AIM:Children aged 0-18 years living with respiratory support represent a growing population worldwide. They have complex medical needs and rely on multidisciplinary care. Transportation is often challenging, and paediatric respiratory support teams are concentrated in a limited number of hospitals. As of 2024, Swedish paediatric long-term respiratory care facilities (PRCF) are centralised at four centres. We aimed to explore the relationship between travel distance from home to PRCF, healthcare utilisation and mortality before centralisation. METHODS:A retrospective, population-based cohort study using data from the Swedish Quality Registry for Respiratory Failure (Swedevox) between 2015 and 2021. Multivariable linear regression models and survival analyses were applied to examine the associations between travel distance, healthcare utilisation and mortality. RESULTS:A total of 596 children were included (mean age 5.4±5.1 years). Of these, 76% lived within 60 min of a PRCF (median 19 km, IQR 8-34), while 24% had travel times exceeding 60 min (median 171 km, IQR 105-268). No association was found between travel time to PRCF and healthcare utilisation or death before age 19. Children whose parents had 12+ years of education underwent more hospitalisations annually (R 0.29, 95% CI 0.01 to 0.57), and children in rural areas had fewer emergency visits (R -0.47, 95% CI 0.84 to -0.10). CONCLUSIONS:No associations were found between travel distance and healthcare utilisation or mortality among children with long-term respiratory support. Centralised PRCF may thus be feasible without compromising outcomes, but reforms should recognise possible unintended effects on children and families.

Children aged 0–18 years who need long-term respiratory support rely on medical technology and comprehensive medical care. For this care to be provided at home, access to medical and social support and care is essential. In Sweden, the most notable form is personal care assistance (PCA), which is granted based on legislation and individual authority decisions. We aim to explore the impact of socioeconomic factors on the availability of PCAs in children on long-term respiratory support. This was a retrospective, population-based cohort analysis of children living with respiratory support in the Swedish Quality Registry for Respiratory Failure (Swedevox) between 2015 and 2021, with crosslinked national registry data on socioeconomic factors and PCA. Associations between socioeconomic factors (country of origin, disposable household income, parents’ educational level and marital status) and having been granted PCA were analysed using multivariable regression models. Of the 600 included children (mean age 5.4 ± 5.1 years), 171 (29

PURPOSE:Children living with respiratory support rely on medical technology, either fully or partially, throughout the day to meet their breathing requirements. Although children and young people living with respiratory support at home undergo long-term treatments and make extensive use of health and social care services, there is a notable absence of comprehensive outcome data on this group. The establishment of the first nationwide Course of DISease reported to the Swedish CPAP Oxygen and VEntilator RegistrY paediatrics cohort aims to investigate the disease trajectory, clinical and socioeconomic risk factors influencing incident illness, hospitalisation risk and mortality among children living with respiratory support. PARTICIPANTS:Data on patients aged 0-18 years reported to the Swedish National Registry for Respiratory Failure and Sleep Apnoea (Swedevox) 1 January 2015 to 29 July 2021 were merged with seven quality or governmental registries, the National Quality Registry for Intensive Care, the National Medical Birth Register, the Swedish Cause of Death Registry, the Registry for Interventions under the Act on Support and Service to Certain Disabled Persons, the Swedish National Patient Registry and with socioeconomic data from Total Population Registry and Longitudinal Integrated Database for health insurance and labour market studies. FINDINGS TO DATE:The cohort includes 716 children, 59% male, who began respiratory support at an average age of 6.4 years (SD 5.4). Among them, 28% use continuous positive airway pressure, 64% long-term mechanical ventilation (LTMV), 3% high-flow oxygen therapy (HFOT) and 5% other methods. Respiratory support is mostly used at night, but many LTMV (54%) and HFOT (81%) users need daytime aid. 77% of LTMV users rely on mask connection, differing from international data. FUTURE PLANS:Future projects include exploring the impact of socioeconomic factors on hospitalisation rates and mortality. The dataset is due for an update in 2026.

BACKGROUND:It has become more common for patients with long-term diseases or receiving aggressive cancer treatments to need intensive care. Research about palliative care in the intensive care unit (ICU) largely focuses on decision-making in relation to end-of-life care and organ donation. Few studies examine the current evidence about how palliative care in its wider conceptualization is understood by intensive care health care professionals. OBJECTIVES:To synthesize the literature on ICU health care professionals' experiences and views of providing palliative care in the ICU. METHODS:This was an integrative review where data were assessed and analyzed using Whittemore and Knafl's approach. RESULTS:Four themes were identified in the synthesis: the meaning of palliative care, relationships with families, multidisciplinary working, and preparation for providing palliative care. DISCUSSION:Our findings suggest there is variation in how palliative care in the ICU is conceptualized and interpreted. Intensive care unit professionals need enhanced competencies and training to develop their confidence in providing palliative care and improve role clarity. Such training should focus on serious illness conversations with patients/families and interdisciplinary teamwork. Integration of palliative consultants into the ICU could be further developed.

PurposeThis study aimed to examine how young people living with Home Mechanical Ventilation experience the transition from childhood to young adulthood in relation to everyday life, perceived health and transition into adult professional healthcare.MethodsNine young adults (three females and six males aged 18-31) were interviewed, and data was primary analysed using phenomenological hermeneutics. In the actual study, data was reworked using secondary analysis as described by Beck. Two interviewees were ventilated invasively and six non-invasively, and one was treated with continuous positive airway pressure (CPAP).ResultsThe results are presented in two main categories. First; moving towards adulthood; and second, To handle changes in health and healthcare contacts. The study highlights the importance of ongoing social relations and being part of a socializing and physically active community. The transfer from paediatric to adult healthcare was solid and worked out well but was a process in which the participants struggled to find their own voice.ConclusionsThe transition into adulthood is a sensitive and challenging time for young people with HMV, but stable, close relationships and a well-organized transfer can enable this group to feel safe and able to find and use their own voice.

In autumn 2023, the Swedish Research School in Integrated CARE for Future Teachers started in the Western Region of Sweden, using the acronym Shift Care. This research school is grounded in the adjustment that is under development in the Swedish healthcare system called integrative care (Swe: Nära Vård). The research programme and PhD students' projects are directed to people of various ages who live their everyday life suffering from complex needs and thus need professional healthcare support. The research school Shift Care [1] is funded by the Swedish Research Council and is run by a collaboration of the four seats of learning that are situated in the Western Region of Sweden. Similar programmes have been funded in some other universities in Sweden. The aim of the research school is to prepare the PhD students to carry out multidisciplinary research and education in a close collaboration with various fields of clinical healthcare practices. Research courses within the Shift Care programme are, however, open for PhD students who are not a part in the programme but want to add an individual course within their PhD education programme. The background of the establishment of the Shift Care research school goes back to an investigation in 2017 initiated by the Swedish government [2] and the work with initiating Good and Integrative (read: Proximity) Care. The goal of this programme is to develop a healthcare organisation that is governed by the patient and to facilitate an active patient participation in healthcare activities and treatments that are individualised. Integrative care is also said to be something that prevents a fragmented professional healthcare system [3], and the reorganisation creates better coordinated professional health care in health prevention and promotion. The primary healthcare provider is viewed as the hub for patients' contacts and caring needs, and digital solutions will be an important facilitator for this. Sweden has a low number [4] of hospital beds, that is, among the lowest numbers in EU. In addition, a great number of healthcare professionals will soon start retiring, resulting in an enormous demand and recruitment needs of young people into various healthcare education programmes and later employment in various healthcare professions. Thus, there is a great challenge and need for further development of knowledge production and teaching to realise the above-mentioned goals and to perform caring in proximity that is easily accessible. The start of the Shift Care research school has provided me and my research team the possibility to further develop knowledge about the lived experience of a life on a ventilator of a young person or a child [5]. Our goal is to develop and spread knowledge generated from a close perspective of the person who uses some kind of technological breathing support. Unfortunately, technological devices have the effect of creating distance between people and when used on an everyday basis also changing the feeling of ‘at-homeness’ [6]. But on the contrary, they can and should have positive effects when used properly as they give energy and well-being to a person living with long-term breathing difficulties and breathlessness. A prerequisite is, however, that the technological equipment is well functioning and that the treatment and care are guided by competent healthcare professionals who provide proximity care. Moreover, the meaning of such life is viewed as something that provides well-being and a meaningful life in good relations with other people and the world. What if authorities and politicians put too much hope in the concept and organisation of Integrative Care? As I see it, there may be a risk, despite the goal of a close and easily accessible contact between the person and health organisations, that the person/patient risks further distance and problems in creating contacts with the healthcare system. This is due to the great expectations and the hope that digital solutions will solve many problems in relation to close access to professional care. Many care-seeking people are old; others may not have good health literacy ability or, as Sweden has a huge rural area, live distant to outpatient health care or hospitals, and may not have well-functioning digital equipment or wireless connection at home. However, this situation also means a fantastic challenge for the nine PhD projects that were awarded within the research school and to those who choose to take courses within the programme, to develop knowledge in caring and caring science as the PhD courses within Shift Care are open for application for other PhD students. Distance easily breeds the feeling that responsibility is far away and depends on another person, that is, not on me, whereas encountering another person in proximity and face to face, especially regards the eyes, immediately awakens the responsibility of doing good to the other. The French philosopher Emanuel Levinas created the ethics of proximity [7] where he ascribed the face as having a special meaning; the other's face not only appeals to us, make us feel responsible and aware of the other person's vulnerability, but also awakens the possibility to relationship. Consequently, there is a clear and important association between proximity and close relationships, something that is the central motive for a caritative ethics [8] as well as in an integrative care approach. In a review [3] of the concept, integrative care was described in the dimensions, communication, coordination, collaboration, cooperation, a population approach, and responsibility and accountability. The latter has a clear association with a proximity caring approach. Last, but not least, I will remind and invite you all to the Nordic College of Caring Science's 5th conference held at the University of Stavanger on 24–25 April starting with a pre-conference on 23 April, spring, 2024. The title is Caring Science – the heart of multi-professional care. There will hopefully be time and place for discussions about how to develop and share knowledge within the caring sciences and hopefully also encounters that will bring forth close relationships in research projects. The conference also means that the editorship for the Scandinavian Journal of Caring Science will change as the 4 years for me and Elisabeth Lindberg end and a new election will take part. We are proud and thankful for the possibility of contributing to the journal and Nordic College of Caring Science.

•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.

PURPOSE An increasing number of children and young adults with complex medical conditions and respiratory failure are treated with home mechanical ventilation (HMV). The current study aimed to describe how young adults using HMV experience their everyday life with the ventilator, their physical impairments and their opportunities for an educational and professional career. MATERIALS AND METHODS Data were collected via narrative interviews with nine young HMV users (3 females and 6 males, aged 18-31 years) in their homes. Two were ventilated invasively, six were ventilated non-invasively and one was treated with continuous positive airway pressure (CPAP) via facemask. Data were analysed using a phenomenological hermeneutical method. RESULT A multi-professional team contributed to participants' safety and ability to participate in society through higher education and professional work. A good and valuable life, mostly feeling healthy were experienced but also prejudice and stiffened social society structures. CONCLUSION The findings of this study prove the importance of having long-standing access to a competent and supportive available multi-professional healthcare team when living with a long-term complex condition. These teams provided well-functioning human and technological support in everyday lives.

I am happy to announce that the 2024 Conference of Nordic College of Caring Science (NCCS) and the European Academy of Caring Science (EACS) will take place at the Faculty of Health Sciences at the University of Stavanger, Norway from the 24th to 25th of April 2024. There will also be a pre-conference on 23 April 2024. More information will follow. However, already this autumn, that is in 2023, there will be at least two important conferences connected to research within the caring and nursing sciences. The first is the Nordic Conference in Nursing Research to be held 2–4 October 2023 in Reykjavik, Iceland. The second conference is the Global Conference on Person-Centred Care held at the University of Gothenburg Centre for Person-Centred Care (GPCC) in Gothenburg, Sweden, May 14–16, 2024. The content presented in these conferences will hopefully be important for further developments in research methodologies within the caring sciences. Someone might pose the question; are there then a special approach and application of research methodologies and methods in research within the caring sciences? The answer is yes! My motive and argument for this ‘yes’ is that as a caring science researcher you always approach people that are in a vulnerable situation in some way, and this fact demands a caring approach meaning being responsible when collecting and analysing data as well as presenting your findings as text. Therefore, I am glad to tell that the journal Scandinavian Journal of Caring Sciences has published a methodological paper in July written by Elisabeth Dahlborg and co-authors [1] with the title ‘Encircling discourses—A guide to critical discourse analysis in caring science’. Their text presents the epistemological foundations, an overview of discourse analytical research and a guide to conduct critical discourse analysis (CDA) from both a caring and nursing perspective. A discourse analysis approach can be carried out in various ways but in common are a critical analysis of communicated data, that is language use in various contexts inscribed and fixed as texts. A CDA approach also aims to reveal structures in power relations in the world as lived. The actual article can be found on the journal's website under most the heading ‘Most Recent published articles’. During Spring, the media flow has focused, despite news about instability around the globe, on the effects of Artificial Intelligence (AI) as a possibility to produce various texts through the use of computer and technology. This technological development and knowledge will indeed be a future challenge to society not least to scientific publishing. What then will happen when texts are produced by logarithms in computer programs? One can imagine a threat to literature, such as fiction and poetry, news in daily press and TV and all sorts of texts that are connected to education including academic education programmes. In language, which is one part of communication, the way that meaning in experiences, senses, thoughts or facts can be shared among people. According to the philosopher Paul Ricoeur [2] it is not only the experience or event expressed in a discourse that passes over to the other but also the intersubjective exchange itself that is the happening in a dialogue. When language becomes fixed into writing, that is produced as text, both its meaning and event becomes open for the other. This is something that differs in an AI-produced text. It worries me that a text per se becomes a technology when AI is used as a tool for language processing in terms of loss of both facts (plagiarism) and sensitivity (feelings, meanings) that is always the case when a text is produced and mediated by a human being. However, there are certainly positive aspects in AI word-producing systems as well as in various problem-solving AI techniques used in health sciences that we have to learn but always critically reflect on. An example in health research launched at the University of Borås is the EU research project Kontiki—where AI is going to be examined as a tool for decision-making and support for patients and professional health carers. I really look forward to further reading about the findings that will be generated from this project. Technology has always had a great impact on professional healthcare work. The term technology originates from Greek word techne and logos, meaning craftsman-like knowledge and creation, to bring forth an artistic creation. Technique on the other hand is related to the method by which something is produced or executed. There is an enormous power in technology and techniques in that it has impact on all it comes in contact with (‘all eyes go to the technology’). In my field of research, technology represents the dream of possibilities, for example breathing assistance to those who need ventilator support to uphold health and life itself and all treatments available in intensive care. Nevertheless, in such context it also means restrictions and ethical challenges in terms of critical reflection of statements as ‘the more technology the better health care and treatment’ or ‘if we can then we must’ (use all available technology). In high-tech care and treatment like digital monitoring, X-ray treatment, blood analyses, etc. the patient and patient's body risk being viewed as a text per se as all information is presented in various forms of texts. However, in high-tech environments, good technology is based on patients' needs and must offer possibilities for the personnel to control the equipment. In such cases, technology with medical treatments gives time and space for the staff to care and give human touch. My argument then when it comes to a technological produced text, that is an AI-generated text, is for the user to learn and control the technology that should be used in good purpose and in the service of human beings. That means not generating false information or plagiarism but to produce/write texts that promote a true dialogue and exchange of thoughts and facts between people. I close my reflections with a quote from Paul Ricoeur [3] that mediates what I have been trying to share with you in this editorial: ‘Thanks to writing, man and only man has a world and not just a situation’ (p38).

Taking on the honourable role as the Editor-In-Chief (EIC) for Scandinavian Journal of Caring Sciences (SJCS) means a lot of communication directed to the editorial office at the publishing house Wiley. It also involves a lot of communication with authors and presumptive authors. These contacts are often productive and end in clarification, but some requests are connected to a more general knowledge about the publication path that makes me reflect on the need for knowledge about the journal publishing processes. Despite the fact that good literature on the subject exists, for example, (1, 2) in this editorial I will draw on issues that often occur in my communication with authors. One aspect is the question why authors want to publish in a scientific journal. It probably has to do with wanting to share their findings or connect with other researchers and practitioners or influence policymakers. Publishing is also closely connected to career advancements where the number of published articles becomes important, something that sometimes makes researchers ‘slice’ the presentations of results into several manuscripts instead of presenting the whole study in one. If you are a PhD student, writing articles is a part of the curricula in your education programme and often a demand from peers to publish a thesis. A second aspect is that choosing a journal may be a main problem. As an experienced researcher, you often know ‘your’ field and journals which make authors already from the start aware of what journal that will suit their actual manuscript. Unfortunately, many manuscripts are immediately rejected because they do not adhere to the journal's aims and scope, poor writing style and/or do not follow formatting guidelines. The latter could, if the manuscript presents a novel topic or methodological approach, lead to a rejection and resubmission after that the author has been asked to revise such errors. An editor's role is to safeguard the journal's aim and scope and make the first decision about immediate rejection without peer review or to allocate the manuscript to the assisting editor (AE) for invitation of reviewers. Note that an immediate rejection therefore is not followed by comments from reviewers. However, the decision could be followed with advice from the EIC about how to improve the text or general advice to submit to another type of journal, for example, related to medical, sociological or specific professional areas. The SJCS is an international and interdisciplinary journal that honours the development of caring sciences, caring sciences theory and methodologies and is not a professional nursing journal per se. The journal aims to contribute to the development and advancement of scientific knowledge on caring related to health, well-being, illness and the alleviation of human suffering. Moreover, it promotes an interdisciplinary team approach. Of special interest are scholarly articles that address and initiate a dialogue on theoretical, empirical and methodological concerns. This information is described in the Instruction for Authors document published on the website. A significant number of manuscripts are therefore rejected in the first step of EIC decision, and no comments from reviewers are available. Other reasons for rejection are poor ethical considerations. Here, the Committee of Publications Ethics (COPE) (3) is a good guide for authors. All manuscripts undergo investigation concerning plagiarism; this is sometimes a problem in review studies. The authors may struggle with writing in a non-native language and risk-presenting content that is too close to the original text that is being reviewed and summarised. Today SJCS offers the possibility to publish manuscripts as open access (OA), which helps the authors disseminate their research findings to the readers. The libraries at the various seats of learning have agreements for subscription packages, so good advice to all authors is to check whether the journal includes the fee for OA publication form. Information from the Committee on Publication Ethics (COPE) and/or the Council of Science Editors' (CSE) (4) White Paper on publication ethics offers good guidance to authors about roles and responsibilities, authorships and reviewers' roles. The review process can take time mainly due to problems in finding reviewers. Another reason could be aspects related to the actual research problem revealed in a manuscript such as finding reviewers with special competences that match the manuscripts. Therefore, if you take on the role as reviewer, and we (EIC and AE) hope you do, please consider that the reviewer process means at least two occasions where you comment on the manuscript. If you are not yet, but want to be a reviewer for the SJCS, a good suggestion is to send in your publication list and CV to the editorial team at Wiley, please approach [email protected].

BACKGROUND:In this paper, we share our experiences of using 'photovoice' methodology as a way to generate data in intensive care units concerning the place and space of care. We have adapted and modified 'photovoice' in researching people's lived experiences of ICU. Researching lived experiences in an intensive care context is challenging because of the complex nature of critical care.AIM:This study aims to explore and discuss photovoice methodolgy in ICU as a data collection method.MATERIALS AND METHODS:Photos and interviews collected from patients, loved ones and staff collected in a previous research proejct.RESULTS:Although there are challenges in using cameras and photographing the environment in the ICU, due to ethics and the voiceless patients therein, many advantages are presented to the researchers in capturing the meaning of lived experiences of various phenomena in the lifeworld in general and in the meaning of place and space. This paper offers applications and reflection over ontological, epistemological and methodological concerns and also offers a detailed approach on how to employ photovoice for successful and rich data generation.DISCUSSION:developing and adapting scientific methods and methodologies contributes to knowledge development in caring science and is therefore an important subject of matter.CONCLUSIONS:Photovoice also presents a powerful tool in disseminating the findings as it opens up the closed world of ICU to the public and increases people's understanding of the significance of place and space of caring practice.

BACKGROUND:Multidisciplinary team meetings (MDTMs) represent an integral component of modern cancer care and have increasingly been implemented to ensure accurate and evidence-based treatment recommendations. During MDTMs, multiple and complex medical and patient-related information should be considered by a multi-professional team whose members contribute various perspectives. Registered nurses (RNs) are expected to share information on the patient perspective at MDTMs. However, research suggests that RNs' contributions to case discussions are limited and that patient perspective is generally underrepresented. Our aim was to explore RNs' views of the prerequisites for and barriers to the inclusion of the patient perspective in MDTMs in Swedish cancer care.METHODS:Data were collected from four focus group interviews with 22 RNs who worked as contact nurses in Swedish cancer care. Interviews were transcribed and analysed using inductive content analysis.RESULTS:The analysis identified two categories and five subcategories. The participants presented different views and expressed ambivalence about the patient perspective in MDTMs. Subcategories were related to medical versus holistic perspectives, the added value of patient perspective, and possibilities for patient contributions. The participants also discussed prerequisites for the patient perspective to be considered in MDTM decision-making process, with subcategories related to structures promoting attention to the patient perspective and determinants of RNs' contributions to case discussions in MDTMs.CONCLUSIONS:This study demonstrates various views related to the patient perspective in MDTMs and identifies a great need to clarify the RN's role. Our results indicate that if enhanced presentation of the patient perspective in MDTMs is desired, key information points and structures must be established to collect and present relevant patient-related information.

In late April, the Nordic College of Caring Science (NCCS) held their fourth international scientific conference. The theme for the conference was ‘Caring in a changing world’. The conference began 26th April with a pre-conference designed for PhD students within the academic field of caring sciences. The NCCS annual board meeting was also held on that date. The venue for the conference was Mälardalen University, situated in a new but also renovated and integrated environment in the central city of Eskilstuna, Sweden. The seats of learning received the Swedish Government's rights and status as a university in 2022. The university offered a fantastic environment for knowledge exchange and socialisation with research colleagues and friends. During the annual meeting with the NCCS board discussed the work and development of the journal. Additionally, the new board was elected, and Associate Professor Mats Holmberg became NCCS's new chairperson. The conference was also held in collaboration with the organisation European Academy of Caring Science (EACS). We all had the opportunity to reflect and listen to interesting speeches, some participated as keynote speakers, and we also took in the content from posters presented by participants. Professor Unni Lindström, Åbo Academy Vasa received a warm welcome and gave a fantastic lecture about caring science, and how the subject has been practically implemented in the Home foundation at the island Åland, Finland. Professor Katie Eriksson's memory award was shared for the first time. The prize was assigned to Associate Professor Susanne Knutsson, The Linnaeus University, Sweden. For me, attending the conference as the Editor-In-Chief for the Scandinavian Journal of Caring Sciences offered the opportunity to present my views of the work as the Editor-in-Chief for the journal. My lecture focused on how to protect and develop the journal's aims and scope and the caring science perspective. What is a caring science perspective when designing, performing and publishing research from a caring science perspective? In answering a part of this question, I am proud to present and recommend the articles published in the Scandinavian Journal of Caring Sciences developed in memory of Professor Katie Eriksson. The articles are written by the professors Ingegerd Bergbom, Dagfinn Nåden and Lisbeth Nyström [1, 2], a part two published in June where Professor Eriksson's theories are summarised and presented in a clear and comprehensive way. I really hope that those two papers will become classical and guide future tentative authors, educators, clinicians, students and researchers within caring science but also scholars that are not so initiated in the subject to become inspired about the message. But of course, I also recommend the reading of the rich and original production of Professor Eriksson's and colleagues on the subject [3-6]. If you as readers want to further deepen your understanding of the caring science perspective an international scholar that I highly value is Professor Simone Roach's [7, 8] writings. Afterwards, when I am reflecting on the theme for the conference ‘Caring in a changing world’ my thoughts go to what is happening in Europe today and that is, unfortunately, war. An expression I heard in a conversation was that war is an exception and peace is normality. I lack the words to express this situation, but maybe my words are delayed and hopefully I can find my words later. Indeed, such a situation as war is a failure but points to and stresses the importance of a caring science approach, for example an ethos including a truthful communication in publishing. During the end of May, the editorial board held a digital meeting where the topic ‘how to guard the journal's aim and scope and a theoretical perspective’ were reflected. We also discussed how to publish research focusing subjects like cultural diversity, equity, inclusion and a variety of professional perspectives. Moreover, there was also consensus about the need to publish articles that deal with development of methodological approaches useful in the caring sciences research field.

Objective The aim of this integrative review was to identify facilitators and barriers to patients' well-being when being cared for in an ICU setting, from the perspective of the patients. Background To become critically ill and hospitalised in an ICU is a stressful, chaotic event due to the life-threatening condition itself, as well as therapeutic treatments and the environment. A growing body of evidence has revealed that patients often suffer from physical, psychological and cognitive problems after an ICU stay. Several strategies, such as sedation and pain management, are used to reduce stress and increase well-being during ICU hospitalisation, but the ICU experience nevertheless affects the body and mind. Design; Methods Since research exploring patients' sense of well-being in an ICU setting is limited, an integrative review approach was selected. Searches were performed in CINAHL, Medline, Psych Info, Eric and EMBASE. After reviewing 66 studies, 12 studies were included in the integrative review. Thematic analysis was used to analyse the studies. The PRISMA checklist for systematic reviews was used. Results The results are presented under one main theme, 'Well-being as a multidimensional experience-interwoven in barriers and facilitators' and six sub-themes representing barriers to and facilitators of well-being in an ICU. Barriers identified were physical stressors, emotional stressors, environmental disturbances and insecurity relating to time and space. Facilitators were meeting physical needs and activities that included dimensions of a caring and relational environment. Conclusion Our main findings were that experiences of well-being were multidimensional and included physical, emotional, relational and environmental aspects, and they were more often described through barriers than facilitators of well-being. Relevance for clinical practice This integrative review has shown that it is necessary to adopt an individual focus on patient well-being in an ICU setting since physical, emotional, relational and environmental stressors might impact each patient differently.

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.

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.

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.

According to my experience as a researcher and supervisor to doctoral students, reflections about how to weighing, assess and decide about what scientific journal to approach as an author could be problematic in academic publishing. Sometimes when designing a study, you can already from the start be totally sure about what journal you consider the most appropriate to target and submit your manuscript to. Being the editor-in-chief for Scandinavian Journal of Caring Sciences, I share these considerations probably with many other researchers. I will therefore discuss some issues that hopefully will be supportive in the process of deciding what scientific journal to submit a manuscript to. One of the primary and most important responsibilities an Editor and Assistant Editor take on is to safeguard the journal's quality, aim and scope. When doing so, it means to help in the process of spreading your result findings and ideas to people in clinical practice and to other researchers. There are some journals that publish manuscripts that have a special professional interest, for example child and maternal care, intensive care, primary or palliative care, organisational and/or a leadership approach. If your manuscript obviously falls into such category, then a good advice could be to focus on some of these journals. Proceed to read and consider if your manuscript's theoretical foundations and content coincide with the aim and scope of these journals. Often when a manuscript becomes immediately rejected, the motive is that the manuscript does not fit the actual journal's aim and scope or in some cases is not prepared according to the demands (language, stylistic errors, word count etc.) presented in the guidelines for authors. The latter seems to be a small problem – given the manuscript fit the aim and scope and present new knowledge of an interesting topic to the readers – in such cases, the editor role may permit a short message to the authors about how to make stylistic improvements. Rejections are always connected with a disappointment and hard to bear especially to inexperienced authors. A creative solution to avoid such disappointments could be to identify and put up three possible journals where the aim and scope seem to fit your manuscript and rank these three journals in order. When doing so, you are better prepared and save time for starting a new and second submission process if you should receive an immediate rejection. Also, consider and balance your options to be published in the most prestigious journals. Sometimes a rejection may be avoided if author/s send the abstract to the editor and ask for an opinion in advance. Holland and Watson (1), two well-experienced editors, present valuable advices in how to targeting the ‘right’ journal. I really recommend reading this book as well as ‘The easy to follow guide’ published on Wiley's website (2) if you lack experience in publishing. When reflecting on if to submit a manuscript to Scandinavian Journal of Caring Sciences, this journal may be considered as generic but there are some special theoretical principles to respond to when preparing the manuscript. This is the fact that Nordic College of Caring Sciences and the journal's editors, editorial team and board members honour manuscripts that takes on a ‘mission to contribute to the development and advancement of scientific knowledge on caring related to health, well-being, illness and community focus and which promotes an interdisciplinary team approach’. This is clearly expressed in the instruction for authors’ guide (3). What then does the concept caring in these instructions mean and how to relate and articulate a caring perspective in a manuscript? The idea of caring stress that caring is the essence of humanity and the motive of professional caring is to alleviate suffering within an attitude of love, mercy and charity (4), that is having an ethical value. Consequently, a caring science research perspective is not related or belong to any kind of speciality within the health professions. Thus, the journal welcomes manuscripts presenting various professional views and also manuscripts that are a result from an interdisciplinary collaboration. However, this collaboration should share and take on an interest in the foundation and values of caring science. Scandinavian Journal of Caring Sciences’ instructions to authors also tell that ‘of special interests are scholarly articles addressing and initiating dialogue on theoretical, empirical and methodological concerns related to critical issues’. These recommendations mean that theoretical papers, reviews and empirical studies carried out within a qualitative and quantitative paradigm are of interest that present new meanings and novel views on research phenomena driven by a caring science perspective. This also concerns papers that present methodological ideas that underpin research with a caring science perspective. An overall goal is that these manuscripts should contribute to influence and develop research and caring practices for a various professionals active in health care as well as researchers. The actual health situation that is connected to the extraordinary situation of the COVID-19 pandemic that has caused so much suffering in society has also revealed new needs of scientific approaches. Physical and social meeting restrictions have put new demands on communications strategies, like the use of telemedicine and software programs. These tools have had an tremendous importance in holding up contacts and are good solutions to both patients and their families as well as healthcare professionals and researchers but has taken a lot of time to launch, in learning how to apply and to receive access to. Many PhD students have been forced to stop their data collection processes due to difficulties in contacting informants or being forced to pause their education programme and instead contribute to the work in clinical practice. I, therefore, claim that there is today a need of developments of various research methodological approaches that suit a caring science perspective and we need to share such good examples.

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.