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  • 1.
    Björling, Gunilla
    et al.
    The Swedish Red Cross University College, Department of Nursing and Care. Karolinska Institutet, Department of Clinical Sciences, Division of Anaesthesia and Intensive Care, Danderyd Hospital.
    Johansson, Dorota
    Bactiguard AB, Stockholm; Tullinge, SE-146 21, Sweden .
    Bergström, Linda
    Bactiguard AB, Stockholm; Tullinge, SE-146 21, Sweden .
    Jalal, Shah
    Karolinska Institutet, Division of Clinical Microbiology, Department of Laboratory Medicine.
    Kohn, Ivar
    Department Anesthesia and Intensive Care, Karolinska University Hospital Huddinge.
    Frostell, Claes
    Karolinska Institutet, Department of Clinical Sciences, Division of Anaesthesia and Intensive Care, Danderyd Hospital.
    Kalman, Sigridur
    Department Anesthesia and Intensive Care, Karolinska University Hospital Huddinge, CLINTEC, Karolinska Institutet.
    Tolerability and performance of BIP endotracheal tubes with noble metal alloy coating: a randomized clinical evaluation study2015In: BMC Anesthesiology, ISSN 1471-2253, E-ISSN 1471-2253, Vol. 15, p. 1-10, article id 174Article in journal (Refereed)
    Abstract [en]

    Background

    Hospital acquired infections worsen the outcome of patients treated in intensive care units and are costly. Coatings with silver or metal alloys may reduce or alter the formation of biofilm on invasive medical devices. An endotracheal tube (ETT) is used to connect the patient to a ventilator and coated tubes have been tested in relation to bacterial colonization and respiratory infection. In the present study, we aimed to evaluate and compare a coated and uncoated ETT for patient symptoms and local tracheal tolerability during short term clinical use. Degree of bacterial colonization was also described.

    Methods

    A silver-palladium-gold alloy coating (‘Bactiguard®’Infection Protection, BIP) has been extensively used on urinary tract catheters and lately also on central venous catheters. We performed a randomised, single-blinded, controlled, first in man, post Conformité Européenne (EC) certification and CE marking study, focused on Bactiguard® coated ETTs (BIP ETT). Thirty patients at a tertiary university hospital scheduled for upper abdominal elective surgery with an expected duration of anaesthesia of at least 3 h were randomised; BIP ETT (n = 20) or standard ETT (n = 10). The tolerability was assessed with a modified version of Quality of Life Head and Neck Module, QLQ-H&N35 and by inspection of the tracheal mucosa with a fibre-optic bronchoscope before intubation and at extubation. Adverse Events (AE) and bacterial adherence were also studied. Statistical evaluations were carried out with the Fisher’s Exact Test, the Clopper-Pearson method, as well as a Proportional Odds Model.

    Results

    Differences between groups were identified in 2 of 8 patient related symptoms with regard to tolerability by QLQ-H&N35 (cough, p = 0.022 and dry mouth, p = 0.014 in the treatment group.). No mucosal damage was identified with bronchoscopy. A low level of bacterial colonization with normal flora, equal between groups, was seen after short-term of intubation (median 5 h). No serious Adverse Events related to the use of an ETT were observed. The results should be treated with caution due to statistical confounders, a small study size and large inter-individual variability in bacterial adhesion.

    Conclusions

    The new device BIP ETT is well tolerated and has good clinical performance during short-term intubation. Studies with larger sample sizes and longer intubation periods (>24 h) in the ICU-setting are needed and can now be planned in order to identify possible differences in clinical outcomes.

  • 2.
    Mattsson, Janet
    Department of Clinical Science and Education, Södersjukhuset; Karolinska Institutet, Stockholm.
    Uncovering pain and caring for children in the pediatric intensive care unit: nurses’ clinical approach and parent’s perspective2013Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    Background: The thesis has a standpoint in a synthesis of caring science and educationscience from a clinical perspective. Children in a Pediatric Intensive Care Unit (PICU) are in an exposed position, dependent on nurses to acknowledge their needs. The alleviation of children’s pain has been investigated from various perspectives, but undertreated pain remains a problem in the PICU. There is a preponderance of empirical evidence pointing toward the role of nurses in uncovering children’s pain and suffering. How nurses interpret the child’s expressions and judge the clinical situation influences their actions in the clinical care. In a PICU, the basis for nurses’ concerns and interpretation of what is meaningful in the nursing care situation are formed by professional concern, workplace culture, traditions, habits, and workplace structures. This influences how parents interpret the meaning of care as well. Patricia Benner’s theory on clinical judgment forms a reference framework for this thesis. The assumption is that children need to be approached from a holistic perspective in the caring situation in order to acknowledge their caring needs. A nurse’s clinical education and insights allow for the possibility to enhance the quality of care for children and parents in the PICU.

    Aim: To uncover clinical concerns, from caring and learning perspectives, in caring for children in the Pediatric Intensive Care Unit (PICU) from nurses and parents perspective.

    Methods: Qualitative methods were used in all studies to unfold and explore the phenomena in the nurses’ and parents’ everyday clinical life world. In Papers I and II, a phenomenographic method was adopted. In Papers III and IV, an interpretive phenomenological approach was adopted.

    Findings: Nurses that have a holistic view of the child and approach the child from a multidimensional perspective, with a focus on the individual child and his/her caring needs, develop a clinical “connoisseurship” and meet the parents’ expectations of the meaning of care. The nurses express that it is only when they focus on the child that subtle signs of pain are revealed. The meaning of nursing care, in the ideal case, is a holistic care where all aspects are integrated and the child as a person has first priority.

    Conclusion: The meaning of caring and children’s needs must become elucidated to improve the cultural influence of what can be seen as good nursing care within the PICU.

  • 3.
    Mattsson, Janet
    et al.
    Department of Clinical Science and Education, Södersjukhuset; Karolinska Institutet.
    Forsner, Maria
    Högskolan Dalarna, Omvårdnad.
    Castrén, Maaret
    Department of Clinical Science and Education, Södersjukhuset; Karolinska Institutet.
    Arman, Maria
    Department of Neurobiology, Care Science and Society, Karolinska Institutet.
    Clinical Judgment of Pain in the Non-Verbal Child at the PICU: A Phenomenographic Study2011In: Journal of Palliative Care & Medicine, ISSN 2165-7386, Vol. 1, no 1, p. 102-Article in journal (Refereed)
  • 4.
    Mattsson, Janet
    et al.
    Karolinska Institutet, Department of Clinical Science and Education; Södersjukhuset.
    Forsner, Maria
    Högskolan Dalarna, Omvårdnad.
    Castrén, Maaret
    Karolinska Institutet. Department of Clinical Science and Education; Södersjukhuset and Section of Emergency Medicine.
    Bolander Laksov, Klara
    Karolinska Institutet, Centre for Medical Education, Department of Learning, Informatics, Management and Ethics.
    Arman, Maria
    Karolinska Institutet, Department of Neurobiology, Care Science and Society.
    A qualitative national study of nurses’ clinical knowledge development of pain in pediatric intensive care2012In: Journal of Nursing Education and Practice, ISSN 1925-4040, E-ISSN 1925-4059, Vol. 2, no 2, p. 107-118Article in journal (Refereed)
    Abstract [en]

    Background: Vulnerable children undergoing intensive care might still experience pain when they should not, due tonurses and pediatricians insufficient knowledge about how critical illness affects childrens’ signs of pain. How signs ofpain are learned in clinical practice might be one of the remaining aspects in nurses insufficient pain alleviation. In theworkplace learning is directed by what the units shared meaning finds as significant and meaningful to learn. However,what it is viewed as meaningful to learn about pain from the nurses’ perspective might not be meaningful from the child’sperspective. When working together in the PICU, nurses rely on each other and interact in many ways, and theirunderstanding is related to situated knowledge and facilitated by a personal reference group of colleagues. Professionalconcern, depending on culture, traditions, habits, and workplace structures forms the clinical learning patterns in thePICU. However little is known about nurses’ clinical learning patterns or collegial facilitation within the PICU. Theseassumptions lead to the aim of the study: to elucidate patterns in clinical knowledge development and unfold the role offacilitator nurses in relation to pain management in the PICU.

    Method: The study had a qualitative interpretive design approach using semi-structured interviews, analyzed withqualitative content analysis to elucidate both manifest and latent content.

    Results: The findings elucidates that the workplace culture supports or hinders learning and collaboration. Knowledgedevelopment within practice is closely connected to the workplace culture and to nurses’ significant networks. Thefindings also clarify that nurses needs to feel safe in the workplace and on an individual level to build and rely onsignificant networks that facilitates their own personal knowledge development. There is an ongoing interaction betweenthe learning patterns and the facilitation the significant networks offer.

    Conclusions: Nurses need to embrace effective learning about children’s pain from day one. Lack of a facilitatingstructure for learning, lack of assessment within clinical practice, and the focus on the individual nurses’ learning areremaining considerable problems when it comes to alleviating the vulnerable child’s pain. To increase the possibility ofpain alleviation in the clinical setting, it is of importance to attend to the caring culture and build a safe collaborative culture that is patient centered. This requires an environment that allows for open discussion, where questioning andreflecting is a natural part of the culture within the group. These factors need highlighting and thorough examination fromthe organization. Nurses focus on learning, and interact in a learning community of practice that is furthered when theyexperience a safe environment and find that their questions are taken seriously. Approaches to promote a scholarship ofnursing care are needed to develop clinical learning and, consequently, raise the quality of pain care.

  • 5.
    Mattsson, Janet Yvonne
    et al.
    Karolinska Institutet, Sweden.
    Arman, Maria
    Karolinska Institutet, Sweden.
    Castren, Maaret
    Karolinska Institutet, Sweden.
    Forsner, Maria
    Högskolan Dalarna, Omvårdnad.
    Meaning of caring in pediatric intensive care unit from the perspective of parents: A qualitative study2014In: Journal of Child Health Care, ISSN 1367-4935, E-ISSN 1741-2889, Vol. 18, no 4, p. 336-345Article in journal (Refereed)
    Abstract [en]

    When children are critically ill, parents still strive to be present and participate in the care of their child. Pediatric intensive care differs from other realms of pediatric care as the nature of care is technically advanced and rather obstructing than encouraging parental involvement or closeness, either physically or emotionally, with the critically ill child. The aim of this study was to elucidate the meaning of caring in the pediatric intensive care unit from the perspective of parents. The design of this study followed Benner's interpretive phenomenological method. Eleven parents of seven children participated in observations and interviews. The following aspects of caring were illustrated in the themes arising from the findings: being a bridge to the child on the edge, building a sheltered atmosphere, meeting the child's needs, and adapting the environment for family life. The overall impression is that the phenomenon of caring is experienced exclusively when it is directed toward the exposed child. The conclusion drawn is that caring is present when providing expert physical care combined with fulfilling emotional needs and supporting continuing daily parental care for the child in an inviting environment.

  • 6.
    Mattsson, Janet Yvonne
    et al.
    Department of Clinical Science and Education, Karolinska Institute.
    Forsner, Maria
    Högskolan Dalarna, Omvårdnad.
    Arman, Maria
    Department of Neurobiology, Care Science and Society, Division of Nursing, Karolinska Institute.
    Uncovering pain in critically ill non-verbal children: Nurses' clinical experiences in the paediatric intensive care unit2011In: Journal of Child Health Care, ISSN 1367-4935, E-ISSN 1741-2889, Vol. 15, no 3, p. 187-198Article in journal (Refereed)
    Abstract [en]

    Critically ill paediatric patients are frequently exposed to pain that is required to be assessed and treated effectively. The most reliable resource for assessing pain is the child itself, but children in the paediatric intensive care unit (PICU) are commonly unable to communicate their needs, requiring professional caregivers to uncover and interpret pain. However, nurses and paediatricians do not have sufficient knowledge of how critical illness affects childrens' signs of pain. The aim of this study was to illuminate clinical experiences of pain in the PICU; describing nurses' perceptions of expressions of pain in non-verbal, critically ill 2-6 year old children. The participants were 17 experienced PICU nurses. Data were analysed according to the phenomenographic method and three qualitatively different main categories, gained from clinical experience, emerged: changes in the measurable parameters; perceived muscular tension; and, altered behaviour. Furthermore, contrasting the categories revealed two diverse perspectives to focus pain: measure-oriented and patient-oriented. Subtle expressions of pain were recognised when focus was patient-oriented. These findings support the necessity of actively looking for pain deriving from various perspectives and considering diverse caring needs when doing so. Acknowledging pain makes pain visible.

  • 7.
    Mattsson, Janet Yvonne
    et al.
    Department of Clinical Science and Education, Karolinska Institutet; Sachsska Barnsjukhuset.
    Forsner, Maria
    Högskolan Dalarna, Omvårdnad.
    Castrén, Maaret
    Department of Clinical Science and Education, Karolinska Institutet; Sachsska Barnsjukhuset.
    Arman, Maria
    Department of Clinical Science and Education, Karolinska Institutet; Sachsska Barnsjukhuset.
    Caring for children in pediatric intensive care units: An observation study focusing on nurses' concerns2013In: Nursing Ethics, ISSN 0969-7330, E-ISSN 1477-0989, Vol. 20, no 5, p. 528-538Article in journal (Refereed)
    Abstract [en]

    Children in the pediatric intensive care unit are indisputably in a vulnerable position, dependent on nurses to acknowledge their needs. It is assumed that children should be approached from a holistic perspective in the caring situation to meet their caring needs. The aim of the study was to unfold the meaning of nursing care through nurses’ concerns when caring for children in the pediatric intensive care unit. To investigate the qualitative aspects of practice embedded in the caring situation, the interpretive phenomenological approach was adopted for the study. The findings revealed three patterns: medically oriented nursing—here, the nurses attend to just the medical needs, and nursing care is at its minimum, leaving the children’s needs unmet; parent-oriented nursing care—here, the nursing care emphasizes the parents’ needs in the situation, and the children are viewed as a part of the parent and not as an individual child with specific caring needs; and smooth operating nursing care orientation—here, the nursing care is focused on the child as a whole human being, adding value to the nursing care. The conclusion drawn suggests that nursing care does not always respond to the needs of the child, jeopardizing the well-being of the child and leaving them at risk for experiencing pain and suffering. The concerns present in nursing care has been shown to be the divider of the meaning of nursing care and need to become elucidated in order to improve the cultural influence of what can be seen as good nursing care within the pediatric intensive care unit.

  • 8.
    Nürnberg Damström, D.
    et al.
    Institution of Physiology and Pharmacology, Section for Anesthesiology and Intensive Care Medicine, Karolinska University Hospital, Stockholm.
    Saboonchi, Fredrik
    Department of Clinical Sciences, Karolinska Institutet, Danderyd Hospital, Stockholm.
    Sackey, P. V.
    Institution of Physiology and Pharmacology, Section for Anesthesiology and Intensive Care Medicine, Karolinska University Hospital, Stockholm,.
    Björling, Gunilla
    Department of Clinical Sciences, Karolinska Institutet, Danderyd Hospital, Stockholm.
    A preliminary validation of the Swedish version of the critical-care pain observation tool in adults2011In: Acta Anaesthesiologica Scandinavica, ISSN 0001-5172, E-ISSN 1399-6576, ISSN 0001-5172, Vol. 55, no 4, p. 379-386Article in journal (Refereed)
    Abstract [en]

    Background: Assessing pain in critically ill patients can be complicated, especially for those unable to communicate. A recently developed pain assessment tool, the Critical-Care Pain Observation Tool (CPOT), has been shown to be a reliable tool for pain assessment in the Intensive Care Unit (ICU). The aim of the study was to validate the Swedish version of the CPOT.

    Methods: Conscious and unconscious adults were observed during two procedures: one non-nociceptive procedure (NNP) (arm- and face wash) and one nociceptive procedure (NP) (turning). In total, there were 240 patient assessments pre-, per- and post-procedure performed by two independent staff members at rest, during and 15 min after the different procedures. Measures of interrater reliability, internal consistency and discriminant validity of the CPOT were obtained to examine the properties of the Swedish version of CPOT.

    Results: The results provide indications of good agreement between the independent raters (ICC=0.84). There was an adequate discriminant validity of the Swedish version of CPOT established by a significant peak for CPOT scores during the NP (per-procedure). There was also a consistent pattern of significant correlations between CPOT and the mean artery pressure (ρ=0.32–0.45).

    Conclusion: The Swedish version of the CPOT is a suitable instrument for assessing pain in critically ill adults. The overall reliability and validity measures converge with findings from previous studies of the CPOT, but in order to achieve enhanced generalizability of the CPOT, we encourage further evaluation of CPOT in broader groups of critically ill patients.

  • 9.
    Prignitz Sluys, Kerstin
    Red Cross University College of Nursing.
    Uppföljning av barn och vuxna efter trauma2014In: Ventilen, ISSN 0348-6257, no 1, p. 8-9Article in journal (Other academic)
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