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  • 1.
    Carnesten, Hillewi
    Mälardalens universitet, Akademin för hälsa, vård och välfärd, Hälsa och välfärd.
    Nurses' caring struggle: Stress in caring within hospital emergency care during the COVID-19 pandemic2024Doktoravhandling, med artikler (Annet vitenskapelig)
    Abstract [en]

    Nurses took a frontline caregiving role during the COVID-19 pandemic in pervasively altered conditions in Swedish hospital emergency healthcare. Little is known about nurses’ experiences of the stress they were subjected to. In this thesis, findings from individual in-depth interviews with both newly graduated registered nurses (NGRNs) and experienced nurses (ERNs), as well as a web-based questionnaire, illuminate nurses’ lived experiences of stress in caring during the COVID-19 pandemic. Three studies employed qualitative methods (I, II, IV), and one a mixed methods approach (III). Study I aimed to describe NGRNs’ experiences of encountering stress in EDs during the COVID-19 pandemic. Findings illuminate how dedicated NGRNs struggle to develop into the nurse they want to be whilst battling extraordinary situations and conflicting emotions. Loss of control and experiences of shortcomings caused by work overload in combination with understaffing force NGRNs into an independent role at an early point in their career. Study II aimed to illuminate the meaning of NGRNs' experiences of caring for patients in EDs during the COVID-19 pandemic. Findings comprise caring being bestowed through spatial, emotional, and temporal barriers. NGRNs want to be present, relieve suffering yet describe caring during the pandemic as being a hidden activity, less acknowledged and left to the recognition of each nurse. Study III aimed to explore healthcare workers’ (HCWs’) experiences of the changed caring reality of the COVID-19 pandemic. Findings disclose traumatic experiences and having to sacrifice moral values and harbour dilemmas in isolation. Experiencing stress was significantly correlated to lower sense of coherence (SOC). Study IV aimed to explore nurses’ lived experiences of stress in the transformed caring reality during the COVID-19 pandemic. The interpreted meaning comprises the dilemma of enduring the unbearable, meaning having to silence one’s inner ethical, caring compass. In conclusion, stress in caring during the COVID-19 pandemic from a nurse perspective, can be understood as a caring struggle entailing bodily, knowledge, and ethical stress in a search for meaning that might be found in togetherness with patients, with colleagues, with dear ones and in nature.

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  • 2.
    Carnesten, Hillewi
    et al.
    Mälardalens högskola, Akademin för hälsa, vård och välfärd.
    Asp, Margareta
    Mälardalens högskola, Akademin för hälsa, vård och välfärd, Hälsa och välfärd.
    Holmberg, Mats
    Mälardalens högskola, Akademin för hälsa, vård och välfärd, Hälsa och välfärd. Region of Sörmland, Eskilstuna, Sweden; Uppsala University, Sweden.
    Caring approach for patients with chest pain–Swedish registered nurses’ lived experiences in Emergency Medical Services2021Inngår i: International Journal of Qualitative Studies on Health and Well-being, ISSN 1748-2623, E-ISSN 1748-2631, Vol. 16, nr 1, artikkel-id 1901449Artikkel, forskningsoversikt (Fagfellevurdert)
    Abstract [en]

    Purpose: Encountering patients with chest pain iscommon for Registered Nurses (RNs) in Emergency Medical Services (EMS) who are responsible for the patient’s medical and nursing care. From a lifeworld perspective, bodily illness is related to existential suffering, requiring knowledge to asses the situation from a holistic perspective. The aim of this study is to describe the caring approach when RNs encounter patients with chest pain. Methods: A phenomenological methodology to capture RNs’ lived experiences was chosen. Seven qualitative in-depth interviews were conducted at three ambulance stations in Sweden. Results: The essence of the caring approach while encountering patients with chest pain comprises two constituents; “trust based on confidence and competence” and “the collegial striving towards the best possible care”. Trust is two-parted; trust in oneself, and striving towards gaining the patient’s trust. Competence and experience when combined, develop into confidence especially in stressful situations. The caring approach is nurtured in a well-functioning collegial team. Conclusions: This study contributes to understanding the caring approach based on the specific patient’s lifeworld in holistic EMS care. By trusting oneself, the patient, and one’s colleague, RNs in EMS shift focus from medical-orientated care to a holistic lifeworld caring approach. More research is needed on trust as a phenomenon in EMS, both from caregivers’ and patients’ perspectives. 

  • 3.
    Carnesten, Hillewi
    et al.
    Mälardalens universitet, Akademin för hälsa, vård och välfärd, Hälsa och välfärd.
    von Heideken Wågert, Petra
    Mälardalens universitet, Akademin för hälsa, vård och välfärd, Hälsa och välfärd.
    Wiklund Gustin, Lena
    Mälardalens universitet, Akademin för hälsa, vård och välfärd, Hälsa och välfärd. The Arctic University of Norway Narvik Norway.
    Toivanen, Susanna
    Mälardalens universitet, Akademin för hälsa, vård och välfärd, Hälsa och välfärd.
    Skoglund, Karin
    Mälardalens universitet, Akademin för hälsa, vård och välfärd, Hälsa och välfärd.
    Jaarsma, Tiny
    Department of Health, Medicine and Caring Sciences Linköping University Linköping Sweden;Julius Center University Medical Center Utrecht Utrecht Netherlands.
    Andreae, Christina
    Mälardalens universitet, Akademin för hälsa, vård och välfärd, Hälsa och välfärd. 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' experiences2024Inngår i: Journal of Advanced Nursing, ISSN 0309-2402, E-ISSN 1365-2648, s. 1-15Artikkel i tidsskrift (Fagfellevurdert)
    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.

  • 4.
    Carnesten, Hillewi
    et al.
    Mälardalens universitet, Akademin för hälsa, vård och välfärd, Hälsa och välfärd.
    von Heideken Wågert, Petra
    Mälardalens universitet, Akademin för hälsa, vård och välfärd, Hälsa och välfärd.
    Wiklund, Lena
    Mälardalens universitet, Akademin för hälsa, vård och välfärd, Hälsa och välfärd.
    Toivanen, Susanna
    Mälardalens universitet, Akademin för hälsa, vård och välfärd, Hälsa och välfärd.
    Skoglund, Karin
    Mälardalens universitet, Akademin för hälsa, vård och välfärd, Hälsa och välfärd.
    Andreae, Christina
    Mälardalens universitet, Akademin för hälsa, vård och välfärd, Hälsa och välfärd.
    Jaarsma, Tiny
    Struggling with frightening experiences in a transformed reality: A mixed methods study of healthcare workers’ experiences during the pandemic.2023Konferansepaper (Annet vitenskapelig)
    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. 

  • 5.
    Carnesten, Hillewi
    et al.
    Mälardalens universitet, Akademin för hälsa, vård och välfärd, Hälsa och välfärd.
    Wiklund Gustin, Lena
    Mälardalens universitet, Akademin för hälsa, vård och välfärd, Hälsa och välfärd. Department of Health and Care Sciences, UiT/The Arctic University of Norway, Narvik, Norway.
    Skoglund, Karin
    Mälardalens universitet, Akademin för hälsa, vård och välfärd, Hälsa och välfärd.
    von Heideken Wågert, Petra
    Mälardalens universitet, Akademin för hälsa, vård och välfärd, Hälsa och välfärd.
    Caring through barriers—Newly graduated registered nurses' lived experiences in emergency departments during the COVID-19 pandemic2023Inngår i: Journal of Advanced Nursing, ISSN 0309-2402, E-ISSN 1365-2648, Vol. 79, nr 6, s. 2269-2279Artikkel i tidsskrift (Fagfellevurdert)
    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. 

  • 6.
    Carnesten, Hillewi
    et al.
    Mälardalens universitet, Akademin för hälsa, vård och välfärd, Hälsa och välfärd.
    Wiklund, Lena
    Mälardalens universitet, Akademin för hälsa, vård och välfärd, Hälsa och välfärd. UiT Arctic Univ Norway, Dept Hlth & Care Sci, Narvik, Norway.
    Skoglund, Karin
    Mälardalens universitet, Akademin för hälsa, vård och välfärd, Hälsa och välfärd.
    von Heideken Wågert, Petra
    Mälardalens universitet, Akademin för hälsa, vård och välfärd, Hälsa och välfärd.
    Battling extraordinary situations and conflicting emotions: A qualitative study of being a newly graduated Registered Nurse in the emergency department during the COVID-19 pandemic2022Inngår i: Nursing Open, E-ISSN 2054-1058, Vol. 9, nr 5, s. 2370-2380Artikkel i tidsskrift (Fagfellevurdert)
    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.

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