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Day surgery is a common phenomenon and is associated with several benefits including cost-effectiveness. However, patients are required to manage their postoperative recovery at home. Patients undergoing orthopedic surgery are a particularly vulnerable group, and their postoperative recovery requires further investigation. This study aimed to describe the experiences of postoperative recovery of patients who had undergone orthopedic day surgery.A qualitative and descriptive study design was used METHODS: Participants were selected purposefully and included 18 orthopedic day-surgery patients who underwent surgery in October and November 2020. Semi-structured interviews were conducted from December 2020 to February 2021. All interviews were recorded and transcribed verbatim. The transcribed data were analyzed using qualitative content analysis with an inductive approach. The process of analysis was done in several steps and resulted in four categories FINDINGS: Four categories that described the postoperative recovery experiences of patients who underwent orthopedic day surgery were developed: (1) Questions arose when I got home; (2) I wanted confirmation that I was on the right path; (3) I felt lonely and dependent on others; and (4) I strove to find a balance between activity and rest CONCLUSIONS: For most patients, there was no follow-up after day surgery. However, patients expressed a desire for confirmation that their recovery process was within the normal trajectory. Most of the recovery takes place at home, leading to feelings of loneliness and highlighting the need for support from healthcare providers and close relatives. A phone call from a nurse after surgery might offer support, reduce feelings of loneliness, and promote a sense of safety. This study highlights the importance of systematic follow-up following orthopedic day surgery.

Adopting a theoretical perspective that acknowledges both formal and informal learning as crucial and emphasises reproductive and developmental learning as complementary, this article analyses and discusses temporary agency nurses’ experiences of working and learning, focusing on conditions for workplace learning. This provides opportunities to address questions about conditions for the integration of work and learning in a work situation characterised by flexibilization and individualisation. More specifically, among individuals moving between different organizational contexts rather than working at ‘a’ (single and stable) workplace provided by the employer. By presenting findings based on a thematic analysis of 21 interviews with individual temporary agency nurses working in Swedish health care, both opportunities and challenges for workplace learning is highlighted. While opportunities for informal learning linked to the movement between various client organizations as well as to nursing as common ground and as valued and recognized competence, is identified, at the same time, challenges connected to both formal and informal learning, are also illuminated. Regarding informal learning, challenges in terms of varied and general support and feedback as well as scarce opportunities and low expectations for the temporary agency nurses’ participation in development work in daily work/at client organizations, is identified. The findings thus also illuminate a risk for temporary agency nurses adjusting to prevailing working conditions rather than engaging in developmental learning. Regarding formal learning, challenges in terms of few opportunities for planned learning activities, is identified. All in all, the findings illuminate conditions for workplace learning for temporary agency nurses as clearly dependent not only on the offers of specific temporary work agencies and client organisations, but also on temporary agency nurses’ interest in and views regarding responsibility for learning, and thus highly varying.

Purpose This study explored the experiences of people with stress-related illness participating in a nature-based intervention programme in a northern natural setting. Methods A longitudinal case study was conducted with two women participating in a nature-based intervention programme on a farm. Data were collected by semi-structured interviews, diaries, rating scales, and self-assessment. Qualitative data were analysed by qualitative content analysis and quantitative data are presented descriptively. Results The theme of finding a source for recovery and well-being permeates all categories. The participants perceived the farm and nature to be a calming refuge; they learned to be in the present and could manage the tasks. In togetherness with each other and the facilitator on the farm they felt understood and confident, experienced joy, and found opportunities for change. They gained knowledge and positive memories and found new approaches in life. Self-assessment questionnaires indicated improvements of functioning in everyday life and reduced stress-related exhaustion at the end of the NBI programme. Conclusions Nature-based interventions lasting for a relatively short period seem to promote health and may be a complement to other treatments of stress-related illness. Further research is needed with a larger number of participants and in various natural settings.PurposeThis study explored the experiences of people with stress-related illness participating in a nature-based intervention programme in a northern natural setting. Validerad;2022;Nivå 2;2022-11-29 (sofila);Funder: European Union New Nordic Nature Based Service Models

Firefighters around the world have the ability to provide first aid before ambulance staff arrive. In Sweden, this assignment is called ‘While Waiting For the Ambulance’ (WWFA). There is limited knowledge about WWFA in rural environments, therefore the aim of this study was to describe the WWFA assignment in a rural environment from the perspective of the firefighters and the ambulance staff. A descriptive design was used with a reflective lifeworld approach, including 16 telephone interviews with firefighters and ambulance staff. The COREQ checklist was applied. A directed responsibility emerges towards affected persons with a situation-adapted attitude during alarms in a WWFA assignment. The firefighters and ambulance staff are each other’s support with a simultaneous need for support from involved organisations. To strengthen this support, training is required, consisting of interprofessional training, feedback from relevant organisations about first aid efforts and expansion of WWFA assignments. Finally, there is a need for a more coordinated picture in order to provide better conditions for future action by the organisations involved, with increased opportunities to save lives in individual local environments.

Funding Information: Elizabeth Hörlin is acknowledged for guidance and help with practical implementation of design of experiments, Niklas Nordgren for AFM imaging and analysis, Karin Hallstensson for SEM imaging, and Erik Mellberg for useful discussions. TA acknowledges the Chair in Sustainable Packaging at EPFL, co-funded by BASF, Logitech, Nestlé, and SIG. Publisher Copyright: Copyright © 2022 Nilsson, Engström, Kaschuk, Vapaavuori, Larsson and Abitbol. Cellulose nanocrystal (CNC) suspensions can self-assemble into chiral nematic films upon the slow evaporation of water. These films are brittle, as indicated by their fracturing instead of plastically deforming once they are fully elastically deformed. This aspect can be mediated to some extent by plasticizing additives, such as glucose and glycerol, however, few reports consider more than one additive at a time or address the influence of additive content on the homogeneity of the self-assembled structure. In this work, design of experiments (DoE) was used to empirically model complex film compositions, attempting to relate additive concentrations in dilute suspension to film properties, and to understand whether outcome specific predictions are possible using this approach. We demonstrate that DoE can be used to predict film properties in multi-additive systems, without consideration given to the different phenomena that occur along the drying process or to the nature of the additives. Additionally, a homogeneity metric is introduced in relation to chiral nematic organization in CNC films, with most of the additive-containing compositions in this work found to reduce the homogeneity of the self-assembly relative to pure CNC films.

Background Positive breastfeeding experiences positively influence subsequent attitudes towards breastfeeding, and increase mothers’ confidence, self-efficacy, motivation and intention to breastfeed. However, the strategies that mothers find useful and effective for creating positive breastfeeding experiences remain largely unknown. The aim of our study was thus to describe experience-based knowledge from mothers about strategies for creating positive breastfeeding experiences. Methods The study followed a qualitative design involving the critical incident technique. Data were collected with an online survey containing open-ended questions that was administered to a Sweden-based parenting group on Facebook in September 2018. Ultimately, 340 incidents from 176 women were identified as offering strategies for creating positive breastfeeding experiences. Data from the written replies were extracted as textual units, condensed and categorised until categories were mutually exclusive, which resulted in six categories. Results Participating women were on average 31.2 years old and the median number of children per participant was two. Mothers’ strategies for creating positive breastfeeding experiences generally included being calm and accepting that initiating breastfeeding takes time and can be difficult initially. Participants described feeling close to the baby by maintaining skin-to-skin contact and being present in the moment by taking time to appreciate the child and the breastfeeding situation, and temporarily forgetting about the world and simply being with the child in the here and now. Participants advocated baby-led breastfeeding and following correct techniques. They also described the importance of keeping an effortless mindset about breastfeeding to prevent perceiving breastfeeding as a compulsion. Mothers described acquiring knowledge about breastfeeding so that they could be prepared if breastfeeding problems occurred and getting support from professionals and family was described as significant for having a positive breastfeeding experience. Caring for oneself and one’s body, with aids if necessary, were described as important strategies, as were having a positive attitude and a strong desire to breastfeed. Conclusion Because positive breastfeeding experiences and support are predictors of future breastfeeding initiation and duration, assisting women in creating positive breastfeeding experiences is important. Asking mothers to formulate strategies that they find useful could facilitate breastfeeding by making their approaches more conscious and visible.

Purpose To investigate nurse anesthetists' experiences of strategies that alleviate adult patients' preoperative anxiety before anesthesia administration. Design The study has a qualitative approach wherein the data were collected through semistructured interviews. The study included interviews with six active nurse anesthetists with at least 5 years of experience who worked in a hospital in southern Sweden. Methods Critical incident technology was used to analyze the data. Findings Four different categories emerged: behavior of nurse anesthetist, preoperatively providing information, diverting attention to create security, and medicine as an alternative. Conclusions Awareness can increase the use of different strategies by both new and experienced nurse anesthetists, as well as by nurses in preoperative units, which in turn alleviates patient anxiety about anesthesia. This may result in a better perioperative experience for the patient.

Purpose To study the factors influencing early postoperative recovery after laparoscopic cholecystectomy. Design A nonexperimental retrospective study. Methods The study was performed using records from all patients who had undergone laparoscopic cholecystectomy at a hospital in Northern Sweden in 2017 (219 patients in total). Nonparametric data were analyzed using Spearman's rho, Mann-Whitney U test, and logistic regression. Parametric data were analyzed using Pearson's correlation, an independent t test, and analysis of variance. Findings The length of stay in the postanesthesia care unit was not predicted by factors such as age, gender, body mass index, American Society of Anesthesiologists classification, postoperative nausea and vomiting, premedication, or type of surgery. Younger age and high classification level were significant predictors of pain during rest and pain when in motion. No significant predictors of postoperative nausea were found. The majority of study participants experienced little or no pain or nausea. The documentation of pain, nausea, and premedication was inadequate in many cases. Conclusions Nurses in postanesthesia care units should work to preventively identify and address patients' medical and emotional needs so that optimal conditions for postoperative recovery can be provided.

IntroductionHealth care workers faced new challenges during the COVID-19 pandemic when physical contact with relatives more or less disappeared.ObjectivesThe aim of this study is to describe the experiences of critical care nurses (CCNs) working in intensive care units (ICUs) under the visiting restrictions imposed as a result of COVID-19.MethodThis study followed a qualitative design. The purposive sample included CCNs with at least 1 year of experience working in an ICU with a visiting policy affected by the pandemic. Data collection was carried out via semi-structured interviews and analyzed through a qualitative content analysis with an inductive approach.ResultsThe study results are presented in three categories with 10 subcategories. CCNs value the presence of patients’ relatives at the bedside and described many challenges when relatives could not be present with the patient during the pandemic.ConclusionClose relatives are able to share essential information about the patients and provide much-needed emotional support to them, the relatives’ role is of central importance and CCNs value their presence in ICUs more than any positive consequences of them not being there.

Aim the aim of the study was to deductively study person-centred care, based on critical care nurses’ experiences during the first phase of the covid-19 pandemic. Design: The study used a qualitative design. Method Data collection was conducted as individual interviews and was analysed with qualitative content analysis with a deductive approach. Participants: Six critical care nurses working in a special covid-19 intensive care unit during the first phase of the pandemic participated. Findings: The findings are presented within the four domains of person-centred practice: the prerequisites, the care environment, person-centred processes and person-centred outcomes. While the ambition and knowledge about how to work in accordance with person-centred practice were high, there were several obstacles to perform it. Conclusion We need to prepare ahead of time so that nurses have optimal organisational prerequisites to be able to work in accordance with person-centred practice, also during pandemics and other crisis, which means to be able to give nursing care in accordance with the ill person’s needs and resources.

Aim The aim of this study was to describe the experience-based knowledge of parents of children aged 0-3 years for creating a positive sleep situation in the family. Design This study has a qualitative design. Data were collected using an online survey and analysed using the critical incident technique. Methods The study participants were recruited through an announcement posted in parenting groups on a social media platform in September 2018. A total of 93 parents answered the questionnaire; 76 of the parents matched the study's selection criteria, and their responses were included in the analysis. Results The results are presented from the two main questions in the survey: "Strategies for creating a positive sleep situation" and "Advice to new parents regarding sleep". Having routines and reading the child's signals were important strategies, as were creating good conditions for sleep and making sure the child was well-fed and content at bedtime. Winding down and giving the child closeness and touch was described as important, and some parents would co-sleep to soothe the child quickly and create a sense of security and belonging. Parents' most frequent advice to other parents was to accept the situation and to let go of the idea that the child should sleep without waking up in a separate bed or room. Conclusion Personal preferences and needs are likely to vary among individuals, and it is important that nurses tailor sleep advice in accordance with families' preferences and needs, taking individual variations and views into account.

In an effort to strengthen health care professionals' ability to anticipate and address multiple trauma patients' needs, this study aims to explore the experience of suffering from multiple trauma.This is a qualitative descriptive study. Nine interviews were analysed using content analysis.The study included patients who had been registered in the Swedish Intensive Care registry [SIR] due to suffering multiple trauma.The analysis revealed one theme, A detour in life, based on three sub-themes: (a) Feeling lost and not knowing what to expect, (b) Striving to get life back on track and (c) Dealing with 'dead ends' during rehabilitation. The theme showed that those who suffered multiple trauma did not know what to expect of their recovery and they expressed experiencing a lack of understanding and guidance from healthcare professionals. As it was important to focus on the present and find ways to move on in life, they sought for other ways to find direction in matters of rehabilitation and care.A shared understanding is essential in order to define a person's needs. By setting short-term goals and improving documentation, healthcare professionals across the trauma recovery continuum could more easily gain insight of their patients' needs and address them with supportive guidance.

The aim of this study was to describe people's experiences of suffering a second myocardial infarction.A descriptive qualitative design. Interviews were conducted with eight persons afflicted by two myocardial infarctions. Data were analysed with qualitative content analysis.The analysis resulted in one theme and four categories. The theme was 'Realising the seriousness' and the categories were: 1) Knowledge from previous experience; 2) A wake-up call for lifestyle changes; 3) The future becomes unpredictable; 4) Trying to find balance in life. The participant's previous experience contributed to a better understanding of the symptoms of myocardial infarction and how to act when suffering a second myocardial infarction. After their second myocardial infarction, the participants became really aware of the need to implement a healthier lifestyle, as doing so might avoid a third myocardial infarction. The risk of suffering or even dying due to yet another myocardial infarction felt more tangible after their second one.A second myocardial infarction is a different event in comparison to the first one, which makes afflicted people realise the seriousness and importance of making life style changes. They are more affected both physically and psychologically.

Purpose To describe anesthetic nurses' experiences of key factors for the successful management of difficult airways in adult patients. Design This study had a qualitative observational and descriptive design following the critical incident technique. Methods Twelve experienced anesthetic nurses were interviewed. Findings We identified five key factors for the successful management of difficult airways: identification of the difficult airway, creating a plan of action, remaining calm and focusing on the task, technical skills, and using the equipment. Identification of the difficult airway implies preassessment with standardized methods and actively observing for signs indicative of a difficult airway. Having all equipment available at bedside during induction and creating a backup plan increases the action force in unexpected situations. A calm and methodical work procedure facilitates the management of the difficult airway as well as selecting techniques and equipment according to the patient and situation. Conclusions Reflective practice can aid the anesthetic nurse in drawing on experience and remaining calm in acute situations.

Aim: To describe what suffering multiple concussions meant for former semi-professional or professional hockey players who were forced to end their career. Results: Nine former Swedish hockey players, who once played on national or professional teams were interviewed. The interviews were analyzed with reference to hermeneutic phenomenology to interpret and explain their experiences. The theme of losing one’s identity as a hockey player was constructed from five subthemes: being limited in everyday life, returning to the hockey stadium as soon as possible, forming a post career identity, lacking understanding and support, and preventing injuries by respecting other players. Conclusion: The former hockey players struggled with developing their off-the-ice identities and with finding other sources of meaning for their lives., Lay abstract Despite considerable attention to improving the initial management of concussions suffered by hockey players, few studies have examined their long-term effects. In response, the study reported here aimed to describe what suffering multiple concussions meant for former semi-professional or professional hockey players who were forced to end their career. Nine former Swedish hockey players, who once played on national or professional teams were interviewed and the interviews were analyzed in order to interpret and explain their experiences. The overall theme was formulated as losing one’s identity as a hockey player. In conclusion, the former hockey players seem to struggle with developing their off-the-ice identities and with finding other sources of meaning for their lives.

Patients’ health-related quality of life and perceptions of care : A longitudinal study based on data from the Swedish Trauma Registry

Objective The aim of our study was to describe specialist nurses’ experiences with the helicopter transport of patients critically ill with COVID-19. Method Our study followed a descriptive qualitative design anchored in the naturalistic paradigm and was based on qualitative content analysis. The study followed the consolidated criteria for reporting qualitative research. Results Six semi-structured interviews were conducted with specialist nurses who have cared for patients critically ill with COVID-19 during helicopter transport. The analysis of the interviews resulted in three themes—designing new routines before transport, working under new conditions and post-transport and reflections—with 11 categories. The goal of the intensive care transport of patients with COVID-19 was twofold: to prevent the spread of infection by using personal protective equipment and to prevent the contamination of the helicopter. Conclusion For the nurses, working in personal protective equipment created a feeling of distance from patients that compromised patient–nurse intimacy. Our results suggest that ensuring the sufficiency of equipment required in the event of major accidents and pandemics is critical.

Purpose To explore gastric bypass patients' perceptions of their postoperative recovery over 1 month. Design A standardized questionnaire, the postoperative recovery profile, was used. Methods Postoperative recovery profile is a multi-item questionnaire for self-assessment of general postoperative recovery. Participants were patients who had undergone gastric bypass surgery (n = 39). The changes in recovery between 1 day and 1 month postsurgery were evaluated by a statistical method developed specifically for analyzing changes in paired ordered data over time. Findings Most of the symptoms and/or functions were significantly improved on a group level. The most marked improvement was to pain and sleeping difficulties followed by mobilization. In terms of the psychological items, the proportion of patients who indicated no problems was high at both endpoints. The items that deviated from the improvement pattern were appetite changes and gastrointestinal function which demonstrated a relatively high proportion of deterioration, and the individual variability was prominent. Conclusions There is a need for interventions to improve recovery on a group as well as an individual level.

Aim Firefighters perform first aid before the ambulance arrives in areas with a long response time in Sweden; this is called ‘While Waiting for the Ambulance’ (WWFA). The aim was to describe WWFA assignments in rural environments, focusing on frequency, event time, actions and survival >30 days after cardiopulmonary resuscitation (CPR) was performed. Methods Retrospective descriptive and comparative design. Results Firefighters in the northern part of Sweden were involved in 518 WWFA assignments between 2012 and 2016. From alarm call until ambulance dispatch, median time was 2:20 min; for firefighters, nearly four minutes. Median dispatch time at out-of-hospital cardiac arrests (OHCA) (n = 52) was 1:40 min for ambulance and three minutes for firefighters. Maximal dispatch time was nearly 10 min for ambulance and 44 min for firefighters. Firefighters arrived first at the scene, after 17 min’ median, for 95 % of assignments, while the ambulance took nearly twice the amount of time. In OHCA situations, time for firefighters was over 19 min versus ambulance at nearly twice the time. CPR was terminated by ambulance staff at 83% (n = 43) of 52 when firefighters performed prolonged CPR. Return to spontaneous circulation after OHCA was 17%, and 9% were alive after >30 days. Conclusion The efficiency of incident time and utilisation rate for WWFA assignments can be increased for the benefit of affected persons, especially in OHCA.

The aim of this study is to describe critical care nurses (CCN's) experiences of working with or as temporary agency staff.This explorative qualitative study is based on interviews with five agency CCNs and five regular CCNs, a total of ten interviews, focusing on the interviewees' experiences of daily work and temporary agency staffing. The interviews were analysed manually and thematically following an inductive approach.Four themes that illustrate both similarities and differences between regular and temporary agency CCNs emerged: "working close to patients versus being responsible for everything", "teamwork versus independence", "both groups needed" and "opportunities and challenges".The study findings illustrate the complexity of the working situation for agency and regular staff in terms of the organisation and management of the temporary agency nurses and the opportunities and challenges faced by both groups.

Summary Background Writing a diary for intensive care patients has been shown to facilitate patientrecovery and prevent post-traumatic stress following hospitalisation. Aim This study aimed to describe the experiences of critical care nurses’ (CCNs’) in writing personal diaries for ICU patients. Method The study was conducted with a qualitative design. Ten CCNs from two hospitals participated. Data were collected with semi-structured interviews and analysed using a qualitative thematic content analysis. Findings The result consists of a theme: Patient diary: a complex nursing intervention in all its simplicity, as well as four categories: Writing informatively and with awareness shows respect and consideration; The diary is important for both patient and CCN; To jointly create an organisation that facilitates and develops the writing; Relatives’ involvement in the diary is a matter of course. Conclusion CCNs are aware of the diary’s importance for the patient and relatives, but experience difficulties in deciding which patients should get this intervention and how to prioritize it. Writing a personal diary for an ICU patient is a nursing intervention that is complicated in its simplicity.

When emergency medical services (EMS) are needed, the choice of transport depends on several factors. These may include the patient's medical condition, transport accessibility to the accident site and the receiving hospital's resources. Emergency care research is advancing, but little is known about the patient's perspective of helicopter emergency medical services (HEMS).The aim of this study was to describe trauma patients' experiences of HEMS.Thirteen persons (ages 21-76) were interviewed using an interview guide. Data were analyzed using qualitative content analysis.The analysis resulted in three themes: Being distraught and dazed by the event - patients experienced shock and tension, as well as feelings of curiosity and excitement. Being comforted by the caregivers - as the caregivers were present and attentive, they had no need for relatives in the helicopter. Being safe in a restricted environment - the participants' injuries were taken seriously and the caregivers displayed effective teamwork.For trauma patients to be taken seriously and treated as 'worst cases' enables them to trust their caregivers and 'hand themselves over' to their care. HEMS provide additional advantageous circumstances, such as being the sole patient and having proximity to a small, professional team.

Several studies have examined various parameters and experiences when patients suffer their first myocardial infarction (MI), but knowledge about when they suffer their second MI is limited.To compare risk factors for MI, that is, diabetes, hypertension and smoking, for the first and second MI events in men and women affected by two MIs and to analyse the time intervals between the first and second MIs.A retrospective cohort study of 1017 patients aged 25-74 years with first and second MIs from 1990 through 2009 registered in the Northern Sweden MONICA registry.More women than men have diabetes and hypertension and are smokers at the first MI. Similar differences between the genders remain at the time of the second MI for diabetes and hypertension, although both risk factors have increased. Smoking decreased at the second MI without any remaining difference between genders. Women suffer their second MI within a shorter time interval than men do. Within 16 months of their first MI, 50% of women had a second MI. The corresponding time interval for men was 33 months.Patients affected by an MI should be made aware of their risk of recurrent MI and that the risk of recurrence is highest during the first few years after an MI. In patients affected by two MIs, women have a higher risk factor burden and suffer their second MI earlier than men do and thus may need more aggressive and more prompt secondary prevention.

Introduction: Interns' experiences communicating with and writing referrals to hospital radiology departments are important for patient safety, image quality, and decision-making in the diagnostic ...

Purpose To study how preoperative anxiety affects postoperative recovery in orthopaedic surgery based on two specific issues: does preoperative anxiety affect postoperative anxiety, pain, and nausea in the postanesthesia care unit (PACU) and does preoperative anxiety affect the quality of recovery. Design This was a nonexperimental quantitative observational study. Methods Patients (N = 37) were included through consecutive selection. Anxiety, pain, and nausea were measured preoperatively, 30 minutes after arrival at PACU and before discharge from PACU. Three days after discharge, participants completed the Quality of Recovery Questionnaire by telephone. Findings There was a significant correlation between preoperative anxiety and anxiety in PACU as well as anxiety, sadness, and depression 3 days after discharge from PACU. Conclusions Patients who experience preoperative anxiety also experience anxiety in PACU. The quality of recovery 3 days after surgery is also affected by preoperative anxiety. Patients experience continued anxiety as well as sadness and depression.

In a rural environment where distances and access to ambulance resources in people's immediate area are limited, other responders like firefighters dispatched to perform a first aid before ambulance arrives in areas where a longer response time exists; an assignment called 'While Waiting for the Ambulance' (WWFA). Knowledge is limited about the experience from a caller's perspective when a person has a life-threatening condition needing emergency help and both firefighters in a WWFA assignment and ambulance staff are involved.The aim of the study is to describe the emergency situation involving a WWFA assignment in a rural environment from the caller's perspective.A descriptive design using qualitative methodology with a reflective lifeworld research (RLR) approach was used for this study, including in-depth interviews with eight callers.An emergency situation involving WWFA assignment in a rural environment mean a sense of being lone and lonely with a vulnerability in while waiting to hand over responsibility for the affected person. Ambivalence in several dimensions arises with simultaneous and conflicting emotions. A tension between powerlessness and power of action where the throw between doubt and hope are abrupt with a simultaneous pendulum between being in a chaos and in a calm.A double ambivalence emerges between, on one hand feeling alone in the situation and having full control, on the other hand, with trust handing over the responsibility, thereby losing control. Contact with the emergency medical dispatcher becomes a saving lifeline to hold onto, and access to emergency help in the immediate area of WWFA is valuable and important. Trust and confidence are experienced when callers are met with empathy, regardless of personal acquaintance with arriving responders.

Purpose To study nurse anesthetists' experiences of key factors for successful airway management in general anesthesia of adult obese patients. Design The study was a qualitative observational study with a descriptive approach. Methods Eight semistructured interviews were conducted. Data were analyzed using the critical incident technique. Findings Five key factors for successful general anesthesia of adult obese patients were identified. These factors were preparing and planning the anesthesia, optimizing patient position, optimizing ventilation through proper preoxygenation and increasing positive end-expiratory pressure, quickly securing the airway, and working in teams. Conclusions Knowledge of key factors that facilitate and improve the anesthesia care of obese patients is important to provide safe and quality anesthesia to this patient group as obese patients often have small margins and urgent situations can quickly arise. This knowledge enables the nurse anesthetist to be one step ahead and to be ready to take action if complications occur.

Background High-fidelity simulation (HFS) has become a bridge between theoretical knowledge and practical skills. A safe and realistic environment is commonly used in nursing education to improve cognitive, affective and psychomotor abilities. Debriefing following a simulation experience provides opportunities for students to analyze and begin to reflect upon their decisions, actions and results. The nursing literature highlights the need to promote the concept of reflective practice and to assist students in reflection, and research indicates the need to refine and develop debriefing strategies, which is the focus of the current paper. Purpose To explore the value of reflections after HFS by investigating nursing students' perceptions of their learning when a Three-step Post-simulation Reflection Model is used. Design A qualitative descriptive research approach was applied. Method A Three-step Post-simulation Reflection Model that combined written and verbal reflections was used after an HFS experience in a second-year course in the Bachelor Program in Nursing at Lulea University of Technology, Sweden. Reflective texts written before and after a verbal group reflection were subjected to qualitative content analysis. Findings The main theme in the first written reflections was identified as “ Starting to act as a nurse ”, with the following categories: feeling stressed, inadequate and inexperienced; developing an awareness of the importance of never compromising patient safety; planning the work and prioritizing; and beginning to understand and implement nursing knowledge. The main theme in the second written reflections was identified to be “ Maturing in the profession ”, with the following categories: appreciating colleagues, good communication and thoughtfulness; gaining increased self-awareness and confidence; and beginning to understand the profession. Conclusion The Three-step Post-simulation Reflection Model fostered an appreciation of clear and effective communication. Having time for thoughtfulness and reflection promotes self-awareness and a better understanding of both the nursing profession and patient safety. The progress demonstrated in the depth of the themes in the written reflections indicates that repeated reflections stimulate and enhance student learning. The findings point towards the potential effectiveness of alternate methods of reflections.

Introduction Prehospital births are fairly rare in Sweden but occasionally occur in the ambulance care system. The ambulance nurse's experience of prehospital births has previously been studied, but there is a lack of research that depicts the woman's perspective of a prehospital birth. Aim To describe women's experiences of unplanned prehospital births. Method A qualitative questionnaire consisting of six open-ended questions that encouraged participants to describe their prehospital-birth experience. Eight women answered the survey and nine birth stories were included. A qualitative content analysis with an inductive approach was used as an analysis method. Results The analysis of the texts resulted in four main categories. The main categories were an unpredictable event, the woman's suffering, her perceived gratitude and the importance of the ambulance nurse now and in the future. The main category of women's suffering resulted in two subcategories: physical stresses and psychological and emotional suffering. Conclusion The women are not prepared to give birth to a child outside the hospital, and the course of events happen quickly. A prehospital birth is described as a tumultuous event for women. The ambulance nurse has a central role in the care outside the hospital. The advice women suggest to ambulance nurses are remaining calm and safe no matter what the situation looks like, listening to the mother and meeting the woman's wishes. Proposals for further research are to investigate the importance of further education in childbirth care for ambulance nurses and how that affects the care of women and their family.

Objectives The aim of this study was to describe patients’ expressed needs during cardiac rehabilitation after suffering a second myocardial infarction in comparison to personnel’s descriptions of how they work with these patients. Research methodology A descriptive qualitative design. Interviews were conducted with patients affected by two myocardial infarctions and registered nurses, physiotherapists and cardiologists working with cardiac rehabilitation. Data were analysed with qualitative content analysis. Findings An interpretation of the underlying meaning in the categories was formulated into one theme: ‘To be seen as a unique person’. Patients expressed a need for individualised care; they wanted the cardiac rehabilitation to be customised to their condition and prognosis; however, they did not perceive their care was individualised. Personnel described the importance of the care being individualised, although they had guidelines to follow. It was crucial for them to see the individual and discover what was important for each patient. Conclusions There was a shared opinion from patients and personnel that individual care is essential. Using the concept and working in accordance with person-centred care could meet the patients’ need for individualised care.

Background: Knowledge is limited concerning the type of symptoms and the time from onset of symptoms to first medical contact at first and second myocardial infarction in the same patient. Aim: This study aimed to describe the type of symptoms and the time from onset of symptoms to first medical contact in first and second myocardial infarctions in men and women affected by two myocardial infarctions. Furthermore, the aim was to identify factors associated with prehospital delays ≥2 h at second myocardial infarction. Methods: A retrospective cohort study with 820 patients aged 31–74 years with a first and a second myocardial infarction from 1986 through 2009 registered in the Northern Sweden MONICA registry. Results: The most common symptoms reported among patients affected by two myocardial infarctions are typical symptoms at both myocardial infarction events. Significantly more women reported atypical symptoms at the second myocardial infarction compared to the first. Ten per cent of the men did not report the same type of symptoms at the first and second myocardial infarctions; the corresponding figure for women was 16.2%. The time from onset of symptoms to first medical contact was shorter at the second myocardial infarction compared to the first myocardial infarction. Patients with prehospital delay ≥2 h at the first myocardial infarction were more likely to have a prehospital delay ≥2 h at the second myocardial infarction. Conclusions: Symptoms of second myocardial infarctions are not necessarily the same as those of first myocardial infarctions. A patient’s behaviour at the first myocardial infarction could predict how he or she would behave at a second myocardial infarction.

The aim of this study is to describe the experiences of critical care nurses (CCNs) when performing successful peripheral intravenous catheterization (PIVC) on adult inpatients in difficult situations. This study uses a descriptive design with a qualitative approach. Semistructured interviews were given to CCNs (n = 22) at a general central county hospital in northern Sweden. The interview text was analyzed with qualitative thematic content analysis. Three themes emerged: "releasing time and creating peace," "feeling self-confidence in the role of expert nurse," and "technical interventions promoting success." CCNs stated that apart from experience, releasing enough time is the most crucial factor for a successful PIVC. They emphasized the importance of identifying the kinds of difficulties that may occur during the procedure, for example, fragile or/and invisible veins. CCNs explained that compared to when they were newly graduated, the difference in their approach nowadays has changed to using their hands more than their eyes and that they feel comfortable with bodily palpations. To further optimize PIVC performing skills, continued possibilities to train and learn in hospital settings are necessary, even after formal education has been completed.

Objectives To describe the characteristics, problems and interventions associated with performing peripheral intravenous catheterisation in difficult situations when registered nurses need support from critical care nurses. Background Only a few studies have focused on peripheral intravenous catheterisation problems or interventions to promote success. There is limited research on the education, knowledge, confidence and skills of registered nurses associated with successful peripheral intravenous catheterisations. Design A descriptive cross-sectional survey design was used. Results A total of 101 questionnaires were completed by critical care nurses (n = 32) and 92 by registered nurses (n = 83); the total number of participants was 115. The same critical care nurses and registered nurses could participate several times on different occasions. Statistical analyses were performed using descriptive statistics. The patterns differed in part between the registered nurses who needed support and the critical care nurses who provided the support. Both registered nurses and critical care nurses used ultrasound to a very low extent (2.2% vs. 1.0%). The registered nurses indicated to a significantly higher extent (p = 0.02) that the veins were invisible and that they had performed the optional interventions. The success rate for critical care nurses was considerably high (86.1%). The most common place for successful insertion was the wrist. Critical care nurses performed fewer interventions, and they informed the patients and assessed that the veins were fragile to a higher extent. Conclusions Superior nursing skills are required in order to adapt and assess specific situations related to peripheral intravenous catheterisation difficulties and to choose the adequate interventions. Young and newly graduated registered nurses should be offered individualised training during the post-educational period on how to assess problems and perform peripheral intravenous catheterisations in specific difficult situations. Relevance to clinical practice Simulation is suggested for practical training in order to increase patient safety related to the performance of technical skills such as peripheral intravenous catheterisation.

Purpose To describe patients' perceptions of quality of care during the perioperative period and to identify areas for quality improvement. Design A cross-sectional descriptive survey design was used. Methods The data were collected (N = 170) using a questionnaire for perioperative care. The methods were descriptive statistics, reported as percentages, and a manifest content analysis of the free text. Finding The areas identified for improvement were information and participation. The participants lacked knowledge, preferred to hand over decision making to the hospital staff, and indicated that having personalized information about the surgery and perioperative period was important. However, too detailed information before surgery could cause increased anxiety. Conclusions This study indicates that participation and information needs in perioperative settings seem to be situation specific. In addition, these needs seem to be personal and surgery specific. Further studies are required to clarify the differences in the satisfaction and quality of care between groups of patients in the perioperative context.

Aims and objectives To explore orthopaedic and general surgery patients' perceptions of their postoperative recovery for one month. Background In general, nursing research in the postoperative context has been directed towards a single symptom or area, which is valuable. However, there is a lack of studies of orthopaedic and general surgery patients' perceptions of postoperative recovery from a short-term perspective. Design A quantitative approach with a longitudinal design was used. Methods A total of 180 patients participated in the study. Data were collected using a standardised questionnaire, the Postoperative Recovery Profile, for self-assessment of recovery. Descriptive statistics reported as proportions were used for the categorical variables. Analytic statistics were used to identify statistically significant differences. Mean values and t-tests were used for quantity variables, and Mann–Whitney U-tests and Chi-squared tests were used for nonparametric variables. Results Overall, the orthopaedic patients were substantially less recovered than the general surgery patients. Two-thirds of the orthopaedic patients and half of the general surgery patients perceived severe or moderate pain in the acute recovery phase. Within the general surgery group, there were significant differences in the recovery between the Gastric Bypass patients and colon/ileum surgery patients. The gastric bypass patients were overall more recovered than the other groups of patients. The Gastric Bypass patients reported that they had improved after one month compared to their own status prior to surgery. Conclusions and relevance to clinical practice Nursing support for orthopaedic patients must be improved, especially after they are discharged from the hospital. To structure and monitor individual recovery, a top-five priority profile of the most important problems should be used during follow-up calls after the patient is discharged from the hospital. Postoperative pain continues to represent a clinical problem that requires attention. Heterogeneity in the perceptions of recovery within the general surgery group was indicated, which may depend on the surgical procedure as well as the patients' expectations and comparisons with their lives before surgery. Rather than return to their preoperative levels, certain patients tend to continue towards a new or different life postoperatively.

Aim To describe patients' experiences of a follow-up visit to an intensive care unit (ICU) after being critically ill and nursed there. Background Knowledge about the follow-up visit needs to be developed, with the previously critically ill patient in focus. Design Qualitative descriptive. Method Semi-structured interviews were conducted with nine patients and analysed using qualitative content analysis. The data collection occurred during spring 2014. Findings During the follow-up visits in ICU, the relatives, the patient diary, and those who took part in the care contribute to fill memory gaps to create a picture and an explanation of the care period. Conclusion The follow-up visit is an important tool in the patients' struggle to create a context and coherence from a missing or unreal time. The patient diary is essential to subsequently be able to relate to the period of care. Relevance to clinical practice The follow-up visit, together with a personal diary, after an ICU stay could be seen as significant for strengthening the patients' feeling of coherence and better health.

Coercive measures are commonly used as a method of intervention, despite insufficient evidence for their effectiveness and benefits. The aim of this study was to describe how people who self-harm perceive alternatives to coercive measures in relation to actual experiences of psychiatric care. A total of 19 self-reports have been analysed with qualitative content analysis, resulting in three categories: a wish for understanding instead of neglect; a wish for mutual relation instead of distrust; a wish for professionalism instead of a counterproductive care. In conclusion, if the caregivers can understand and collaborate with the patient, there is seldom any need for coercive measures.

Summary Background Women experience more sore throats than men after endotracheal intubation. Aim The aim of this study was to investigate the incidence of self-rated sore throat immediately, and 2–4 hours postoperatively, in women after elective gynaecological surgery under general anaesthesia using an endotracheal tube (ETT) size 6.5 or 7.0 mm in inner diameter. Method Eighty-two female participants who had undergone elective gynaecological surgery participated, 44 and 38 were intubated with size 6.5 mm ETT and 7.0 mm ETT respectively. They estimated the occurrence of sore throat preoperatively and postoperatively, according to a 4-point Likert scale. Statistical data were analysed using the Package for Social Science (SPSS) 19. Results Sore throat was present in 29.5% of participants who were intubated with size 6.5 mm ETT immediately postoperatively and in 39.5% of those who were intubated with size 7.0 mm ETT. Conclusion Nurses specialising in the supervision of daily care specific to the intubated patient should note and alleviate sore throat as part of their nursing care.

Working as an ambulance nurse means interacting with and caring for acutely ill and injured patients. It can even involve births before arrival to the hospital (BBA), which are rare but increasing due to the centralization of maternity wards.This study describes the experiences of specialist ambulance nurses with BBA.A qualitative study was conducted, and nine specialist ambulance nurses who had assisted with one or more prehospital births were interviewed. Data were analysed with thematic content analysis.The analysis revealed three categories that were compiled into a theme of feeling fright and exhilaration. The findings showed that BBA causes feelings of anxiety and stress. The experience is also associated with joy and relief when the baby is born. Childbirth is a situation for which specialist ambulance nurses feel less prepared, lack of knowledge, and wish for more education.Specialist ambulance nurses face challenges in the pre-hospital care environment during BBA, with long distances, a lack of equipment aboard the ambulance, and no assistance from midwives. To feel secure in the complex role that is required when assisting with a BBA, specialist ambulance nurses should be given the opportunity to receive scenario training.

Purpose To explore (1) associations between patient and perioperative factors and dimensions of quality of care and (2) perioperative patients' self-rated physical health in relation to information, encouragement, and participation. Design A nonexperimental descriptive exploratory design (n = 170 participants). Methods Analyses were performed using quantitative techniques; collected data were quantitative in nature. Multiple logistic regression and Mann-Whitney U tests were used to analyze the data. Findings The factor associated with patients' satisfaction within the dimension of "identity-oriented approach of the caregivers," including the quality of information, encouragement, and participation, was self-estimated physical health. Those who estimated their physical health as being good were generally more satisfied. Patients who rated their physical health as being less than good were significantly less satisfied with the information provided before surgery about their stay in the postanesthesia care unit (PACU). Conclusions Nurses should chart patients' estimations of their physical health initially in care to provide reinforced support for patients who estimate their physical health is less than good. Before surgery, patients who have estimated their physical health as being less than good should be given realistic information about their stay in the PACU—that they will be in a PACU after surgery, what that stay means, and why it is necessary.

The aim of this study was to describe the contents of a patient diary and its significance for persons cared for in an ICU.An empirical study with a qualitative design. Eight telephone interviews and one face-to-face interview were conducted with nine persons previously been treated in an ICU and been given a patient diary. In addition, the person would have read his/her diary. The data have been analysed with qualitative content analysis.The study identified one overarching theme; Gaining understanding, and four categories; The diary is written for me, Creating memories from the time of care, Who writes in the diary and, The ability to return to the diary. The diary meant that participants gained an understanding of their time in the ICU while they were critically ill and the diary was important to be able to return to.What formerly critically ill patients appreciate most about the diary is that the diary is personally written, which makes them feel confirmed and valuable as a person. Guidelines for how and when a diary should be written and used would likely encourage critical care nurses and relatives to write in it.

When professional actors have been used in mental health simulations with nursing students, the experience has been regarded as a meaningful contribution to their education and described as a safe way of experiencing challenging situations that can occur in clinical settings. The aim was to study nursing students' reflections after meetings with nursing patients and their relatives, as enacted by professional actors, in psychiatric/elderly care. The design was a qualitative descriptive research approach. Gibbs's ( 1988 ) reflective cycle was the basis for the questions that were asked. Written reflections with 60 nursing students were analysed using qualitative thematic content analysis. The analysis produced the theme "being touched and feeling empathy," with four categories: "becoming aware of what knowledge and skills are needed," "wanting to do well and to have the right answer," "daring to get close and being present," and "knowledge comes alive." Simulation with real people who act as patients or relatives in vulnerable situations creates feelings of empathy. To talk with them, experience eye contact, and see how they react on touch makes nursing students feel they have experienced closeness and their knowledge has become alive.

Background Intensive care of children means not only caring for a child; it means care for the whole family. Aim The aim of the study was to describe parents' experiences of having a critically ill child in an intensive care unit (ICU). Participants A purposive sample of seven parents who had their child treated in an ICU during 2012 in Sweden. Design The design uses an inductive, qualitative approach with data collected by means of qualitative interviews. Methods The interviews were transcribed verbatim and subjected to qualitative content analysis. Results The analysis resulted in one theme: the desire of parents to be involved and present, with four categories such as wanting to understand and know what is happening, feeling frustration about their child's care and treatment, a health care environment that arouses emotions, and needs for support and processing. Conclusion It is of great importance to parents to be informed continuously about their child's condition and the care and treatment that are planned. This may increase parents' sense of ownership, control and security. Relevance to clinical practice Providing answers to those questions that can be answered and being available to parents when they have questions about their critically ill child, the meaning of it all, and what the future will hold are suggested in clinical practice.

Background Ambulance nurses work daily in both emergency and non-emergency situations that can be demanding. One emotionally demanding situation for ambulance nurses is to nurse children who are ill. Aim The aim of this study was to describe ambulance nurses' experiences of nursing critically ill or injured children. Method Eight specialist ambulance nurses were interviewed and the interviews were analyzed using qualitative content analysis. Findings The analysis resulted in one theme, a difficult aspect of ambulance nursing care, with five categories. The security of both child and parents was considered to be paramount. Ambulance nurses felt relieved when they handed over the responsibility and the child to the receiving unit. The ambulance nurses felt that more training, education and follow-up was desirable in order to increase their security when nursing children. Conclusion Ambulance nurses are subject to stressful feelings while nursing children. As providing reassurance to the child and its parents is a cornerstone of the treatment, it is important for the ambulance nurses to take the time to build up a trusting relationship in such an encounter. Skill development in the area might lead to increased security and reduce the mental burden resulting from negative stress.

Objectives: The objective of the study was to describe new fathers’ experiences with care related to complicated childbirth. Methods: A qualitative approach consisting of individual interviews using a semi-structured interview guide with open-ended questions was applied. A purposive sample of eight fathers participated. The interview text was subjected to qualitative thematic content analysis. Results: Analysis revealed the following three categories: (1) feeling scared and uncared for during acute situations; (2) appreciating the opportunity to participate in care and becoming a family; and (3) needing continued care. Based on these three categories, a recurring theme was identified: struggling to be recognized by care staff as a partner in the family was revealed. Conclusion: Although fathers lack support and understanding from care staff, they strive to fulfill their roles as fathers by guarding their families and keeping them together. Caregivers involved in the childbirth process should realize that by acknowledging and encouraging fathers in these roles, they in turn support the entire family unit. Interventions developed for fathers and family care requires further development. Additional research concerning how midwives and critical care nurses (CCNs) view the presence of fathers in the emergency situations that may accompany childbirth is also needed.

Background Intensive care is conducted in intensive care units (ICUs), and also during the transportation of critically ill people. Aim The aim of the study was to describe critical care nurses' (CCNs) experiences of nursing critically ill patients during helicopter transport. Participants Seven CCNs, five women and two men participated in this study. Design Seven participants from two centres in Sweden were recruited. The design uses an inductive, qualitative approach with data collected by means of qualitative interviews with seven CCNs. Methods The interviews were transcribed verbatim and subjected to qualitative thematic content analysis. Results The analysis resulted in one theme which is safe nursing care, but sometimes feeling afraid and six categories as follows: experiencing the care environment as an ICU with limited space; a loud environment complicates communication; planning and checking to minimize risks; experience and good co-operation; facing the dilemma of allowing relatives to accompany the patient or not; feeling the patient's and their own fear. Conclusion CCNs plan for the transportation and control of patients to improve patient safety, but can sometimes feel afraid. Good co-operation is necessary. Relevance to clinical practice The possibilities for CCNs to provide effective nursing care in helicopters are good, although in some cases limited by the environmental conditions.

Background: Providing nursing care for a critically ill obstetric patient or a patient who has just become a mother after a complicated birth can be a challenging experience for critical care nurses (CCNs). These patients have special needs because of the significant alterations in their physiology and anatomy together with the need to consider such specifics as breastfeeding and mother-child bonding. Aim: The aim with this study was to describe CCNs’ experience of nursing the new mother and her family after a complicated childbirth. Method: The design of the study was qualitative. Data collection was carried out through focus group discussions with 13 CCNs in three focus groups during spring 2012. The data were subjected to qualitative content analysis. Findings: The analysis resulted in the formulation of four categories: the mother and her vital functions are prioritized; not being responsible for the child and the father; an environment unsuited to the new family and collaboration with staff in neonatal and maternity delivery wards. Conclusion and relevance to clinical practice: When nursing a mother after a complicated birth the CCNs give her and her vital signs high priority. The fathers of the children or partners of the mothers are expected to take on the responsibility of caring for the newborn child and of being the link with the neonatal ward. It is suggested that education about the needs of new families for nursing care would improve the situation and have clinical implications. Whether the intensive care unit is always the best place in which to provide care for mothers and new families is debatable.

In previous studies people receiving mechanical ventilation treatment have described experiencing distress over their inability to speak and feelings such as anxiety. More research is needed to improve their experience in the intensive care unit and promote recovery. The aim of this study was to describe the intensive care unit experiences of people undergoing mechanical ventilation.Qualitative, personal interviews were conducted during 2011 with eight people who were mechanically ventilated in an intensive care unit in the northern part of Sweden. Interview transcripts were analysed using qualitative content analysis.Two themes emerged, with four and three categories, respectively. Being dependent for survival on other people and technical medical equipment created a sense of being vulnerable in an anxious situation and a feeling of uncertainty about one's own capacity to breathe. Having lines and tubes in one's body was stressful. Being given a diary and follow-up visit to the intensive care unit after the stay were important tools for filling in the missing time, but there was also one participant who did not want to remember his stay in the intensive care unit.To be dependent on other people and technical medical equipment for survival creates a sense of being delivered into the hands of others, as the people being mechanically ventilated could not trust their body to function.