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Eklund, R., Hjelmfors, L., Nyquist, S., Sveen, J., Hultström, M., Lipcsey, M., . . . Orwelius, L. (2024). Surviving COVID-19: patients' experiences of care and path to recovery. International Journal of Qualitative Studies on Health and Well-being, 19(1), Article ID 2301953.
Open this publication in new window or tab >>Surviving COVID-19: patients' experiences of care and path to recovery
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2024 (English)In: International Journal of Qualitative Studies on Health and Well-being, ISSN 1748-2623, E-ISSN 1748-2631, Vol. 19, no 1, article id 2301953Article in journal (Refereed) Published
Abstract [en]

Purpose: To examine patients' experiences of receiving care on an ICU for COVID-19 and the subsequent rehabilitation process.

Methods: An explorative and inductive design was used. Participants were recruited from two university hospitals in Sweden. Patients admitted to the ICU due to COVID-19 from March 2020 to April 2021, who enrolled in the ICU follow-up, and understood and spoke Swedish were invited to participate. In total, 20 participants completed a semi-structured interview, of whom 18 were included in the thematic analysis.

Results: The analysis resulted in two themes: "An isolated world with silver linings" and "Recovery in the wake of the pandemic". Findings show that patients cared for on an ICU for COVID-19 during the pandemic felt safe but experienced a sense of vulnerability. After discharge, physical rehabilitation was a slow process with frustrating day-to-day fluctuations. Mentally, participants felt isolated, fatigued, and emotionally sensitive. Patients reported that love and support from family and friends were crucial for the recovery process.

Conclusions: This study highlights the challenges of recovering from COVID-19, emphasizing the importance of continued support from health care, public services, family and friends. It provides important insights into patients' experiences and can inform future healthcare strategies and policies.

Place, publisher, year, edition, pages
Taylor & Francis, 2024
Keywords
COVID-19, intensive care, psychosocial well-being, psychosocial support, recovery, rehabilitation
National Category
Nursing
Identifiers
urn:nbn:se:uu:diva-521174 (URN)10.1080/17482631.2024.2301953 (DOI)001137343700001 ()38184794 (PubMedID)
Funder
Region Östergötland, ROE-978823
Available from: 2024-01-24 Created: 2024-01-24 Last updated: 2024-01-24Bibliographically approved
Gustavsson, M. E., von Schreeb, J., Arnberg, F. & Juth, N. (2023). "Being prevented from providing good care: a conceptual analysis of moral stress among health care workers during the COVID-19 pandemic". BMC Medical Ethics, 24(1), Article ID 110.
Open this publication in new window or tab >>"Being prevented from providing good care: a conceptual analysis of moral stress among health care workers during the COVID-19 pandemic"
2023 (English)In: BMC Medical Ethics, ISSN 1472-6939, E-ISSN 1472-6939, Vol. 24, no 1, article id 110Article in journal (Refereed) Published
Abstract [en]

BackgroundHealth care workers (HCWs) are susceptible to moral stress and distress when they are faced with morally challenging situations where it is difficult to act in line with their moral standards. In times of crisis, such as disasters and pandemics, morally challenging situations are more frequent, due to the increased imbalance between patient needs and resources. However, the concepts of moral stress and distress vary and there is unclarity regarding the definitions used in the literature. This study aims to map and analyze the descriptions used by HCWs regarding morally challenging situations (moral stress) and refine a definition through conceptual analysis.MethodsQualitative data were collected in a survey of 16,044 Swedish HCWs who attended a COVID-19 online course in autumn 2020. In total, 643 free-text answers with descriptions of moral stress were analyzed through content analysis.ResultsThree themes emerged from the content analysis (1) "Seeing, but being prevented to act; feeling insufficient/inadequate and constrained in the profession," (2) "Someone or something hindered me; organizational structures as an obstacle," and (3) "The pandemic hindered us; pandemic-related obstacles." The three themes correspond to the main theme, "Being prevented from providing good care."DiscussionThe main theme describes moral stress as various obstacles to providing good care to patients in need and acting upon empathic ability within the professional role. The themes are discussed in relation to established definitions of moral stress and are assessed through conceptual analysis. A definition of moral stress was refined, based on one of the established definitions.ConclusionsOn the basis of the study results and conceptual analysis, it is argued that the presented definition fulfils certain conditions of adequacy. It is essential to frame the concept of moral stress, which has been defined in different ways in different disciplines, in order to know what we are talking about and move forward in developing prevention measures for the negative outcomes of this phenomenon.

Place, publisher, year, edition, pages
BioMed Central (BMC), 2023
Keywords
Moral stress, Moral distress, Ethical/moral challenges, Health care workers, COVID-19 pandemic, Conceptual analysis
National Category
Nursing
Identifiers
urn:nbn:se:uu:diva-518749 (URN)10.1186/s12910-023-00993-y (DOI)001117681100001 ()38071309 (PubMedID)
Available from: 2024-01-09 Created: 2024-01-09 Last updated: 2024-01-09Bibliographically approved
Halvorsen, P., Hultström, M., Hästbacka, J., Larsson, I.-M., Eklund, R., Arnberg, F. K., . . . Lipcsey, M. (2023). Health-related quality of life after surviving intensive care for COVID-19: a prospective multicenter cohort study. Scientific Reports, 13(1), Article ID 18035.
Open this publication in new window or tab >>Health-related quality of life after surviving intensive care for COVID-19: a prospective multicenter cohort study
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2023 (English)In: Scientific Reports, E-ISSN 2045-2322, Vol. 13, no 1, article id 18035Article in journal (Refereed) Published
Abstract [en]

In survivors of severe coronavirus disease 2019 (COVID-19) incomplete mental and physical recovery may considerably impact daily activities and health-related quality of life (HRQoL). HRQoL can be evaluated with the RAND-36 questionnaire, a multidimensional instrument that assesses physical and mental aspects of health in eight dimensions. The objective was to investigate HRQoL in intensive care patients previously treated for COVID-19 at three Nordic university hospitals, in a prospective multi-center cohort study. HRQoL was measured using RAND-36, 3-9 months after discharge from intensive care units (ICU). One hospital performed a second follow-up 12 months after discharge. A score under the lower limit of the 95% confidence interval in the reference cohorts was considered as significantly reduced HRQoL. We screened 542 and included 252 patients. There was more than twice as many male (174) as female (78) patients and the median age was 61 (interquartile range, IQR 52-69) years. Hypertension was the most common comorbidity observed in 132 (52%) patients and 121 (48%) patients were mechanically ventilated for a median of 8 (IQR 4-14) days. In RAND-36 physical functioning, physical role functioning, general health (p < 0.001 for all) and social functioning (p < 0.05) were below reference, whereas bodily pain, emotional role functioning and mental health were not. In a time-to-event analysis female sex was associated with a decreased chance of reaching the reference HRQoL in the physical function, bodily pain and mental health dimensions. Higher body mass index was found in the physical functioning dimension and hypertension in the physical functioning, vitality and social functioning dimensions. Similar results were seen for diabetes mellitus in general health, vitality and mental health dimensions, as well as pulmonary illness in the physical role functioning dimension and psychiatric diagnosis in the social functioning dimension. Mechanical ventilation was associated with a decreased likelihood of achieving reference HRQoL in the bodily pain and physical functioning dimensions. Patients treated in an ICU because of COVID-19 had lower HRQoL 3-9 months after ICU discharge than 95% of the general population. Physical dimensions were more severely affected than mental dimensions. Female sex and several comorbidities were associated with a slower rate of recovery.

Place, publisher, year, edition, pages
Springer Nature, 2023
National Category
Public Health, Global Health, Social Medicine and Epidemiology Anesthesiology and Intensive Care
Identifiers
urn:nbn:se:uu:diva-514926 (URN)10.1038/s41598-023-45346-2 (DOI)001094273200024 ()37865685 (PubMedID)
Funder
Uppsala UniversityScience for Life Laboratory, SciLifeLabKnut and Alice Wallenberg Foundation, KAW 2020.0182Knut and Alice Wallenberg Foundation, KAW 2020.0241Swedish Heart Lung Foundation, 20210089Swedish Heart Lung Foundation, 20190639Swedish Heart Lung Foundation, 20190637Swedish Research Council, 2014-02569Swedish Research Council, 2014-07606Swedish Society of Medicine, SLS-938101NordForsk, TYH2021310Östergötland County Council
Available from: 2023-10-24 Created: 2023-10-24 Last updated: 2023-12-15Bibliographically approved
Jonsson, U., Linton, S. J., Ybrandt, H., Ringborg, A., Leander, L., Moberg, K., . . . Arnberg, F. K. (2023). Internet-delivered psychological treatment as an add-on to treatment as usual for common mental disorders: A systematic review with meta-analysis of randomized trials. Journal of Affective Disorders, 322, 221-234
Open this publication in new window or tab >>Internet-delivered psychological treatment as an add-on to treatment as usual for common mental disorders: A systematic review with meta-analysis of randomized trials
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2023 (English)In: Journal of Affective Disorders, ISSN 0165-0327, E-ISSN 1573-2517, Vol. 322, p. 221-234Article, review/survey (Refereed) Published
Abstract [en]

BACKGROUND: Psychological treatments for common mental disorders are increasingly being delivered remotely via the internet. Evidence suggests that internet-delivered cognitive behavioural therapy (iCBT) is superior to waitlist. However, the benefits are unclear of using this treatment modality as an add-on to treatment as usual (TAU) in regular healthcare.

METHODS: The literature was systematically searched up to August 2021 for randomized trials of internet-delivered psychological treatments using TAU as the comparator. Eligible participants were diagnosed with depressive, anxiety, obsessive-compulsive, or trauma- and stress-related disorders. Outcomes of interest were symptoms, functioning, quality of life, healthcare utilization, and negative effects. Results were synthesized using random-effects meta-analyses. Quality of evidence was assessed using GRADE.

RESULTS: The included studies evaluated iCBT for adults with depression (k = 9), depressive or anxiety disorders (k = 4), and post-traumatic stress disorder (k = 2) and were conducted in primary care or similar settings. For depression, low-certainty evidence suggested beneficial short-term effects on symptoms (g = -0.23; 95 % CI: = -0.37, -0.09), response rate (OR = 2.46; 1.31, 4.64), and remission (OR = 1.70; 1.19, 2.42;). The certainty of evidence was very low for long-term effects, other outcomes, and other disorders.

LIMITATIONS: TAU varied across studies and was often insufficiently described.

CONCLUSIONS: iCBT as a complement to usual care for adult with depression may result in a small incremental effect, which potentially could be clinically important. Studies are lacking for several common disorders and for children, adolescents, and the elderly. More robust studies of long-term effects are also needed, to better inform clinical decision-making.

Place, publisher, year, edition, pages
Elsevier, 2023
Keywords
Cognitive behavior therapy, OCD, Online therapy, PTSD, Primary care, Web-based treatment
National Category
Psychiatry
Identifiers
urn:nbn:se:uu:diva-490586 (URN)10.1016/j.jad.2022.11.036 (DOI)000914792200030 ()36400149 (PubMedID)
Funder
Government of Sweden
Available from: 2022-12-13 Created: 2022-12-13 Last updated: 2023-03-15Bibliographically approved
Hensler, I., Sveen, J., Cernvall, M. & Arnberg, F. K. (2023). Longitudinal follow-up of the randomized controlled trial of access to the trauma-focused self-management app PTSD Coach. Internet Interventions, 32, 100618, Article ID 100618.
Open this publication in new window or tab >>Longitudinal follow-up of the randomized controlled trial of access to the trauma-focused self-management app PTSD Coach
2023 (English)In: Internet Interventions, ISSN 2214-7829, Vol. 32, p. 100618-, article id 100618Article in journal (Refereed) Published
Abstract [en]

Apps that target posttraumatic stress are rarely evaluated and long-term examination of symptom change is rare. In a waitlist-controlled randomized controlled trial, we found that the Swedish version of the self-management app PTSD Coach confers benefits on posttraumatic stress and depressive symptoms after three months use. Here, we aimed to evaluate between-group effects on functional disability as well as within-group changes on mental health, somatic illness and functional disability after access to the Swedish PTSD Coach app during 9 months. In addition, we described negative effects, helpfulness and satisfaction with the app. Among the 179 trauma-exposed adults (92% women) randomized to instant access or delayed access to PTSD Coach, symptoms of posttraumatic stress, depression, somatic illness and functional disability decreased and were maintained within 3 to 9 months of app access. Posttraumatic stress continued to improve during follow up. PTSD Coach was considered slightly to moderately helpful and satisfactory, and 43% reported any negative effect related to using the app. PTSD Coach is an effective self-management intervention for trauma-related distress. Future research should investigate mechanisms of change, as well as individual characteristics that predict symptom reduction after access to PTSD Coach in order to inform clinical practice.

Place, publisher, year, edition, pages
Elsevier, 2023
Keywords
PTSD, posttraumatic stress disorder, mHealth, self-management app, mobile phone intervention
National Category
Psychiatry
Research subject
Psychiatry; Psychology
Identifiers
urn:nbn:se:uu:diva-497318 (URN)10.1016/j.invent.2023.100618 (DOI)001005267500001 ()
Projects
PTSD Coach Sverige
Funder
The Swedish Crime Victim Compensation and Support Authority, 03448/2017Swedish National Board of Health and Welfare, 10.1-37970/2020
Available from: 2023-02-27 Created: 2023-02-27 Last updated: 2023-07-03Bibliographically approved
Gustavsson, M. E., Juth, N., Von Schreeb, J. & Arnberg, F. K. (2023). Moral Stress among Swedish Health Care Workers During the COVID-19 Pandemic: A Cross-Sectional Study. Scandinavian Journal of Work and Organizational Psychology, 8(1), 2-2
Open this publication in new window or tab >>Moral Stress among Swedish Health Care Workers During the COVID-19 Pandemic: A Cross-Sectional Study
2023 (English)In: Scandinavian Journal of Work and Organizational Psychology, E-ISSN 2002-2867, Vol. 8, no 1, p. 2-2Article in journal (Refereed) Published
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:uu:diva-506389 (URN)10.16993/sjwop.170 (DOI)
Available from: 2023-06-27 Created: 2023-06-27 Last updated: 2023-06-27
Englund, L., Bergh Johannesson, K. & Arnberg, F. K. (2023). Reporting under extreme conditions: journalists' experience of disaster coverage. Frontiers in Communication, 8, Article ID 1060169.
Open this publication in new window or tab >>Reporting under extreme conditions: journalists' experience of disaster coverage
2023 (English)In: Frontiers in Communication, E-ISSN 2297-900X, Vol. 8, article id 1060169Article in journal (Refereed) Published
Abstract [en]

IntroductionMedia presence on site and reports on disasters are crucial parts of disaster communication. Aside from authorities, civil society, concerned businesses and citizens, the media constitute an important actor. The working conditions, situational competence and management among journalists on duty in a disaster area are important factors within the complex area of crisis management and disaster communication. This study aims to explore the working conditions, challenges, and coping strategies among journalists covering the Haiti earthquake in 2010. MethodsTen months after the event, Scandinavian journalists (n = 32) provided free-text responses about their work on site through a web survey. The free- text responses underwent content analysis. In addition, self-report questionnaires were used to assess general mental health and posttraumatic stress. ResultsWe found that journalists faced five main challenges in Haiti: situational (technicalities, practical, collegial), professional (mission, approach, roles), personal (traits, emotions, coping), traumatic (general mental health and posttraumatic stress) and experiential (learning and growth). They described a difficult and challenging mission, but also an eye-opening and life-changing experience. Most respondents' questionnaire responses indicated low risk for both poor mental health and posttraumatic stress, with a few significant exceptions. Being properly equipped and mentally prepared, getting collegial support and maintaining professional focus were seen as important, and good leadership and clear instructions from editors at home were highlighted. DiscussionCorroboration of the present findings would strengthen our knowledge of their experiences, and may provide valuable insights for designing preparedness activities in the future as well as for applying to other communication functions in disasters.

Place, publisher, year, edition, pages
Frontiers Media S.A., 2023
National Category
Media and Communications Communication Studies
Research subject
Psychology; Media and Communication Studies
Identifiers
urn:nbn:se:uu:diva-506419 (URN)10.3389/fcomm.2023.1060169 (DOI)001022947200001 ()
Available from: 2023-06-27 Created: 2023-06-27 Last updated: 2023-07-20Bibliographically approved
Eklund, R., Bondjers, K., Hensler, I., Bragesjö, M., Bergh Johannesson, K., Arnberg, F. & Sveen, J. (2022). Daily uplifts during the COVID-19 pandemic: what is considered helpful in everyday life?. BMC Public Health, 22(1), Article ID 85.
Open this publication in new window or tab >>Daily uplifts during the COVID-19 pandemic: what is considered helpful in everyday life?
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2022 (English)In: BMC Public Health, E-ISSN 1471-2458, Vol. 22, no 1, article id 85Article in journal (Refereed) Published
Abstract [en]

Background

Knowledge of what is uplifting and helpful during pandemics could inform the design of sustainable pandemic recommendations in the future. We have explored individuals’ views on helpful and uplifting aspects of everyday life during the coronavirus disease 2019 (COVID-19) pandemic.

Methods

Participants answered a brief, daily survey via text messages during 14 consecutive days in July–August, 2020. The survey included the question: “During the past 24 hours, is there anything that has made you feel good or helped you in your life?” We used content analysis to compile responses from 693 participants, who provided 4,490 free-text answers, which resulted in 24 categories subsumed under 7 themes.

Results

Positive aspects during the COVID-19 pandemic primarily related to social interactions, in real life or digitally, with family, friends and others. Other important aspects concerning work, colleagues and maintaining everyday life routines. One theme concerning vacations, going on excursions and being in nature. Leisure and recreation activities, such as hobbies and physical exercise, also emerged as important, as did health-related factors. Bodily sensations, thoughts, feelings and activities that benefited well-being were mentioned frequently. Lastly, people commented on the government strategies for containing COVID-19, and whether to comply with restrictions.

Conclusions

To summarize, daily uplifts and helpful aspects of everyday life centered around social relationships. To comply with recommendations on physical distancing, people found creative ways to maintain social connections both digitally and face-to-face. Social interaction, maintenance of everyday life routines, hobbies and physical activity appeared to be important for well-being.

Place, publisher, year, edition, pages
Springer NatureSpringer Nature, 2022
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:uu:diva-465049 (URN)10.1186/s12889-022-12506-4 (DOI)000742366700003 ()35027034 (PubMedID)
Available from: 2022-01-17 Created: 2022-01-17 Last updated: 2024-01-15Bibliographically approved
Gustavsson, M. E., Juth, N., Arnberg, F. & von Schreeb, J. (2022). Dealing with difficult choices: a qualitative study of experiences and consequences of moral challenges among disaster healthcare responders. Conflict and Health, 16(1), Article ID 24.
Open this publication in new window or tab >>Dealing with difficult choices: a qualitative study of experiences and consequences of moral challenges among disaster healthcare responders
2022 (English)In: Conflict and Health, E-ISSN 1752-1505, Vol. 16, no 1, article id 24Article in journal (Refereed) Published
Abstract [en]

Background: Disasters are chaotic events with healthcare needs that overwhelm available capacities. Disaster healthcare responders must make difficult and swift choices, e.g., regarding who and what to prioritize. Responders dealing with such challenging choices are exposed to moral stress that might develop into moral distress and affect their wellbeing. We aimed to explore how deployed international disaster healthcare responders perceive, manage and are affected by moral challenges.

Methods: Focus groups discussions were conducted with 12 participants which were Swedish nurses and physicians with international disaster healthcare experience from three agencies. The transcribed discussions were analyzed using content analysis.

Results: We identified five interlinked themes on what influenced perceptions of moral challenges; and how these challenges were managed and affected responders’ wellbeing during and after the response. The themes were: “type of difficult situation”, “managing difficult situations”, “tools and support”, “engagement as a protective factor”, and “work environment stressors as a risk factor. Moral challenges were described as inevitable and predominant when working in disaster settings. The responders felt that their wellbeing was negatively affected depending on the type and length of their stay and further; severity, repetitiveness of encounters, and duration of the morally challenging situations. Responders had to be creative and constructive in resolving and finding their own support in such situations, as formal support was often either lacking or not considered appropriate.

Conclusion: The participating disaster healthcare responders were self-taught to cope with both moral challenges and moral distress. We found that the difficult experiences also had perceived positive effects such as personal and professional growth and a changed worldview, although at a personal cost. Support considered useful was foremost collegial support, while psychosocial support after deployment was considered useful provided that this person had knowledge of the working conditions and/or similar experiences. Our findings may be used to inform organizations’ support structures for responders before, during and after deployment.

Place, publisher, year, edition, pages
Springer Nature, 2022
National Category
Nursing Psychology
Identifiers
urn:nbn:se:uu:diva-474268 (URN)10.1186/s13031-022-00456-y (DOI)000792087900001 ()35527276 (PubMedID)
Funder
Swedish National Board of Health and Welfare
Available from: 2022-05-11 Created: 2022-05-11 Last updated: 2024-03-14Bibliographically approved
Javakhishvili, J. D., Arnberg, F., Greenberg, N., Kazlauskas, E., Lotzin, A. & Xavier, M. (2022). Dealing with the COVID-19 pandemic in Europe: five lessons from the European Society for Traumatic Stress Studies. European Journal of Psychotraumatology, 13(1), Article ID 2046330.
Open this publication in new window or tab >>Dealing with the COVID-19 pandemic in Europe: five lessons from the European Society for Traumatic Stress Studies
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2022 (English)In: European Journal of Psychotraumatology, ISSN 2000-8198, E-ISSN 2000-8066, Vol. 13, no 1, article id 2046330Article in journal (Refereed) Published
Abstract [en]

The paper provides insights into the mental health consequences of the coronavirus disease 2019 (COVID-19) pandemic from the Central, Eastern, Nordic, Southern, and Western subregions of Europe, represented by five member countries of the European Society for Traumatic Stress Studies (ESTSS). On the basis of the existing national research and experiences in these countries, we propose five lessons learned. (1) There is no evidence of a mental health pandemic so far in the countries in focus. No increase in severe mental disorders but some increase in the symptoms of common mental health disorders are observable. More high-quality longitudinal studies are needed to understand the mental health burden of the pandemic. (2) The pandemic affects countries (including the mental health situation) differently, depending on the level of the exposure, management policies, pre-pandemic structural characteristics, and healthcare resources. (3) The pandemic affects people differently: the exposure severity to pandemic-related stressors differs between individuals, as well as individual resources to cope with these stressors. There are winners and losers as well as identifiable at-risk groups that need particular attention. (4) Besides the negative consequences, the pandemic has had a positive impact. The rapidly applied innovations within the system of healthcare responses provide a window of opportunity for positive changes in mental healthcare policies, strategies, and practices. The increased focus on mental health during the pandemic may contribute to the prioritization of mental health issues at policy-making and organizational levels and may reduce stigma. (5) A stress- and trauma-informed response to COVID-19 is required. The European community of psychotraumatologists under the leadership of ESTSS plays an important role in promoting stress- and trauma-informed healthcare and policies of pandemic management. Based on the lessons learned, we propose a stepped-care public mental health model for the prevention of adverse mental health outcomes during pandemics.

HIGHLIGHTS: Population mental health is affected differently in the COVID-19 pandemic: there are winners and losers, as well as identifiable at-risk groups that need particular attention.A stress- and trauma-informed public mental health stepped-care model can address pandemic-related mental health burden in a systematic way.

Place, publisher, year, edition, pages
Informa UK Limited, 2022
Keywords
COVID-19, ESTSS, Europe, pandemic, public mental health, stress-informed, trauma-informed
National Category
Psychiatry
Identifiers
urn:nbn:se:uu:diva-474549 (URN)10.1080/20008198.2022.2046330 (DOI)000790016700001 ()35558684 (PubMedID)
Available from: 2022-05-17 Created: 2022-05-17 Last updated: 2022-05-25Bibliographically approved
Organisations
Identifiers
ORCID iD: ORCID iD iconorcid.org/0000-0002-1317-2093

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