In their absence; intensive care nurses' experiences of communicating and supporting relatives from a distance.

BACKGROUND: Having a critically ill family member in the intensive care unit (ICU) is a challenging situation and ICU nurses play an important part in supporting relatives to make sense of the situation. Strict visiting policies inhibited the family's presence in ICUs during 2020-22, and the communication between nurses and families changed drastically. Information and support are at the core of the ICU nurses' profession, and the pandemic backdrop created a split between what intensive care nurses have a professional responsibility to perform and which actions were possible. To get a fuller picture, the aim of this study was: To describe intensive care nurses' experiences of communicating and supporting relatives from a distance while working during visiting restrictions. METHOD: A qualitative descriptive design using individual and semi-structured interviews with 16 ICU nurses. The interviews were analyzed using inductive thematic analysis. This study followed the consolidated criteria for reporting qualitative research (COREQ). RESULTS: Due to the visiting restriction during the COVID-19 pandemic, ICU nurses found themselves in a situation where proximity and time to develop an interpersonal connection with relatives disappeared overnight. The nurses' experiences of communicating with and supporting families is described in three themes: "Finding ways to create order out of chaos"; "Guiding the relatives to a fuller picture of the situation"; and "Feeling insufficient in their support". CONCLUSION: Visiting restrictions in the ICU meant that ICU nurses missed vital information about their patients as a person, which might have had a negative effect on personalizing and centring the patient care. But using a combination of digital and audio tools helped nurses to guide the relatives to a clearer picture of the situation as a whole. The support that nurses were able to provide to relatives was often insufficient due to the visiting restriction and as a consequence, they experienced physical and psychological stress.

Perioperative Comfort and Discomfort: Transitioning From Epidural to Oral Pain Treatment After Pancreas Surgery: A Qualitative Study.

PURPOSE: To explore patients' experiences of pain treatment in the perioperative period after surgery for pancreatic cancer. DESIGN: A qualitative descriptive design using semi-structured interviews. METHODS: This study was a qualitative study based on 12 interviews. Participants were patients that had undergone surgery for pancreatic cancer. The interviews were conducted 1 to 2 days after the epidural was turned off, in a surgical department in Sweden. The interviews were analysed with qualitative content analysis. The Standard for Reporting Qualitative Research checklist was used for reporting the qualitative research study. FINDINGS: The analysis of the transcribed interviews, generated one theme: Maintaining a sense of control in the perioperative phase, and two subthemes: (i) Sense of vulnerability and safety, and (ii) Sense of comfort and discomfort, were found. CONCLUSIONS: The participants experienced comfort after pancreas surgery if they maintained a sense of control in the perioperative phase and when the epidural pain treatment provided pain relief without any side effects. The transition from epidural pain treatment to oral pain treatment with opioid tablets was experienced individually, from an almost unnoticed transition to the experience of severe pain, nausea, and fatigue. The sense of vulnerability and safety among the participants were affected by nursing care relationship and the environment on the ward.

Developing new possibilities for interprofessional learning- students' experience of learning together in the ambulance service.

BACKGROUND: It is known that setting and context matters, and contextual factors influence interprofessional education (IPE). Activities developed in a new setting should therefore be evaluated to determine students' experiences and learning. IPE in the ambulance service may present a new setting for interprofessional learning (IPL). AIM: The aim of this study was to explore undergraduate students' experiences of collaboration and learning together during their clinical rotation in the ambulance service. STUDY DESIGN AND METHOD: A mixed convergent parallel design was used to describe nursing and medical students' experiences of collaboration and learning together during their clinical rotation in the ambulance service during autumn 2019. Two group interviews with nursing students (n = 20; response rate 80%) were conducted and the medical students (n = 40; response rate 72.5%) answered a self-assessment questionnaire regarding their IPE. The group discussions were analysed using an inductive thematic analysis and descriptive statistics were used to describe the medical students' self-assessed experiences and competencies in interprofessional collaboration. RESULTS: In the context of the ambulance service, some of the challenges included, the team vary daily, a context that can be unpredictable, and the team being required to make decisions in various situations with limited support. The context presented good opportunities to learn together, since they faced a broad variety of situations and had opportunities to follow patients through the chain of care. CONCLUSION: The students' experiences show that the ambulance service offers possibilities for IPL. The ambulance service enhanced the students' learning in an unfamiliar environment, encouraging them to develop collaborative learning strategies and situational leadership regardless of established hierarchical structures and stereotypes that are sometimes present in other parts of the health care service. ETHICAL APPROVAL: By the Swedish Ethical Review Authority. No: 2019-03595.

'Like holding the axe on who should live or not': adolescents' and adults' perceptions of valuing children's health states using a standardised valuation protocol for the EQ-5D-Y-3L.

PURPOSE: There is an increasing interest for using qualitative methods to investigate peoples' cognitive process when asked to value health states. A standardised valuation protocol for the EQ-5D-Y-3L instrument was recently developed. Little is known regarding how people think, reason, and feel when asked to value health states for children. The aim was to explore how adolescents and adults perceive the task of valuing children's health states using the standardised valuation protocol. METHODS: This was a qualitative study where adults (n = 10) and adolescents (n = 10) from the general population participated in individual video-interviews. Initially, participants reported their own health with the EQ-5D-3L instrument. Then they were asked to complete several valuations tasks for a 10-year-old child according to the standardised valuation protocol, followed by a semi-structured interview with open-ended questions to further explore participants' perceptions. A qualitative content analysis was performed. RESULTS: The two main categories that emerged from the data were 'Thoughts and feelings when valuing children's health states' and 'Strategies when valuing children's health states'. Participants expressed feeling doubt, awfulness and being reluctant to trade-off life years, and questioned who has the right to value health states for children. Experience and point of view were strategies participants used to complete the valuation tasks. CONCLUSION: The findings from the present study can contribute to the understanding and interpretation of quantitative results where the standardised valuation protocol has been used to derive values for the EQ-5D-Y-3L. Furthermore, results of the study support the feasibility of including adolescents in valuation studies.

Challenging encounters as experienced by registered nurses new to the emergency medical service: explored by using the theory of communities of practice.

The aim of this study was to explore challenging encounters experienced by registered nurses (RN) during their first year in the emergency medical service by using the social learning theory of communities of practice. During the first year in a new professional practice, a new RN experiences a transition during which the new professional identity is being formed. This is a challenging and demanding period of time. According to the learning theory of communities of practice by Lave and Wenger, individuals' learning and development in a new professional practice occurs through participation in social activity and is influenced by context. This study is based on the qualitative data from semi-structured interviews. Thirty-two RNs working in the Swedish emergency medical service were interviewed via telephone during the spring of 2017. A qualitative content analysis with deductive reasoning of the interviews was used. The analysis process generated the main category; New RNs participation is challenged by unpredictability and uncertainty in practice. The main category was based on three generic categories; Loneliness in an unpredictable context, Uncertainty about the team, and Uncertainty in action. The challenges new RNs encounter during the first year relate to all three dimensions of a community of practice; mutual engagement, joint enterprise and shared repertoire. The encountered challenges also relate to the EMS context. Taking into account all these aspects when designing support models for RN's professional development may be advantageous for creating positive development for RNs new to the EMS and/or similar practices.

Get it together: Issues that facilitate collaboration in teams of learners in intensive care.

INTRODUCTION: The study describes issues that facilitate collaboration in teams of learners in an interprofessional education unit in intensive care. METHODS: A descriptive qualitative study design was applied using semi-structured interviews based on the critical incident technique and qualitative content analysis. Nineteen participants, eight learners in their specialist training, nine supervisors and two head supervisors in Sweden identified 47 incidents. RESULT: Teams of learners having control was the core issue. Motivation, time, experiences and reflection were central issues for facilitating collaboration. CONCLUSION: Efficiently training teams how to collaborate requires learners having control while acting on their common understanding and supervisors taking a facilitating role supporting teams to take control of their critical analysis.

Exploring teams of learners becoming "WE" in the Intensive Care Unit--a focused ethnographic study.

BACKGROUND: Research about collaboration within teams of learners in intensive care is sparse, as is research on how the learners in a group develop into a team. The aim of this study was to explore the collaboration in teams of learners during a rotation in an interprofessional education unit in intensive care from a sociocultural learning perspective. METHODS: Focused Ethnographic methods were used to collect data following eight teams of learners in 2009 and 2010. Each team consisted of one resident, one specialist nurse student and their supervisors (n = 28). The material consisted of 100 hours of observations, interviews, and four hours of sound recordings. A qualitative analysis explored changing patterns of interplay through a constant comparative approach. RESULTS: The learners' collaboration progressed along a pattern of participation common to all eight groups with a chronological starting point and an end point. The progress consisted of three main steps where the learners' groups developed into teams during a week's training. The supervisors' guided the progress by gradually stepping back to provide latitude for critical reflection and action. CONCLUSION: Our main conclusion in training teams of learners how to collaborate in the intensive care is the crucial understanding of how to guide them to act like a team, feel like a team and having the authority to act as a team.