness and find meaning in a changed reality. Qualitative results comprised four categories; Working in a dehumanized world; Living in betrayal of ones' own conscience; Lack of structure in a chaotic time and Regaining vitality together. Subdimensions comprehensibility and meaningfulness were associated significantly with post-traumatic stress disorder in multiple regression analysis. In multiple regression analysis, sense of coherence was the most prominent coping strategy.

    Conclusions

    Forcing oneself to perform beyond one's limit, sacrificing moral values and lacking management was a traumatic experience to healthcare workers during the pandemic. Reorienting as a way of coping was possible in togetherness with colleagues. There is an urgency of interventions to meet the needs among healthcare workers who took on a frontline role during the COVID-19 pandemic and to prevent mental health illness in future crisis.

  • 2.
    Carnesten, Hillewi
    et al.
    Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare.
    von Heideken Wågert, Petra
    Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare.
    Wiklund, Lena
    Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare.
    Toivanen, Susanna
    Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare.
    Skoglund, Karin
    Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare.
    Andreae, Christina
    Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare.
    Jaarsma, Tiny
    Struggling with frightening experiences in a transformed reality: A mixed methods study of healthcare workers’ experiences during the pandemic.2023Conference paper (Other academic)
    Abstract [en]

    Background: The COVID-19 pandemic continues to impact health care workers’ (HCWs’) mental health. Research show that psychological distress and hard challenges abide with strong commitment to contribute. Yet, in-depth understanding of HCWs’ experiences of the changed caring reality during the pandemic is missing. Mixed methods research (MMR) accommodates several features apart from employing either quantitative or qualitative methods. This presentation focuses on examples from the 13-step mixed method by Leech and Onwuegbuzie.

    Methods: 97 HCWs in one hard-hit region in Sweden answered a web-based questionnaire measuring symptoms of stress (using DSM-5 criteria for post-traumatic stress syndrome, PTSD) in relation to perceived sense of coherence (SOC-scale) and self-compassion (SCS) as well as HCWs’ experiences. First, qualitative data (experiences of the pandemic) was analyzed by qualitative content analysis, then quantitative data (associations between PTSD and SOC/SCS) were analyzed with linear regression adjusted for covariates. Thirdly, a synthesis, the meta-inference of qualitative and quantitative data, explained a new comprehensive understanding. 

    Results: By analyzing the categories and subcategories from the qualitative analysis in relation to symtoms of stress and SOC/SCS, a synthesis emerged. This was undertaken by merging and comparing the findings and discussing the new comprehensive understanding. Finally, to fully outline the mixed methods approach, qualitative and quantitative data were synthesized into a new comprehensive whole, a meta inference. 

    Conclusion: This study moves away from dichotomic traditions between qualitative or quantitative approaches. By broadening the methodological departure this study may provide a new comprehensive understanding and contribute to enhance quality in MMR. 

  • 3.
    Carnesten, Hillewi
    et al.
    Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare.
    Wiklund Gustin, Lena
    Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare. Department of Health and Care Sciences, UiT/The Arctic University of Norway, Narvik, Norway.
    Skoglund, Karin
    Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare.
    von Heideken Wågert, Petra
    Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare.
    Caring through barriers—Newly graduated registered nurses' lived experiences in emergency departments during the COVID-19 pandemic2023In: Journal of Advanced Nursing, ISSN 0309-2402, E-ISSN 1365-2648, Vol. 79, no 6, p. 2269-2279Article in journal (Refereed)
    Abstract [en]

    Aim: To illuminate the meaning of newly graduated registered nurses' experiences of caring for patients in emergency departments during the COVID-19 pandemic. Design: A phenomenological hermeneutical study guided by Lindseth and Norberg. Methods: In-depth one-on-one interviews with 14 nurses from five hospitals were conducted from March to November 2020 and analysed using thematic analysis. The consolidated criteria for reporting qualitative research (COREQ) were used as the reporting guideline. Results: The findings comprise one main theme Caring through barriers and three themes with sub-themes. In the first theme, having intention to care, participants revealed their dedication to care for patients during the pandemic despite extensive stress, little experience and skills. The second theme, with tied hands in human suffering, illuminates experiences of being disconnected from the patient, overwhelmed by responsibility and unable to relieve suffering. The third theme, feeling inadequate, reveals experiences of lack of support and doubts meaning less space to develop into the nurse one wants to be. Conclusion: Findings reveal a new understanding of new nurses' experiences during times of crisis. The essence of caring in the emergency department during the pandemic can be explained as mediated through spatial, temporal and emotional barriers preventing new nurses from providing holistic care. Impact: The results may be used as anticipatory guidance for new nurses and inform targeted support interventions to support new nurses entering the profession in crisis conditions. Public Contribution: This study involved new nurses in semi-structured interviews. 

  • 4.
    Carnesten, Hillewi
    et al.
    Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare.
    Wiklund, Lena
    Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare. UiT Arctic Univ Norway, Dept Hlth & Care Sci, Narvik, Norway.
    Skoglund, Karin
    Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare.
    von Heideken Wågert, Petra
    Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare.
    Battling extraordinary situations and conflicting emotions: A qualitative study of being a newly graduated Registered Nurse in the emergency department during the COVID-19 pandemic2022In: Nursing Open, E-ISSN 2054-1058, Vol. 9, no 5, p. 2370-2380Article in journal (Refereed)
    Abstract [en]

    Aim: To describe newly graduated registered nurses' (NGRNs') experiences of encountering stress in emergency departments (EDs) during the COVID-19 pandemic. Design: A qualitative descriptive study. Methods: Data from 14 in-depth interviews with NGRNs working in an ED for 3-36 months after graduation was analysed by the means of qualitative content analysis as described by Graneheim and Lundman. Interviews were conducted from March to November 2020 covering the first two waves of the pandemic. Results: Data revealed three categories and nine subcategories comprised in the theme Battling extraordinary situations and conflicting emotions. Empowered by acknowledging themselves as important caregivers during the pandemic NGRNs struggle against limitations and exert themselves beyond their known limit. External stressors due to work overload in combination with understaffing force NGRNs into the role of the experienced nurse prematurely and internal stressors derives from part taking in less qualitative care.

  • 5.
    Enblad, Per
    et al.
    Uppsala universitet, Neurokirurgi.
    Skoglund, Karin
    Mälardalen University, School of Health, Care and Social Welfare. Uppsala universitet, Neurokirurgi.
    Hillered, Lars
    Uppsala universitet, Neurokirurgi.
    Marklund, Niklas
    Uppsala universitet, Neurokirurgi.
    Wake-up test and stress hormone levels in patients with brain injury: A focus on mechanisms involved: Reply2012In: Critical Care Medicine, ISSN 0090-3493, E-ISSN 1530-0293, Vol. 40, no 6, p. 2002-2003Article in journal (Refereed)
  • 6.
    Flygt, Johanna
    et al.
    Uppsala University, Sweden.
    Gumucio, Astrid
    Uppsala University, Sweden.
    Ingelsson, Martin
    Uppsala University, Sweden.
    Skoglund, Karin
    Uppsala University, Sweden.
    Holm, Jonatan
    Uppsala University, Sweden.
    Alafuzoff, Irina
    Uppsala University, Sweden.
    Marklund, Niklas
    Uppsala University, Sweden.
    Human Traumatic Brain Injury Results in Oligodendrocyte Death and Increases the Number of Oligodendrocyte Progenitor Cells2016In: Journal of Neuropathology and Experimental Neurology, ISSN 0022-3069, E-ISSN 1554-6578, Vol. 75, no 6, p. 503-515Article in journal (Refereed)
    Abstract [en]

    Oligodendrocyte (OL) death may contribute to white matter pathology, a common cause of network dysfunction and persistent cognitive problems in patients with traumatic brain injury (TBI). Oligodendrocyte progenitor cells (OPCs) persist throughout the adult CNS and may replace dead OLs. OL death and OPCs were analyzed by immunohistochemistry of human brain tissue samples, surgically removed due to life-threatening contusions and/or focal brain swelling at 60.6 ± 75 hours (range 4–192 hours) postinjury in 10 severe TBI patients (age 51.7 ± 18.5 years). Control brain tissue was obtained postmortem from 5 age-matched patients without CNS disorders. TUNEL and CC1 co-labeling was used to analyze apoptotic OLs, which were increased in injured brain tissue (p < 0.05), without correlation with time from injury until surgery. The OPC markers Olig2, A2B5, NG2, and PDGFR-α were used. In contrast to the number of single-labeled Olig2, A2B5, NG2, and PDGFR-α-positive cells, numbers of Olig2 and A2B5 co-labeled cells were increased in TBI samples (p < 0.05); this was inversely correlated with time from injury to surgery (r = -0.8, p < 0.05). These results indicate that severe focal human TBI results in OL death and increases in OPCs postinjury, which may influence white matter function following TBI.

  • 7.
    Holmström, Inger
    et al.
    Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare. Uppsala University, Uppsala, Sweden.
    Gustafsson, S.
    Heby Primary Health Care Center, Heby, Sweden.
    Wesström, J.
    Örsundsbro Primary Health Care Center, Örsundsbro, Sweden.
    Skoglund, Karin
    Mälardalen University, School of Health, Care and Social Welfare.
    Telephone nurses’ use of a decision support system: An observational study2019In: Nursing and Health Sciences, ISSN 1441-0745, E-ISSN 1442-2018, Vol. 21, no 4, p. 501-507Article in journal (Refereed)
    Abstract [en]

    Telephone nurses give advice and support and make assessments based on verbal communication only. Web-based decision support systems are often used to increase patient safety and make medically correct assessments. The aim of the present this study was to describe factors affecting the use of a decision support system and experiences with this system among telephone nurses in Swedish primary health care. Observations and semistructured interviews were conducted. Six registered nurses with at least 1 year of experience of telephone nursing participated. Field notes and interviews were analyzed by qualitative content analysis. The main findings of the present this study were factors that decrease the decision support system use or promote deviation from decision support system use, factors that are positive for decision support system use and the decision support system complicates the work. Underuse and deviations from decision support systems can be a safety risk, because decisions are based on too little information. Further research with observations of telephone nurses’ use of decision support systems is needed to develop both telephone nursing and decision support systems.

  • 8.
    Håkansson Eklund, Jakob
    et al.
    Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare.
    Holmström, Inger K.
    Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare. Uppsala universitet.
    Kumlin, Tomas
    Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare.
    Kaminsky, Elenor
    Uppsala universitet, Sweden.
    Skoglund, Karin
    Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare.
    Höglander, Jessica
    Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare.
    Sundler, Annelie J
    Högskolan Borås, Sweden.
    Condén, Emelie
    Region Västmanland, Sweden.
    Summer Meranius, Martina
    Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare.
    "Same same or different?" A review of reviews of person-centered and patient-centred care2019In: Royal college of Nursing, Sheffield, UK, 2019Conference paper (Refereed)
  • 9.
    Håkansson Eklund, Jakob
    et al.
    Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare.
    Holmström, Inger K.
    Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare. Uppsala universitet.
    Kumlin, Tomas
    Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare.
    Kaminsky, Elenor
    Uppsala universitet.
    Skoglund, Karin
    Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare.
    Höglander, Jessica
    Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare.
    Sundler, Annelie J
    Condén, Emelie
    Region Västmanland, Sweden.
    Summer Meranius, Martina
    Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare.
    "Same same or different?" A review of reviews of person-centred and patinet-centred care2018In: International Conference on Communication in Healthcare, Porto, Portugal, 2018Conference paper (Refereed)
  • 10.
    Håkansson Eklund, Jakob
    et al.
    Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare.
    Holmström, Inger K.
    Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare.
    Kumlin, Tomas
    Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare.
    Kaminsky, Elenor
    Uppsala Univ, Dept Publ Hlth & Caring Sci, Uppsala, Sweden..
    Skoglund, Karin
    Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare.
    Höglander, Jessica
    Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare.
    Sundler, Annelie Johansson
    Univ Boras, Fac Caring Sci Work Life & Social Welf, SE-50190 Boras, Sweden..
    Conden, Emelie
    Uppsala Univ, Vastmanland Hosp, Clin Res Ctr, Uppsala, Sweden..
    Summer Meranius, Martina
    Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare.
    "Same same or different?" A review of reviews of person-centered and patient-centered care2019In: Patient Education and Counseling, ISSN 0738-3991, E-ISSN 1873-5134, Vol. 102, no 1, p. 3-11Article, review/survey (Refereed)
    Abstract [en]

    Objective: To provide a synthesis of already synthesized literature on person-centered care and patient-centered care in order to identify similarities and differences between the two concepts. Methods: A synthesis of reviews was conducted to locate synthesized literature published between January 2000 and March 2017. A total of 21 articles deemed relevant to this overview were synthesized using a thematic analysis. Results: The analysis resulted in nine themes present in person-centered as well as in patient-centered care: (1) empathy, (2), respect (3), engagement, (4), relationship, (5) communication, (6) shared decision-making, (7) holistic focus, (8), individualized focus, and (9) coordinated care. The analysis also revealed that the goal of person-centered care is a meaningful life while the goal of patient-centered care is a functional life. Conclusions: While there are a number of similarities between the two concepts, the goals for person-centered and patient-centered care differ. The similarities are at the surface and there are important differences when the concepts are regarded in light of their different goals. Practice implications: Clarification of the concepts may assist practitioners to develop the relevant aspects of care. Person-centered care broadens and extends the perspective of patient-centered care by considering the whole life of the patient.

  • 11.
    Marmstål Hammar, Lena
    et al.
    Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare. School of Education, Health, and Society, Dalarna University, Sweden.
    Holmström, Inger K.
    Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare. Department of Public Health and Caring Sciences, Uppsala University, Sweden.
    Skoglund, Karin
    Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare.
    Summer Meranius, Martina
    Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare.
    Sundler, Annelie Johansson
    Faculty of Caring Science, Work Life and Social Welfare, University of Borås, Sweden.
    The care of and communication with older people from the perspective of student nurses. A mixed method study2017In: Nurse Education Today, ISSN 0260-6917, E-ISSN 1532-2793, Vol. 52, p. 1-6Article in journal (Refereed)
    Abstract [en]

    Background Undergraduate nurse education needs to prepare student nurses to meet the demands and to have the necessary communication skills for caring for an increasing older population. The challenges involve how best to support and empower student nurses to learn the communication skills needed to care for older people. Objective The aim of this study was to investigate student nurses' views on the care of and communication with older people. Design A descriptive study with a mixed-method approach was conducted. Methods Quantitative and qualitative data were collected from a questionnaire completed by third-year Swedish student nurses in 2015. Results The student nurses reported positive attitudes to the care of and communication with older people. The findings focus on the central aspects related to relationship building, techniques for communication and external prerequisites. Conclusions Despite positive attitudes, student nurses had a limited view of communication with older people. Educators need to increase student nurses' capacity to communicate effectively with older people. Educational interventions to improve and evaluate the communication competency of nurses and student nurses are needed.

  • 12.
    Olsson Duse, Beatrice
    et al.
    Children and the Youth Clinic, Eskilstuna, Sweden.
    Sporrong, Ylva
    Department of Emergency Saschsska Children and Youth Hospital, Stockholm, Sweden.
    Bartocci, Marcco
    Department of Woman and Child Health, Karolinska Institute and Karolinska University Hospital, Neonatal Intensive Care Unit, Stockholm, Sweden.
    Skoglund, Karin
    Mälardalen University, School of Health, Care and Social Welfare.
    Efficacy of topical lidocaine‐prilocaine (EMLA ® ) for management of infant pain during pneumococcal vaccination: A randomized controlled trialIn: Paediatric and Neonatal Pain, ISSN 2637-3807Article in journal (Refereed)
    Abstract [en]

    Few studies have evaluated whether topical anesthetic cream reduces pain during pneumococcal vaccination. This is crucial, since effective pain management should be evidence-based. Previous studies have shown that topical lidocaine-prilocaine (EMLA®) reduces vaccination-related pain, measured using pain-rating instruments and observation of crying time. This intervention study aimed to compare the efficacy of topical lidocaine-prilocaine cream with that of the standard of care on the expression of pain during the first pneumococcal vaccination administered at age 3 months under the Swedish national vaccination program. A randomized controlled trial included 72 infants receiving their first pneumococcal vaccination (Prevenar 13®). The study showed that topical lidocaine-prilocaine before pneumococcal vaccination significantly reduced infants’ expression of pain according to the Face, Legs, Activity, Cry, Consolability (FLACC) score (P = .006) and increased latency to cry (P = .001). There were no statistically significant differences in the total crying time (P = .146) between the groups. Topical lidocaine-prilocaine cream reduced pain expression and increased latency to cry in infants receiving their first pneumococcal vaccine. Systematic efforts are needed to successfully implement the use of topical anesthetic cream and other effective non-pharmacological pain-relieving strategies during infant vaccination procedures.

  • 13.
    Skoglund, Karin
    Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare.
    Omvårdnad av personer med andningsstöd2022In: Omvårdnad i hemmet vid komplexa vårdbehov / [ed] Lena-Karin Gustafsson; Mirkka Söderman, Studentlitteratur AB, 2022, 1, p. 143-160Chapter in book (Other academic)
  • 14.
    Skoglund, Karin
    et al.
    Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare.
    Bescher, Milo
    Cardiothorac Surg Intens Care Unit CTSICU, New York, NY USA..
    Ekwall, Savannah
    Nord Clin, Postoperat Care Plast Surg, Stockholm, Sweden..
    Marmstål Hammar, Lena
    Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare. Dalarna Univ, Sch Hlth & Welf, Falun, Sweden.;Karolinska Inst, Dept Neurobiol Care Sci & Soc, Div Nursing, Stockholm, Sweden..
    Intrahospital transport of critically ill patients: Nurse anaesthetists' and specialist ICU nurses' experiences2024In: Nursing in Critical Care, ISSN 1362-1017, E-ISSN 1478-5153Article in journal (Refereed)
    Abstract [en]

    BackgroundIntrahospital transport (IHT) is often performed by nurse anaesthetists and specialist intensive care nurses. Studies have shown that IHT increases the risk of mortality and morbidity, with up to 71% negative incidents. Using checklists when preparing for an IHT is important. Several international guidelines exist to ensure IHT safety and reduce the risk of complications. However, existing guidelines are often problematic in clinical practice. AimThis study aimed to describe the experiences of nurse anaesthetists and specialized intensive care nurses during the IHT of adult patients with critical illnesses. Study DesignThis study adopted a mixed-methods approach. MethodsData were collected through a questionnaire completed by 66 nurses with specialist education in anaesthesia or intensive care. The data were analysed with qualitative content analysis, and the quantitative data were analysed with descriptive statistics. ResultsTwo categories with two subcategories each emerged from the analysis of the responses of nurse anaesthetists and specialist intensive care nurses regarding their IHT experiences: creating good circumstances (subcategories: being risk-conscious and the importance of meticulous preparations) and the importance of routines and education (subcategories: following guidelines and having adequate training). ConclusionIHT was described as a high risk for patient safety and complications. Routines with good compliance and education can positively impact patient safety during IHT. Checklists and scenario training can better prepare nurse anaesthetists and specialist intensive care nurses to manage complications that may arise during IHT, resulting in safer patient care. Relevance for Clinical PracticeThe findings underscore the importance of written guidelines for IHT, emphasizing awareness and adherence by the entire team. Careful pre-IHT preparations, coupled with an understanding of potential risks, are vital for ensuring patient safety. Clinical training and discussions following incidents during IHT play a crucial role in raising the collective awareness of patient safety within the entire team.

  • 15.
    Skoglund, Karin
    et al.
    Mälardalen University, School of Health, Care and Social Welfare. Uppsala universitet, Neurokirurgi.
    Enblad, Per
    Uppsala universitet, Neurokirurgi.
    Hillered, Lars
    Uppsala universitet, Neurokirurgi.
    Marklund, Niklas
    Uppsala universitet, Neurokirurgi.
    The neurological wake-up test increases stress hormone levels in patients with severe traumatic brain injury2012In: Critical Care Medicine, ISSN 0090-3493, E-ISSN 1530-0293, Vol. 40, no 1, p. 216-222Article in journal (Refereed)
    Abstract [en]

    Objectives: The "neurological wake-up test" is needed to evaluate the level of consciousness in patients with severe traumatic brain injury. However, the neurological wake-up test requires interruption of continuous sedation and may induce a stress response and its use in neurocritical care is controversial. We hypothesized that the neurological wake-up test induces an additional biochemical stress response in patients with severe traumatic brain injury.

    Patients: Twenty-four patients who received continuous propofol sedation and mechanical ventilation after moderate to severe traumatic brain injury (Glasgow Coma Scale score <= 8; patient age 18-71 yrs old) were analyzed. Exclusion criteria were age <18 yrs old, ongoing pentobarbital infusion, or markedly increased intracranial pressure on interruption of continuous sedation.

    Design: Single-center prospective study. During postinjury days 1-8, 65 neurological wake-up tests were evaluated. Adrenocorticotrophic hormone, epinephrine, and norepinephrine levels in plasma and cortisol levels in saliva were analyzed at baseline (during continuous intravenous propofol sedation) and during neurological wake-up test. Data are presented using medians and 25th and 75th percentiles.

    Setting: The study was performed in a university hospital neurocritical care unit.

    Interventions: None.

    Measurements and Main Results: At baseline, adrenocorticotrophic hormone and cortisol levels were 10.6 (6.0-19.4) ng/L and 16.0 (10.7-31.8) nmol/L, respectively. Immediately after the neurological wake-up test, adrenocorticotrophic hormone levels increased to 20.5 (11.1-48.4) ng/L (p < .05) and cortisol levels in saliva increased to 24.0 (12.3-42.5) nmol/L (p < .05). The plasma epinephrine and norepinephrine levels increased from a baseline of 0.3 (0.3-0.6) and 1.6 (0.9-2.3) nmol/L, respectively, to 0.75 (0.3-1.4) and 2.8 (1.28-3.58) nmol/L, respectively (both p < .05).

    Conclusions: The neurological wake-up test induces a biochemical stress response in patients with severe traumatic brain injury. The clinical importance of this stress response remains to be established but should be considered when deciding the frequency and use of the neurological wake-up test during neurocritical care.

  • 16.
    Skoglund, Karin
    et al.
    Uppsala universitet, Neurokirurgi.
    Enblad, Per
    Uppsala universitet, Neurokirurgi.
    Marklund, Niklas
    Uppsala universitet, Neurokirurgi.
    Effects of the neurological wake-up test on intracranial pressure and cerebral perfusion pressure in brain-injured patients2009In: Neurocritical Care, ISSN 1541-6933, E-ISSN 1556-0961, Vol. 11, no 2, p. 135-142Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: To evaluate the effects of the neurological "wake-up test" (NWT), defined as interruption of continuous propofol sedation and evaluation of the patient's level of consciousness, on intracranial pressure (ICP) and cerebral perfusion pressure (CPP) in patients with severe subarachnoid hemorrhage (SAH) or traumatic brain injury (TBI). METHODS: A total of 127 NWT procedures in 21 severely brain-injured adult patients with either TBI (n = 12) or SAH (n = 9) were evaluated. ICP and CPP levels prior to, during and after the NWT procedure were recorded. RESULTS: During the NWT, ICP increased from 13.4 +/- 6 mmHg at baseline to 22.7 +/- 12 (P < 0.05) and the CPP increased from 75.6 +/- 11 to 79.1 +/- 21 mmHg (P < 0.05) in TBI patients. Eight patients showed a reduced CPP during the NWT due to increased ICP. In SAH patients, ICP increased from 10.6 +/- 5 to 16.8 +/- 8 mmHg (P < 0.05) and the CPP increased from 76.9 +/- 13 to 84.6 +/- 15 mmHg (P < 0.05). CONCLUSION: When continuous propofol sedation was interrupted and NWT was performed in severely brain-injured patients, the mean ICP and CPP levels were modestly increased. A subset of patients showed more pronounced changes. To date, the role of the NWT in the neurointensive care of TBI and SAH patients is unclear. Although the NWT is safe in the majority of patients and may provide useful clinical information about the patient's level of consciousness, alternate monitoring methods are suggested in patients showing marked ICP and/or CPP changes during NWT.

  • 17.
    Skoglund, Karin
    et al.
    Mälardalen University, School of Health, Care and Social Welfare.
    Enblad, Per
    Uppsala Univ.
    Marklund, Niklas
    Uppsala Univ.
    Monitoring and Sedation Differences in the Management of Severe Head Injury and Subarachnoid Hemorrhage Among Neurocritical Care Centers2013In: Journal of Neuroscience Nursing, ISSN 0888-0395, E-ISSN 1945-2810, Vol. 45, no 6, p. 360-368Article in journal (Refereed)
    Abstract [en]

    Background: The emergence of specialized neurocritical care (NCC) centers has been associated with an improved survival of patients with severe traumatic brain injury or subarachnoid hemorrhage. However, there are no established guidelines on sedation strategy or the frequency of evaluating the level of consciousness using the neurological wake-up test (NWT) in sedated NCC patients. Objectives: The aim was to compare the (1) monitoring techniques, (2) sedation principles, and (3) the use of the NWT in patients with severe traumatic brain injury or subarachnoid hemorrhage in 16 NCC centers. Method: A systematic survey of all 16 centers providing NCC in Scandinavia was performed using a questionnaire regarding the routine primary choice of sedative and analgesic compounds, monitoring techniques, and the frequency of the NWT, sent to the director of each center during 1999, 2004, and 2009. Results: The response rate was 100%. Except for one center in 1999, all included centers routinely used monitoring of intracranial and cerebral perfusion pressure. In contrast, newer monitoring techniques such as microdialysis, jugular bulb oximetry, and brain tissue oxygenation were infrequently used throughout the survey period. Approximately half of the NCC centers used propofol infusion as the primary sedative, whereas the remaining centers used midazolam infusion, and there was a marked variation in the choice of analgesia in each evaluated year. The NWT was never used in 50% of centers and six times daily in one center from 1999 to 2009. Most differences among the NCC centers remained unchanged over the evaluated 10-year period. Discussion: Although Scandinavian countries have similar healthcare systems, there were marked differences among the participating NCC centers in the choice of monitoring tools and sedatives and the routine use of the NWT. These differences likely reflect different clinical management traditions and a lack of evidence-based guidelines in routine NCC. 

  • 18.
    Skoglund, Karin
    et al.
    Uppsala Universitet, Institutionen för neurovetenskap, Sweden.
    Hillered, Lars
    Uppsala Universitet, Institutionen för neurovetenskap, Sweden.
    Tsitsopoulos, Parmenion
    Uppsala Universitet, Institutionen för neurovetenskap, Sweden.
    Engquist, Henrik
    Uppsala Universitet, Institutionen för neurovetenskap, Sweden.
    Purins, Karlis
    Uppsala Universitet, Institutionen för neurovetenskap, Sweden.
    Lewén, Anders
    Uppsala Universitet, Institutionen för neurovetenskap, Sweden.
    Enblad, Per
    Uppsala Universitet, Institutionen för neurovetenskap, Sweden.
    Marklund, Niklas
    Uppsala Universitet, Institutionen för neurovetenskap, Sweden.
    The Neurological Wake-up Test Does not Alter Cerebral Energy Metabolism and Oxygenation in Patients with Severe Traumatic Brain Injury2014In: Neurocritical Care, ISSN 1541-6933, E-ISSN 1556-0961, Neurocritical Care, ISSN 1541-6933, Vol. 2014, no 20, p. 413-426, article id 3Article in journal (Refereed)
    Abstract [en]

    Background: The neurological wake-up test (NWT) is used to monitor the level of consciousness in patients with traumatic brain injury (TBI). However, it requires interruption of sedation and may elicit a stress response. We evaluated the effects of the NWT using cerebral microdialysis (MD), brain tissue oxygenation (PbtiO2), jugular venous oxygen saturation (SjvO2), and/or arterial-venous difference (AVD) for glucose, lactate, and oxygen in patients with severe TBI.Methods: Seventeen intubated TBI patients (age16–74 years) were sedated using continuous propofol infusion. All patients received intracranial pressure (ICP) and cerebral perfusion pressure (CPP) monitoring in addition to MD, PbtiO2and/or SjvO2 . Up to 10 days postinjury, ICP, CPP, PbtiO2 (51 NWTs), MD (49 NWTs), and/or SjvO2 (18 NWTs) levels during propofol sedation (baseline) and NWT were ompared. MD was evaluated at a flow rate of 1.0 µL/min (28 NWTs) or the routine 0.3 µL/min rate (21 NWTs). Results: The NWT increased ICPandCPP levels (p<0.05). Compared to baseline, nterstitial levels of glucose, lactate, pyruvate, glutamate, glycerol, and the actate/pyruvate ratio were unaltered by the NWT. Pathological SjvO2(<50 % or >71 % ;n=2 NWTs) and PbtiO2(<10 mmHg; n=3 NWTs) values were rare at baseline and did not change following NWT. Finally, the NWT did not alter the AVD of glucose, lactate, or oxygen. Conclusions: The NWT-induced stress response resulted in increased ICP and CPP levels although it did not negatively alter focal neurochemistry or cerebral oygenation in TBI patients.

  • 19.
    Skoglund, Karin
    et al.
    Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare.
    Holmström, Inger K.
    Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare. Uppsala University, Sweden.
    Sundler, Annelie Johansson
    Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare.
    Hammar, L.M
    Dalarna University, Sweden.
    Previous work experience and age do not affect final semester nursing student self-efficacy in communication skills2018In: Nurse Education Today, ISSN 0260-6917, E-ISSN 1532-2793, Vol. 68, p. 182-187Article in journal (Refereed)
    Abstract [en]

    Background: With the continuing increase in the older population, being able to communicate with the elderly is one of the many important skills in caring for older people. Therefore, student nurses need support during education to be prepared with the necessary communication skills to meet these demands. Objective: The aim of this study was to describe the development of communication skills during nursing education. Design: A quantitative descriptive and comparative study. Settings: The nursing programme at a university in an urban area of Sweden. Participants: Student nurses in the first and third year in a nursing programme in Sweden in 2015. Methods: Data were collected with a self-efficacy questionnaire and analysed with descriptive and comparative statistics. Results: The student nurses in the final semester had a higher self-rated ability to communicate with older people than students in the second semester of the education year. There was also a difference in self efficacy between students with or without former experience of health care work or work in care with older persons in the second semester. However, these differences were not seen in the final semester. The age of the students did not affect the self-efficacy rate in either semester. Conclusions: Student nurses in the present study scored themselves relatively highly, while student nurses in previous studies expressed a need for more communication skills training. Further studies with observations of student nurses’ actual communicative skills in clinical and simulations settings are needed, to pinpoint weak spots and targets for such an education. 

  • 20.
    Skoglund, Karin
    et al.
    Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare.
    Holmström, Inger
    Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare. Uppsala universitet, Sweden.
    Sundler, Annelie J
    Högskolan Borås, Sweden.
    Marmstål Hammar, Lena
    Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare. Högskolan Dalarna, Sweden.
    Previous work experience and age do not affect final semester nursing students self-efficacy in communication skills2018In: Nordic Conference in Nursing Research, Oslo, Norway, 2018Conference paper (Refereed)
  • 21.
    Skoglund, Karin
    et al.
    Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare.
    Åhlman, Ebba
    The intensive care unit, Västmanland hospital,Västerås, Sweden.
    Mallin, Sofia
    The intensive care unit, Mälar hospital,Eskilstuna, Sweden.
    Holmgren, Jessica
    Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare.
    Intensive care nurses' experiences of caring for patients during the COVID-19 pandemic based on an analysis of blog posts2023In: Nursing in Critical Care, ISSN 1362-1017, E-ISSN 1478-5153Article in journal (Refereed)
    Abstract [en]

    Background

    In 2019, coronavirus disease 2019 (COVID-19) broke out worldwide, leading to a pandemic. Studies have shown that COVID-19 patients in intensive care units (ICUs) require more nursing care than other patients. ICU nurses who care for patients with COVID-19 have shown signs of psychological and physical strain.AimThe aim of this study was to illuminate ICU nurses' experiences of caring for patients with COVID-19 in ICUs during the first wave of the pandemic.DesignA qualitative, descriptive and inductive approach was used.

    Method

    A total of 70 blog posts from 13 bloggers in the United States, Great Britain, Finland and Sweden were analysed using qualitative inductive manifest content analysis.

    Results

    The results reveal an overall theme: ‘An overturned existence under extreme conditions’. Furthermore, three categories—‘the virus caused changes in work and private lives’, ‘unreasonable demands’, and to hold on to caring ideals thanks to the support of others’—and seven subcategories were identified.

    Conclusion

    Caring for patients with COVID-19 during the first wave of the pandemic was demanding because of a lack of knowledge about the disease and the severity of the illness. This led to ICU nurses experiencing extreme conditions that affected various aspects of their lives. Support from colleagues and teamwork were revealed to be particularly important for how nurses dealt with the demands of working during a pandemic, as was sufficient recovery time between work shifts.

    Relevance to Clinical Practice

    Work in ICUs was challenging and demanding, even before the pandemic. This study contributes to an understanding of the complex work environment that existed in hospitals during the first wave of the COVID-19 pandemic. The knowledge obtained from this study can be used to revise working conditions and identify health interventions for ICU nurses.

  • 22.
    Skoglund, Karin
    et al.
    Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare. Mälardalen University.
    Åhlman, Ebba
    Region Västmanland.
    Mallin, Sofia
    Region Sörmland.
    Holmgren, Jessica
    Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare.
    Using blogs to describe Intensive Care nurses’ experiences of caring for patients in the COVID-19 pandemic.2023Conference paper (Refereed)
    Abstract [en]

    Using blogs to describe Intensive Care nurses’ experiences of caring for patients in the COVID-19 pandemic.

    Background: In 2019, coronavirus disease 2019 (COVID-19) broke out worldwide, causing a pandemic. Research shows that patients with COVID-19 in intensive care units (ICUs) require more nursing care than other patients in ICU. The ICU nurses who care for these patients have shown signs of psychological and physical strain and experienced a lower sense of work satisfaction and feelings of helplessness. Analysis of blog posts has been conducted, to illuminate ICU nurses’ experiences of caring for patients with COVID-19.

    Method: To acquire a deeper understanding of ICU nurses’ experiences of caring for patients with COVID-19 during the first wave of the pandemic, analyzing text from ICU nurses’ blog posts was suitable.

    Seventy blog posts from 13 bloggers in the United States, Great Britain, Finland, and Sweden were analyzed using a manifest qualitative content analysis.

    Results: The results revealed an overall theme: “An overturned existence under extreme conditions.” Furthermore, three categories – “The virus caused changes in work and private life,” “Unreasonable demands,” and “To hold on to caring ideals thanks to the support of others”, were identified.

    Conclusion: Collecting data through blogs makes it possible to obtain information from a wide geographic area at almost no cost. Based on the overwhelming situation at ICUs, during the pandemic, analyzing blogposts was suitable to catch ICU nurses experiences without taking any time or focus from the participants during their work.

    Caring for patients with COVID-19 during the first wave of the pandemic was demanding, and support from colleagues and teamwork were important.

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  • 23.
    Summer Meranius, Martina
    et al.
    Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare.
    Holmström, Inger
    Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare. Uppsala University, Uppsala, Sweden.
    Håkansson, Jakob
    Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare.
    Breitholtz, Agneta
    Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare.
    Moniri, Farah
    Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare.
    Skogevall, Sofia
    Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare.
    Skoglund, Karin
    Mälardalen University, School of Health, Care and Social Welfare.
    Rasoal, Dara
    Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare.
    Paradoxes of person‐centred care: A discussion paper2020In: Nursing Open, E-ISSN 2054-1058, Vol. 7, no 5, p. 1321-1329Article, review/survey (Refereed)
    Abstract [en]

    AIM: Previous research has mainly focused on the advantages of PCC and less on its disadvantages. Hence, there is a need to further explore the recent research regard-ing PCC from both sides. Therefore, the aim of this paper is to elucidate the advan-tages and disadvantages of PCC.

    DESIGN: Discussion paper.

    METHODS: We searched relevant literature published January 2000–March 2018 in PubMed, Medline, CHINAL, Scopus and Web of Science.

    RESULTS: The results showed that PCC can contribute to improved health and well-being, improved mutual interaction in relationships, improved cost-effectiveness and im-proved work environment, while the disadvantages can involve increased personal and financial costs, exclusion of certain groups, increased personal and financial costs, exclu-sion of staff's personhood and unfairness due to empathy. An analysis of the existing literature on PCC showed paradoxes, which call for further investigation.

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