Isabell Fridh

Close relatives’ experiences of caring and of the physical environment when a loved one dies in an ICU

AIMnThe aim of this study was to explore close relatives experiences of caring and the physical environment when a loved one dies in an intensive care unit (ICU).nnnMETHODnInterviews were conducted with 17 close relatives of 15 patients who had died in three adult ICUs. The interviews were analysed using a phenomenological-hermeneutic method.nnnFINDINGSnThe analysis resulted in seven themes; Being confronted with the threat of loss, Maintaining a vigil, Trusting the care, Adapting and trying to understand, Facing death, The need for privacy and togetherness and Experiencing reconciliation. The experience of a caring relationship was central, which meant that the carers piloted the close relatives past the hidden reefs and through the dark waters of the strange environment, unfamiliar technology, distressing information and waiting characterised by uncertainty. Not being piloted meant not being invited to enter into a caring relationship, not being allowed access to the dying loved one and not being assisted in interpreting information.nnnCONCLUSIONnThe participants showed forbearance with the ICU-environment. Their dying loved ones serious condition and his or her dependence on the medical-technical equipment were experienced as more frightening than the equipment as such. Returning for a follow-up-visit provided an opportunity for reconciliation and relief from guilt.

Doing one's utmost: Nurses' descriptions of caring for dying patients in an intensive care environment

AIMnThe aim of this study was to explore nurses experiences and perceptions of caring for dying patients in an intensive care unit (ICU) with focus on unaccompanied patients, the proximity of family members and environmental aspects.nnnMETHODnInterviews were conducted with nine experienced ICU nurses. A qualitative descriptive approach was employed. The analysis was performed by means of conventional content analysis [Hsieh HF, Shannon SE. Three approaches to qualitative content analysis. Qual Health Res 2005;15:1277-88] following the steps described by e.g. Elo and Kyngas [Elo S, Kyngas H. The qualitative content analysis process. J Adv Nurs 2008;62:107-15].nnnFINDINGSnThe analysis resulted in a main category; Doing ones utmost, described by four generic categories and 15 sub-categories, comprising a common vision of the patients last hours and dying process. This description was dominated by the nurses endeavour to provide dignified end-of-life care (EOLC) and, when relatives were present, to give them an enduring memory of their loved ones death as a calm and dignified event despite his/her previous suffering and death in a high-technological environment.nnnCONCLUSIONnThis study contributes new knowledge about what ICU nurses focus on when providing EOLC to unaccompanied patients but also to those whose relatives were present. Nurses EOLC was mainly described as their relationship and interaction with the dying patients relatives, while patients who died alone were considered tragic but left a lesser impression in the nurses memory.

Family presence and environmental factors at the time of a patient’s death in an ICU

Background:u2002 In an intensive care unit (ICU), privacy and proximity are reported to be important needs of dying patients and their family members. It is assumed that good communication between the ICU team and families about end‐of‐life decisions improves the possibilities of meeting families’ needs, thus guaranteeing a dignified and peaceful death in accordance with end‐of‐life care guidelines. The aim of this study was to explore the circumstances under which patients die in Swedish ICUs by reporting on the presence of family and whether patients die in private or shared rooms. An additional aim was to investigate the frequency of end‐of‐life decisions and whether nurses and family members were informed about such decisions.

Let there be light and darkness: findings from a prestudy concerning cycled light in the intensive care unit environment.

The present study reports findings concerning light in an intensive care unit setting presented from 3 aspects, giving a wide view. The first part is a systematic review of intervention studies concerning cycled light compared with dim light/noncycled light. The findings showed that cycled light may be beneficial to preterm infant health. Second, a lighting intervention in the intensive care unit is presented, comparing and assessing experience of this lighting environment with that of an ordinary room. Significant differences were shown in hedonic tone, favoring the intervention environment. In the third part, measured illuminance, luminance, and irradiance values achieved in the lighting intervention room and ordinary room lighting are reported.

Development and Psychometric Evaluation of the Instrument: Attitudes Towards Organ Donor Advocacy Scale (ATODAS)

The consequences of advocacy in nursing are critical when caring for a potential organ donor. No specific instrument has been available to measure attitudes toward organ donor advocacy. The aim of this study was to develop and psychometrically evaluate an instrument for measuring intensive and critical care (ICU) nurses’ attitudes toward organ donor advocacy. The study was conducted in two stages: instrument development and instrument evaluation and refinement. A questionnaire was developed (Attitude Toward Organ Donor Advocacy Scale (ATODAS)), which was sent to half of all nurses working in ICUs (general-, neuro-, thoracic- or paediatric-) in Sweden (n=1180). The final response rate was 42.5% (n=502). In order to explore validity and reliability, the expected scale dimensionality of the questionnaire was examined both by explorative principal component analysis (with oblique, varimax rotation) and by confirmatory multi-trait analysis. The confirmatory factor analysis indicated that the ATODAS could best be explained by five factors; Attitudes toward championing organ donation at a structural hospital level; Attitudes toward championing organ donation at a political and research level; Attitudes toward actively and personally safeguarding the will and wishes of the potential organ donor, Attitudes toward safeguarding the potential donor’s will and wishes by a professional approach and Attitudes toward safeguarding the will and wishes of the relatives. This initial testing indicated that the ATODAS has good psychometric properties and can be used in future research to explore if interventions may influence attitudes and behaviors related to organ donor advocacy.

Att vaka — en begreppsanalytisk studie

To watch over a sick or dying person is a common phrase and phenomenon used both by relatives and hospital staff. The aim of this study was to analyse the concept of watch and its meaning for caring in the context of intensive care. The study was conducted in two steps. First an etymological and semantic analysis was conducted, in the second step, 35 persons, including 19 registered nurses undergoing a specialist training program in critical care and 16 persons representing the public were asked to write down their personal opinions about the meaning of the concept. A synthesis of the semantic analysis and the empirical study was made and finally a tentative meaning of the concept was formulated. To watch (over someone) is to be present by a persons side with attention, in the purpose of protecting the loved one from danger and to assist and help in presence of illness and/or dying. The person who watches can do it day or night and be a next of kin or a nurse. To watch means to be emotionally involved and your own needs are put aside in favour of the concern and care for the ill or dying person.

The Meaning of Being a Living Kidney, Liver, or Stem Cell Donor - A Meta-Ethnography

Background Studies on living donors from the donors’ perspective show that the donation process involves both positive and negative feelings involving vulnerability. Qualitative studies of living kidney, liver, and allogeneic hematopoietic stem cell donors have not previously been merged in the same analysis. Therefore, our aim was to synthesize current knowledge of these donors’ experiences to deepen understanding of the meaning of being a living donor for the purpose of saving or extending someones life. Methods The meta-ethnography steps presented by Noblit and Hare in 1988 were used. Results Forty-one qualitative studies from 1968 to 2016 that fulfilled the inclusion criteria were analyzed. The studies comprised experiences of over 670 donors. The time since donation varied from 2 days to 29 years. A majority of the studies, 25 of 41, were on living kidney donors. The synthesis revealed that the essential meaning of being a donor is doing what one feels one has to do, involving 6 themes; A sense of responsibility, loneliness and abandonment, suffering, pride and gratitude, a sense of togetherness, and a life changing event. Conclusions The main issue is that one donates irrespective of what one donates. The relationship to the recipient determines the motives for donation. The deeper insight into the donors’ experiences provides implications for their psychological care.

Understanding the Perceived Threat of the Risk of Graft Rejections : A Middle-Range Theory

From a clinical viewpoint, graft rejection is one of the greatest threats faced by an organ transplant recipient (OTR). We propose a middle-range theory (MRT) of Perceived Threat of the Risk of Graft Rejection (PTRGR) as a contribution to the practice of transplant nursing. It could also apply to the detection of risky protective behavior, that is, isolation, avoidance, or non-adherence. The proposed MRT covers the following concepts and the relationship between them: transplant care needs, threat reducing interventions, intervening variables, level of PTRGR, protective strategies, and evidence-based practice. Parts of this theory have been empirically tested and support the suggested relationship between some of the concepts. Further tests are needed to strengthen the theoretical links. The conceptual framework might serve as a guide for transplant nurses in their efforts to promote post-transplant health and reduce threat-induced emotions.

A new tool to assess relatives’ experience of dying and death in the intensive care unit

Professor Kentish-Barnes and co-workers recently published an article in Intensive Care Medicine, in which they presented the results of a questionnaire study aimed at assessing the experience of relatives of patients who died in the intensive care unit (ICU) (1).

Extensive human suffering : a point prevalence survey of patients´most distressing concerns

AIMnTo explore patients most distressing concerns during a hospital stay.nnnBACKGROUNDnThe characteristics of hospitalised patients have changed. Care is provided at a higher age, lengths of stay have fallen and the nursing workload is increasing. It is presumed that hospitalised patients are more seriously ill and have more palliative needs than previously. Studies show that inpatients suffer from more distress than similar outpatients although there is a lack of overall knowledge about inpatients distress and major concerns, regardless of age, diagnosis or care setting.nnnMETHODSnThis study was part of a point prevalence survey (PPS) concerning symptom prevalence. Of the 710 patients who participated in the PPS, 678 (95%) answered an open-ended question in a questionnaire: What is your main concern or what is most distressing or troublesome for you at present? Using a life-world approach, the text was analysed qualitatively and patients concerns were interpreted in two main dimensions, an intersubjective dimension and a temporal dimension.nnnFINDINGSnThe patients reported extensive suffering due to illness, symptoms and failing health. Patients were concerned about family members, existential issues and the future. Three aspects of the patients most distressing concerns were interpreted: The suffering self, The suffering person in close relations and The suffering person in a threatening world.nnnCONCLUSIONnHospitalised patients are affected by severe illness, distressing symptoms and existential quandaries, revealing extensive human suffering in the midst of the demanding activities that take place during an ordinary day in a hospital. To support patients and alleviate suffering, hospital staff need to be more sensitive to patients most distressing concerns. This presupposes a hospital environment in which the value system supports caring and comforting behaviour.Aim nTo explore patients most distressing concerns during a hospital stay. n nBackground nThe characteristics of hospitalised patients have changed. Care is provided at a higher age, lengths of stay have fallen and the nursing workload is increasing. It is presumed that hospitalised patients are more seriously ill and have more palliative needs than previously. Studies show that inpatients suffer from more distress than similar outpatients although there is a lack of overall knowledge about inpatients distress and major concerns, regardless of age, diagnosis or care setting. n nMethods nThis study was part of a point prevalence survey (PPS) concerning symptom prevalence. Of the 710 patients who participated in the PPS, 678 (95%) answered an open-ended question in a questionnaire: What is your main concern or what is most distressing or troublesome for you at present? Using a life-world approach, the text was analysed qualitatively and patients concerns were interpreted in two main dimensions, an intersubjective dimension and a temporal dimension. n nFindings nThe patients reported extensive suffering due to illness, symptoms and failing health. Patients were concerned about family members, existential issues and the future. Three aspects of the patients most distressing concerns were interpreted: The suffering self, The suffering person in close relations and The suffering person in a threatening world. n nConclusion nHospitalised patients are affected by severe illness, distressing symptoms and existential quandaries, revealing extensive human suffering in the midst of the demanding activities that take place during an ordinary day in a hospital. To support patients and alleviate suffering, hospital staff need to be more sensitive to patients most distressing concerns. This presupposes a hospital environment in which the value system supports caring and comforting behaviour.