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  • 1.
    Åkerman, Eva
    Jönköping University, School of Health Science, HHJ, Dep. of Nursing Science.
    Assessment and tools for follow-up of patients' recovery after Intensive Care2012Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    Aim: The overall aim of this thesis was to describe and explore the use and content of ICU-diaries and to develop and psychometrically test a questionnaire to detect physical and psychosocial problems for ICU patients in their recovery process.

     Methods: This thesis is based on four studies. Study I had an explorative descriptive design with a quantitative and qualitative approach. Data were collected by telephone interviews with staff at Swedish ICUs (n = 65) which kept ICU-diaries. One question “what was the purpose of keeping ICU-diaries” was analysed with latent content analysis, and the other data were analysed with descriptive and comparative statistics. Study II had an explorative descriptive cohort design with a concurrent mixed method approach. The sample in study II was a part of the sample in study IV in which 421 former ICU patients responded to a new developed questionnaire 3-set 4P two months after discharge from ICU. Patients from this sample who have had an ICU-diary (n = 115) responded to a questionnaire six months after discharge from ICU. Fifteen patients were interviewed about the content and usefulness of the ICU-diary. Data were analysed with descriptive statistics, descriptively by content and interviews with manifest content analysis and then combined at the interpretive level to seek convergence, as enable by the mixed method approach. Study III had a methodological design. In this study, the questionnaire 3-set 4P was developed and psychometrically tested in a pilot setting. In study IV, the questionnaire was further developed and tested based on psychometric evaluation of the 3-set 4P. In study III the questionnaire was responded by 39 patients and in study IV by 421 patients. Data in study III and IV were analysed with descriptive statistics and psychometrical tests.

     Results: The main purpose for keeping ICU-diaries was to provide a tool in the recovery by helping the patient remember and give time back. Keeping ICU-diaries was common although there was a difference in practice and patient recruitment among different hospitals (study I). An ICU-diary with content and photos in a chronological order describing the whole picture of critical illness and ICU stay could be a tool for the patient to construct a coherent individual story. The ICU-diary could be one piece to give a deeper understanding and meaning in the personal story and to give a realistic expectation of the recovery process. Absence of guidelines for keeping ICU-diaries could affect the possibility for the ICU-diary to be a helpful tool during the recovery process (study II). In study III, the 3-set 4P was developed to be used for identifying and evaluating former ICU patients’ physical, psychosocial problems and outcome during follow-up. The psychometrical tests showed acceptable validity and internal consistency reliability. The stability reliability was acceptable in two of three sets. The psychometrical tests of the further modified version of 3-set 4P in study IV showed good construct validity and internal consistency but it needs some modification before it can be used in clinical practice (study IV).

     Conclusion: Recovery can be a difficult process where different tools can be useful. Today there is no evidence about tools to use during follow-up. To promote high quality of the follow-up there is a need for evidence-based guidelines. The ICU-diary is one tool but this thesis shows that guidelines for keeping ICU-diaries have to be developed to meet the patients’ wishes in order for the ICU-diary to become a useful tool during the process to recovery. The 3-set 4P can after some modification be used at the follow-up clinic to identify the individual patient’s problems and create an individual program for recovery.

  • 2.
    Åkerman, Eva
    et al.
    Jönköping University, School of Health and Welfare, HHJ, Dep. of Nursing Science.
    Ersson, Anders
    Skåne University Hospital, Department of Intensive Care Medicine in Malmö, Sweden.
    Fridlund, Bengt
    Jönköping University, School of Health and Welfare, HHJ, Dep. of Nursing Science. Jönköping University, School of Health and Welfare, HHJ, Quality Improvement and Leadership in Health and Welfare.
    Samuelson, Karin
    Division of Nursing, Department of Health Sciences, Lund University, Lund, Sweden.
    Preferred content and usefulness of a photodiary as described by ICU-patients-A mixed method analysis2013In: Australian Critical Care, ISSN 1036-7314, E-ISSN 1878-1721, Vol. 26, no 1, p. 29-35Article in journal (Refereed)
    Abstract [en]

    Many ICU-patients have memory-gaps which may affect their recovery. A tool in the recovery can be an ICU-diary to explain and clarify thoughts and events from the ICU-period. There are different standards for the content in the ICU-diary. The aim of this study was to identify the preferred content and usefulness of an ICU-diary as described by ICU-patients.

    Method: a descriptive, exploratory cohort design with a mixed method approach. The patients answered a questionnaire (n=115) and participated in an interview (n=15) six months after the ICU-stay. Data analysis was carried out in three stages; the questionnaire was analysed by descriptive statistics and categorized by content (four open-ended questions) and the interviews were analysed by manifest content analysis.

    Results: The patients explained that detailed information about daily activities and medical facts had to be included to understand and give a sense of coherence of what had happened. The content in the ICU-diary had to be chronological in order to follow the process in which photos were an important part. The patients re-read the ICU-diary during the recovery which helped them to fill in the memory gaps and used it as a tool for communication.

    Conclusion; To construct a coherent story, it was essential that the ICU-diary was complete and were amplified by photos, all appearing in a chronological order. The results of this study could form a basis for further developments of standards and guidelines for ICU-diaries

  • 3.
    Åkerman, Eva
    et al.
    Jönköping University, School of Health and Welfare, HHJ, Dep. of Nursing Science.
    Fridlund, Bengt
    Jönköping University, School of Health and Welfare, HHJ, Dep. of Nursing Science. Jönköping University, School of Health and Welfare, HHJ, Quality Improvement and Leadership in Health and Welfare. Jönköping University, School of Health and Welfare, HHJ. ADULT.
    Samuelson, Karin
    Baigi, Amir
    Ersson, Anders
    Psychometric evaluation of 3-set 4P questionnaire2013In: Intensive & Critical Care Nursing, ISSN 0964-3397, E-ISSN 1532-4036, Vol. 29, no 1, p. 40-47Article in journal (Refereed)
    Abstract [en]

    This is a further development of a specific questionnaire, the 3-set 4P, to be used for measuring former ICU patients’ physical and psychosocial problems after ICU and the need for follow-up. The aim was to psychometrically test and evaluate the 3-set 4P questionnaire in a larger population. The questionnaire consists of three sets: “physical”, “psychosocial” and “follow-up”. The questionnaires were sent by mail to all patients with >24 hour length of stay at four ICUs in Sweden. Construct validity was measured with exploratory factor analysis with varimax rotation resulting in “physical set” three factors, “psychosocial set” five factors and “follow-up set” four factors with strong factor loadings and a total explained variance of 62 - 77.5%. Thirteen questions in the SF-36 were used for concurrent validity showing Spearman’s rs 0.3-0.6 in eight and <0.2 in five questions. Test-retest was used for stability reliability. In set follow-up the correlation was strong to moderate and in physical and psychosocial sets the correlations were moderate to fair. This could be due to that the physical and psychosocial status changed rapidly during the test period. All three sets had good homogeneity. In conclusion, the 3-set 4P showed overall acceptable results, but it has to be further modified in different cultures before being an instrument which may be fully operational in clinical practice.

     

  • 4. Åkerman, Eva
    et al.
    Granberg-Axéll, Anetth
    Ersson, Anders
    Fridlund, Bengt
    Jönköping University, School of Health Science, HHJ, Dep. of Nursing Science. Jönköping University, School of Health Science, HHJ. Quality improvements, innovations and leadership in health care and social work.
    Bergbom, Ingegerd
    Use and practice of patient diaries in Swedish intensive care units: a national survey2010In: Nursing in Critical Care, ISSN 1362-1017, E-ISSN 1478-5153, Vol. 15, no 1, p. 26-33Article in journal (Refereed)
    Abstract [en]

    Aims and objectives: To describe and compare the extent and application of patients' diaries in Sweden.

    Background: Since 1991, patient diaries have been used in intensive care unit (ICU) follow-up in Sweden. There is paucity of relevant data evaluating the effect of this tool and also on what premises patients are enrolled. Likewise, data are sparse on the diaries' design, content structure and the use of photographs.

    Design: Descriptive explorative design by a semi-structured telephone interview.

    Methods: The interview results were analysed with descriptive statistics and differences between the ICU levels were explored by χ2 analysis. Qualitative manifest content analysis was performed to explore the purpose of diary writing.

    Results: Of all ICUs (n = 85), 99% responded and 75% used diaries. The source of inspiration was collegial rather than from scientific data. The main reason for keeping a diary was to help the patient to recapitulate the ICU stay. Discrepancies between the different levels of ICUs were detected in patient selection, dedicated staff for follow-up and the use of photographs. Comparison between the χ2 analysis and the content analysis outcome displayed incongruence between the set unit-goals and the activities for achievement but did not explain the procedural differences detected.

    Conclusion: The uses of diaries in post ICU follow up were found to be common in Sweden. A majority used defined goals and content structure. However, there were differences in practice and patient recruitment among the levels of ICUs. These discrepancies seemed not to be based on evidence-based data nor on ongoing research or evaluation but merely on professional judgement. As ICU follow-up is resource intense and time consuming, it is paramount that solid criteria for patient selection and guidelines for the structure and use of diaries in post-ICU follow-up are defined.

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