Högskolan i Skövde

Aim: This study aimed to explore newly graduated nurses' lived experiences of transition while participating in a Clinical Nursing Introduction Program and to describe factors that influence personal and professional development.

Methodological Design: A phenomenological hermeneutic design was used for researching lived experiences.

Research Methods: The data comprised nurses' individual and group interviews (n = 14) and written narratives (n = 21) after completing the Clinical Nursing Introduction Program approximately 1 year after graduation. The data was analysed using phenomenological hermeneutical approach.

Results: The lived experiences of transitioning while participating in the Clinical Nursing Introduction Program mean personal and professional growth, which, after 1 year, manifests as increased security and self-confidence. The findings are presented in five themes: Belonging to a community, Stepping out of the comfort zone, The clinical wards' environment and atmosphere, Developing an allowing attitude, and Gaining confidence in profession and self.

Conclusions: This study illuminates the pivotal role of the Clinical Nursing Introduction Program, comprising a community with peers, designated education days away from the ward, and group reflection sessions that facilitate the transition of newly graduated nurses into professional practice. These factors not only mitigate transition shock but also promote the development of competence and confidence, which are essential for personal and professional growth. The results also emphasised the need for ongoing group-based reflective supervision, which is essential for promoting lifelong learning within the nursing profession. These findings from a hospital setting can be implemented for newly graduated nurses in other healthcare settings, such as Primary Care and Community care. By facilitating such supportive environments, healthcare organisations can ensure smoother transitions and empower newly graduated nurses (NGNs) to thrive in their roles, ultimately enhancing the quality of patient care.

Background: Suicide attempts can lead to life-threatening conditions that require intensive care. In such situations, patients often experience existential fear when cared for in highly technological and unfamiliar environments such as the intensive care unit. The circumstances surrounding the suicide attempt, together with their critical condition, may further influence their ability to cope and shape their experience of care. Understanding these experiences is important to ensure that the therapeutic relationship supports the recovery process. Interprofessional collaboration and communication are essential for coordinated, recovery-oriented care.

Aim: To map the existing evidence on how patients, family members and healthcare personnel experience care in intensive care units following a suicide attempt, to identify key themes, knowledge gaps and implications for clinical practice and future research.

Study Design: This scoping review was conducted using the Arksey and O'Malley methodology and the PRISMA-ScR list. Six databases were systematically searched using predefined keywords. All English-language studies addressing the review aim were included.

Results: The search yielded 1107 articles. After screening, 13 were assessed in full, and five met the inclusion criteria. These studies, published between 1985 and 2011, comprised four surveys and one qualitative interview study. Findings indicate that patients felt misunderstood, families lacked information and support, and personnel experienced emotional strain. Attitudes varied widely, and healthcare personnel expressed a need for further education and reflective practice in suicide care.

Conclusions: Only five relevant studies were identified, all published between 1985 and 2011, with just one including patient or family perspectives. This limited and dated research highlights a clear gap in research on intensive care following suicide attempts and precludes firm conclusions about care experience. With these constraints, the findings tentatively suggest the importance of compassionate, holistic and collaborative approaches to care, as well as the potential value of personnel's support and training and policies that attend to the mental health needs of suicidal patients and their families.

Relevance to Clinical Practice: The findings may suggest the potential relevance of a holistic approach to caring for patients after a suicide in ICU practice, where physical, psychological, social and emotional aspects of care are considered in supporting recovery and well-being.

Impact Statements 

What is known about the topic

○Suicide is a prevalent global health issue, and many individuals who attempt suicide require advanced, life-saving treatment in the ICU.

○Patients admitted after a suicide attempt often experience severe psychological distress and therefore require empathetic and supportive interactions from healthcare professionals.

○The highly technological and intensive environment of the ICU can pose additional challenges for these patients, influencing their emotional state and overall experience of care.

What this paper adds

○This study underscores the marked scarcity of research and limited development of expertise in this area, highlighting an urgent need for further investigation and targeted educational initiatives.

○This study provides an initial glimpse into the vulnerability experienced by patients, family members and healthcare personnel in the context of ICU care following a suicide attempt.

○This study suggests that gaps in knowledge and uncertainty among healthcare personnel may be associated with countertransference reactions, potentially influencing how care is experienced and delivered.

Background: Discrepancies between academic nursing education and the realities of clinical practice may contribute to challenges during the transition from student to professional nurse. To address this, many countries and hospitals have implemented clinical introduction programmes for newly graduated nurses. However, limited knowledge exists regarding how these programmes influence nurses’ experiences of transitioning into their professional role over time.

Objectives: This study seeks to explore the lived experiences of nurses one year after completing a clinical nursing introduction programme, two years post-graduation.

Design: The study adopted a qualitative descriptive phenomenological design.

Setting: The setting was a general hospital in southwest Sweden.

Participants: The participants comprised 12 registered nurses two years after graduation who had completed a one-year clinical nursing introduction programme.

Methods: Semi-structured interviews were conducted and analysed using qualitative thematic analysis grounded in descriptive phenomenology.

Findings: Three themes were identified: A hunger for more, responsibility for being a caring nurse, and becoming self-aware and self-confident. Two years post-graduation and one year after completing the clinical nursing introduction programme, nurses expressed a strong drive for ongoing professional and personal growth, characterized by curiosity and a desire for autonomy. They emphasized responsibility for delivering patient-centred care, often prioritizing caring values to the extent of considering leaving workplaces that failed to support these ideals. Finally, participants reported increased confidence and self-awareness, viewing help-seeking as a sign of professional security rather than weakness. This development was supported by collegial relationships and reflective discussions on ethical dilemmas.

Conclusions: The clinical nursing introduction programme may provide an important foundation for ongoing professional and personal growth. The findings suggest that protected time, peer interaction, reflective practice, and supportive management were perceived as contributing to a developmental trajectory from ‘being’ to ‘becoming’ a nurse, while supporting lifelong learning, caring values, and clinical confidence. However, these perceived longer-term benefits should be interpreted with caution, as they may also reflect broader processes of professional maturation and workplace socialisation. The findings indicate that introduction programmes that incorporate opportunities for reflection, collegial support, and leadership engagement may help support the continued development of competence and confidence beyond the programme period.

Background: Family involvement in the intensive care unit (ICU) is recognized as important, yet its implementation is complex and varies across contexts, including Scandinavian settings.

Aim: This integrative review aimed to synthesize and integrate the evidence on family involvement in Scandinavian ICUs across the perspectives of family members, patients, and healthcare professionals. Findings are presented thematically rather than by perspective to capture shared and contrasting dimensions within overarching concepts.

Design: An integrative review was conducted following Whittemore and Knafl's framework.

Methods: A systematic search was conducted in five databases (PubMed, PsycINFO, and CINAHL) covering January 2010–October 2023, with an update in January 2025. A systematic search strategy was applied, and reporting adhered to PRISMA guidelines. Peer-reviewed studies published between 2013 and 2024 in English, Danish, Swedish, or Norwegian were included.

Findings: Fourteen studies met the inclusion criteria: nine qualitative (including one case-oriented) and five cross-sectional surveys. The review highlights the critical role of family involvement in the ICU, emphasizing its positive impact on patient care and family wellbeing. Active participation by family members provides both practical assistance and emotional support, fostering a patient-centred approach that improves patient outcomes. However, integrating families into care also presents significant challenges. Healthcare professionals' attitudes and behaviours, along with institutional policies and resource limitations, strongly influence the experience of family involvement. Families often face emotional stress and uncertainty, which can affect their engagement and lead to varying levels of participation. These findings underscore the need for strategies that balance collaboration with sensitivity to contextual and individual factors.

Conclusions: Family involvement in Scandinavian ICUs is a complex, context-dependent phenomenon shaped by relational, emotional, and organizational factors. It requires healthcare teams to balance challenges with the benefits for patients and families.

Background: There are little data on the impact of frailty on critically ill older patients treated in intensive care units (ICUs) and on their characteristics and outcomes. More understanding of the longitudinal health and recovery process is needed and of the recovery traits of older patients after intensive care.

Aim: This project aims to identify characteristics and outcomes in patients 65 years or older admitted to ICUs and to explore how health and recovery is experienced after discharge, with a special focus on frailty.

Study Design: This research project will conduct both retrospective and prospective data collection with a sample of approximately 3200 patients. This is a longitudinal, multicentre, prospective, observational research project with a nested cohort covering 12 months of admissions and comprising four studies. The first aims to map the characteristics of patients admitted to the ICUs, their treatments and their outcomes. The second will use questionnaires to assess their health and recovery process up to 18 months after discharge. The third and fourth studies aim to describe and understand their lived experiences using research interviews, with the fourth study including only frail patients.

Relevance to Clinical Practice: The project comprises studies that seek to identify the characteristics of older people admitted to ICUs, to examine how frailty impacts them and to understand what they experience during and foremost after intensive care. The project also aims to understand the facilitators and barriers to promoting health and recovery after discharge from ICUs and to contribute to the growing body of evidence supporting health and recovery initiatives. The results need to be spread and the knowledge sprung from this project may be implemented and used by intensive care unit clinicians.

Background and objectives: Patients with recurrent Clostridioides difficile infection (rCDI) suffer long after infection. However, knowledge is incomplete regarding their perceptions of in-hospital care, antibiotic treatment and the most common risk factors for rCDI. Valid information processes are crucial for enabling such patients to avoid the suboptimal use of healthcare services and gain health literacy, good health and quality of life. This study aims to explore rCDI patients' perceptions of the causes of rCDI, information processes and strategies for the future.

Methods: Ten interviews, conducted with rCDI patients based on open-ended questions, were analysed using qualitative content analysis.

Results: All the respondents identified antibiotic treatment as a trigger of rCDI, but they were unaware of other important factors. They also reported receiving inadequate information, often entirely absent or delivered by healthcare professionals under great pressure, together with other barriers that prevented successful information transmission. In addition to a lack of proper information, they described self-created barriers, some of which were severely counterproductive or even harmful, such as avoiding healthcare when they were ill or not collecting prescribed antibiotics due to fear.

Conclusions: The respondents were often left to seek information and develop explanatory models, strategies and behaviours for the future by themselves. We recommend more standardized and personalized patient information to support effective preventive behaviours and to foster a better understanding of one of the most important tools of modern medicine - antibiotics. 

Background: The healthcare sector has a negative ecological impact, and intensive care is one of the most resource-consuming areas. Nurses have a duty to contribute to climate change reduction, design climate-resilient healthcare systems, and support individuals and communities in adapting to the effects of the planetary health crisis. It is essential to incorporate environmental sustainability into nursing education so that nurses can advocate for conscientious and ethically sustainable healthcare that benefits both patients and the planet. This study aimed to explore postgraduate intensive care nursing student experiences of environmental sustainability in clinical practice at intensive care units.

Methods: Data were collected using a qualitative questionnaire, and the data were analysed using inductive thematic analysis. The participants were 24 registered nurses studying postgraduate, specialist intensive care nursing courses at four universities in the south and west regions of Sweden.

Results: The results describe critical care students’ environmental sustainability experiences in one overarching theme with five subthemes. Intensive care is a challenging context in terms of sustainability, where saving lives is the number one priority. There were good and bad sustainability habits among the staff, and awareness was key to improving. Clinical supplies come in unsustainable packages, and the participants wished for better alternatives and they wanted more knowledge and education on sustainable practices. The findings also emphasized the importance of a holistic perspective throughout each patient’s pathway.

Conclusions: Sustainability in intensive care units is somewhat unrecognised today, although intensive care nurses want that to change. The context where saving lives is prioritized makes implementing ecologically responsible practices a challenge. However, environmental sustainability in intensive care is feasible, with education needed for nurses to take on the responsibility of making improvements. Hospital management prioritizing sustainability is also important to support clinicians in implementing sustainable practices in intensive care units.

Highlights

•People's places and spaces during isolation were polarized.

•Weak socioeconomic groups were voiceless in the Swedish press.

•An analysis based on the ethics of justice and care is presented.

•The hegemonic discourse was constructed as the Discourse of inequity.

The aim of this theoretical paper is to critically reflect on the ethical and methodological issues that arose during a study that observed nurses’ care-giving in an intensive care unit setting. The authors critically discuss the methodological and ethical issues as well as the practical realities that were encountered when evaluating a complex intervention using unstructured qualitative observations. We describe the process with negotiating access and entering into the clinical field. Moreover, we reflect on experiences related to methodological issues such as the observer role, how to construct field notes, and how to encounter ethical dilemmas and other problems when being an observer in a closed and protected setting like an intensive care unit. We argue that qualitative observations give an insider perspective when studying the conditions for health and well-being. Our experiences can be transferred to other contexts and guide researchers interested in doing qualitative observational studies.

Aim: The overall aim of this doctoral thesis was to examine and evaluate if and how an intensive care unit (ICU) room, which had been designed using the principles of evidence-based design (EBD), impacted the safety, wellbeing and caring for patients, their family members and staff.

Methods: Paper I explored the nursing staff experiences of working in an EBD intensive care patient room through 13 interviews that were analysed by qualitative content analysis. Paper II focussed on the meaning of caring and nursing activities performed in two patient rooms—one EBD refurbished and one standard. Ten non-participant observations were conducted, which were followed by interviews. The data were analysed using a phenomenological hermeneutical approach. Paper III evaluated the relationship between a refurbished intensive care room and adverse events (AE) in critically ill patients. A total of 1,938 patients’ records were included in the analysis. Descriptive statistics and binary logistic regressions were conducted. Paper IV studied visitors’ (N = 99) experiences of different healthcare environmental designs of intensive care patient rooms through questionnaires. Descriptive statistics and linear regressions were conducted for the analysis.

Main results: The refurbished intervention room was reported as a positive experience for the working nursing staff and the visiting family members. The nursing staff additionally indicated the intervention room strengthened their own wellbeing as well as their caring activities. Although there were no observed, objective differences regarding the caring and nursing activities due to the different environments, the differences were instead interpreted as being due to different developed nursing competencies. The visitors reported the enriched healthcare environment to have a higher everydayness and a feeling that it was a safer place compared to the control rooms. The findings revealed a low incident of AEs in both the intervention room as well as in the control rooms, lower than previous described in literature. The likelihood for adverse events were not significantly lower in the intervention room compared to the control rooms.

Conclusion: This dissertation contributed to the existing knowledge on how a refurbished patient room in the ICU was experienced by nursing staff and visiting family members. The dissertation also showed the complexity of conducting interventional research in high-tech environments. The new knowledge on the importance of the healthcare environment on wellbeing, safety and caring must be considered by stakeholders and decision-makers and implemented to reduce suffering and increase health and wellbeing among patients, their families and staff.