Guidance for implementation of ethics and integrity training

The report is a summary of the results of participant breakout sessions to identify best practices and key elements for the implementation of training programmes for researchers in ERI. It is a guidance document for research integrity and ethics practitioners in academia. It identifies the key themes that lead to good practices and essential principles for an effective and successful approach to training. The report focuses on a hands-on approach with a checklist to help create an effective ERI training programme and provides links to relevant resources that help build that training

Conditions and strategies to meet the challenges imposed by the COVID-19-related visiting restrictions in the intensive care unit: A Scandinavian cross-sectional study

publishedVersio

Family involvement in the intensive care unit in four Nordic countries

Background - Relevance to clinical practice The findings from the study highlighting family involvement, high-quality communication and flexible visiting policy as central aspects of family care may inspire clinicians to identify aspects of everyday family care in their ICUs calling for further improvement. Aims and objectives - To describe family involvement, communication practices and visiting policies in adult ICUs. Design - A cross-sectional survey. Method - A questionnaire consisting of 11 sections was developed, pilot tested and e-mailed to 196 ICUs. The participants were intensive care nurses in adult ICUs in four Nordic countries. Results - The survey was conducted in October to December 2019. The response rate was 81% (158/196) of the invited ICUs. Most of the units had fewer than 11 beds. Family participation in patient care, including involvement in ward rounds and presence during cardiopulmonary resuscitation, varied between the countries, whereas most families in all countries were involved in decision-making. Family conferences were generally initiated by staff or family members. Children under 18 did not always receive information directly from the staff, and parents were not advised about how to inform their children. Although most respondents described open visiting, restrictions were also mentioned in free-text comments. Conclusions - The level of family care in ICUs in the four Nordic countries is generally based on nurses' discretion. Although most Nordic ICUs report having an open or flexible visiting policy, a wide range of potential restrictions still exists. Children and young relatives are not routinely followed up. Family members are included in communication and decision-making, whereas family involvement in daily care, ward rounds and family-witnessed resuscitation seem to be areas with a potential for improvement

Prevalence, associated factors and outcomes of pressure injuries in adult intensive care unit patients: the DecubICUs study

Funder: European Society of Intensive Care Medicine; doi: http://dx.doi.org/10.13039/501100013347Funder: Flemish Society for Critical Care NursesAbstract: Purpose: Intensive care unit (ICU) patients are particularly susceptible to developing pressure injuries. Epidemiologic data is however unavailable. We aimed to provide an international picture of the extent of pressure injuries and factors associated with ICU-acquired pressure injuries in adult ICU patients. Methods: International 1-day point-prevalence study; follow-up for outcome assessment until hospital discharge (maximum 12 weeks). Factors associated with ICU-acquired pressure injury and hospital mortality were assessed by generalised linear mixed-effects regression analysis. Results: Data from 13,254 patients in 1117 ICUs (90 countries) revealed 6747 pressure injuries; 3997 (59.2%) were ICU-acquired. Overall prevalence was 26.6% (95% confidence interval [CI] 25.9–27.3). ICU-acquired prevalence was 16.2% (95% CI 15.6–16.8). Sacrum (37%) and heels (19.5%) were most affected. Factors independently associated with ICU-acquired pressure injuries were older age, male sex, being underweight, emergency surgery, higher Simplified Acute Physiology Score II, Braden score 3 days, comorbidities (chronic obstructive pulmonary disease, immunodeficiency), organ support (renal replacement, mechanical ventilation on ICU admission), and being in a low or lower-middle income-economy. Gradually increasing associations with mortality were identified for increasing severity of pressure injury: stage I (odds ratio [OR] 1.5; 95% CI 1.2–1.8), stage II (OR 1.6; 95% CI 1.4–1.9), and stage III or worse (OR 2.8; 95% CI 2.3–3.3). Conclusion: Pressure injuries are common in adult ICU patients. ICU-acquired pressure injuries are associated with mainly intrinsic factors and mortality. Optimal care standards, increased awareness, appropriate resource allocation, and further research into optimal prevention are pivotal to tackle this important patient safety threat

Prevalence, associated factors and outcomes of pressure injuries in adult intensive care unit patients: the DecubICUs study

Funder: European Society of Intensive Care Medicine; doi: http://dx.doi.org/10.13039/501100013347Funder: Flemish Society for Critical Care NursesAbstract: Purpose: Intensive care unit (ICU) patients are particularly susceptible to developing pressure injuries. Epidemiologic data is however unavailable. We aimed to provide an international picture of the extent of pressure injuries and factors associated with ICU-acquired pressure injuries in adult ICU patients. Methods: International 1-day point-prevalence study; follow-up for outcome assessment until hospital discharge (maximum 12 weeks). Factors associated with ICU-acquired pressure injury and hospital mortality were assessed by generalised linear mixed-effects regression analysis. Results: Data from 13,254 patients in 1117 ICUs (90 countries) revealed 6747 pressure injuries; 3997 (59.2%) were ICU-acquired. Overall prevalence was 26.6% (95% confidence interval [CI] 25.9–27.3). ICU-acquired prevalence was 16.2% (95% CI 15.6–16.8). Sacrum (37%) and heels (19.5%) were most affected. Factors independently associated with ICU-acquired pressure injuries were older age, male sex, being underweight, emergency surgery, higher Simplified Acute Physiology Score II, Braden score 3 days, comorbidities (chronic obstructive pulmonary disease, immunodeficiency), organ support (renal replacement, mechanical ventilation on ICU admission), and being in a low or lower-middle income-economy. Gradually increasing associations with mortality were identified for increasing severity of pressure injury: stage I (odds ratio [OR] 1.5; 95% CI 1.2–1.8), stage II (OR 1.6; 95% CI 1.4–1.9), and stage III or worse (OR 2.8; 95% CI 2.3–3.3). Conclusion: Pressure injuries are common in adult ICU patients. ICU-acquired pressure injuries are associated with mainly intrinsic factors and mortality. Optimal care standards, increased awareness, appropriate resource allocation, and further research into optimal prevention are pivotal to tackle this important patient safety threat

Correction to: Prevalence, associated factors and outcomes of pressure injuries in adult intensive care unit patients: the DecubICUs study

The original version of this article unfortunately contained a mistake

Challenges and opportunities for sexual and reproductive healthcare services for immigrant women in Sweden

This thesis aims to obtain an understanding of immigrant women’s access to healthcare services in Sweden in relation to sexual and reproductive health and rights (SRHR). Data were obtained from three different quantitative cross-sectional studies using self-administrated questionnaires and one qualitative study based on in-depth interviews. The sample consists of immigrant women, predominantly refugees from Afghanistan, Iraq, Syria, and Somalia in Study I (n=288) and Thai immigrant women in Studies II–IV: Study II (n=804), Study III (n=19) and Study IV (n=266). The results indicate that social capital factors seem to play an important role in knowledge about sexual and reproductive health (SRH) services. About one-third of immigrant women reported lack of knowledge of where to go for contraceptive counselling. Lack of knowledge was associated with experiencing lack of emotional social support and not having children. An even higher proportion lacked knowledge of where to go for HIV testing, which was associated with not having participated in a health examination. In a sample of Thai immigrant women, lack of knowledge about SRH services was associated with living without a partner, having low trust in others, having predominantly bonding social relationships and belonging to the oldest age groups. In all studies, the majority had not been tested for HIV or participated in contraceptive counselling. Among the Thai women, despite expressing a need for SRH care, most participants had not sought this type of care. Women found it challenging to seek care in Sweden due to lack of knowledge about the healthcare system and language difficulties. The majority of Thai women reported a significant need for information related to SRH services. Women who had never been HIV tested in Thailand had increased odds of not being tested in Sweden. Lack of knowledge of where to turn for contraceptive counselling and HIV testing among immigrant women is a missed opportunity, as all citizens in Sweden have free access to these services. Providing information on SRH services to all immigrants in their native language, regardless of immigration status, is an important step in achieving equal access to SRH care

Assessment and tools for follow-up of patients' recovery after Intensive Care

Aim: The overall aim of this thesis was to describe and explore the use and content of ICU-diaries and to develop and psychometrically test a questionnaire to detect physical and psychosocial problems for ICU patients in their recovery process.  Methods: This thesis is based on four studies. Study I had an explorative descriptive design with a quantitative and qualitative approach. Data were collected by telephone interviews with staff at Swedish ICUs (n = 65) which kept ICU-diaries. One question “what was the purpose of keeping ICU-diaries” was analysed with latent content analysis, and the other data were analysed with descriptive and comparative statistics. Study II had an explorative descriptive cohort design with a concurrent mixed method approach. The sample in study II was a part of the sample in study IV in which 421 former ICU patients responded to a new developed questionnaire 3-set 4P two months after discharge from ICU. Patients from this sample who have had an ICU-diary (n = 115) responded to a questionnaire six months after discharge from ICU. Fifteen patients were interviewed about the content and usefulness of the ICU-diary. Data were analysed with descriptive statistics, descriptively by content and interviews with manifest content analysis and then combined at the interpretive level to seek convergence, as enable by the mixed method approach. Study III had a methodological design. In this study, the questionnaire 3-set 4P was developed and psychometrically tested in a pilot setting. In study IV, the questionnaire was further developed and tested based on psychometric evaluation of the 3-set 4P. In study III the questionnaire was responded by 39 patients and in study IV by 421 patients. Data in study III and IV were analysed with descriptive statistics and psychometrical tests.  Results: The main purpose for keeping ICU-diaries was to provide a tool in the recovery by helping the patient remember and give time back. Keeping ICU-diaries was common although there was a difference in practice and patient recruitment among different hospitals (study I). An ICU-diary with content and photos in a chronological order describing the whole picture of critical illness and ICU stay could be a tool for the patient to construct a coherent individual story. The ICU-diary could be one piece to give a deeper understanding and meaning in the personal story and to give a realistic expectation of the recovery process. Absence of guidelines for keeping ICU-diaries could affect the possibility for the ICU-diary to be a helpful tool during the recovery process (study II). In study III, the 3-set 4P was developed to be used for identifying and evaluating former ICU patients’ physical, psychosocial problems and outcome during follow-up. The psychometrical tests showed acceptable validity and internal consistency reliability. The stability reliability was acceptable in two of three sets. The psychometrical tests of the further modified version of 3-set 4P in study IV showed good construct validity and internal consistency but it needs some modification before it can be used in clinical practice (study IV).  Conclusion: Recovery can be a difficult process where different tools can be useful. Today there is no evidence about tools to use during follow-up. To promote high quality of the follow-up there is a need for evidence-based guidelines. The ICU-diary is one tool but this thesis shows that guidelines for keeping ICU-diaries have to be developed to meet the patients’ wishes in order for the ICU-diary to become a useful tool during the process to recovery. The 3-set 4P can after some modification be used at the follow-up clinic to identify the individual patient’s problems and create an individual program for recovery

Challenges and opportunities for sexual and reproductive healthcare services for immigrant women in Sweden

This thesis aims to obtain an understanding of immigrant women’s access to healthcare services in Sweden in relation to sexual and reproductive health and rights (SRHR). Data were obtained from three different quantitative cross-sectional studies using self-administrated questionnaires and one qualitative study based on in-depth interviews. The sample consists of immigrant women, predominantly refugees from Afghanistan, Iraq, Syria, and Somalia in Study I (n=288) and Thai immigrant women in Studies II–IV: Study II (n=804), Study III (n=19) and Study IV (n=266). The results indicate that social capital factors seem to play an important role in knowledge about sexual and reproductive health (SRH) services. About one-third of immigrant women reported lack of knowledge of where to go for contraceptive counselling. Lack of knowledge was associated with experiencing lack of emotional social support and not having children. An even higher proportion lacked knowledge of where to go for HIV testing, which was associated with not having participated in a health examination. In a sample of Thai immigrant women, lack of knowledge about SRH services was associated with living without a partner, having low trust in others, having predominantly bonding social relationships and belonging to the oldest age groups. In all studies, the majority had not been tested for HIV or participated in contraceptive counselling. Among the Thai women, despite expressing a need for SRH care, most participants had not sought this type of care. Women found it challenging to seek care in Sweden due to lack of knowledge about the healthcare system and language difficulties. The majority of Thai women reported a significant need for information related to SRH services. Women who had never been HIV tested in Thailand had increased odds of not being tested in Sweden. Lack of knowledge of where to turn for contraceptive counselling and HIV testing among immigrant women is a missed opportunity, as all citizens in Sweden have free access to these services. Providing information on SRH services to all immigrants in their native language, regardless of immigration status, is an important step in achieving equal access to SRH care