Organ Donation: Behaviour and Beliefs in Sweden.

Introduction: Barely one-fifth of people in Sweden have expressed their will regarding organ donation in the national Swedish Donor Registry, and the number of organ donations in Sweden remains low. Objective: The aim of this study was to map behaviour and beliefs regarding organ donation in Sweden. Methods: In a descriptive cross-sectional survey following a quantitative approach and 600 questionnaires were issued to randomly selected individuals across Sweden. Of them, 206 (36.3%) were completed. Data were analysed using descriptive statistics and presented as frequencies and percentages. Analytical statistical testing involved Pearson chi-square tests, Mann-Whitney U tests, and Kruskal-Wallis tests. Results: The results indicate a discrepancy between positive opinion about organ donation in Sweden and the number of people enrolled in the Swedish Donation Registry. The most common argument for not wanting to donate organs was the notion of being too old to. Although self-rated knowledge about organ donation was admittedly low, so was interest in interest in learning more about it. Younger patients more frequently wanted information than older patients did. Conclusion: Not wanting to donate organs due to age and/or illness may indicate a misconception. Making one's will known does not involve assessing one's health status or age but solely concerns the wish to do so. The findings thus raise an important question: How can people's interest in learning more about organ donation be induced in ethical ways?

Critical care nurses' experiences of nursing intoxicated patients after abuse of drugs.

BACKGROUND: Patients intoxicated after abusing illicit drugs constitute a significant proportion of patients cared for in intensive care units. Intensive critical care nurses who nurse accidentally intoxicated patients face complex and demanding situations, and there is a lack of studies regarding this topic. AIMS AND OBJECTIVES: To illuminate Swedish intensive critical care nurses' experiences of nursing accidentally intoxicated patients after abuse of illicit drugs. DESIGN: A qualitative design with an inductive approach was used. METHODS: Semi-structured interviews were conducted with eight intensive critical care nurses at an intensive care unit in Sweden. Data were analysed using qualitative content analysis. FINDINGS: The themes found illuminate intensive critical care nurses' experiences of nursing accidentally intoxicated patients after their abuse of illicit drugs: feeling empathy and a wish to provide dignified care; dreading nursing the patient and feeling a lack of empathy; feeling frustration and questioning the care; lacking knowledge about a complex and challenging situation. CONCLUSIONS: It is essential to respond to intoxicated patients with empathy and dignity. Intensive critical care nurses should learn how to identify factors that lead to provocation and agitation in order to reduce the occurrence of dangerous situations in intensive care units. RELEVANCE TO CLINICAL PRACTICE: To create a caring environment where the interaction becomes more positive and harmonious, an intensive care nurse needs a deep understanding of what a drug abuse disorder means. Moreover, the ability to see the person behind the abuse and to provide non-judgemental support is required. What is known about this topic Patients intoxicated after abuse of illicit drugs constitute a significant proportion of patients cared for in ICUs worldwide. Intensive critical nurses who nurse accidentally intoxicated patients face complex and demanding situations, and few studies have addressed this topic. What this paper contributes It is essential to respond to intoxicated patients who are admitted to the ICU with empathy and dignity, as well as to learn how to identify factors that lead to provocation and agitation in order to reduce the occurrence of dangerous situations. Education is warranted and must be enhanced, including knowledge about drug abuse and training in communication and empathy Nursing should include an understanding of what the disease of drug abuse means and the development of the ability to see the person behind the abuse and to provide non-judgemental support.

Caring for critically ill patients during interhospital transfers: A qualitative study.

BACKGROUND: The coronavirus pandemic has resulted in an increased number of interhospital transfers of patients with artificial airways. The transfer of these patients is associated with risks and has been experienced as highly challenging, which needs to be further explored. AIMS AND OBJECTIVES: To describe critical care nurses' experiences of caring for critically ill patients with artificial airways during interhospital transfers. DESIGN: A cross-sectional study using a qualitative approach was conducted during spring 2020. Participants were critical care nurses (n = 7) from different hospitals (n = 2). METHODS: The data were collected through semi-structured interviews based on an interview guide. A qualitative content analysis using an inductive approach was performed. RESULTS: The analysis resulted in one main theme, "Preserving the safety in an unknown environment," and three sub-themes, "Being adequately prepared is essential to feel secure," "Feeling abandoned and overwhelmingly responsible," and "Being challenged in an unfamiliar and risky environment." CONCLUSIONS: Critical care nurses experienced interhospital transfers of critically ill patients with artificial airways as complex and risky. It is essential to have an overall plan in order to prevent any unpredictable and acute events. Adequate communication and good teamwork are key to the safe transfer of a critically ill patient in that potential complications and dangers to the patient can be prevented. RELEVANCE TO CLINICAL PRACTICE: Standardized checklists need to be created to guide the transfers of critically ill patients with different conditions. This would prevent failures based on human or system factors, such as lack of experience and lack of good teamwork.

Associations between ASA classification, self-estimated physical health, psychological wellbeing and anxiety among Swedish orthopaedic patients.

BACKGROUND: The evaluation of one's physical health and psychological wellbeing may be subjective. Aspects of functional capacity, including the patients' own estimation of physical health and wellbeing, have been shown to be strong predictors of postoperative outcomes and should be the focus of further research. AIM: This study aimed to explore the associations between ASA classification, self-estimated physical health, psychological wellbeing and anxiety among orthopaedic patients. METHODS: This was a longitudinal study using a quantitative approach. SETTINGS: A central county hospital in northern Sweden. RESULTS: A high ASA classification rated by anaesthetists was not associated with physical health and psychological wellbeing self-estimated as less than good. A high ASA classification was significantly associated with self-estimated anxiety prior to surgery. Three days and one month post-surgery, the situation was reversed, and the ASA I/II group, to a significantly higher extent, rated that they felt anxiety. CONCLUSION: Preoperative screening systems for orthopaedic patients should not only focus on the medical and objective physical issues but also include the patients' own estimation of their physical health and psychological wellbeing. It is essential that orthopaedic patients receive relevant information that provides a realistic outlook, as well as an honest and optimistic future view.

Patients' Experiences of Pain and Postoperative Nausea and Vomiting in the Early Postoperative Period After an Elective Knee Arthroplasty.

PURPOSE: The aim of this study is to explore patients' experience of pain and postoperative nausea and vomiting (PONV) in the early postoperative period after knee arthroplasties. DESIGN: This is a retrospective cohort study with a quantitative approach. Data from patients registered in the Swedish Perioperative Registry were used. We used the Strenghtening the Reporting of Observational Studies in Epidemiology (STROBE) guidelines for cross-sectional studies. METHODS: Data were collected from patients (N = 439) undergoing knee arthroplasties. The analysis was performed with descriptive and analytic statistics. FINDINGS: The findings indicate that women experienced significantly higher levels of pain than men and suffered significantly more often from PONV. However, the relationship of postoperative pain and PONV was not significant. There was also no significance for the relationship among postoperative pain, PONV, and age. CONCLUSIONS: Care needs to be sensitive to differences in experiencing pain and PONV depending on sex or gender bias, with a goal of increasing the equality in care.

Intensive critical care nurses' with limited experience: Experiences of caring for an organ donor during the donation process.

OBJECTIVE: To describe how intensive critical care nurses, whose experience is limited, experience caring for an organ donor during the donation process. BACKGROUND: Intensive critical care nurses are involved in the care of organ donors and their relatives. This may be challenging and evoke a sense of providing an inhumane care. Few studies have explored how intensive critical care nurses whose experience is limited experience caring for an organ donor during the donation process. DESIGN: An interview study with an inductive qualitative approach was conducted. The study was reported according to COREQ guidelines. METHODS: This study was performed during 2019. Participants were intensive critical care nurses (n = 7) from different hospitals (n = 4) with <3 years of experience and involvement in the donation process at least once but no more than three times. Data were analysed using qualitative content analysis. FINDINGS: Five categories emerged: the donation process is emotionally challenging; supporting relatives is an essential but demanding task; a complex and multifaceted process involving a high level of responsibility; needing appropriate prerequisites in the form of education and collegial support; and providing a dignified care based on respect for the organ donor. CONCLUSIONS: Having limited experience as an intensive critical care nurse may not automatically mean that caring for an organ donor is experienced as more challenging than it is for a more-experienced colleague. However, certain intensive critical care nurses whose experience caring for an organ donor is limited found it to be highly demanding due to its complexity, specifically in regard to informing relatives of the loss of their loved one and providing them with support. RELEVANCE TO CLINICAL PRACTICE: Our study revealed a need for further education. This need could be met by simulation tasks during the specialist education in intensive critical care nursing, where primarily ethical aspects and strategies for meeting with and supporting relatives should be examined and practiced.

Peripheral intravenous catheter difficulty - A clinical survey of registered nurse and critical care nurse performance.

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

Problems associated with performance of peripheral intravenous catheterization in relation to working experience.

The aim of this study was to explore general registered nurses' (RNs) assessments of problems associated with difficult peripheral intravenous catheterization (PIVC) depending on their years of working experience, that is, those who had worked 3 years or less and those who had worked more than 3 years. The design was a quantitative, nonexperimental, descriptive, and analytic survey. The participating RNs (n = 83) were divided into two groups according to the length of their working experience, and the analysis was performed using the SPSS, version 24, software. The RNs also had the opportunity to answer a free-text question related to the aim. The results showed that less experienced RNs assessed to a significantly higher extent that they lacked time, experience, and ability and that there was no blood return; however, they assessed that the peripheral venous catheters were in the vein. If critical care nurses had been requested for support earlier, this request was seen as a reason not to try PIVC at all because critical care nurses were assessed as more experienced and skilled. To develop the kind of effective problem-solving and clinical reasoning needed for practice, a supportive setting must be created throughout nursing education as well as after graduation. Further research should focus on the education needs associated with PIVC and seek to understand to what extent learning in clinical skill simulation laboratories is transferred to actions in the clinical setting.

Patients' Perceptions of Short-Term Recovery After a Gastric Bypass.

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

Critical care nurses' experiences of performing successful peripheral intravenous catheterization in difficult situations.

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

Patients' Perceptions of Perioperative Quality of Care in Relation to Self-rated Health.

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

Patterns of Changes in Patients' Postoperative Recovery From a Short-Term Perspective.

PURPOSE: To explore patterns of changes in patients' postoperative recovery over 1 month within different surgery groups. DESIGN: A quantitative longitudinal survey design was used. METHODS: A standardized questionnaire was used (N = 167 patients); the postoperative recovery profile for self-assessment of recovery. The postoperative recovery profile developed for hospitalized patients contains 17 items distributed over five dimensions: physical symptoms, physical function, psychological function, social function, and activity. FINDINGS: Overall, orthopaedic patients perceived a lower recovery than general surgery patients. All major surgery groups and subgroups except for joint replacement patients indicated significant systematic changes toward lower levels of problems. The orthopaedic patients assessed their psychological functioning as impaired, and the gastric bypass group was the most recovered. CONCLUSIONS: The patients' expectations should be charted initially, and patients should be given realistic information to achieve a realistic hope for a good life in the future. A patient's recovery trajectory may not start after the surgery is completed. Rather, it has already commenced before surgery.

Patients' Perceptions of Quality of Care During the Perioperative Procedure.

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

Patients' perceptions of their postoperative recovery for one month.

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

People's experiences of suffering a lower limb fracture and undergoing surgery.

AIMS AND OBJECTIVES: To describe people's experiences of suffering a lower limb fracture and undergoing surgery, from the time of injury through to the care given at the hospital and recovery following discharge. BACKGROUND: There is a lack of research on people's experiences of suffering a lower limb fracture and undergoing surgery - from injury to recovery. DESIGN: A qualitative approach was used. METHODS: Interviews with nine participants were subjected to thematic content analysis. RESULTS: One theme was expressed: from realising the seriousness of the injury to regaining autonomy. Participants described feelings of frustration and helplessness when realising the seriousness of their injury. The wait prior to surgery was a strain and painful experience, and participants needed orientation for the future. They expressed feelings of vulnerability about being in the hands of staff during surgery. After surgery, in the postanaesthesia unit, participants expressed a need to have control and to feel safe in their new situation. To mobilise and regain their autonomy was a struggle, and participants stated that their recovery was extended. CONCLUSIONS AND RELEVANCE TO CLINICAL PRACTICE: Participants found themselves in a new and unexpected situation and experienced pain, vulnerability and a striving for control during the process, that is, 'from realising the seriousness of the injury to regaining autonomy'. How this is managed depends on how the patient's needs are met by nurses. The nursing care received while suffering a lower limb fracture and undergoing surgery should be situation specific as well as individual specific. The safe performance of technical interventions and the nurse's comprehensive explanations of medical terms may help the patient to feel secure during the process.

From reaching the end of the road to a new lighter life - people's experiences of undergoing gastric bypass surgery.

OBJECTIVES: It is limited research that focuses on people's experiences from prior to surgery to the postoperative period after a gastric bypass. The aim of this retrospective study was to describe people's experiences of undergoing gastric bypass surgery. METHOD: A qualitative approach was used. Interviews with ten participants were subjected to qualitative content analysis. RESULTS: The analysis of the interviews resulted in one theme: from reaching the end of the road to a new lighter life. Prior to surgery participants described a sense of inferiority and that they were not able to 'take any more'. Shortly after surgery participants felt both vulnerable and safe in the unknown environment and expressed needs of orientation and to have the staff close. Despite information prior to surgery it was difficult to imagine ones' situation after homecoming, thus it was worth it so far. CONCLUSION: The care given in the acute postoperative phase for people who undergo gastric bypass surgery, should aim to provide predictability and management based on individual needs. Being treated with respect, receiving closeness, and that the information received prior to surgery complies with what then happens may facilitate postoperative recovery after a gastric bypass surgery.