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Nordin, A., Engström, A., Strömbäck, U., Juuso, P. & Andersson, M. (2024). Close relatives' perspective of critical illness due to COVID-19: Keeping in touch at a distance. Nursing Open, 11(1), Article ID e2068.
Open this publication in new window or tab >>Close relatives' perspective of critical illness due to COVID-19: Keeping in touch at a distance
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2024 (English)In: Nursing Open, E-ISSN 2054-1058, Vol. 11, no 1, article id e2068Article in journal (Refereed) Published
Abstract [en]

AimTo elucidate the meaning of being a close relative of a critically ill person cared for in intensive care during the initial phase of the COVID-19 pandemic.DesignA narrative inquiry design following the COREQ guidelines.MethodsIndividual interviews with fifteen close relatives of patients critically ill with COVID-19 were analysed using phenomenological hermeneutics.ResultsThe surreal existence of not being allowed to be near was emotionally difficult. While distancing due to restrictions was challenging, physicians' phone calls served as a connection to their relatives and brought a sense of security. Keeping notes helped them remember what happened and brought order to a chaotic situation.ConclusionClose relatives feel secure when they receive regular information about their critically ill relative, not just when their condition worsens. They wish to be physically near to their critically ill person; when this is impossible, digital technology can provide support, but further accessibility developments are needed.

Place, publisher, year, edition, pages
John Wiley & Sons, 2024
Keywords
COVID-19, critical care, nursing, person-centred care, relatives
National Category
Nursing Anesthesiology and Intensive Care
Research subject
Nursing Science
Identifiers
urn:nbn:se:kau:diva-97926 (URN)10.1002/nop2.2068 (DOI)001127930300001 ()2-s2.0-85180507390 (Scopus ID)
Available from: 2024-01-05 Created: 2024-01-05 Last updated: 2024-01-08Bibliographically approved
Fritzson, M., Nordin, A., Børøsund, E., Johansson, M., Varsi, C. & Ängeby, K. (2023). A mobile application for early labour support -feasibility pilot study. Women and Birth, 36(6), 495-503
Open this publication in new window or tab >>A mobile application for early labour support -feasibility pilot study
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2023 (English)In: Women and Birth, ISSN 1871-5192, E-ISSN 1878-1799, Vol. 36, no 6, p. 495-503Article in journal (Refereed) Published
Abstract [en]

Background: Use of mobile applications (apps) are increasing during pregnancy but few of these are evidence-based or evaluated in research. Aim: To examine the feasibility, including perceived usefulness and usability, and the preliminary effects of an app based on the Confident birth method. Methods: A mixed-method approach, including 48 women, was used to evaluate acceptability, usability and to test study design and procedures. iPhone-users (n = 24) tested the app during pregnancy while the remaining (n = 24) formed a control group. Background characteristics and outcome measurements were collected from all women at baseline. Women in the app group received two follow-up phone calls from a midwife concerning usefulness and ease of use of the app. A follow-up questionnaire after birth were used to measure preliminary effects of the intervention as well as system usability of the app. Results: Women using the app found the app exercises simple, understandable, and useful. System usability score showed a mean score of 85.3 indicating excellent system usability. Notes from phone calls resulted in four categories: positive feedback about the app, negative feedback about the app, partners involvement, and knowledge. Preliminary effects of labour experience showed no significant differences between the two groups, in terms of early labour or childbirth experience. Conclusion: The app tested in this feasibility study, was perceived as useful and appreciated by women. Areas for improvement of the app were identified. The result shows promise for further efficacy testing in a forthcoming randomised controlled trial. 

Place, publisher, year, edition, pages
Elsevier, 2023
Keywords
Antenatal education, Blended care, Early labour, Feasbility study, Mixed method, Mobile application
National Category
Obstetrics, Gynecology and Reproductive Medicine
Research subject
Nursing Science
Identifiers
urn:nbn:se:kau:diva-94563 (URN)10.1016/j.wombi.2023.03.008 (DOI)001101598000001 ()37030985 (PubMedID)2-s2.0-85153075747 (Scopus ID)
Available from: 2023-05-11 Created: 2023-05-11 Last updated: 2023-12-11Bibliographically approved
Iwaya, L. H., Nordin, A., Fritsch, L., Børøsund, E., Johansson, M., Varsi, C. & Ängeby, K. (2023). Early Labour App: Developing a practice-based mobile health application for digital early labour support. International Journal of Medical Informatics, 177, 105139-105139, Article ID 105139.
Open this publication in new window or tab >>Early Labour App: Developing a practice-based mobile health application for digital early labour support
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2023 (English)In: International Journal of Medical Informatics, ISSN 1386-5056, E-ISSN 1872-8243, Vol. 177, p. 105139-105139, article id 105139Article in journal (Refereed) Published
Abstract [en]

Background: Pregnant women in early labour have felt excluded from professional care, and their partners have been restricted from being involved in the birthing process. Expectant parents must be better prepared to deal with fear and stress during early labour. There is a need for evidence-based information and digital applications that can empower couples during childbirth. Objective: To develop and identify requirements for a practice-based mobile health (mHealth) application for Digital Early Labour Support. Methods: This research started with creating an expert group composed of a multidisciplinary team capable of informing the app development process on evidence-based practices. In consultation with the expert group, the app was built using an agile development approach (i.e., Scrum) within a continuous software engineering setting (i.e., CI/CD, DevOps), also including user and security tests. Results: During the development of the Early Labour App, two main types of challenges emerged: (1) user challenges, related to understanding the users’ needs and experience with the app, and (2) team challenges, related to the software development team in particular, and the necessary skills for translating an early labour intervention into a digital solution. This study reaffirms the importance of midwife support via blended care and the opportunity of complementing it with an app. The Early Labour App was easy to use, the women needed little to no help, and the partner’s preparation was facilitated. The combination of the app together with blended care opens up awareness, thoughts and feelings about the method and provides good preparation for the birth. Conclusion: We propose the creation of the Early Labour App, a mHealth app for early labour support. The preliminary tests conducted for the Early Labour App show that the app is mature, allowing it to be used in the project’s Randomised Control Trial, which is already ongoing.

Place, publisher, year, edition, pages
Elsevier, 2023
Keywords
Mhealth, Mobile health, Mobile app, Early labor, Midwifery, Pregnancy, Prenatal care
National Category
Health Sciences Computer and Information Sciences
Research subject
Computer Science
Identifiers
urn:nbn:se:kau:diva-96158 (URN)10.1016/j.ijmedinf.2023.105139 (DOI)001036408000001 ()37406571 (PubMedID)2-s2.0-85164245277 (Scopus ID)
Funder
Vinnova, 2018-03025Region Värmland, RUN/220266
Available from: 2023-07-27 Created: 2023-07-27 Last updated: 2023-08-10Bibliographically approved
Nordin, A., Engstrom, A., Andersson, M. & Fredholm, A. (2023). Intensive Care Managers' Experiences of the COVID-19 Pandemic: A Dramatic Change of the Intensive Care Landscape. Journal of Nursing Management, 2023, Article ID 3052994.
Open this publication in new window or tab >>Intensive Care Managers' Experiences of the COVID-19 Pandemic: A Dramatic Change of the Intensive Care Landscape
2023 (English)In: Journal of Nursing Management, ISSN 0966-0429, E-ISSN 1365-2834, Vol. 2023, article id 3052994Article in journal (Refereed) Published
Abstract [en]

Aim. To describe intensive care managers' experiences of premises and resources of care in intensive care units during the COVID-19 pandemic. Background. Intensive care units (ICUs) were enormously pressured during the COVID-19 pandemic from many ill patients, requiring advanced care. Hospital and community volunteers increased staff strength. Obligatorily, recruitments were also conducted using transfer of staff from different hospital departments. However, there is little knowledge about intensive care managers' (ICMs) experiences of leadership during the COVID-19 pandemic. Methods. A qualitative descriptive study was conducted from March to April 2022. Semistructured interviews were held with 12 ICMs who were purposively sampled from the ICU in ten Swedish hospitals. Data were analysed using qualitative content analysis. Results. Two themes emerged: a dramatic change of the intensive care landscape and we could handle more than we thought, but at a steep price. Participants described that the ICUs had to perform extraordinary changes at a very fast pace, which initially created a sense of cohesion. Training and introduction to war-like conditions associated with uncertainty meant that ICMs had to support ICU staff in prioritising interventions. Participants described how ICUs stood strong against a pandemic, but stress, worries, and anxiety took a heavy toll on ICU staff and ICMs. The pandemic eroded the resilience in ICUs. Participants described a deterioration in health and said that sick leaves and resignations occurred. Conclusion. Our findings show ICMs' experiences as a field of tension between resources and demands, whereby the changes created a heavy burden that left intensive care weakened. Implications for Nursing Management. Findings emphasised the importance of creating working conditions using human resources and materials in order to rebuild resilience in intensive care with the ability to conduct safe patient care.

Place, publisher, year, edition, pages
Hindawi Publishing Corporation, 2023
National Category
Nursing Anesthesiology and Intensive Care
Research subject
Nursing Science
Identifiers
urn:nbn:se:kau:diva-97289 (URN)10.1155/2023/3052994 (DOI)001079579400002 ()2-s2.0-85174399328 (Scopus ID)
Available from: 2023-11-02 Created: 2023-11-02 Last updated: 2023-11-27Bibliographically approved
Nordin, A., Engström, Å., Fredholm, A., Persenius Wentzel, M. & Andersson, M. (2023). Measuring moral distress in Swedish intensive care: Psychometric and descriptive results. Intensive & Critical Care Nursing, 76, Article ID 103376.
Open this publication in new window or tab >>Measuring moral distress in Swedish intensive care: Psychometric and descriptive results
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2023 (English)In: Intensive & Critical Care Nursing, ISSN 0964-3397, E-ISSN 1532-4036, Vol. 76, article id 103376Article in journal (Refereed) Published
Abstract [en]

Objectives: To investigate the construct validity and psychometric properties of the Swedish version of the Moral Distress Scale–Revised and to describe moral distress in an intensive care context. Research Methodology/Design: The Italian Moral Distress Scale–Revised was translated and semantically adjusted to the Swedish intensive care context. A web survey with 14 moral distress items, as well as three additional and eight background questions was answered by critical care nurses (N = 71) working in intensive care units during the second year of the coronavirus disease pandemic. Inferential and descriptive statistics were used to investigate the Italian four-factor model and to examine critical care nurses’ moral distress. Results: The result shows a factor model of four components differing from the previous model. Critical care nurses demonstrated significant differences in moral distress regarding priorities compared to before the pandemic, type of household; experience as critical care nurses and whether they had supervised students during the pandemic. Conclusion: The component structure might have originated from the specific situation critical care nurses perceived during the pandemic. The health care organisations’ role in preventing and healing the effects of moral distress is important for managers to understand. Implications for clinical practice: Moral distress is common in intensive care and it is necessary to use valid instrument when measuring it. A psychometrical investigation of the Swedish version of the Moral Distress Scale–Revised, adapted for intensive care shows need for further semantic and cultural adaptation. Perceived priorities during the pandemic, household type, supervising during the pandemic and working experience were related to critical care nurses’ experience of moral distress and managers need to be aware of conditions that may trigger such a response.

Place, publisher, year, edition, pages
Elsevier, 2023
Keywords
Critical care nurses, Intensive care units, Moral distress, Psychometrics, Validity
National Category
Nursing
Research subject
Nursing Science
Identifiers
urn:nbn:se:kau:diva-93615 (URN)10.1016/j.iccn.2022.103376 (DOI)000926137000001 ()2-s2.0-85146903930 (Scopus ID)
Funder
Karlstad UniversityLuleå University of TechnologyLandstinget i Värmland
Available from: 2023-02-13 Created: 2023-02-13 Last updated: 2023-03-09Bibliographically approved
Andersson, M., Fredholm, A., Nordin, A. & Engström, Å. (2023). Moral Distress, Health and Intention to Leave: Critical Care Nurses’ Perceptions During COVID-19 Pandemic. Sage Open Nursing, 9
Open this publication in new window or tab >>Moral Distress, Health and Intention to Leave: Critical Care Nurses’ Perceptions During COVID-19 Pandemic
2023 (English)In: Sage Open Nursing, E-ISSN 2377-9608, Vol. 9Article in journal (Refereed) Published
Abstract [en]

Introduction: Moral distress increases the risk that critical care nurses will lose the ability to provide quality nursing care. Aims: To describe person-related conditions and perceptions of moral distress, health and intention to leave among critical care nurses in intensive care units, and to examine the relationship between person-related conditions, moral distress, health and intention to leave. Method: Cross-sectional, with 220 critical care nurses in 15 Swedish ICUs, and data gathered via a self-reported questionnaire. Results: Highest moral distress scores were reported in futile care and poor teamwork and 21% reported entertaining an intention to leave. Self-reported health was lower than before the COVID-19 pandemic and 4.1% reported pronounced exhaustion disorder. Self-reported health, reduced capacity to tolerate demands under time pressure, emotional instability or irritability, physical weakness, or being more easily fatigued and with decreased well-being were factors that had a relationship with futile care. Sleeping problems and intention to leave had a relationship with poor teamwork. Conclusions: Different strategies are needed to reduce moral distress and the leadership is crucial for managing crises such as the COVID-19 pandemic. 

Place, publisher, year, edition, pages
Sage Publications, 2023
Keywords
Covid-19 pandemic, critical care nurses, health, intensive care, moral distress
National Category
Nursing
Research subject
Nursing Science
Identifiers
urn:nbn:se:kau:diva-94665 (URN)10.1177/23779608231169218 (DOI)000861045100011 ()35688753 (PubMedID)2-s2.0-85153609241 (Scopus ID)
Funder
Karlstad UniversityRegion VärmlandLuleå University of Technology
Available from: 2023-05-15 Created: 2023-05-15 Last updated: 2023-05-26Bibliographically approved
Andersson, M., Nordin, A., Fredholm, A. & Engström, Å. (2023). The four domains of the person-centred practice framework from the perspective of critical care nurses in intensive care units during a pandemic. Intensive & Critical Care Nursing, 78, Article ID 103449.
Open this publication in new window or tab >>The four domains of the person-centred practice framework from the perspective of critical care nurses in intensive care units during a pandemic
2023 (English)In: Intensive & Critical Care Nursing, ISSN 0964-3397, E-ISSN 1532-4036, Vol. 78, article id 103449Article in journal (Refereed) Published
Abstract [en]

Objectives: The aim was to describe the Person-Centred Practice Framework’s four domains (prerequisites, care environment, person-centred processes, and person-centred outcomes) through the perspectives of critical care nurses working in intensive care units during the second year of the COVID-19 pandemic. Furthermore, the aim was to investigate the relationships between prerequisites, care environment, person-centred processes, and person-centred outcomes. Design/methods: A cross-sectional study involving questionnaires. Prerequisites were measured using person- related conditions, the care environment by using the Person-Centred Climate Questionnaire–Staff version, the person-centred processes by using the Person-Centred Care Assessment Tool and person-centred outcomes were measured with one question about present health and well-being and by using Self-rated Exhaustion Disorder. Descriptive and analytic statistics were used. Data was collected from July 2021 to November 2021. Setting: Critical care nurses (n =217) working in 15 Swedish adult intensive care units. Results: Participants’ average length of experience in intensive care units was 14 years, and most participants experienced increased nursing care responsibilities. They perceived the climate as safe but had limitations in terms of its everydayness and community. Participants perceived the organisations both supported and hindered personalized care. Most participants experienced a variety of exhaustion symptoms, and their health had positive relationship with community. Conclusion: By showing how prerequisites, care environment, person-centred process influences critical care nurses’ health and well-being, organisations might identify aspects in the work environment that require targeted interventions to reach healthy workplaces. Implications for clinical practice: To preserve the health and well-being of critical care nurses and to flourish as humans in their professional roles, they need to interact with and form relationships with their colleagues, patients, and relatives. Organisations should have a person-centred approach for every individual in the workforce to harness each critical care nurses’ knowledge and skills for individuals to growth in their roles.  

Place, publisher, year, edition, pages
Elsevier, 2023
Keywords
COVID-19, Critical care nurses, Health, Intensive care, Person-centred practice framework, Well-being
National Category
Nursing
Research subject
Nursing Science
Identifiers
urn:nbn:se:kau:diva-94899 (URN)10.1016/j.iccn.2023.103449 (DOI)001001432900001 ()37169630 (PubMedID)2-s2.0-85158831731 (Scopus ID)
Funder
Karlstad UniversityLandstinget i Värmland, LIVFOU-968530
Available from: 2023-05-29 Created: 2023-05-29 Last updated: 2023-06-26Bibliographically approved
Nordin, A., Ängeby, K. & Fritsch, L. (2022). Body-Area Sensing in Maternity Care: Evaluation of Commercial Wristbands for Pre-birth Stress Management. In: Lecture Notes of the Institute for Computer Sciences Social Informatics and Telecommunications Engineering: . Paper presented at 16th European-Alliance-for-Innovation (EAI) International Conference on Body Area Networks (BodyNets), 25 December 2021 through 26 December 2021 (pp. 168-175). Springer, 420
Open this publication in new window or tab >>Body-Area Sensing in Maternity Care: Evaluation of Commercial Wristbands for Pre-birth Stress Management
2022 (English)In: Lecture Notes of the Institute for Computer Sciences Social Informatics and Telecommunications Engineering, Springer, 2022, Vol. 420, p. 168-175Conference paper, Published paper (Refereed)
Abstract [en]

Many women use digital tools during pregnancy and birth. There are many existing mobile applications to measure quantity and length of contractions during early labour, but there is a need to offer evidence-based, credible electronic and digital solutions to parents-to-be. This article presents ongoing research work in a research project regarding mobile telemetric supported maternity care. It summarizes an approach for stress management in late maternity and under birth preparation that is based on body area sensing, our investigation of the properties of commercially available wearable wristbands for body sensing, and the insights gained from testing the wristbands from the project's perspective. We found that sensing precision is very variable depending on the wristband model, while the flows of medical personal data exclusively are routed through vendor cloud platforms outside the EU. The impact of our findings for the use of commercial wristbands in European medical research and practice is discussed in the conclusion.

Place, publisher, year, edition, pages
Springer, 2022
Keywords
Body area networking, Midwifery, Mobile health, Self-metering, Stress management, Wearables, Digital devices, mHealth, Wearable technology, Cloud platforms, Digital solutions, Digital tools, Evidence-based, Mobile applications, On-body, Property, Obstetrics
National Category
Health Sciences Computer and Information Sciences
Research subject
Nursing Science; Computer Science
Identifiers
urn:nbn:se:kau:diva-89507 (URN)10.1007/978-3-030-95593-9_14 (DOI)000774502300014 ()2-s2.0-85125236499 (Scopus ID)9783030955922 (ISBN)
Conference
16th European-Alliance-for-Innovation (EAI) International Conference on Body Area Networks (BodyNets), 25 December 2021 through 26 December 2021
Available from: 2022-04-13 Created: 2022-04-13 Last updated: 2022-09-07Bibliographically approved
Andersson, M., Nordin, A. & Engström, Å. (2022). Critical care nurses’ perception of moral distress in intensive care during the COVID-19 pandemic – A pilot study. Intensive & Critical Care Nursing, 72, Article ID 103279.
Open this publication in new window or tab >>Critical care nurses’ perception of moral distress in intensive care during the COVID-19 pandemic – A pilot study
2022 (English)In: Intensive & Critical Care Nursing, ISSN 0964-3397, E-ISSN 1532-4036, Vol. 72, article id 103279Article in journal (Refereed) Published
Abstract [en]

Objectives: To describe critical care nurses’ perception of moral distress during the second year of the COVID-19 pandemic. Design/Methods: A cross-sectional study involving a questionnaire was conducted. Participants responded to the Italian version of the Moral Distress Scale-Revised, which consists of 14 items divided in dimensions Futile care (three items), Ethical misconduct (five items), Deceptive communication (three items) and Poor teamwork (three items). For each item, participants were also invited to write about their experiences and participants’ intention to leave a position now was measured by a dichotomous question. The data were analysed with descriptive statistics and qualitative content analysis. The study followed the checklist (CHERRIES) for reporting results of internet surveys. Setting: Critical care nurses (n = 71) working in Swedish adult intensive care units. Results: Critical care nurses experienced the intensity of moral distress as the highest when no one decided to withdraw ventilator support to a hopelessly ill person (Futile care), and when they had to assist another physician or nurse who provided incompetent care (Poor teamwork). Thirty-nine percent of critical care nurses were considering leaving their current position because of moral distress. Conclusions: During the COVID-19 pandemic, critical care nurses, due to their education and experience of intensive care nursing, assume tremendous responsibility for critically ill patients. Throughout, communication within the intensive care team seems to have a bearing on the degree of moral distress. Improvements in communication and teamwork are needed to reduce moral distress among critical care nurses.

Place, publisher, year, edition, pages
Elsevier, 2022
Keywords
COVID-19, Ethics, Intensive Care, Moral distress, Nursing
National Category
Nursing Social Work
Research subject
Nursing Science
Identifiers
urn:nbn:se:kau:diva-91295 (URN)10.1016/j.iccn.2022.103279 (DOI)000861045100011 ()35688753 (PubMedID)2-s2.0-85131831585 (Scopus ID)
Available from: 2022-07-08 Created: 2022-07-08 Last updated: 2022-10-24Bibliographically approved
Nordin, A. (2022). Digital technology for communication and meetings with relatives to critically ill patients in intensive care during the covid-19 pandemic. In: : . Paper presented at European federation of Critical Care Nurses associations (EfCCNa) 9th Congress.
Open this publication in new window or tab >>Digital technology for communication and meetings with relatives to critically ill patients in intensive care during the covid-19 pandemic
2022 (English)Conference paper, Oral presentation only (Other academic)
National Category
Nursing
Research subject
Nursing Science
Identifiers
urn:nbn:se:kau:diva-94197 (URN)
Conference
European federation of Critical Care Nurses associations (EfCCNa) 9th Congress
Available from: 2023-04-04 Created: 2023-04-04 Last updated: 2023-04-04Bibliographically approved
Organisations
Identifiers
ORCID iD: ORCID iD iconorcid.org/0000-0001-8709-342X

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