Communication with mechanically ventilated intensive care unit patients (The COMMEC-ICU study)

Principal investigator (PI): Tone Rustøen, Marte-Marie Wallander Karlsen main supervisor for the PhD candidate.

The overarching aim of this multicenter study is to develop a multimodule intervention (COMMEC-ICU) for improving communication for intubated ICU patients, implement it, and evaluate the effects both on patients and nurses. The plan is to include 300 patients and 100 nurses. The study is in its initial phase, data collection is planned to start during 2024, at three different hospitals.

Tonje Hauff will be the PhD candidate in the study.

The study will be in collaboration with former developers of earlier interventions in this area : COM-ICU (Anna Holm & Pia Dreyer, Aarhus University), and SPEACS-2 (Mary Beth Happ, The Ohio State University).

Other project members: Kirsti Tøien, and Brita Fosser-Olsen will participate and contribute to the study.

“Minor things of major importance”; - development and implementation of a bundle to optimize comfort in intensive care patients.

Helene Berntzen and Ann-Marie Storsveen

Based on the findings from a doctoral project on pain and wakefulness in intensive care where patients reported an overwhelming amount of discomforts other than pain, we developed a “Comfort bundle” aiming to inspire and remind nurses to systematically plan and promote comfort to the intensive care patient. It includes a wall-hung bedside whiteboard aiming to display the individualized comfort measures and to involve and communicate with other healthcare personnel, patients, and relatives about matters important to the individual patient. The implementation of a Comfort Bundle is ongoing from 2023 and will be evaluated through focus group interviews with nurses.

Assessment of discomfort in intensive care patients and psychometric testing of the applied questionnaire IPREA-N

Helene Berntzen (PI), Brita Fosser Olsen and Edda Johansen lead this multicenter project where we have translated and culturally adapted the French questionnaire "Inconforts des patients de Reanimation" (IPREA) into Norwegian and will use this in a cross-sectional study in five different hospital in south-eastern Norway. We will also psychometrically test the Norwegian version IPREA-N. Data collection will start in autumn 2024.

Visiting restrain to hospitals; family caregivers of COVID-19 ICU-patients experiences. An exploratory study

Principal investigator (PI): Kirsti Tøien

Project group: Helene Berntzen, Hanne Alfheim, Ranveig Lind

In this qualitative study, family members’ experiences of being restricted from visiting COVID19 patients in the intensive care unit during the pandemic were investigated. Individual semi-structured interviews with one close relative of each of 12 COVID-19 patients who were admitted to ICU, were performed using a semi-structured interview guide based on previous research and with input from the health care service users. Three themes were generated from the data; “Experiencing a double burden”, “Becoming an insignificant other” and “Regaining significance.” From admission, the family members became bystanders, deprived of most contact with the patients, as communication and information from the intensive care unit appeared unstructured and haphazard. However, when patients were discharged, great responsibility was placed on the family members.

The Injury Prevention and Outcomes after Trauma project: Risk of- and outcome after interpersonal violence-related severe injury, a nationwide register based study in Norway

Principal investigator (PI): Kirsti Tøien

This project aims to investigate trauma risk factors and long-term outcome in patients injured after interpersonal violence. We will use the Norwegian Trauma Registry where all patients admitted severely injured by violence to dedicated trauma hospitals in Norway are registered. We will also use the NTRplus research database (IPOT-project database) consisting of data from the KUHR Database with data on diagnoses from patient contacts with the primary health care service, the Cause of Death Registry and the Norwegian Prescription Database (NorPD) for the time period 2014–2020. Patients in this database are matched on age and gender with controls (1:10). The project will provide knowledge about inequalities in socioeconomic status between patients injured by interpersonal violence and accidents both before and after the injury.

PhD candidate: Øystein Øygaarden Flæten

Nurse led follow up after being a patient in the ICU

Principal investigator (PI): Kirsti Tøien

Totally 523 patients are included and followed for one year with measurement of post-traumatic stress (PTS) symptoms, sense of coherence, pain, hope, return to work and health related quality of life. All included patients were screened for PTS symptoms, and if they had a PTS symptoms above a clinical bothersome level they were randomised to follow up consultations (n= 111) with an intensive care nurse with special training in this task, or a control group (n=113). Patients with a score below a bothersome level of PTS symptoms were not randomised but participated as a comparing group (n=299).Two PhD candidates are connected to this project:

Åse Valsø: Her main focus was on differences in PTS symptoms and sense of coherence in intervention and control group after the intervention and pain in the whole sample. She defended her thesis: “Posttraumatic stress symptoms, sense of coherence and pain after intensive care treatment and the effect of early nurse-led follow-up consultations” in January 2023.

Mona Austenå: Her focus is on return to work, hope and sense of coherence in the whole sample.

Symptoms, functional status and quality of life in intensive care patients.

PI, Tone Rustøen, Kristin Hofsø is the main supervisor for four PhD candidates.

A longitudinal study including a heterogeneous sample (n=603) of ICU patients and followed them for 12 months from admission. The impact of pre comorbid conditions, clinical characteristics and treatment on symptoms during the ICU (until 7 days) as well as a set of core outcome measures (i.e., functional status, cognitive function, post-traumatic stress disorder, QOL, anxiety and depression and general symptoms) will be examined longitudinally. The data collection and follow-up period was completed in July 2021.

The following sub-studies, from the above study:

Christin S. Hansen: is investigating symptoms during ICU, and QOL at 12 months.

Renato Mesina: is investigating functional status and activity of daily living in survivors during the first 12 months after ICU admission, from the same study population.

Malin Brandvold: Cognitive functioning at baseline (admission) and during the first year after ICU admission

Klara Friberg: Post traumatic stress symptoms and hope during the first year after ICU admission (Brita Fosser Olsen main supervisor).

Ragnhild Nyhagen: Symptom communication in the intensive care (Marit Kirkevold main supervisor).

Covid 19

Kristin Hofsø: Survival rates and long-term outcomes for patients with COVID-19 admitted to the Norwegian ICUs.

Kristina Fjone: long-term outcomes for patients with COVID-19 admitted to Norwegian ICUs

Kirsti Tøien: Visiting restrain to hospitals; family caregivers of COVID-19 ICU-patients experiences. An exploratory study. A qualitative study describing family caregivers of COVID 19 patients’ experiences and needs during the visiting restrain at the ICU in the COVID19 pandemic. Twelve patients have been included in the study and interviewed with a semi-structured interview guide based on previous research and with input from the health care service users. Analysis of the interviews is in progress. The project group consists of Ranveig Lind PhD, Helene Berntzen PhD and Hanne Alfheim PhD.

Hope in ICU patients

Helene Berntzen and Nina Kynø:

In a qualitative interview study involving 13 patients recently discharged from three different ICUs, we examine facilitating factors and barriers that may impact on levels of hope among ICU patients both during their ICU stay and short after ICU discharge. Analyses are in progress spring 2022. PI is Tone Rustøen.

Kristin Sunde Flatlandsmo, Hanne Alfheim, Kirsti Tøien, Brita Fosser Olsen: To strengthen hope in intensive care unit patients – a randomized controlled trial (HOPE-ICU)

Intraoperative peripheral nerve injuries, symptoms and functional status after steep Trendelenburg positioning with or without lithotomy

PI: Signe Berit Bentsen; PhD student Benedikte Bjøro

Positioning of the patients on the operating table is teamwork where operating room nurses have a pivotal role in order to protect the patients from experiencing injuries due to e.g. nerve compression and compromised circulation. The purpose of this study is to increase the knowledge of intraoperative peripheral injuries (IPNI) related to steep Trendelenburg position with or without lithotomy. As IPNI is an unclear phenomenon that can be difficult to diagnose, we will identify pain and other symptoms immediately after surgery that might have an impact on development of IPNI. A longitudinal study including patients (n=600) undergoing gynecologic-, urologic- and gastro surgical procedures in steep Trendelenburg with or without lithotomy will be included and be followed up to 12 months after surgery.

The experience with nurse-written diaries in intensive care

Tone Rustøen is PI and Helene Berntzen is the main supervisor and Ingrid Egerod/Suzanne Herling co-supervisors.

Lisa M. Högvall’s Phd is investigating the use of diaries in a Norwegian intensive care context with particular focus on acute acquired brain injury (ABI)-patients with an uncertain prognosis of survival or cognitive function. The project comprises one survey to patients who have received a diary after their ICU-stay, one focus-group study with ICU-nurses from different ICUs and one interview study with TBI-survivors and their families using a case study design.

Patient Experienced Symptoms and Complications after Discharge from Day Surgery

PhD-student: Mi Stjernberg, PI: Johan Ræder, Main Supervisor: Marlin Comelon, Co-Supervisors: Tone Rustøen & Berit T. Valeberg.

The aim of this project is to identify potential risk factors and address postdischarge symptoms and complications after day surgery, in a two part sequence. In order to provide better and more dedicated patient education, prophylaxis and drug treatment to prevent and reduce postdischarge symptoms, admission or re-admission, we will perform two large prospective, observational studies at Oslo University Hospital (OUH). The establishment of bench-mark values of incidence and severity of postdischarge complications in a large, Norwegian, non-selected patient material, will be of use also for other institutions in their quality assurance of these large patient populations.

Tapering of Analgosedation and Occurrence of Iatrogenic Withdrawal Syndrome in Paediatric Intensive Care Treatment

Mette Dokken, PhD student, Gunnar Bentsen (main supervisor), Ingrid Egerod, Tone Rustøen, co-supervisors.

The study has both a quantitative and a qualitative approach. Paper 1 is published: To describe the prevalence and severity of iatrogenic Withdrawal Syndrome among severely ill patients in two Norwegian PICUs. In the second paper will to test a new algorithm for tapering analgosedation (opioids and benzodiazepines), and describe whether this algorithm will change the prevalence of IWS. The algorithm is developed by Mette Dokken, Rakel Iren Huse, Gudny Abrahamsen Rosseland, Frode Even Fagermoen and Gunnar Kristoffer Bentsen in PICU RH. In the 3rd paper to explore and understand nurses and physicians experience of using and follow a newly developed algorithm in the tapering of the drugs.

Pain and music based caregiving in nursing home patients

Tone Rustøen PI, Petter Borchgrevink, Reidun Sanvik (main supervisor) and Martin Engelstad (PhD student).

As many as 262 patients with dementia and pain are included. The first paper “Chronic pain conditions and use of analgesics among nursing home patients with dementia” will be submitted soon. In the second paper we will evaluate the effect of music based caregiving in a randomized controlled trial. In the third paper will we look more into the effect of the intervention related to psychosocial symptoms.

Health care, pain medication and treatment outcome after discharge from trauma hospital - experiences and perspectives among patients and physicians

Jeanette Finstad: Phd Project

A substudy of "Improving Patients Outcome after Trauma (IPOT)". The main aim of the IPOT study is to prevent injuries, adverse outcomes and improve trauma treatment. In my qualitative project, we want to gain a better understanding of which factors, before and after injury, are perceived to be related to unfavorable patient outcomes and reduced clinical outcome in trauma patients, including pain treatment, continued use of prescription drugs, disability and reduced quality of life.

We have a network funded by Helse Sør Øst: Norwegian Symptom Management Network (NORSMAN).The overall purpose of this network is to strengthen research that is focused on decreasing symptom burden and improving quality of life outcomes in patients with chronic conditions.

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