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Aims: To explore how parents experienced their child with delirium and how parents viewed our delirium management bundle. Design: We conducted a qualitative exploratory descriptive study using semi‐structured individual or dyad interviews. Methods: Twelve semi‐structured interviews with 16 parents of 12 critically ill children diagnosed with delirium in a paediatric intensive care unit were conducted from October 2022 to January 2023 and analysed through a reflexive thematic analysis. Findings: We generated five themes: (1) knowing that something is very wrong, (2) observing manifest changes in the child, (3) experiencing fear of long‐term consequences, (4) adding insight to the bundle, and (5) family engagement. Conclusion: The parents in our study were able to observe subtle and manifest changes in their child with delirium. This caused fear of lasting impact. The parents regarded most of the interventions in the delirium management bundle as relevant but needed individualization in the application. The parents requested more information regarding delirium and a higher level of parent engagement in the care of their child during delirium. Impact: This paper contributes to understanding how parents might experience delirium in their critically ill child, how our delirium management bundle was received by the parents, and their suggestions for improvement. Our study deals with critically ill children with delirium, their parents, and staff working to prevent and manage paediatric delirium (PD) in the paediatric intensive care unit. Reporting Method: The consolidated criteria for reporting qualitative research guidelines were used to ensure the transparency of our reporting. Patient or Public Contribution: No patient or public contribution to the research design. What does this Paper Contribute to the Wider Global Community?: ‐ It increases awareness of the parent's perspective on PD in critically ill children.‐ It shows how PD might affect parents, causing negative emotions such as distress, frustration, and fear of permanent damage.‐ It shows that the parents in our study, in addition to the care bundle, requested more information on delirium and more involvement in the care of their delirious child. [ABSTRACT FROM AUTHOR]

Aim: To describe different patterns of communication aimed at preventing, identifying and managing symptoms between mechanically ventilated patients and clinicians in the intensive care unit. Design: We conducted a fieldwork study with triangulation of participant observation and individual interviews. Methods: Participant observation of nine patients and 50 clinicians: nurses, physiotherapists and physicians. Subsequent individual face‐to‐face interviews with nine of the clinicians, and six of the patients after they had regained their ability to speak and breathe spontaneously, were fully alert and felt well enough to sit through the interview. Findings: Symptom communication was found to be an integral part of patient care. We identified three communication patterns: (1) proactive symptom communication, (2) reactive symptom communication and (3) lack of symptom communication. The three patterns co‐existed in the cases and the first two complemented each other. The third pattern represents inadequate management of symptom distress. Conclusion: Recognition of symptoms in non‐speaking intensive care patients is an important skill for clinicians. Our study uncovered three patterns of symptom communication, two of which promoted symptom management. The third pattern suggested that clinicians did not always acknowledge the symptom distress. Implications for Patient Care: Proactive and reactive symptom assessment of non‐speaking patients require patient verification when possible. Improved symptom prevention, identification and management require a combination of sound clinical judgement and attentiveness towards symptoms, implementation and use of relevant assessment tools, and implementation and skill building in augmentative and alternative communication. Impact: This study addressed the challenges of symptom communication between mechanically ventilated patients and clinicians in the intensive care unit. Our findings may have an impact on patients and clinicians concerned with symptom management in intensive care units. Reporting Method: We used the consolidated criteria for reporting qualitative research. Patient Contribution: A user representative was involved in the design of the study. [ABSTRACT FROM AUTHOR]

Aim: To understand the content and context of a realized peer mentor intervention, and to explore how mentors and mentees experienced the intervention. Design: The study was designed as a qualitative process evaluation of a 24-week peer mentor intervention. Methods: Semi-structured individual interviews were conducted from November 2021 to May 2022 in a purposeful sample of older vulnerable people with ischemic heart disease, referred to as mentees (n = 13), and their peer mentors (n = 12). Thematic analysis was used to analyse, categorize and interpret interview data. Results: Five themes captured the content and context of the peer mentor intervention as experienced by mentors and mentees. 'Takes one to know one', stressing the importance of the mentor--mentee matching process; 'Varying demand for mentors', illustrating the difficulties in predicting who has the greatest need for mentoring; 'Varying degree of familiarity', describing the mentor--mentee relationship as a continuum from formal mentor to informal friend; 'Putting the patient first', illustrating how mentors support mentees based on their personal experiences of successful recovery while letting the mentee set the pace and goals; and 'Varying view of success', showing how intervention success is perceived differently by mentors and mentees. Conclusions: The study provides new knowledge on how and under what contextual circumstances a mentor intervention works. These findings are important for the implementation of future peer mentor interventions to achieve successful peer mentor support. Implications and Impact: Non-attendance and drop-out from the cardiac rehabilitation program are prevalent problems among older vulnerable people with cardiovascular disease. This study describes a low-cost peer mentor intervention that can support this group of patients. Reporting Method: Standards for reporting qualitative research (SRQR) guided our study. Patient or Public Contribution: A board of cardiovascular patients have contributed to the development and implementation of the intervention being evaluated. [ABSTRACT FROM AUTHOR]

Aim: Intensified healthcare specialization has increased the need for patient transfers. We aimed to describe in‐hospital and interhospital patient transfer decisions during the traumatic brain injury (TBI) trajectory from a nursing perspective. Design: Ethnographic fieldwork. Methods: We used participant observation and interviews at three sites representing the acute, subacute and stable stages of the TBI trajectory. Deductive analysis was applied supported by transition theory. Results: During the acute stage (neurointensive care), transfer decisions were facilitated by physicians assisted by critical care nurses, in the subacute stage (highly specialized rehabilitation), transfer decisions were collaborative among in‐house healthcare professionals, community staff and family, and during the stable stage (municipal rehabilitation), transfer decisions were made by non‐clinical staff. Most of the resources allocated during the trajectory went towards highly specialized rehabilitation, whereas more resources are needed during the end of the trajectory. No Patient or Public Contribution: Patients and the public were not involved in this study. [ABSTRACT FROM AUTHOR]

Aims: The study aims were to provide a comprehensive description of the short‐ and long‐term experience of necrotizing soft‐tissue infections from the patient and family perspective. Further, to describe how unmet needs related to diagnosis, treatment and rehabilitation are experienced. And finally, to present patient and family recommendations for improvements. Design: The study had a longitudinal qualitative multi‐centre two‐country design. Methods: Qualitative content analysis was applied to 87 semi‐structured interviews involving 50 participants from Denmark and Sweden. In most interviews, patient and family were interviewed separately. Data were collected in 2015–2018. This is the fifth and final paper reporting the study. Findings After initial inductive coding, we constructed a matrix of four timepoints (pre‐admission, acute admission, after 6 months and after 2 years) describing physical, psychological and social responses and recommendations for improvement. We analysed deductively according to timepoints and predefined categories describing patient and family responses to life with necrotizing soft‐tissue infections. The study suggested that physical recovery was obtained before psychological recovery. The aftermath of job loss and lacking social services amplified the burden. Patients still recovering experienced lack of understanding from family, friends and professionals that failed to recognize the complexity of their suffering. Conclusions: Half of the patients in our study reported making a full recovery while the remaining described issues still unresolved 2 years after intensive care unit discharge. Predisposing factors and symptoms align with other studies of critical illness. During the acute stage, patients receive state‐of‐the art treatment and care, but as time passes, rehabilitation becomes less available and less patient‐centred. Impact The study will increase nurses' understanding of patient and family suffering and complexity of long‐term survival of necrotizing soft‐tissue infections. Patient or Public Contribution: From the planning stage of the study, we collaborated with a necrotizing soft‐tissue infection survivor. [ABSTRACT FROM AUTHOR]

Critically ill patients often require spiritual counseling. In Denmark, most hospital chaplains are provided by the State Church. More knowledge is needed regarding health care chaplaincy in this semi-agnostic non-secular welfare society. Our study aimed to explore how hospital chaplains describe their role and elements of chaplaincy in relation to patient, family and healthcare professionals in Danish intensive care units. Using a multicenter qualitative design, we performed semi-structured key-informant interviews with ten hospital chaplains. Content analysis exposed elements of chaplaincy based on spirituality, rituality, neutrality, confidentiality, advocacy, and equality. Most elements are similar in other countries; the main differences are related to educational requirements, institutional integration, research activity, and documentation practice. Chaplains fill an ambiguous role, negotiating values of church and hospital. Modern chaplaincy is propelled toward professionalism, quantification, certification and evaluation. We discuss the contemporary role of hospital chaplains and the consequences of categorizing them as part of the ICU team. [ABSTRACT FROM AUTHOR]

Aims The Danish public healthcare system provides a comprehensive cardiac rehabilitation (CR) programme, but attendance rates are low among older vulnerable women. Effective interventions enabling increased CR attendance are warranted. Knowledge about everyday life and social support needs is crucial to the development of effective CR interventions in this group. To explore mastery of everyday life and social support needs in older, vulnerable women with myocardial infarction (MI) and their relatives. Methods and results A qualitative explorative design using semi-structured individual or dyadic interviews with patients (n = 21) and their relatives (n = 13) and applying thematic analysis. Five themes captured mastery of everyday life and social support needs. 'The Big Picture' suggesting that comorbidities dwarfed the impact of MI. 'Blaming the Doctor' illustrated issues of distrust and treatment delay. 'Rehabilitation Barriers' explained why these vulnerable patients failed to participate in CR. 'Caregiver Concerns' described relatives dual roles as supporters and supported. 'Finding their Way' indicated how patients were assisted by peer support to negotiate the trajectory. Conclusion The study offers a basis for the development of CR interventions customized to this group of patients. Interventions should target patients with multimorbidity, low motivation for lifestyle changes, and transportation issues. Peer support is suggested for this group of patients where relatives are also apt to be vulnerable. [ABSTRACT FROM AUTHOR]

Aims and objectives: To explore critical care nurses' experiences of research participation during a one‐year recovery programme for intensive care survivors. Background: Nurse‐led postintensive care follow‐up consultations have emerged to help patients to recover and overcome problems related to critical illness and admission at the intensive care unit (ICU). Previous research exploring post‐ICU follow‐up programmes have shown inconclusive evidence of their effectiveness on patient‐reported outcome measurements, and provider evaluation is scarce. The context of this study is the Recovery and Aftercare in Postintensive care Therapy (RAPIT) trial. Design: A qualitative descriptive telephone interview study. Methods: Data were collected after completion of the RAPIT trial. Participants (n = 14) were trained intensive care nurses, who delivered the post‐ICU recovery programme, representing nine out of ten sites from the RAPIT trial. Two focus group discussions were used to construct a semistructured interview guide. A thematic data analysis was performed using Braun and Clark's six‐step method. This study conforms to the COREQ Research Reporting Guidelines for qualitative studies. Results: Our study indicated that nurses considered participation in research as a positive experience. The main finding "Stimulated by insight" described how nurses' engagement and professional growth was gained by reflection, patient feedback and research competencies acquired in the clinical setting. The research programmes stimulated to new knowledge, broaden their perspectives and enhanced critical reflection of ICU nursing practice. Conclusions: The study indicates that nurses developed research competencies and enhanced their job satisfaction by using critical reflection and patient feedback. However, there is still a substantial need for support to strengthen nurses' competencies in collaboration with colleagues, managers and researchers. Relevance to Clinical Practice: This study can contribute to the development of recommendations supporting nurses doing research and to optimise implementation of clinical research. [ABSTRACT FROM AUTHOR]

Copyright of Journal of Advanced Nursing (John Wiley & Sons, Inc.) is the property of John Wiley & Sons, Inc. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Introduction: Advanced pediatric nurse practitioners (APNPs) working in acute settings are represented in pediatric hospitals, clinics, and wards around the world. They work independently and autonomously. The aim of this study was to compare the role of APNPs in four different countries to gain knowledge on the qualifications and experience of the practitioners and their impact on pediatric patients and families. Method: A qualitative design with semistructured keyinformant interviews with four nurses from Sweden, Norway, England, and the United States was conducted. Analyses were performed using thematic analysis. Results: Three themes were identified: 1) Qualification and Competencies, illustrated parallels within the four educations and daily practice. 2) Responsibility and Autonomy, highlighted differences. The informants experienced a mutual understanding of the concepts of advanced practice. Interprofessional collaboration with aphysician was crucial to ensure best practice. 3) Holistic Nurse Perspective highlighted the importance of APNPs having competencies to make holistic and family-centered decisions at a higher level. Conclusion: From the perspective of four APNPs, advanced pediatric nursing practice is beneficial to the patient, family, and professionals. The formal education varies in the countries studied, but the basic tenets of practice are the same. Family-centered practice and holism are basic to the APNP role. [ABSTRACT FROM AUTHOR]

Background: Diaries written for patients in the intensive care unit (ICU) are offered in many European countries. In Austria, ICU diaries have been relatively unknown, but since 2012, they have started to emerge. Aim: The aim of this study was to explore the extent and application of ICU diaries in Austria in 2015. Method: The study had a prospective multiple methods design of survey and interviews. All ICUs in Austria were surveyed in 2015 to identify which ICUs used diaries. ICUs using diaries were selected for semi‐structured key‐informant telephone interviews on the application of ICU diaries. Interviews were analysed by content analysis. Results: Of the 178 ICUs contacted, 13 had implemented ICU diaries. In all ICUs, diaries were sporadically introduced by a few dedicated nurses. Experiences of participating nurses can be summarized in two main themes: (a) the process of innovation and (b) the process of practice. Sub‐themes were: (i) inspiration, creativity and innovation and (ii) purpose, indications, responsibility, authorship, experience, negative reception, and post‐ICU practice. Individual nurses at each ICU found ways to organize and format ICU diaries while dealing with ambivalence and legal implications. Conclusion: The implementation of a new nursing intervention is an ongoing process. Being innovative and responsible can be challenging, especially in hierarchical team structures. We recommend that nurses work towards national standards for the diary concept in order to enable future research into the process and outcome of ICU diaries. Relevance to Clinical Practice: The implementation of ICU diaries in routine care requires an ongoing adaptive, reflective process. Nurses may experience innovation, leading to the development of their own, feasible adaptions and structures. [ABSTRACT FROM AUTHOR]

Aims and objectives: To explore nurse–patient interactions in relation to the mobilisation of nonsedated and awake, mechanically ventilated patients in the intensive care unit. Background: Lighter sedation has enabled the early mobilisation of mechanically ventilated patients, but little is known about the nurses' role and interaction with critically ill patients in relation to mobilisation. Design and methods: The study had a qualitative design using an ethnographic approach within the methodology of interpretive description. Data were generated in two intensive care units in Denmark, where a strategy of no sedation was applied. Participant observation was conducted during 58 nurse–patient interactions in relation to mobilisation between nurses (n = 44) and mechanically ventilated patients (n = 25). We conducted interviews with nurses (n = 16) and patients (n = 13) who had been mechanically ventilated for at least 3 days. The data were analysed using inductive, thematic analysis. The report of the study adhered to the COREQ checklist. Finding: We identified three themes: "Diverging perspectives on mobilisation" showed that nurses had a long‐term and treatment‐oriented perspective on mobilisation, while patients had a short‐term perspective and regarded mobilisation as overwhelming in their present situation. "Negotiation about mobilisation" demonstrated how patients actively negotiated the terms of mobilisation with the nurse. "Inducing hope through mobilisation" captured how nurses encouraged mobilisation by integrating aspects of the patient's daily life as a way to instil hope for the future. Conclusions: Exploring the nurse–patient interactions illustrated that mobilisation is more than physical activity. Mobilisation is accomplished through nurse–patient collaborations as a negotiated, complex and meaningful achievement, which is driven by the logic of care, leading to hope for the future. Relevance to clinical practice: The study demonstrated the important role of nurses in achieving mobilisation in collaboration and through negotiation with mechanically ventilated patients in the intensive care unit. [ABSTRACT FROM AUTHOR]

Abstract Background After discharge from the intensive care unit, patients and relatives struggle to rebuild their lives while suffering from fatigue and distress. Intensive care unit diaries written by relatives are a novel approach that may help relatives and patients process the critical illness experience together. Objectives To explore patients' and relatives' perceptions and use of a diary written by relatives for the critically ill patient. Design Hermeneutical-phenomenological interview study. Setting Two regional mixed surgical/medical intensive care units in a regional hospital. Participants 10 critically ill patients and 13 relatives. All participants were 18 years or older, all patients had undergone mechanical ventilation. Methods Dyadic, in-depth interviews conducted at 3–6 months and 8–16 months after discharge from the intensive care unit in 2015–2017. Interviews were analyzed using Ricoeur's theory of interpretation; a three-step process initiated by a naïve reading; followed by a structural analysis exploring the internal relations of the text, and finally, a critical interpretation to identify the most probable interpretation. Results Before sharing the intensive care unit diary, relatives had to feel able to give the diary to the patient, which meant separating themselves from the diary and being available for discussions with the patient. Likewise, the patients had to be prepared to receive the diary and to acknowledge relatives' efforts. Sharing the diary included interpreting the content of the diary, and developing a re-configured story based on the diary. Conclusion The diary written by relatives for the critically ill patient was fulfilled when the diary was shared between the authoring relative and patient and a re-configured story was developed. This enabled a strengthened relationship between patient and relative. Not sharing could be disappointing to the relative, but did not preclude discussion of the experience of critical illness. This study provides professionals with knowledge about supporting patients and relatives through intensive care unit diaries written by relatives. Relatives need guidance on when to share the diary with the patient and how to accept patient rejection. [ABSTRACT FROM AUTHOR]

Copyright of Journal of Advanced Nursing (John Wiley & Sons, Inc.) is the property of John Wiley & Sons, Inc. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Background: Knowledge about the organization and factors of importance to rehabilitation of veterans with lower limb amputation is sparse. The aim of this study was, therefore, to improve understanding of the influences of "military identity" on the organization of rehabilitation services and to investigate those factors influential in achieving successful rehabilitation, including interprofessional collaboration between different sectors involved in the rehabilitation of veterans with lower limb amputations. Methods: We used a qualitative exploratory design, triangulating interviews and participant observation. Data were generated using in-depth semi-structured interviews (n-6) exploring in-hospital and posthospital rehabilitation in Danish veterans after unilateral lower limb amputation due to trauma. We conducted four sessions of participant observation, during weekly post-hospitalization rehabilitation and included field notes in the dataset. Results: Two main themes emerged: "experiencing different identities" and "experiencing discontinuity in rehabilitation." The first theme illustrated how veterans actively shift between the identities of disabled person, wounded veteran and athlete according to the context. The second theme illustrated the frustration of negotiating military versus civilian mindsets during rehabilitation and lack of coordination between the public healthcare system, municipal services and the military. Conclusion: Veterans live with shifting identities after returning to civilian life, increasing their awareness of the transition from active service to a new life as a civilian. During rehabilitation, it is important to acknowledge the disparities between the military and civilian mindsets and to integrate the different sets of values, such as structure versus autonomy. [ABSTRACT FROM AUTHOR]

Abstract: Aim: The aim of this study was to explore the extent to which the qualitative and quantitative data converge and explain mechanisms and drivers of social inequality in cardiac rehabilitation attendance. Background: Social inequality in cardiac rehabilitation attendance has been a recognized problem for many years. However, to date the mechanisms driving these inequalities are still not fully understood. Design: The study was designed as a convergent mixed methods study. Methods: From March 2015—March 2016, patients hospitalized with acute coronary syndrome to two Danish regional hospitals were included in a quantitative prospective observational study (N = 302). Qualitative interview informants (N = 24) were sampled from the quantitative study population and half brought a close relative (N = 12) for dyadic interviews. Interviews were conducted from August 2015 to February 2016. Integrated analyses were conducted in joint displays by merging the quantitative and qualitative findings. Results: Qualitative and quantitative findings primarily confirmed and expanded each other; however, discordant results were also evident. Integrated analyses identified socially differentiated lifestyles, health beliefs, travel barriers and self‐efficacy as potential drivers of social inequality in cardiac rehabilitation. Conclusion: Our study adds empirical evidence regarding how a mixed methods study can be used to obtain an understanding of complex healthcare problems. The study provides new knowledge concerning the mechanisms driving social inequality in cardiac rehabilitation attendance. To prevent social inequality, cardiac rehabilitation should be accommodated to patients with a history of unhealthy behaviour and low self‐efficacy. In addition, the rehabilitation programme should be offered in locations not requiring a long commute. [ABSTRACT FROM AUTHOR]

Aims and objectives: To explore experiences and informational needs regarding sexual health in men and women with epilepsy or multiple sclerosis. Background: Sexual health and well‐being are dependent on access to comprehensive information about sexuality and good‐quality sexual health care in an environment that affirms and promotes sexual health. Design: The study had a qualitative explorative design using focus group methodology and framework analysis to capture the patient perspective. Methods: We strategically selected 26 participants at a neurological clinic at a university hospital in Denmark and conducted four homogeneous focus group interviews: women with epilepsy (n = 8), men with epilepsy (n = 7), women with multiple sclerosis (n = 5) and men with multiple sclerosis (n = 6). We used the framework method for analysis and initially developed a matrix of disease versus gender before the authors triangulated their views and decided on the final themes. Results: We identified four themes and nine subthemes. Our main findings included insights on the impact of ignorance regarding sexual rehabilitation, demonstrating the importance of information in patients with sexual dysfunction related to chronic neurologic disease. The study expanded our understanding of sexual activity in the unpredictable body of epilepsy and the progressively changing body of multiple sclerosis. The participants agreed that they would have taken a more constructive path to solve their sexual problems if they had been aware of common responses to their disease. Conclusions: Our study suggests that people with epilepsy or multiple sclerosis might be under‐informed regarding the impact of their disease on their sexual health. We have shown how knowledge deficits put people at risk for symptoms of isolation, guilt, frustration and depression. Patient information is a modifiable factor that, if improved, might increase the quality of life for this group of patients. Relevance to clinical practice: Implementation of improved patient information at the neurological clinic is recommended. [ABSTRACT FROM AUTHOR]

Social, educational and health related equality is an ideal in the Nordic welfare states. However studies have shown that wellpositioned patients achieve better treatment and more services, for example time and examinations, than others do. This article examines how patients and relatives mobilise resources in decision-making in a stroke unit. In particular, it focuses on the challenges in optimising the rehabilitation process faced by patients and relatives, and the strategies they use. Data were generated using participant observation and semi-structured interviews. Qualitative content analysis was applied to investigate the patients' and relatives' experiences of decision-making. We present a field-specific form of capital: An individual or a family's resources that are valued in the field of rehabilitation as physical, behavioural and cognitively embedded attitudes and practices. Rehabilitation capital consists of four closely interrelated components: Performative Participation (Cognitively Embedded Performance and Self-initiating Activities), Bodily Progression, Institutional Acceptance and Institutional Potential. It is a resource potentially benefitting patients and relatives during inpatient rehabilitation and may provide patients with an advantage, to ensure the best rehabilitation. The possession of Rehabilitation capital (high or low) contributes explanations for unequal practices and treatments at a micro-level in healthcare institutions. [ABSTRACT FROM AUTHOR]

Purpose: This study aimed to provide an understanding of the lived experience of rehabilitation in adults with traumatic brain injury (TBI) from hospital discharge up to four years post-injury. Materials and methods: We used a qualitative explorative design with semi-structured in-depth interviews. Twenty participants with TBI were included from a level I Trauma Center in Denmark at 1-4 years post-injury. Qualitative thematic analysis was applied for data analysis. Results: Three main themes emerged during analysis: A new life, Family involvement, and Rehabilitation impediments. These themes and their sub-themes described the patient perspective of TBI and rehabilitation post hospitalization. Participants reassessed their values and found a new life after TBI. Family caregivers negotiated rehabilitation services and helped the participant to overcome barriers to rehabilitation. Although participants were entitled to TBI rehabilitation, they had to fight for the services they were entitled to. Conclusion: Individuals with TBI found ways of coping after injury and created a meaningful life. Barriers to TBI rehabilitation were overcome with help from family caregivers rather than health care professionals. Future studies need to find ways to ease the burden on family caregivers and pave the way for more accessible rehabilitation in this vulnerable group of patients. [ABSTRACT FROM AUTHOR]

Background: Cardiac rehabilitation participation is an essential component of the contemporary management of coronary heart disease. However, patients with low socioeconomic position are less likely to attend the rehabilitation programme. Aim: We aimed to explore the effect of potential mediators between socioeconomic position defined by educational attainment and cardiac rehabilitation attendance. Methods: Prospective observational study of patients with acute coronary syndrome (N=302). Logistic regression and mediation analysis was conducted to explore mechanisms of non-attendance. Results: Thirty per cent attended full cardiac rehabilitation. Patients with low educational attainment, comorbidities, long commute to cardiac rehabilitation centre, and lone dwelling were less likely to attend full cardiac rehabilitation, whereas patients with high anxiety and depression score were more likely to attend full cardiac rehabilitation. Patients with low educational attainment had lower self-efficacy and longer commute compared with patients with high educational attainment. The potential mediators included in the study, however, did not have a significant mediation effect. Conclusion: Our study demonstrated a variety of mechanisms contributing to cardiac rehabilitation non-attendance. Further, the study demonstrated that non-attendance was especially related to the cardiac rehabilitation elements involving lifestyle modifications. However, the mechanisms explaining social inequality in full cardiac rehabilitation are still not fully understood. [ABSTRACT FROM AUTHOR]

Background: Delirium in the intensive care unit (ICU) has received more attention in the past decade. Early detection, prevention and treatment of delirium are important, and the most commonly used tool for delirium assessment is the Confusion Assessment Method for the ICU (CAM-ICU). Aim: The aim of this study was to identify nurses' and physicians' perceived professional barriers to using the CAM-ICU in Danish ICUs. Methods: This study uses a qualitative explorative multicentre design using focus groups and a semi-structured interview guide. Five focus groups with nurses (n=20) and four with physicians (n=14) were conducted. Strategic sampling was used to include participants with varying CAM-ICU experience at units, with variable implementation of the tool. Results: Using a hermeneutical approach, three main themes and nine sub-themes emerged. The main themes were (1) Professional role issues: CAM-ICU screening affected nursing care, clinical judgment and professional integrity; (2) Instrument reliability: nurses and physicians expressed concerns about CAM-ICU assessment in non-sedated patients, patients with multi-organ failure or patients influenced by residual sedatives/opioids; and (3) Clinical consequence: after CAM-ICU assessment, physicians lacked evidence-based treatment options, and nurses lacked physician acknowledgment and guidelines for disclosing CAM-ICU results to patients. Conclusion: In this study, ICU nurses and physicians raised a number of concerns regarding the use of the CAM-ICU for delirium detection. It might be necessary to revalidate the instrument as ICU care has changed in recent years, with lighter sedation and early mobilization of patients. We recommend that nurses and physicians receive more training in the use of the CAM-ICU to address some of the issues identified in our study. Relevance to clinical practice: There is a need for ongoing training and clearer guidelines on how to proceed with the delirium screening of non-sedated patients. [ABSTRACT FROM AUTHOR]

Background: The Danish public healthcare system provides comprehensive care based on the principle of equal access. However, it is well documented that patients with low socioeconomic position are less likely to participate in cardiac rehabilitation. More knowledge is needed to understand this phenomenon. The aim of the study was to explore the patient experience of barriers to completion of phase II cardiac rehabilitation, and to investigate the impact of socioeconomic factors on completion of cardiac rehabilitation. Methods: The study had a qualitative explorative design using semi-structured individual or dyadic interviews with patients (n = 24) and close relatives (n = 12). Informants were sampled from a quantitative prospective study of 302 patients with acute coronary syndrome and data were analyzed using the framework method. Results: Patients in different socioeconomic groups were challenged by a rigid and non-individualized rehabilitation program. A total of five themes were identified that might explain non-participation in cardiac rehabilitation: exclusion by time and place, exclusion by health beliefs, exclusion from counseling, exclusion by alienation, and exclusion of relatives. The themes were described in a matrix of socioeconomic factors of age, sex, education and employment. Conclusions: Patients in various socioeconomic subgroups felt excluded from cardiac rehabilitation for different reasons. This study supports earlier findings and provides examples of real-life issues that need to be addressed to prevent attrition and encourage participation. Equal access to cardiac rehabilitation can only be reached if the physical and psychological needs of patient and family are met by tailoring therapy to consider age, sex, education and employment groups. [ABSTRACT FROM AUTHOR]

Background There is a current trend towards lighter or no sedation of mechanically ventilated patients in the intensive care unit. The advantages of less sedation have been demonstrated as shorter duration of mechanical ventilation and reduced length of stay in the intensive care unit and hospital. Non-sedated patients are more awake during mechanical ventilation, but little is known about how this affects the intensive care patient. Aim To explore patients’ experiences of being awake during critical illness and mechanical ventilation in the intensive care unit. Design & methods The study was based on Interpretive Description, an applied inductive, qualitative approach with an ethnographic exploration of the patient experience. A longitudinal perspective was obtained through 13 months of fieldwork followed by two patient interviews after intensive care and after hospital discharge. Data were analyzed using thematic analysis. Setting & participants The fieldwork was conducted in two intensive care units at a university hospital in Denmark, where the no sedation strategy for mechanically ventilated patients was implemented. Twenty-eight patients were observed in the intensive care unit. Twenty patients, who had been awake for most of the time on mechanical ventilation, were interviewed during the first week after discharge from intensive care. Thirteen of these patients were interviewed again two to four months after discharge. Findings Three themes were identified: “A sense of agency”, “The familiar in the unfamiliar situation” and “Awareness of surrounding activities”. Patients had the ability to interact from the first days of critical illness and a sense of agency was expressed through initiating, directing and participating in communication and other activities. Patients appreciated competent and compassionate nurses who were attentive and involved them as individual persons. Initiatives to enhance familiar aspects such as relatives, personal items and care, continuity and closeness of nurses contributed to the patients' experience of feeling safe and secure in the unfamiliar setting. Patients were aware of the surrounding activities and felt powerless when ignored by the staff and were affected when witnessing fellow patients’ suffering. Conclusion Being awake during mechanical ventilation entailed new opportunities and challenges for critically ill patients. Patients found themselves at the interface between agency and powerlessness as they were able to interact, yet were bound by contextual factors such as bodily weakness, technology, spatial position and relational aspects. This knowledge is important to develop patient-centered nursing practice in the context of lighter sedation. [ABSTRACT FROM AUTHOR]

Background:While the increasing number of people surviving cancer is promising, the long-term health effects warrant broad, innovative interventions. We investigated the feasibility and acceptability of a 24-week intervention called ‘Active Book Club’ comprising audio book listening, pedometer walking and supervised book club meetings. Material and methods:An exploratory and descriptive design was applied. Qualitative data included baseline and post-intervention focus group interviews as well as post-intervention individual interviews. The study also included data on retention, attendance, and adherence. Seventeen self-referred cancer survivors with various oncological and sociodemographic backgrounds were included. Results:Eight (47%) participants completed the entire intervention. Their median attendance at the book club meetings was eight [interquartile range (IQR) 6–9] of nine possible, and they reached the walking step goal in a median of 11 (IQR 7–12) of the first 12 weeks, and seven (IQR 1–10) of the last 12 weeks. The qualitative analysis revealed five themes including:Motivation and expectations(i.e. reasons for enrollment),Attentive listening(i.e. experiences of the audio book format),Affected by the story(i.e. experiences of the content of the books),Group involvement(i.e. experiences of the book club meetings) andWalking regularly(i.e. experiences of the walking program). Overall, findings revealed that while audio books may bring new meaning to physical activity and serve as a relief from own concerns, certain stories may affect some individuals negatively. The substantial dropout rate, however, suggested that modification is necessary and that patient involvement in choice of literature may be critical to enhance acceptability. Conclusion:The ‘Active Book Club’ represents a novel psychosocial intervention potentially supporting physical activity adoption and mental health in cancer survivors. However, several issues related to feasibility and acceptability including choice of literature genre, format and supervision of book club meetings need to be considered before larger scale clinical trials are initiated. [ABSTRACT FROM PUBLISHER]

Aims and objectives To describe the content of former intensive care unit patients' memories of delusions. Background Intensive care unit patients often have strange and frightening experiences during the critical stage of illness. Earlier studies have provided small-sample in-depth descriptions of patient experiences in intensive care unit, but large-scale studies are also needed to inform intensive care unit follow-up. Methods The study had a qualitative design using phenomenological hermeneutic analysis inspired by Ricoeur's interpretive theory. Patients were assessed with Confusion Assessment Method of the Intensive Care Unit for delirium in intensive care unit, and after discharge, memories of delusions were described by 114 of 325 patients in face-to-face (after two weeks) and telephone interviews (after two and six months) using the Intensive Care Unit Memory Tool. Results Four themes emerged: the ever-present family, dynamic spaces, surviving challenges and constant motion. Memories of delusions were a vivid mix of fact and fiction, demonstrating dynamic shifts in time, place and motion, but not dependent on the presence of delirium assessed by Confusion Assessment Method of the Intensive Care Unit. Conclusions Analysis based on Ricoeurian phenomenological hermeneutics provided insights into themes in intensive care unit patients' memories of delusions. More studies are needed to understand the meaning of memories of delusions, the commonality of themes and the association between delusions and delirium after an intensive care unit stay. Relevance to clinical practice Understanding patients' memories of delusions is beneficial to nurses caring for patients that are anxious, upset or agitated. It opens a window to the world of the patient who is unable to communicate due to intubation and general weakness. We recommend the provision of nurse-led intensive care unit follow-up enabling patients to describe and discuss their intensive care unit experiences. [ABSTRACT FROM AUTHOR]

Background: Family-centred care (FCC) is acknowledged as fundamental to supporting parents of premature infants, and communication is central to this practice. Accordingly, nurses need good communication skills. GFCC is an intervention developed to improve nurse-parent communication in the neonatal intensive care unit. This intervention helps nurses to realize person-centred communication as an approach to optimize contemporary practice. Aims and objectives: Aims of this article were (a) to explore how parents of premature infants experience guided family-centred care (GFCC), and (b) to compare how parents receiving GFCC versus standard care (SC) describe nurse-parent communication in the neonatal intensive care unit. Design: Our qualitative study had a descriptive and comparative design using semi-structured interviews to explore the parent's experience of GFCC. Methods: We conducted 10 dyad interviews with parents (n=20) and two individual interviews with mothers of premature infants (n=2). Parents in the intervention group versus SC group were 13 versus 9. Thematic analysis was applied. Findings: GFCC was generally experienced as supportive. Three interrelated themes were identified that illustrated how the intervention helped parents cope as persons, parents and couples: (a) discovering and expressing emotions, (b) reaching a deeper level of communication, and (c) obtaining mutual understanding. In contrast, SC communication was more superficial and less structured. Factors such as inaccessibility of nurses, inability to ask for assistance and parent popularity impaired successful communication. Conclusion and implications for practice: Our study suggested that compared to SC, GFCC provided structured delivery of supportive communication between nurses and parents of premature infants. The intervention promoted the discovery of the parents' individual preferences and concerns, which enabled more focused communication, and set the stage for better nurse-parent and parent-parent understanding. We recommend GFCC as a method to improve communication in the neonatal intensive care unit. [ABSTRACT FROM AUTHOR]

Introduction. Long-term psychological consequences of critical illness are receiving more attention in recent years.The aim of our study was to assess the correlation of ICU-delirium and symptoms of posttraumatic stress disorder (PTSD) anxiety and depression after ICU-discharge in a Danish cohort. Methods. A prospective observational cohort study assessing the incidence of delirium in the ICU. Psychometrics were screened by validated tools in structured telephone interviews after 2 months (n = 297) and 6 months (n = 248) after ICU-discharge. Results. Delirium was detected in 54% of patients in the ICU and symptoms of PTSD in 8% (2 months) and 6% (6 months) after ICU-discharge. Recall of ICU stay was present in 93%. Associations between ICU-delirium and post-discharge PTSD-symptoms were weak and insignificant.Memories of delusions were significantly associated with anxiety after two months. Remaining associations between types of ICU-memories and prevalence of post-discharge symptoms of PTSD, anxiety, and depression were insignificant after adjusting for age. Incidence of ICU-deliriumwas unaffected by preadmission use of psychotropic drugs. Prevalence of PTSD-symptoms was unaffected by use of antipsychotics and sedation in the ICU. Conclusion. ICU-delirium did not increase the risk of PTSD-symptoms at 2 and 6 months after ICU discharge. [ABSTRACT FROM AUTHOR]

Aim To explore the challenges and caring activities of spouses of intensive care unit survivors during the first year of patient recovery. Background Every year, millions of people globally are discharged from an intensive care unit after critical illness to continue treatment, care and rehabilitation in general hospital wards, rehabilitation facilities and at home. Consequently, millions of spouses become informal caregivers. Little is known, however, about the concrete challenges spouses face in post-intensive care unit everyday life. Design Explorative, qualitative grounded theory study. Methods Participants were spouses of intensive care unit survivors. The study was undertaken in Denmark in 2009-2010. Data consisted of 35 semi-structured dyad interviews at 3 and 12 months post-intensive care unit discharge, two group interviews with patients and two with spouses. Findings 'Shifting their role from spouse to caregiver and back' was identified as the core category of the study. The role shifts progressed in a dynamic process involving four elements: (1) committing to caregiving; (2) acquiring caregiving skills; (3) negotiating level of caregiving and (4) gradually leaving the caregiver role. Post- ICU caregiving comprised five patient dimensions: observing, assisting, coaching, advocating and managing activities. Conclusions Spouses play a vital and multifaceted role in post-intensive care unit recovery. The findings can inform healthcare professionals in their efforts to prepare intensive care unit patients' families for the time following intensive care unit and hospital discharge. Hospital staff, rehabilitation experts and primary care professionals must acknowledge spouses' important contribution from intensive care unit admission throughout recovery. [ABSTRACT FROM AUTHOR]

The article offers information on a study that describe the post-operative patient response to transcatheter aortic valve implantation (TAVI) on the evening of the procedure. The study used prospective, comparative observational study triangulating nurse assessment and structured interviews. It suggests that patients older than 80 years did as well as the younger patients.

ABSTRACT Background Diaries written for patients in the Intensive Care Unit ( ICU) have been used in many European countries since the early 1990s to support patients and their relatives in their understanding of the ICU experience. ICU diaries have been introduced in Germany since 2008 via the internet, newsletters, newspapers, lectures and publications in German nursing journals. Aim The aim of the study was to update our knowledge of the extent and application of ICU diaries in Germany in 2014. Design The study had a prospective mixed methods multicenter design. Method All 152 ICUs in the two German federal states of Baden-Württemberg and Schleswig-Holstein were surveyed to identify units that had implemented ICU diaries. An additional 69 ICUs from other parts of Germany were included in the survey. We excluded diaries used in neonatal ICUs. Out of 43 units using diaries 14 were selected for semi-structured key-informant telephone-interviews on the application of ICU diaries. Results According to the survey, 8 out of 152 ICUs in the two federal states of Baden-Württemberg and Schleswig-Holstein had implemented ICU diaries and another six were planning implementation. Another 35 ICUs in other areas of Germany had implemented diaries and three units were planning to do so. Interviews were conducted with nurses at 14 selected ICUs. Informants reported successful adaption of the diary concept to their culture, but variability in application. No units were identified where all nursing staff participated in keeping ICU diaries. Conclusion Six years after the introduction of ICU diaries, ICU nurses in Germany are becoming familiar with the concept. Nursing shortage and bureaucratic challenges have impeded the process of implementation, but the adaption of ICU diaries to German conditions appears to be successful and is still in progress. Relevance to Clinical Practice Implementation of ICU diaries is feasible after adjusting for cultural and legal issues. [ABSTRACT FROM AUTHOR]

Aims and objectives To investigate the effects of delirium in the intensive care unit on health-related quality of life, healthcare dependency and memory after discharge and to explore the association between health-related quality of life and memories, patient diaries and intensive care unit follow-up. Background Up to 83% of intensive care unit patients experience delirium. In addition to increased risk of mortality, morbidity and cognitive impairment, the experience itself is unpleasant. A number of studies have focused on memories associated with delirium, but the association between delirium, memories and health-related quality needs further investigation. Design We used an observational multicentre design with telephone interviews. Methods Adult intensive care unit patients ( n = 360) were consecutively recruited and interviewed using the intensive care unit- Memory Tool one week after intensive care unit. Interviews were repeated after two and six months and supplemented with Short Form-36 and the Barthel Index. Results Delirium was detected in 60% of the patients in our study, and delirious patients had significantly fewer factual memories and more memories of delusion than nondelirious patients up to six months postintensive care unit discharge. Delirium, memories and intensive care unit diaries with follow-up did not affect health-related quality of life and healthcare dependency. Memories of delusions might have an impact on patients assessed as nondelirious. Conclusions More than half of the patients in intensive care unit experience delirium, which is associated with fewer factual memories and more memories of delusions. Short Form-36 might not be sensitive to delirium-related outcomes. Future research should include the development of better assessment tools to determine the long-term consequences of intensive care unit delirium. Relevance to clinical practice We recommend regular assessment to prevent, detect and treat delirium. We also recommend an intensive care unit follow-up programme providing an opportunity for postintensive care unit patients, particularly previously delirious patients, to discuss their memories and experiences with intensive care unit professionals. [ABSTRACT FROM AUTHOR]

Background: As more patients with cardiac failure are being bridged to transplantation with left ventricular assist devices (LVAD), more insight into the lives of their close relatives is needed. Aims: To explore the experiences and coping strategies of LVAD patients' close relatives during bridge to transplantation and to generate theory. Methods: The study had a qualitative design using grounded theory and NVivo version 9 to analyse one paired interview (n =2) and one group interview (n =5) with LVAD patients' close relatives. Results: The main finding was the importance of supporting the close relatives who support the LVAD patient. The core category was support and self-preservation in close relatives. We constructed the support cascade model illustrating support from close relatives to the patient (main obligation) and to other family members (other obligations), and support from personal and professional relations to the close relatives. Conclusions: Support from close relatives potentially benefits patients, family, healthcare providers, and society in general. Our study highlighted the importance of supporting the close relatives supporting the patient and we have suggested some modifiable factors to enable social support and ease transitions in the illness trajectory. We suggest that awareness of social support systems might be beneficial in comprehensive care planning for LVAD patients and their close relatives. [ABSTRACT FROM AUTHOR]

EGEROD I, STORLI SL and ÅKERMAN E. Nursing Inquiry 2011; 18: 235-246 Intensive care patient diaries in Scandinavia: a comparative study of emergence and evolution Critical illness and intensive care therapy are often followed by psychological problems such as nightmares, hallucinations, delusions, anxiety, depression, and symptoms of posttraumatic stress. Intensive care patient diaries have been kept by nurses and the patients' family since the early 1990s in the Scandinavian countries to help critically ill patients come to terms with their illness after hospital discharge. The aim of the study was to describe and compare the emergence and evolution of intensive care patient diaries in Denmark, Norway, and Sweden. The study had a comparative international design using secondary analysis of qualitative data generated by key-informant telephone interviews with intensive care nurses ( n = 114). The study showed that diaries were introduced concurrently in the three Scandinavian countries as a grass-roots initiative by mutual cross-national inspiration. The concept has evolved from a pragmatic practice to an evidence-based domain of inquiry propelled by academically prepared nurses. Several schools of thought were identified in our study: diaries as (i) a therapeutic instrument, (ii) an act of caring, (iii) an expression of empathy, and (iv) a hybrid of the above. Diaries have the potential to fulfill the existential needs of patients who struggle to make sense of their experiences and construct their own illness narrative. [ABSTRACT FROM AUTHOR]

Basic stimulation (BS) is a multimodal approach used in the intensive care unit (ICU) to help patients to perceive, move, communicate and learn. The concept was developed in Germany in the 1970s to help multi-handicapped children. It was adapted to nursing in the 1980s, and to critical care nursing in the 1990s. Little is known about the use of BS outside of Germany although it has been gaining momentum in German-speaking countries as well as Scandinavia. The aim of the present study is to describe the extent and application of BS at Danish ICUs in 2006. The study had a prospective, descriptive, qualitative, multicentre design. Data were generated from key-informant telephone interviews (n = 10). This study has shown that BS is dependent upon the personal interest of individual nurses. At most units the concept is rarely used, or used by only few practitioners, for only few patients, or only few of the elements of the technique are applied. The tenets of BS are similar to those of conventional nursing, and in some cases to health care in general. The concept shows promising potential for critical care nursing. It has, however, been introduced unsystematically at Danish ICUs and needs more management support, systematic implementation and clinical research. [ABSTRACT FROM AUTHOR]