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BACKGROUND: During the COVID-19 pandemic, intensive care units (ICUs) were under heavy pressure, with a significantly increased number of severely ill patients. Hospitals introduced restrictions, and families could not visit their ill and dying family members. Patients were cared for without privacy, and several died in shared patient rooms, leaving the intensive care nurse to protect the patient's need for loving care in a vulnerable situation at the end of life. AIMS: This study aimed to investigate how piloting and watch over were revealed in end-of-life care for patients with COVID-19 in intensive care COVID-19. STUDY DESIGN: A qualitative study was conducted with an abductive approach was conducted. Data were collected via semi-structured interviews to cover the research area while allowing the informant to talk freely about the topic; 11 informants were interviewed. RESULTS: The findings are presented based on four categories: The road to the decision, End-of-life care, Farewell of close family members and Closure. Each category and subcategory reveal how piloting and watch over were addressed in the end-of-life care of patients with COVID-19 in the ICU during the pandemic. Overall findings indicated that workload and organization of care directly affect the quality of care given, the acceptance of privacy and the possibility of dignified end-of-life care. CONCLUSIONS: Workload directly affects the quality of care, risking dehumanization of the patient. Visiting restrictions hindered supporting family members through the various piloting phases. Visiting restrictions also forced the ICU nurses to take on the role of the relative in watching over the patient. RELEVANCE TO CLINICAL PRACTICE: Collaboration with family members is essential for the intensive care nurse to be able to provide a person-centred and dignified end-of-life care.

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BACKGROUND: Intensive care unit diaries are often used to support patients during their psychological recovery. The intensive care unit stay can be upsetting, disturbing and traumatic for both patients and their families especially when the patient does not survive. AIM: To investigate the connection between intensive care unit diaries and the grieving process experienced by family members of adult patients deceased in the intensive care unit. METHODS: Systematic literature review according to PRISMA guidelines: PubMed, CINAHL and Cochrane Library were consulted. The Caldwell's framework was used for the quality appraisal. RESULTS: Only six studies examine this topic. The potential benefits of intensive care unit diaries in family members' bereavement process may be an aid to realise how extremely ill their loved one was, may provide comfort and may help relatives to cope with their loss. CONCLUSION: The use of intensive care unit diaries to help family members' bereavement process may be a useful tool but further research is necessary to better understand their role and benefits.

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OBJECTIVES: To examine conditions and strategies to meet the challenges imposed by the coronavirus disease 2019 (COVID-19)-related visiting restrictions in Scandinavian intensive care units. RESEARCH METHODOLOGY/DESIGN: A cross-sectional survey. SETTING: Adult intensive care units in Denmark, Norway and Sweden. MAIN OUTCOME MEASURES: Likert scale responses and free-text comments within six areas: capacity and staffing, visiting policies and access to the unit, information and conferences with relatives, written information, children as relatives and follow-up initiatives. RESULTS: The overall response rate was 53% (74/140 participating units). All intensive care units had planned for capacity extensions; the majority ranging between 11 and 30 extra beds. From March-June 2020, units had a mean maximum of 9.4 COVID-19 patients simultaneously. Allowing restricted visiting was more common in Denmark (52%) and Norway (61%) than in Sweden where visiting was mostly denied except for dying patients (68%), due to a particular increased number of COVID-19 patients. The restrictions forced nurses to compromise on their usual standards of family care. Numerous models for maintaining contact between relatives and patients were described. CONCLUSION: Visitation restrictions compromised the quality of family care and entailed dilemmas for healthcare professionals but also spurred initiatives to developing new ways of providing family care.

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Losing a loved one in the intensive care unit relates to a risk of developing stress and complicated grief. Education in intensive care nursing should cover end-of-life care, and the use of simulation in nursing education is a powerful instrument to develop confidence in end-of-life care. The aim of this study was to explore postgraduate nursing students' experiences with simulation training in end-of-life communication with intensive care patients and their families. Twenty-nine students answered a questionnaire and nine students participated in an interview. Analyses were conducted according to the principles of phenomenography. The result is presented in four categories including the following: the design of the scenario affects learning, uncertainty overshadows learning, intertwining theory and practice contributes to learning, and learning to encounter existential dimensions. The conclusion is that high-fidelity simulation training contributes toward preparing students to be attuned to what it can be like to be a family member in this situation. The scenarios contributed toward preparing the students to engage in end-of-life conversations during clinical placements.

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BACKGROUND: Patients in intensive care units (ICUs) are among the most vulnerable, and they require support to start their recovery. The design of the patient area in the ICU can play a prominent role in both the quality of care and patients' recovery. The lighting environment has the opportunity to restore and strengthen the natural human circadian rhythm and health. AIM: To evaluate patients' self-reported recovery after being cared for in an ICU room rebuilt according to evidence-based design principles that promote recovery. METHOD: An intervention was set up in a two-bed patient room including a cycled lighting system. Self-reported recovery was reported at 6 and 12 months after discharge. Data were analyzed using a 2(mechanically ventilated, nonmechanically ventilated) × 2(intervention room, ordinary room) analysis of covariance (ANCOVA) and 2(male, women) × 2(intervention room, ordinary room) ANCOVA. RESULTS: Data from the different rooms showed no significant main effects for recovery after 6 months, p = .21; however, after 12 months, it become significant, p. < .05. This indicated that patient recovery was positively influenced for patients cared for in the intervention room (M = 8.88, SD = 4.07) compared to the ordinary room (M = 10.90, SD = 4.26). There were no interaction effects for gender or if the patients had been mechanically ventilated either at 6 or 12 months' postdischarge. CONCLUSIONS: A cycled lighting system may improve patient self-reported recovery after ICU care; however, more research on the topic is needed.

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OBJECTIVES: The objective of the research was to study the visitors' experiences of different healthcare environment designs of intensive care unit (ICU) patient rooms. BACKGROUND: The healthcare environment may seem frightening and overwhelming in times when life-threatening conditions affect a family member or close friend and individuals visit the patient in an ICU. A two-bed patient room was refurbished to enhance the well-being of patients and their families according to the principles of evidence-based design (EBD). No prior research has used the Person-centred Climate Questionnaire-Family version (PCQ-F) or the semantic environment description (SMB) in the ICU setting. METHODS: A sample of 99 visitors to critically ill patients admitted to a multidisciplinary ICU completed a questionnaire; 69 visited one of the two control rooms, while 30 visited the intervention room. RESULTS: For the dimension of everydayness in the PCQ-F, a significantly better experience was expressed for the intervention room (p < .030); the dimension regarding the ward climate general was also perceived as higher in the intervention room (p < .004). The factors of pleasantness (p < .019), and complexity (p < 0.049), showed significant differences favoring the intervention room in the SMB, with borderline significance on the modern factor (p < .061). CONCLUSION: Designing and implementing an enriched healthcare environment in the ICU setting increases person-centered care in relation to the patients' visitors. This could lead to better outcomes for the visitors, for example, decreasing post-traumatic stress disorder symptoms, but this needs further investigations.

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BACKGROUND: Healthcare environment can affect health. Adverse events (AEs) are common because rapid changes in the patients' status can suddenly arise, and have serious consequences, especially in intensive care. The relationship between the design of intensive care units (ICUs) and AEs has not been fully explored. Hence, an intensive care room was refurbished with cyclic lightning, sound absorbents and unique interior, and exterior design to promote health. AIMS: The aim of this study was to evaluate the differences between a regular and a refurbished intensive care room in risk for AEs among critically ill patients. DESIGN: This study retrospectively evaluated associations of AEs and compared the incidence of AEs in patients who were assigned to a multidisciplinary ICU in a refurbished two-bed patient room with patients in the control rooms between 2011 and 2018. METHODS: There were 1938 patients included in this study (1382 in control rooms; 556 in the intervention room). Descriptive statistics were used to present the experienced AEs. Binary logistic regressions were conducted to estimate the relationship between the intervention/control rooms and variables concerning AEs. Statistical significance was set at P < 0.05. RESULTS: For the frequency of AEs, there were no significant differences between the intervention room and the control rooms (10.6% vs 11%, respectively, P < 0.805). No findings indicated the intervention room (the refurbished room) had a significant influence on decreasing the number of experienced AEs in critically ill patients. CONCLUSIONS: The findings revealed a low incident of AEs in both the intervention room as well as in the control rooms, lower than previously described. However, our study did not find any decreases in the AEs due to the design of the rooms. RELEVANCE TO CLINICAL PRACTICE: Further research is needed to determine the relationship between the physical environment and AEs in critically ill patients.

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OBJECTIVE: To explore critical care nurses' lived experiences of transferring intensive care patients between hospitals. METHODS: A phenomenological hermeneutic approach using data generated through individual interviews with 11 critical care registered nurses. SETTING: Two general intensive care units in Sweden. FINDINGS: Five themes were identified: it depends on me; your care makes a difference; being exposed; depending on interprofessional relationships; and sensing professional growth. These themes were synthesised into a comprehensive understanding showing how transferring intensive care patients between hospitals meant being on an ambivalent journey together with the patient but also on a journey within yourself in your own development and growth, where you, as a nurse, constantly are torn between contradictory feelings and experiences. CONCLUSION: Interhospital intensive care unit-to-unit transfers can be a challenging task for critical care nurses but also an important opportunity for professional growth. During the transfer, nurses become responsible for the patient, their colleagues and the entire transfer process. In a time of an increasing number of interhospital intensive care unit-to-unit transfers, this study illuminates the risk for missed nursing care, showing that the critical care nurse has an important role in protecting the patient from harm and safeguarding dignified care.

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AIMS AND OBJECTIVES: To reveal meanings of family members' lived experiences when a loved one undergoes an interhospital intensive care unit-to-unit transfer. BACKGROUND: Interhospital intensive care unit-to-unit transfers take place between different hospitals and their respective intensive care units (ICUs). These types of transfers are an increasing phenomenon but are sparsely studied from the family members' perspective. Indeed, the patient's critical illness and care can have a major impact on family members. During the transfer process, there is a demand for the involved intensive care health personnel to make family members feel safe and cared for. DESIGN: A qualitative design based on phenomenological hermeneutics. METHODS: The study was conducted at two Swedish general ICUs. Data were generated through individual in-depth interviews with seven family members and analysed using a phenomenological hermeneutical approach. The Criteria for Reporting Qualitative Research principles were applied in the conduct and reporting of this study. RESULTS: Four themes that reveal meanings of family members' lived experiences were developed: losing your safe haven, dealing with uncertainty, carrying your own and others' burdens and a wish to be close. CONCLUSIONS: The study reveals that an interhospital intensive care unit-to-unit transfer affects the whole family and is characterised by family members experiencing many negative feelings. The findings also illustrate that being a family member when a loved one is transferred means being exposed to the core existential elements of being human, such as loneliness and searching for meaning. RELEVANCE TO CLINICAL PRACTICE: The study highlights the importance of maintaining a family-centred approach during the transfer process. Our findings can provide deeper knowledge for intensive care health personnel, better preparing them for the delicate task of providing family-centred care during the interhospital intensive care unit-to-unit transfer process.

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TOPIC: A substantial number of patients die in the intensive care unit, so high-quality end-of-life care is an important part of intensive care unit work. However, end-of-life care varies because of lack of knowledge of best practices. CLINICAL RELEVANCE: Research shows that high-quality end-of-life care is possible in an intensive care unit. This article encourages nurses to be imaginative and take an individual approach to provide the best possible end-of-life care for patients and their family members. PURPOSE OF PAPER: To provide recommendations for high-quality end-of-life care for patients and family members. CONTENT COVERED: This article touches on the following domains: end-of-life decision-making, place to die, patient comfort, family presence in the intensive care unit, visiting children, family needs, preparing the family, staff presence, when the patient dies, after-death care of the family, and caring for staff.

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BACKGROUND: Post-intensive care syndrome-family is a common problem in relatives of patients who die in an intensive care unit. Family-centred end-of-life care with support for the family during and after the death is supposed to prevent suffering and avoid illness. AIMS AND OBJECTIVES: This study aimed to investigate family-centred end-of-life care and bereavement follow-up services offered to family members of patients who die in Swedish intensive care units. DESIGN, METHODS: A cross-sectional study using a 16-question survey based on family-centred end-of-life care was sent to all 81 adult intensive care units. Data were analysed by descriptive statistics and chi-square. Respondents were able to add individual comments to the questionnaire. RESULTS: Although the majority (76.7%) offered some kind of follow up, this service was not always offered. Modes for invitation, timing, and contents in the follow up varied between the units. The staff tried to individualize the follow-up service according to the family's needs. Nurses and social workers were the only professionals who provided follow-up conversations on their own. Most of the intensive care units (97.3%) kept diaries that were handed over to the family when they left the unit after the patient's death or at a follow-up visit. Only 8.8% reported that they always offer the family the opportunity to be present during resuscitation. Most respondents reported that patients (60.6%) died in a private room. CONCLUSIONS: Family-centred end-of-life care varied among the intensive care units, and some families were not offered any follow up at all. Timing, invitation, and elements in the follow up differ between the units. Diaries were commonly kept and usually given to the family. Few units offered the family to be present during resuscitation. RELEVANCE TO CLINICAL PRACTICE: There is a need for national guidelines to ensure that all bereaved families receive equal and individual family-centred end-of-life care.

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AIMS AND OBJECTIVES: The overall aim of the study was to illuminate the patients' lived experiences of waiting for and undergoing an endovascular aortic repair (EVAR) in a hybrid operating room (OR). BACKGROUND: The hybrid OR is an example of the technological advancements within hospitals. The environmental impact on humans is well recognised but is rarely taken into account when hospitals are designed or rebuilt. The patient's experience of a hybrid OR is not earlier described. DESIGN: A qualitative design based on hermeneutic phenomenology was implemented. METHODS: Interviews were conducted with 18 patients. A thematic interpretation based on van Manen's approach was then used to analyse the findings. The consolidated criteria for reporting qualitative studies (COREQ) were used (Data S1). RESULTS: The following three themes emerged from the interviews: (a) being scheduled for surgery induced both anxiety and hopefulness; (b) feeling watched over and surrendering to others in the technology intense environment and (c) feeling relief but unexpected exhaustion after surgery. In the discussion, the results were additionally reflected upon out from the four lifeworld existentials: lived body, lived space, lived time and lived others. CONCLUSIONS: The hybrid OR technology did not frighten the patients, but it was also not an environment that promoted or was conductive to having a dialogue with the staff. The disease and surgery brought feelings of anxiety, which was largely associated with the uncertainty of the situation. We suggest that continuity in contact with staff and patient-centred information could be solutions to further calm the patients. RELEVANCE TO CLINICAL PRACTICE: The hybrid OR environment itself did not seem to frighten the patient, but the way the high-tech environment increased the distance between the patient and the multiple staff members needs further investigation.

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AIM: The aim of the study was to evaluate team composition and staff roles in a hybrid operating room during endovascular aortic repairs. DESIGN: Quantitative descriptive design. METHODS: Nine endovascular aortic repairs procedures were video-recorded between December 2014 and September 2015. The data analysis involved examining the work process, number of people in the room and categories of staff and their involvement in the procedure. RESULTS: The procedures were divided into four phases. The hybrid operating room was most crowded in phase 3 when the skin wound was open. Some staff categories were in the room for the entire procedure even if they were not actively involved. The largest number of people simultaneously in the room was 14.

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INTRODUCTION: Western Europe today is a culturally diverse society and expected to become more so in the future. When patients from unfamiliar cultures become critically ill and require intensive care, this places considerable demands on the cultural and linguistic competencies of the intensive care staff. Existing research regarding the transcultural aspects of intensive care is scarce and, in Sweden, non-existent. OBJECTIVE: To explore the experiences of critical care nurses and enrolled nurses in caring for culturally diverse patients in intensive care units. METHOD: Four focus group interviews were conducted with a total of 15 interviewees. The collected data were subjected to qualitative content analysis. FINDINGS: The findings mostly concerned the nursing staff's experiences of caring for relatives. Caring for the relatives of culturally diverse patients was described as challenging due to linguistic and cultural barriers. CONCLUSIONS: To overcome linguistic and cultural barriers, intensive care units should be reorganised and restructured to create a more welcoming environment for relatives. Alternative communication methods should be developed and traditional ways of using support from interpreters support must be re-evaluated. Education to ensure cultural competence and the promotion of an intercultural approach is key and the development of research programmes is recommended.

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Introduction: A hybrid operating room (OR) is a surgical OR with integrated imaging equipment and the possibility to serve both open surgery and image-guided interventions. Aim: This study aimed to investigate the work processes and types of collaboration in a hybrid OR during endovascular aortic repair (EVAR). Methods: Data consisted of video recordings from nine procedures, with a total recording time of 48 hrs 39 mins. The procedures were divided into four episodes (Acts). A qualitative cross-case analysis was conducted, resulting in a typical case. The type of collaboration during specific tasks was discussed and determined based on Thylefors´ team typology. Results: An extensive amount of safety activities occurred in the preparation phase (Acts 1 and 2), involving a number of staff categories. After the skin incision (Act 3), the main activities were performed by fewer staff categories, while some persons had a standby position and there were persons who were not at all involved in the procedure. Discussion: The different specialist staff in the hybrid OR worked through different types of collaboration: multi-, inter- and transprofessional. The level of needed collaboration depended on the activity performed, but it was largely multiprofessional and took place largely in separate groups of specialties: anesthesiology, surgery and radiology. Waiting time and overlapping tasks indicate that the procedures could be more efficient and safe for the patient. Conclusion: This study highlights that the three expertise specialties were required for safe treatment in the hybrid OR, but the extent of interprofessional activities was limited. Our results provide a basis for the development of more effective procedures with closer and more efficient interprofessional collaboration and reduction of overlapping roles. Considerable waiting times, traffic flow and presence of people who were not involved in the patient care are areas of further investigation.

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This paper focuses on the patient's perspective and the philosophical underpinnings that support what might be considered optimal for the future design of the intensive care unit (ICU) patient room. It also addresses the question of whether the aspects that support at-homeness are applicable to ICU patient rooms. The concept of "at-homeness" in ICUs is strongly related to privacy and control of space and territory. This study investigates whether the sense of at-homeness can be created in an ICU, when one or more patients share a room. From an interdisciplinary perspective, we critically reflect on various aspects associated with conflicts surrounding the use of ICU patient rooms. Thus, from an architectural and a caring perspective, the significance of space and personal territory in ICU patient rooms is emphasized. Recommendations for further research are suggested. In conclusion, privacy and control are deemed to be essential factors in the stimulation of recovery processes and the promotion of well-being in situations involving severe illness or life-threatening conditions.

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Medical technology has progressed tremendously over the last few decades, but the same development cannot be seen in the design of these intensive care unit environments. Authors report results of a study of evidence-based room design, emphasizing the impact on conveying a caring attitude to patients. Ten nonparticipant observations were conducted in patient rooms with 2 different designs, followed by interviews. The data were analyzed using a phenomenological-hermeneutical approach. The results did not reveal that it was obvious that redesigned spaces resulted in a more caring attitude. The meanings of caring displayed during nursing activities were interpreted by interpreting gazes. Some of the nursing staff had an instrumental gaze, interpreted as caring with a task-orientated approach, while others communicated their caring with an attentive and attuned gaze, where the needs of the patients regulated the working shift. The study findings indicated that caring may not be perceived when nurses use a task-oriented approach. However, when nurses practice a person-centered approach, using an attentive and attuned gaze, caring is conveyed. Caring in intensive care contexts needs to be assisted by a supportive environment design that cultivates the caring approach.

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Providing comfort in an intensive care unit (ICU) setting is often related to pain relief and end-of-life care; environmental factors are often neglected, despite the major role of the environment on the patients' well-being and comfort. The aim of this article was to explore the meanings of comfort from a theoretical and empirical perspective to increase the understanding of what comfort means in ICU settings. A lexical analysis and serials of workshops were performed, and data were analyzed using a qualitative content analysis. The findings from the theoretical analysis show that comfort has a broad range of synonyms related to both subjective experiences and objective and physical qualities. The findings from the empirical part reveal 4 themes: comfort in relation to nature, comfort in relation to situation and people, comfort in relation to place, and comfort in relation to objects and material. Materiality, functionality, memory, culture, and history stipulate comfort. It is challenging to discern what comfort is when it comes to function and emotions. We also found that comfort is closely linked to nature and well-being.

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AIM: The aim of this study was to explore the meaning of family members' experience of waiting in an intensive care context using Rodgers' evolutionary method of concept analysis. METHOD: Systematic searches in CINAHL and PubMed retrieved 38 articles which illustrated the waiting experienced by family members in an intensive care context. Rodgers' evolutionary method of concept analysis was applied to the data. FINDINGS: In total, five elements of the concept were identified in the analysis. These were as follows: living in limbo; feeling helpless and powerless; hoping; enduring; and fearing the worst. Family members' vigilance regarding their relative proved to be a related concept, but vigilance does not share the same set of attributes. The consequences of waiting were often negative for the relatives and caused them suffering. The references show that the concept was manifested in different situations and in intensive care units (ICUs) with various types of specialties. CONCLUSIONS: The application of concept analysis has brought a deeper understanding and meaning to the experience of waiting among family members in an intensive care context. This may provide professionals with an awareness of how to take care of family members in this situation. The waiting is inevitable, but improved communication between the ICU staff and family members is necessary to reduce stress and alleviate the suffering of family members. It is important to acknowledge that waiting cannot be eliminated but family-centred care, including a friendly and welcoming hospital environment, can ease the burden of family members with a loved one in an ICU.

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Interhospital intensive care unit-to-unit transfers are an increasing phenomenon, earlier mainly studied from a patient safety perspective. Using data from video recordings and participant observations, the aim was to explore and interpret the observed nature of the patient's situation during interhospital intensive care unit-to-unit transfers. Data collection from eight transfers resulted in over 7 hours of video material and field notes. Using a hermeneutical approach, three themes emerged: being visible and invisible; being in a constantly changing space; and being a fettered body in constant motion. The patient's situation can be viewed as an involuntary journey, one where the patient exists in a constantly changing space drifting in and out of the health personnel's attention and where movements from the journey become part of the patient's body. Interhospital transfers of vulnerable patients emerge as a complex task, challenging the health personnel's ability to maintain a caring atmosphere around these patients.

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