Intensive care units are stressful environments and can bring negative psychological outcomes among critical care nurses. The aim of the present study is to describe critical care nurses’ characteristics and perceptions of health in relation to sex, and also provide their description of a healthy and sustainable work environment in intensive care units using a person-centred practice framework. A cross-sectional design was employed with 136 participants who responded to a questionnaire. Descriptive statistics and qualitative content analysis were used. Regardless of sex, critical care nurses perceived their current health to be significantly lower than their health before the COVID-19 pandemic. They described effective staff relationships and a supportive organization as being essential for a healthy and sustainable work environment. Critical care nurses have recovered to their perceived pre-pandemic health to some degree. Well-functioning teams and a supportive organizational system might nurture a healthy and sustainable work environment. 

Introduction: Using the COVID-19 pandemic as an example of a national and international crisis, it has been possible to show how critical care nurses (CCNs) were affected by their work situation with impact on health and wellbeing. This study sought out to investigate how CCNs stress was affected and to provide some answers as to how to react and organize care in a future crisis. The specific focus was CCNs' stressors related supervision of nurses untrained in intensive care and how these were handled in a salutogenic perspective.Aim: The aim of this study was to analyze CCNs' experiences of supervision of nurses without training in intensive care during the COVID-19 pandemic, and to analyze these experiences with the help of the salutogenic concept sense of coherence.Materials and Methods: The phenomena under study were explored during the years of 2021-2022 through in-depth interviews and interpreted using deductive content analysis.Results: By analyzing CCNs experiences of supervising nurses without training in intensive care with the lens of sense of coherence, it was possible to show in what way these concepts influenced how to cope with the demanding situation. Sense of coherence was influenced by the inevitable prioritization of patient care and nursing interventions. This prioritization caused moral distress, but was also enhanced or decreased by CCNs sense of coherence.Conclusion: When recruiting and introducing new personnel in a future crisis to any field of healthcare, but particularly to the intensive care, we would, on the basis of these findings, suggest that well-established plans are vital for how to move personnel throughout the organization, and for how to introduce the field of intensive care. Plans for how to model care with the help of RNs without specialist training should be put in place. A communication plan for the organization is also of importance to enhance transparency.

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.

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.

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. 

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.  

Introduction The demands of the pandemic such as staff shortages and limited resources combined with new guidelines regarding infection control may have required the prioritizing of nursing interventions. Objectives The aim of this study was to describe critical care nurses' experiences of prioritizing nursing interventions for patients with COVID-19 in intensive care units (ICUs) during the pandemic. Method A qualitative descriptive study was gathered from open-ended questions included in a cross-sectional online questionnaire. Characteristics were presented using descriptive statistics, and open-ended questions were analyzed using qualitative content analysis with an inductive approach. The study was conducted in Sweden and focused on critical care nurses working in ICUs during spring 2021 and the second year of the COVID-19 pandemic. Results During the COVID-19 pandemic, 87% of the critical care nurses had provided orientations for new co-workers, and 52% had supervised intensive care nursing students. In all, 70 answered the question of whether they had prioritized nursing care differently during the pandemic; 86% reported that they had and 14% had not. The qualitative analysis resulted in one theme, Institutional constraints as an obstacle for nursing interventions, with three categories: Prioritizing lifesaving interventions, Performing nursing interventions less frequently, and Not able to provide the nursing care I wish to provide. Conclusion Institutional constraints as an obstacle for nursing interventions is the overall theme. It illustrates how critical care nurses have been forced to prioritize, thereby not being able to provide the nursing interventions they wanted to do provide, and it describes their feelings in this situation. The nurses need recovery and possibilities for reflection. The organization must also recover and not only return to how it was before the pandemic but also to learn from recent events and take actions to reduce the long-term effects on staffing.

This paper demonstrates a practical dimension to the discussion about threshold concepts. Threshold concepts have thus far mostly been acknowledged to elucidate learning processes mainly connected to theoretical concepts. By exploring situations that prompted experiences of autonomy and authenticity in clinical learning, findings showed how a practical experience could have the same power to transform thinking and identity as theoretical thresholds and serve as a trigger for transformational learning, therefore making the discussion about ‘practical thresholds' or thresholds in practice possible. The present study explores situations that prompted autonomy and authenticity, and offers context for and substance to these situations by adopting variation theory and the threshold concept framework. In order to learn more about situations that prompt experiences of autonomy and authenticity, and create prerequisites for such experiences, this paper examines how students discern and interpret these situations by analysing them through variation theory and the threshold concept framework.

This study examines autonomy in learning, related to medical and health care students perception of learning and development in clinical education. An understanding of the ways in which students learning and professional development is facilitated by autonomy, and a qualitative different understanding of the concept is vital for future development of learning and teaching strategies in medical and health care education. Self-directed learning and management of the learning process have been, and still are, stressed within health care and medical education, thus paying less interest to internal processes of learning involving responsibility and independence. The aim of the study was to investigate the relationship between autonomy in learning and narratives of personal challenge and development in the context of student experiences in clinical education. The study was undertaken using narrative inquiry. Findings consist of four themes; Dependence of the clinical supervisor, Feelings of ambivalence, Professional becoming and Need for authenticity. Through our analysis of findings we suggest that autonomy should be regarded as something that develops in relation to others and not as a merely individual phenomenon and that an authentic clinical situation enhances students' experiences of autonomy. (C) 2014 Elsevier Ltd. All rights reserved.