Objectives: The impact of dental occlusion on the experiences of head and neck cancer patients and their oral, social and psychological functioning has been sparsely investigated. There is a lack of knowledge regarding the experience of tooth loss and dentures among patients treated for head and neck cancer. The aim of this study was to describe the experiences of head and neck cancer patients of prophylactic tooth extractions and temporary removable dentures, 6 months after radiotherapy treatment.

Material and methods: An individual interview with 25 patients 6 months after radiotherapy was subjected to a qualitative content analysis.

Results: Two categories, Impaired oral function and Belief in the future, and seven subcategories described the patients' experiences of temporary removable dentures during the first 6 months after prophylactic tooth extractions. The temporary removable dentures affected the patients' ability to chew, swallow and speak, caused pain, and were experienced as an enemy. Despite that, the patients were hopeful and had a wish for recovery, which gave them the energy to live.

Conclusion: Prophylactic tooth extractions and temporary removable dentures 6 months after radiotherapy treatment affect head and neck cancer patients' recovery and everyday life. However, they have the will to take on these challenges, pertaining not only to themselves, but also to relatives and health professionals. At the individual level, the patient needs individualized professional support to get through the arduous procedure, from the acute situation until the end of the rehabilitation phase.

The use of lighting simulation tools has been growing over the past years which has improved lighting analysis. While computer simulations have proven to be a viable tool for analyzing lighting in physical environments, they have difficulty in assessing the effects of light on occupant’s perception. Evidence-based design (EBD) is a design method that is gaining traction in building design due to its strength in providing means to assess the effects of built environments on humans. The aim of this study was to develop a conceptual framework for integrating EBD with lighting simulation tools. Based on a literature review, it was investigated how EBD and lighting simulation can be combined to provide a holistic lighting performance evaluation method. The results show that they can mutually benefit from each other. EBD makes it possible to evaluate and/or improve performance metrics by utilizing user feedback. On the other hand, performance metrics can be used for a better description of evidence, and to analyze the effects of lighting with more details. The results also show that EBD can be used to evaluate light simulations to better understand when and how they should be performed. A framework is presented for integration of lighting simulation and EBD

Purpose: The purpose of this study was to elucidate how nurses perceive their role in caring for children as relatives to a parent with a serious physical illness.

Method: A qualitative explorative design with focus group interviews was used. In total, 22 nurses working at one neurological, one haematological and two oncological wards were interviewed. The transcripts from the interviews were analysed in steps in accordance with inductive qualitative content analysis.

Results: This study revealed six variations in how nurses perceived their role in the encounter with child relatives, ranging from being convinced that it is not their responsibility to being aware of the children's situation and working systematically to support them.

Conclusion: Nurses should consider whether their patients have children who might be affected by their parent's illness. The nurses' self-confidence when meeting these children must be increased by education in order to strengthen their professional role. Furthermore, guidelines on how to encounter child relatives are required.

Background The operating room nurse is, among other things, responsible for patient safety and maintaining an aseptic environment. For hygienic reasons unnecessary traffic in the operating room should be avoided, which may mean that the operating room nurse works long shifts without relief. Operating departments are usually separated, where there might be no daylight opportunities in the operating room. The purpose of the study was to describe operating room nurses' experiences of limited access to daylight in the workplace. Method Qualitative design with four semi-structured focus groups of totally 15 operating room nurses. The analysis was performed with a content analysis with an inductive approach. Results The study generated two main categories, difference in light and contact with the outer world. Operating room nurses felt that daylight affected them differently from the light from lamps, where daylight was considered important for experiencing well-being. Daylight could lead to a sensation of joy but also increased awareness and energy which seemed to improve the ability to perform at work. The limited access to daylight contributed to fatigue and led to an internal stress that affected the nurses even after work. Having opportunities to look out through windows under a workday was important to experience contact with the outside world and created a sense of time. Conclusion To look out can reduce the feeling of being trapped in the closed context that the operating department entails. It can also lead to increased well-being and comfort in the workplace. We consider that daylight is an important component in the physical work environment that needs to be taken into consideration in further research as well as in new construction of operations departments.

Objective: The objective of this study was to evaluate the effects of the decision support tool (DST) on the assessment of the acutely ill or injured out-of-hospital patient.

Methods: This study included systematic reviews of randomized controlled trials (RCT) where the DST was compared to usual care in and out of the hospital setting. The databases scanned include: (1) Cochrane Reviews (up to January 2010); (2) Cochrane Controlled Clinical Trials (1979 to January 2010); (3) Cinahl (1986 to January 2010); and (4) Pubmed/Medline (1926 to January 2010). In addition, information was gathered from related magazines, prehospital home pages, databases for theses, conferences, grey literature and ongoing trials.

Results: Use of the DST in prehospital care may have the possibility to decrease “time to definitive care” and improve diagnostic accuracy among prehospital personnel, but more studies are needed.

Conclusions: The amount of data in this review is too small to be able to draw any reliable conclusions about the impact of the use of the DST on prehospital care. The research in this review indicates that there are very few RCTs that evaluate the use of the DST in prehospital care.

Introduction: Prehospital emergency medicine is a challenging discipline characterized by a high level of acuity, a lack of clinical information and a wide range of clinical conditions. These factors contribute to the fact that prehospital emergency medicine is a high-risk discipline in terms of medical errors. Prehospital use of Computerized Decision Support System (CDSS) may be a way to increase patient safety but very few studies evaluate the effect in prehospital care. The aim of the present study is to evaluate a CDSS.

Methods: In this non-blind block randomized, controlled trial, 60 ambulance nurses participated, randomized into 2 groups. To compensate for an expected learning effect the groups was further divided in two groups, one started with case A and the other group started with case B. The intervention group had access to and treated the two simulated patient cases with the aid of a CDSS. The control group treated the same cases with the aid of a regional guideline in paper format. The performance that was measured was compliance with regional prehospital guidelines and On Scene Time (OST).

Results: There was no significant difference in the two group's characteristics. The intervention group had a higher compliance in the both cases, 80% vs. 60% (p < 0.001) but the control group was complete the cases in the half of the time compare to the intervention group (p < 0.001).

Conclusion: The results indicate that this CDSS increases the ambulance nurses' compliance with regional prehospital guidelines but at the expense of an increase in OST.

Background

Prehospital work is accomplished using guidelines and protocols, but there is evidence suggesting that compliance with guidelines is sometimes low in the prehospital setting. The reason for the poor compliance is not known. The objective of this study was to describe how guidelines and protocols are used in the prehospital context.

Methods

This was a single-case study with realistic evaluation as a methodological framework. The study took place in an ambulance organization in Sweden. The data collection was divided into four phases, where phase one consisted of a literature screening and selection of a theoretical framework. In phase two, semi-structured interviews with the ambulance organization's stakeholders, responsible for the development and implementation of guidelines, were performed. The third phase, observations, comprised 30 participants from both a rural and an urban ambulance station. In the last phase, two focus group interviews were performed. A template analysis style of documents, interviews and observation protocols was used.

Results

The development of guidelines took place using an informal consensus approach, where no party from the end users was represented. The development process resulted in guidelines with an insufficiently adapted format for the prehospital context. At local level, there was a conscious implementation strategy with lectures and manikin simulation. The physical format of the guidelines was the main obstacle to explicit use. Due to the format, the ambulance personnel feel they have to learn the content of the guidelines by heart. Explicit use of the guidelines in the assessment of patients was uncommon. Many ambulance personnel developed homemade guidelines in both electronic and paper format. The ambulance personnel in the study generally took a positive view of working with guidelines and protocols and they regarded them as indispensable in prehospital care, but an improved format was requested by both representatives of the organization and the ambulance personnel.

Conclusions

The personnel take a positive view of the use of guidelines and protocols in prehospital work. The main obstacle to the use of guidelines and protocols in this organization is the format, due to the exclusion of context knowledge in the development process.

To suffer from kidney failure requiring dialysis is a major setback on the patient’s life situation. The trend in dialysis care is that the patients should be increasingly involved in their own dialysis treatment. The aim of this study was to illustrate the patients’ experiences of participation in their own dialysis treatment. A qualitative approach was chosen and the study consists of nine narrative interviews with patients in self-care dialysis who had hemodialysis or peritoneal dialysis at two different hospitals. The results are categorized into the areas of safety and freedom. In order to feel safe the patients must have good knowledge of their disease and dialysis treatment. Patients experience freedom when they participate in their own dialysis treatment and may manage their dialysis schedule. The result also shows that the patients perceive themselves to be healthier when they are able to perform their own dialysis. The major challenge for today’s dialysis care is to involve the patients more in their own treatment and to offer them greater flexibility.

Objective

Evidence supports the recommendation for follow-up session(s) for patients after discharge from an intensive care unit (ICU). The aim of these follow-up sessions is to allow patients to express and discuss their experiences and problems following their time in an ICU. To optimise the knowledge gained from the follow-up session experience, it is necessary to describe how patients experience these sessions. The aim of this study was to describe how ICU-patients, experience a follow-up session.

Design/setting

This study adopted a qualitative design utilising semi-structured interviews, and which examined the experiences of seven men and five women. Qualitative content analysis was utilised.

Findings

The participants stated that the information gained from these sessions, which had previously seemed unclear to some of them, was, on the whole, now clarified and confirmed. A discernible difference was found between participants who were cared for on a general ward and those who were cared for on a rehabilitation ward and also were offered a meeting with a counsellor, following discharge their from the ICU. The findings also indicated that participants who were not offered psychosocial support showed a greater need for a follow-up session.

Conclusion

This study has highlighted the need for increasing collaboration between intensive care staff and staff in other units to provide support to this patient group in order to reduce their suffering post intensive care experience.

Aim: The overall aim of this thesis was to acquire knowledge about whether tactile touch as a complementary method can (i) promote comfort and (ii) reduce stress reactions during care in an intensive care unit (ICU) Method: In Paper I, five nurses with a touch therapist training were interviewed about their experiences of preparation before giving tactile touch in an ICU. To analyse the meaning of preparation as a phenomenon, Giorgi’s descriptive phenomenological approach was used. In Paper II and III a randomised controlled trial was set up to investigate the effects of a five-day tactile touch intervention on patients’ oxytocin levels in arterial blood (II), on patients’ blood pressure, heart rate and blood glucose level, and on patients’ levels of anxiety, sedation and alertness (III). Forty-four patients were randomised to either an intervention group (n = 21) or a control group (n = 23). Data were analysed with non-parametric statistics. In Paper IV, six patients who had received the tactile touch intervention were interviewed to illuminate the experience of receiving tactile touch during intensive care. To gain a deeper understanding of the phenomenon and to illuminate the meaning, Ricoeur’s phenomenological hermeneutical method, developed by Lindseth and Norberg, was used. Findings: The nurses need four constituents (inner balance, unconditional respect for the patients’ integrity, a relationship with the patient characterized by reciprocal trust and a supportive environment) to be prepared and go through the transition from nurse to touch therapist (I). In the intervention study, no significant differences were shown for oxytocin levels between intervention and control group over time or within each day (II). There were significantly lower levels of anxiety for patients in the intervention group. There were no significant differences between the intervention and control groups for blood pressure, heart rate, the use of drugs, levels of sedation or blood glucose levels (III). The significance of receiving tactile touch during intensive care was described as the creation of an imagined room along with the touch therapist. In this imagined room, the patients enjoyed tactile touch and gained hope for the future (IV). Conclusion: Nurses needed internal and external balance to be prepared for providing tactile touch. Patients did not notice the surroundings as much as the nurses did. Patients enjoyed the tactile touch and experienced comfort. The impact on stress parameters were limited, except for levels of anxiety which declined significantly. The results gave some evidence for the benefit of tactile touch given to patients in intensive care.

Vetenskaplig teori och metod är ett heltäckande stöd genom hela din högskole­utbildning avseende vetenskapliga kunskaper med examens­arbetet som mål. Den fungerar som en ständig kunskapskälla och uppslagsverk samt ger vägledning avseende metod, inför vetenskaplig granskning, sammanställning, presentation och publicering av det färdiga examensarbetet.

Till denna tredje upplaga av boken har kapitel om tematisk analys, diskursanalys och Delfimetoden lagts till. Samtliga kapitel har genomgått omfattande revideringar med nya exempel och några kapitel har fått nya författare, vilket medfört helt nya versioner av kapitlen. Dessutom finns nu instuderingsfrågor till varje kapitel.

Vetenskaplig teori och metod vänder sig främst till studenter på grundläggande och avancerad nivå inom omvårdnad, vårdvetenskap, socialt arbete, fysioterapi och arbetsterapi.

Tactile touch is a complementary therapy that is rarely undertaken in intensive care units (ICUs) in Sweden. This study was a part of a larger project that examines whether tactile touch can relieve the suffering of patients in the ICU. The aim of this study was to describe nurses’ lived experience of preparation before giving tactile touch in an ICU. Four assistant nurses and one registered nurse, each with diplomas in tactile touch working at three different ICUs in Sweden, participated in the study. A phenomenological approach was chosen to achieve experience-based and person-centred descriptions. Data were collected through interviews and analysed following Giorgi's method. The main finding was that before providing tactile touch, the nurses needed to add the new role as touch therapists, to their professional one. The essential aspect being the transition from nurse to touch therapist. Findings included a general structure, with four constituents; a sense of inner balance, an unconditional respect for the patients’ integrity, a relationship with the patient characterised by reciprocal trust, and a supportive environment. Furthermore, the study underlines the difficulties to integrate a complementary caring act, such as tactile touch, in a highly technological environment.

Aim.  To explore the effects of five-day tactile touch intervention on oxytocin in intensive care patients. The hypotheses were that tactile touch increases the levels of oxytocin after intervention and over a six-day period.

Background.  Research on both humans and animals shows a correlation between touch and increased levels of oxytocin which inspired us to measure the levels of oxytocin in arterial blood to obtain information about the physiological effect of tactile touch.

Design.  Randomised controlled trial.

Method.  Forty-four patients from two general intensive care units, were randomly assigned to either tactile touch (n = 21) or standard treatment – an hour of rest (n = 23). Arterial blood was drawn for measurement of oxytocin, before and after both treatments.

Results.  No significant mean changes in oxytocin levels were found from day 1 to day 6 in the intervention group (mean −3·0 pM, SD 16·8). In the control group, there was a significant (p = 0·01) decrease in oxytocin levels from day 1 to day 6, mean 26·4 pM (SD 74·1). There were no significant differences in changes between day 1 and day 6 when comparing the intervention group and control group, mean 23·4 pM (95% CI −20·2–67·0).

Conclusion.  Our hypothesis that tactile touch increases the levels of oxytocin in patients at intensive care units was not confirmed. An interesting observation was the decrease levels of oxytocin over the six-day period in the control group, which was not observed in the intervention group.

Relevance to clinical practice.  Tactile touch seemed to reduce the activity of the sympathetic nervous system. Further and larger studies are needed in intensive care units to confirm/evaluate tactile touch as a complementary caring act for critically ill patients.

The study aimed to investigate the effects of a five-day tactile touch intervention in order to find new and unconventional measures to moderate the detrimental influence of patients’ stressors during intensive care. The hypothesis was that tactile touch would decrease stress indicators such as anxiety, glucose metabolism, blood pressure, heart rate and requirements of sedative drugs and noradrenalin. A randomized controlled trial was undertaken with 44 patients, which were assigned either to tactile touch or standard treatment (a rest hour). Observations of the stress indicators were made before, during and after the intervention or standard treatment. The study showed that tactile touch led to significantly lower levels of anxiety. The circulatory parameters suggested increased circulatory stability indicated by a reduction in noradrenalin requirement. The results need to be further validated through studies with larger sample sizes.

Background: The supervision process is characterized by differences between the supervisors’ and the students’ expectations before the start of writing a bachelor thesis as well as after its completion. A review of the literature did not reveal any scientifically tested questionnaire for evaluating nursing students’ expectations of the supervision process when writing a bachelor thesis.

Objectives: The aim of the study was to determine the construct validity and internal consistency reliability of a questionnaire for measuring nursing students’ expectations of the bachelor thesis supervision process.

Design & Methods: The study had a developmental and methodological design carried out in four steps including construct validity and internal consistency reliability statistical procedures: construction of the items, assessment of face validity, data collection and data analysis.

Settings & Participants: This study was conducted at a university in southern Sweden, where students on the “Nursing student thesis, 15 ECTS” course were consecutively selected for participation. Of the 512 questionnaires distributed, 327 were returned, a response rate of 64%.

Results: Five factors with a total variance of 74% and good communalities, ≥0.64, were extracted from the 10-item STQ. The internal consistency of the 10 items was 0.68. The five factors were labelled: The nature of the supervision process, The supervisor's role as a coach, The students’ progression to self-support, The interaction between students and supervisor and supervisor competence.

Conclusions: A didactic, useful and secure questionnaire measuring nursing students’ expectations of the bachelor thesis supervision process based on three main forms of supervision was created.

Touch has been a part of the healing process in many civilisations and cultures throughout the centuries. Nurses frequently use touch to provide comfort and reach their patients. The aim of this study was to illuminate the meaning of receiving tactile touch when being cared for in an intensive care unit. Tactile touch is a complementary method including the use of effleurage, which means soft stroking movements along the body. The context used to illuminate the meaning of receiving tactile touch was two general intensive care units (ICUs). Six patients, who have been cared for in the two ICUs, participated in the study. A phenomenological–hermeneutical method based on the philosophy of Ricoeur and developed for nursing research by Lindseth and Norberg [Lindseth A, Norberg A. A phenomenological hermeneutical method for researching lived experience. Scandinavian Journal of Caring Sciences, 2004;18:145–53] was chosen for the analysis. Data consisted of narratives, which were analysed in three recurring phases: naïve understanding, structural analyses and comprehensive understanding. Two main themes were found: being connected to oneself and being unable to gain and maintain pleasure. The comprehensive understanding of receiving tactile touch during intensive care seems to be an expression of enjoying tactile touch and gaining hope for the future. This study reveals that it is possible to experience moments of pleasure in the midst of being a severely ill patient at an ICU and, through this experience also gain hope.

Background: The way health care professionals touch patients and relatives in the intensive care unit plays a significant role. A negative feeling can be caused by being touched in the wrong way, this is why a holistic approach with respect for the patient is important for the ability to make the patient and their relatives feel secure, avoiding unnecessary suffering.

Aim: The aim of the study was to describe the meaning of caring touch that is given in the ICU from the health care professionals perspective.

Method: Qualitative interview study with health care professionals in the intensive care unit, analysed using inductive content analysis, resulting in two themes and four main categories.

Findings: Two themes emerged: Imperative touch and emotional touch and four main categories: touch as a natural tool, create a prerequisite for touch, empathetic touch and conversant touch.

Conclusion: Caring touch can be used as a natural tool in the daily work in order to bring comfort and calm to the patient in the intensive care unit.

Aim: To evaluate factors associated with parental separation during the parenthood transition.

Design: Prospective, longitudinal and explorative.

Methods: This is a quantitative longitudinal study of N784 subjects throughout the pregnancy journey with multivariate regression analysis of survey data derived from three validated measurement scales; the Sense of Coherence scale, the Multidimensional Scale of Perceived Social Support and the Perceived Quality of the Dyadic Relationship scale conducted 2014-2016.

Results: N17 participants separated at 2 years. Parental separation was significantly greater for those women and partners with low or changing sense of coherence, perceived social support and perceived quality of the parental-couple relationship indexes. Partners with a change in sense of coherence (p: .003) and perceived quality of the parental-couple relationship (p: .020) between 1 week and 2 years were at greater risk for separation. Attending professional preparatory support with a partner for women (p: .013) and attending the "Inspirational Lecture" for partners (p: .046) were, to a lesser extent, associated with a risk of parental separation.

Aims

To continuing the quest of the concept of transition in nursing research and to explore how the concept of transition is used in occupational therapy, oral health and social work as well as in interdisciplinary studies in health and welfare, between 2003–2013.

Design

An integrative literature review.

Methods

PubMed, CINAHL, PsycINFO, DOSS, SocIndex, Social Science Citation Index and AMED databases from 2003–2013 were used. Identification of 350 articles including the concept of transition in relation to disciplines included. Assessment of articles are in accordance to Meleis' typologies of transition by experts in each discipline. Chosen key factors were entered into Statistical Package for the Social Sciences (SPSS).

Results

Meleis' four typologies were found in all studied disciplines, except development in oral health. The health‐illness type was the most commonly explored, whereas in social work and in occupation therapy, situational transitions dominated.

BACKGROUND: Supervisors play a key part as role models and supporting the learning during residents' post-graduate medical education, but sometimes lack sufficient pedagogic training and are challenged by high demands in today's healthcare. The aim of this study was to describe the strengths and areas for improvement identified in the supervision process by residents and supervisors in post-graduate medical education.

METHODS: This study included supervisors and residents working at departments and health centres who have used a web-based questionnaire, as a part of the Evaluation and Feedback For Effective Clinical Teaching (EFFECT) model, during the period 2016-2019. Descriptive statistics and content analysis were used to analyse ratings and comments to describe strengths and areas for improvement in the supervision process.

RESULTS: The study included 287 resident evaluations of supervisors and 78 self-evaluations by supervisors. The supervisor as a role model, being available, and, giving personal support, were the three most important strengths identified by the residents and supervisors. Residents in primary care also identified the role modelling of general practice competence as a strength, whereas residents and supervisors in hospital departments addressed supervisors as energetic and showing work was fun. The area with the need of most improvement was, Giving and receiving feedback.

CONCLUSIONS: To be able to give feedback, residents and supervisors, needed to see each other in work, and the learning environment had to offer time and space to pedagogical processes, like feedback, to improve the learning environment.

BACKGROUND:

Hypothermia is a common problem in the surgical context and can lead to serious consequences for the patient and increased costs for society.

AIMS:

To study day-surgery patients' peripheral and core temperatures during the preoperative phase.

METHODS:

In total, 50 day-surgery patients participated in the study. Two sets of measurements of temperatures were made: core temperature and peripheral temperatures (two measuring points on the upper body and lower extremities respectively) were measured on arrival at the day-surgery unit, as well as on arrival at the operating theatre. The data were normally distributed and a paired t-test was used for statistical analysis.

FINDINGS:

Peripheral temperatures had significant changes, with measuring points on the upper body decreasing and measuring points on the lower extremities increasing in temperature. The results show no significant change in core temperature.

CONCLUSION:

The measurements show that 28% of the patients were below recommended preoperative temperature on arrival at the operating theatre. Further research is needed to study the development of body temperature perioperatively as well as at what point reheating interventions should be introduced.

Aim and objective: The aim was to describe the nurses’ perception about how to promote hope in critically ill patients, cared for in intensive care units in Indonesia.

Background: The concept of hope and hopelessness has been in focused in nursing from various orientations as a subjective phenomenon in relation to illness experiences. There is a lack of studies examining patterns of how nurses promote hope in critically ill patients in in tensivecare.

Design and Method: Five specialized intensive care nurses from two different intensive care units were interviewed. The interviews were analysed according to a qualitative content analysis.

Results: The patient’s hope is something personal and depends on different factors. These factors can either be a supporting system or an inhibiting factor to the nurse’s illumination of hope. Meaning, if something is very important for the patient (i.e. the family), there can be a radical difference if that person is present and supporting, present and not supporting or even not present at all.

Conclusion: By using interventions including information, communication and religion, the nurses may release hope within the patient. This hope can be cultural and socially bound but it does not avoid the facts of the promotion that can be tailored by the nurses to individual circumstances and possibly used in other wards but also in different countries.

Purpose: The purpose of the study was to illuminate the experience of caring touch in intensive care from the perspectives of patients, next-of-kin, and healthcare professionals.

Design and Method: This study was explorative, and data were collected through qualitative observations (n = 9) with subsequent interviews (n = 27) at two general intensive care units. An inductive approach was embraced to be open-minded to the participants' experiences.

Findings: The results are presented in one generic category-caring touch creates presence-which generated five subcategories: to touch and be touched with respect, touch as guidance and communication, touch causes suffering, touch creates compassion, and touch creates security.

Conclusion: When the ability to communicate with words is lost, it is body language that reveals what a person is trying to express. Nurses create a way of being present with the patients by touching them, to communicate I am here for you. Caring touch is a tool to show compassion and respect and to protect the integrity of the lived body. The caring touch is soothing and comforting for the patient and next-of-kin and creates security. It also helps to awaken the motivation to get healthy, which is needed in an environment that is foreign.

Background

Sedation of intensive care patients is necessary for comfort and to implement appropriate treatment. The trend of sedation has gone from deep to light sedation. The topic is of interest to intensive care nursing because patients are generally more awake, which requires a different clinical approach than caring for deeply sedated patients.

Purpose

The aim of this study was to describe intensive care unit (ICU) nurses experiences of caring for patients who are lightly sedated during mechanical ventilation.

Methods

A qualitative approach was used. Semi-structured interviews with nine intensive care nurses were conducted. The interview texts were subjected to qualitative content analysis, resulting in the formulation of one main category and six sub-categories.

Findings

The nurses’ experience of lightly sedated patients was described as a challenge requiring knowledge and experience. The ability to communicate with the lightly sedated patient is perceived as important for ICU nurses. Individualised nursing care respecting the patients’ integrity, involvement and participation are goals in intensive care, but might be easier to achieve when the patients are lightly sedated.

Conclusion

The results reinforce the importance of communication in nursing care. It is difficult however to create an inter-personal relationship, encourage patient involvement, and maintain communication with deeply sedated patients. When patients are lightly sedated, the nurses are able to communicate, establish a relationship and provide individualised care. This is a challenge requiring expertise and patience from the nurses. Accomplishing this increases the nurses satisfaction with their care. The positive outcome for the patients is that their experience of their stay in the ICU might become less traumatic.

BACKGROUND: Weaning from mechanical ventilation is a complex and central intensive care process. This complexity indicates that the challenges of weaning must be explored from different perspectives. Furthermore, physicians' experiences and the factors influencing their decision-making regarding weaning are unclear.

OBJECTIVES: This study aimed to explore and describe the factors influencing physicians' decision-making when weaning patients from invasive mechanical ventilation in Swedish intensive care units (ICUs).

METHODS: This qualitative study used an exploratory and descriptive design with qualitative content analysis. Sixteen physicians from five ICUs across Sweden were purposively included and interviewed regarding their weaning experiences.

FINDINGS: The physicians expressed that prioritising the patient's well-being was evident, and there was agreement that both the physical and mental condition of the patient had a substantial impact on decision-making. Furthermore, there was a lack of agreement on whether patients should be involved in the weaning process and how their resources, needs, and wishes should be included in decision-making. In addition, there were factors not directly linked to the patient but which still influenced decision-making, such as the available resources and teamwork. Sometimes, it was difficult to point out the basis for decisions; in that decisions were made by gut feeling, intuition, or clinical experience.

CONCLUSION: Physicians' decision-making regarding weaning was a dynamic process influenced by several factors. These factors were related to the patient's condition and the structure for weaning. Increased understanding of weaning from the physicians' and ICU teams' perspectives may improve the weaning process by broadening the knowledge about the aspects influencing the decision-making.

BACKGROUND: The medical and nursing care of the patient on mechanical ventilation has developed and proceeds in terms of ventilator functions, sedation strategies and patient participation. New data are needed to explore the weaning process from the patients' perspective. Therefore, the aim of this study was to explore the meaning of being a patient on mechanical ventilation during the weaning process in the intensive care unit.

METHODS: This study used van Manen's hermeneutic phenomenological approach. Interviews were conducted, including twenty former intensive care patients from three different hospitals in Sweden.

FINDINGS: Five themes emerged including thirteen related themes; Maintaining human dignity, Accepting the situation, Enduring the difficulties, Inadequate interaction and A sense of unreality. The experiences differed from each other and varied over time, and the same patient expressed both pleasant and unpleasant experiences. Weaning was not a separate experience but intertwined with that of being on mechanical ventilation in the intensive care unit.

CONCLUSIONS: The patient's experiences differ and vary over time, with the same patient expressing various experiences. The favourable experiences were more clearly described, compared to previous research, this might depend on factors related to communication, participation and proximity to healthcare professionals and next-of-kin.

Purpose: The experience of cancer could lead to positive psychological changes following the struggle with diagnosis and treatment. Understanding post-traumatic growth and its influencing factors in women affected by gynecological cancer is essential to enhance their possibility of achieving positive changes. The purpose of this study was to describe the post-traumatic growth level and explore the influencing factors of post-traumatic growth in Chinese women diagnosed with gynecological cancer. Method: A cross-sectional survey with a convenience sampling method was employed to collect data using the Post-traumatic Growth Inventory (PTGI), Distress Disclosure Index (DDI), Medical Coping Modes Questionnaire (MCMQ), and Multidimensional Scale of Perceived Social Support (MSPSS). The questionnaires were administered to 344 participants recruited from two hospitals in Hefei City, the capital of Anhui Province in China, between March 2018 and March 2019. All statistical analyses were performed using nonparametric tests. The Mann-Whitney U Test was used to distinguish the intergroup differences. Correlations were evaluated with Spearman rank correlation coefficients. Results: Total score for PTGI was 56.5 (range 48.0–68.0). The subscale with the highest centesimal score in the PTGI was appreciation of life and the lowest was spiritual change. The top five items with the highest scores of PTGI belonged to appreciating life, personal strength, and relating to others. Self-disclosure, confrontation, avoidance, acceptance-resignation, perceived social support, education level, cancer type and the place they lived had significant influence on post-traumatic growth. Conclusions: The findings indicate that women who have high levels of perceived social support, confrontation, avoidance, self-disclosure and education level tend to experience more post-traumatic growth, while, conversely, high levels of acceptance-resignation have a negative influence on promoting post-traumatic growth. These meaningful findings propose new perspectives for promoting post-traumatic growth in Chinese women diagnosed with gynecological cancer.