Tone Rustøen

• Løvås, Ina; Landmark, Tormod; Rustøen, Tone; Vedul-Kjelsås, Einar; Butler, Stephen H. & Glette, Mari [Show all 7 contributors for this article] (2026). Distribution of chronic primary and secondary pain in a patient sample with psychiatric disorders. Scandinavian Journal of Pain. ISSN 1877-8860. 26(1). doi: 10.1515/sjpain-2026-0025.
• Hofsø, Kristin; Rustøen, Tone; Bjordal, Kristin; Hagen, Milada; Aouizerat, B. & Astrup, Guro Lindviksmoen (2026). Association between symptom experience and long-term survival in people treated for cancer. ESMO Open. 11(10), p. 1–7. doi: 10.1016/j.esmoop.2026.108579. Full text in Research Archive
• Högvall, Lisa; Herling, Suzanne Forsyth; Egerod, Ingrid; Rustøen, Tone & Berntzen, Helene (2026). Creating a shared narrative: A qualitative study on the impact of nurse-written ICU diaries for TBI-survivors and their family caregivers. Neuropsychological Rehabilitation. ISSN 0960-2011. doi: 10.1080/09602011.2026.2684576. Full text in Research Archive
• Myrenget, Martin Elstad; Sandvik, Reidun Karin Norheim Myhre; Borchgrevink, Petter Christian; Selbæk, Geir; Småstuen, Milada & Rangul, Vegar [Show all 10 contributors for this article] (2026). The effect of a music-based care intervention on neuropsychiatric symptoms: secondary analysis of a cluster-randomised controlled study in nursing home residents with dementia and pain. BMC Geriatrics. 26, p. 1–11. doi: 10.1186/s12877-026-07301-4. Full text in Research Archive Show summary

  Background: Neuropsychiatric symptoms (NPS) are highly prevalent in nursing home residents. The main aims of this study were to examine whether music-based care (MBC) had sustained effects on NPS in nursing home residents with dementia and chronic pain and to describe the distribution of NPS. Methods: A secondary analysis of a cluster-randomised controlled trial with intervention and control groups was performed. The 8-week MBC intervention included daily individualised prerecorded music integration. A large sample of nursing home residents with dementia and chronic pain in 12 nursing homes in Norway were screened for pain and dementia by experts and included in the study. The Neuropsychiatric Inventory Nursing Home Edition (NPI-NH) was completed for the residents at pre-test and after the 8-week MBC intervention. Descriptive statistics were used to characterise the sample, and multilevel mixed model analysis assessed the difference in change in NPI-NH scores before and after the intervention between the groups. Results: The sample (n = 232) had a mean age of 86 years (SD 8.8), with 71% being female. Overall, 41%, 38% and 21% had severe, moderate or mild dementia, respectively, while 77% had moderate pain and 23% severe pain. Over two-thirds (68%) of the sample had at least one clinically important (≥ 4) NPI-NH symptom at pre-test, with mean NPI-NH total score of 19 (range 0–89). The most commonly identified NPI-NH subcategories were agitation (44%), affective symptoms (34%) and psychosis (25%) at pre-test. There was no significant difference in changes either comparing the NPI-NH total score (p = 0.396) (confidence interval: CI [–2.6 to 6.6]) between the intervention group (n = 108) and the control group (n = 124) or comparing any of the three NPI subcategories: psychosis (p = 0.203) (CI [–0.5 to 2.3]), agitation (p = 0.830) (CI [–2.3 to 1.8]) or affective symptoms (p = 0.447) (CI [–0.9 to 2.1]). Conclusions: No statistically significant sustained effect of the MBC intervention on NPI symptoms was found among residents with dementia and chronic pain. Future studies should include measurement points closer to the intervention to evaluate short-term effects of MBC.

• Mesina, Renato Jr Santiago; Rustøen, Tone; Hagen, Milada; Laake, Jon Henrik & Hofsø, Kristin (2025). The association between self-reported symptoms, rehabilitation and long-term functional disability in ICU survivors. Intensive and Critical Care Nursing. ISSN 0964-3397. 92. doi: 10.1016/j.iccn.2025.104184. Full text in Research Archive
• Nikolaisen, Mette Kure; Hofsø, Kristin; Rustøen, Tone; Ræder, Johan; Hagen, Milada & Olsen, Brita Fosser (2025). Symptoms on the first day after discharge from the intensive care unit:A cross-sectional study. Heart & Lung. ISSN 0147-9563. 75, p. 26–33. doi: 10.1016/j.hrtlng.2025.09.004. Full text in Research Archive
• Helme, Aina Evensen; Bjørnaas, Mari Asphjell; Grimholt, Tine Kristin; Hofsø, Kristin; Rustøen, Tone & Hagen, Julia (2025). Half alive but still longing for death: Exploring the experiences of patients waking up in the intensive care unit after a suicide attempt—a qualitative study. Australian Critical Care. ISSN 1036-7314. 39(1), p. 101484–101484. doi: 10.1016/j.aucc.2025.101484. Full text in Research Archive Show summary

  Background Patients admitted to intensive care units (ICUs) after suicide attempts are in a vulnerable state and experience emotional distress simultaneously battling the suicidal crisis. Despite a notable rise in ICU admissions for serious suicide attempts, little research has explored the specific experiences of these patients. Existing literature highlights the influence of communication with healthcare personnel, indicating that empathetic and individualised care can foster hope and improve self-worth. This study seeks to fill the knowledge gap concerning the experiences of ICU patients post a suicide attempt. Objective This objective of study was to explore how patients describe their feelings and experiences upon waking up in the ICU after a suicide attempt and what aspects of care the patients find most valuable during their ICU stay. Methods This research employs a qualitative design, incorporating semistructured interviews with patients from medical and surgical ICUs in Norway. Data were analysed using reflexive thematic analysis. Findings Patients described a surreal experience and complex emotions, including perceived failure and a lack of self-worth. Furthermore, the ICU environment seemed to exacerbate patients’ negative feelings. The study identified two main themes: “Half alive”— trying to connect to reality while struggling with complex emotions, and “A bridge to humanity through compassionate care and small gestures”, emphasising the significance of empathetic interactions with healthcare professionals. Importantly, participants valued direct, informal conversations and small, compassionate gestures. Conclusions The findings reveal that care through empathetic communication and a supportive environment is crucial during this critical phase of the treatment. Additionally, patients often have trouble distinguishing reality upon regaining consciousness in the ICU, further emphasising the importance of compassionate and well-informed care. Our findings highlight the need for specialised training and sensitivity among ICU personnel to adequately address both the physical and emotional needs of patients recovering from suicide attempts.

• Dokken, Mette; Rustøen, Tone; Thomsen, Thordis; Bentsen, Gunnar & Egerod, Ingrid (2025). Nurses' and physicians’ experience of a new algorithm for tapering analgosedation in the paediatric intensive care unit: A focus-group investigation. Australian Critical Care. ISSN 1036-7314. 38(2). doi: 10.1016/j.aucc.2024.101141. Full text in Research Archive Show summary

  Aim/objective Iatrogenic withdrawal syndrome occurs frequently during the tapering phase of opioids and benzodiazepines in paediatric intensive care units. The aim of this study was to explore physicians' and nurses' experiences in patient care and staff collaboration during the tapering phase using a new “algorithm for tapering analgosedation” Methods We used a qualitative explorative design with focus groups. The framework method was followed including transcription, familiarisation, coding, developing a framework, applying the framework, charting data into the framework matrix, and interpreting the data. The study was conducted at two paediatric intensive care units at Oslo University Hospital in Norway. Nurses and physicians who had used the new algorithm participated in the study. Findings Three focus-group interviews were conducted with a total of 15 informants. Three main themes were identified with relevant subthemes: “Caring for a child in withdrawal”, “Advantages of the algorithm”, and “Challenges of the algorithm”. The algorithm positively affected patient care and staff collaboration during tapering. The use of the Withdrawal Assessment Tool-1 integrated in the algorithm required experienced nurses due to the risk of false-positive patient assessments. Conclusion Nurses and physicians in our study experienced that the new algorithm promoted staff collaboration and positively affected patient care. The use of the Withdrawal Assessment Tool-1 integrated in the algorithm required experienced staff and resources for continuous staff education.

• Hansen, Christin Saltnes; Rustøen, Tone; Beitland, Sigrid; Puntillo, Kathleen; Hagen, Milada & Hofsø, Kristin (2025). Self-reported symptoms in ICU patients and their impact on long-term outcomes-a prospective multicenter study. Intensive Care Medicine. ISSN 0342-4642. 51, p. 1260–1270. doi: 10.1007/s00134-025-07995-x. Full text in Research Archive Show summary

  Purpose The aim was to identify possible associations between patient symptom subgroups, identified while in the ICU, adjusted for clinical and demographic variables and PICS outcomes, three months after ICU admission. Methods A prospective multi-center cohort study. Based on reported symptom prevalence in the ICU, patients were categorized into a Low, Middle or High symptom subgroup. PICS outcomes were measured using validated questionnaires (i.e., Katz Index; Cognitive Failure questionnaire, The Hospital Anxiety and Depression Scale, Impact of Event Scale) three months after ICU admission. Possible associations between ICU symptom subgroups and dichotomized PICS outcomes were modeled using conditional backward logistic regression. Results We included 175 patients with a median age of 62 years (interquartile range 49–70) and 65.1% were males. Three months after ICU admission, 23.5% had physical disability, 12.1% cognitive failure, 18.3% anxiety, 16.6% depression, and 16.7% post-traumatic stress. In multivariate analyses, patients in the High symptom subgroup compared to Low/Middle symptom subgroups had higher odds for worse outcomes in all PICS domains. The odds ratios (95%CI) were 3.31 (1.25–8.78) for physical disability, 3.56 (1.20–10.60) for cognitive failure, 3.70 (1.41–9.67) for anxiety, 4.74 (1.79–12.58) for depression and 4.38 (1.49–12.84) for post-traumatic stress, respectively. Conclusion A subgroup of patients with high symptom burden during ICU stay had worse physical, cognitive and mental health outcomes three months after ICU admission compared to patients with medium/low symptom burden. Future studies are needed to evaluate if early interventions in the ICU can reduce long-time burden in the PICS domains in ICU survivors.

• Austenå, Mona; Rustøen, Tone; Hagen, Milada; Valsø, Åse; Sunde, Kjetil & Tøien, Kirsti (2025). Hope among patients discharged from an intensive care unit: A prospective cohort study. Nursing in Critical Care. ISSN 1362-1017. 30(4). doi: 10.1111/nicc.13235. Full text in Research Archive Show summary

  Aim To describe the levels of hope in patients during the first year after ICU treatment, and to explore possible associations between hope and selected demographic, clinical and psychosocial factors. Study Design This is a prospective cohort study and a predefined sub-study of a randomized controlled trial. Adults discharged from five mixed ICUs were included. All patients were screened for post-traumatic stress symptoms at baseline, and data on hope, post-traumatic stress and social support were collected 3, 6 and 12 months later. Linear regression analyses and linear mixed models for repeated measurements with hope as the dependent variable were used. Results Median age was 57 years (range 18–94), 47% were women, median length of ICU stay was 3 days (range 1–83), Simplified Acute Physiology Score II was 24 (range 0–78) and 54% received mechanical ventilation. Not having prior mental health problems (B = 1.93, 95% CI [0.90, 2.98]), lower level of post-traumatic stress symptoms (B = −0.08, 95% CI [−0.11, −0.04]) and more social support (B = 0.37, 95% CI [0.31, 0.43]) were all independently associated with higher levels of hope during the first year after critical illness. The levels of hope were higher in the study cohort than in the general Norwegian population and remained unchanged during follow-up. Conclusions Patients maintained a stable level of hope throughout follow-up. Absence of prior mental health problems, lower post-traumatic stress symptoms and more social support after ICU discharge were associated with higher hope. Relevance to Clinical Practice Patients' hope should be strengthened during the ICU stay through psychosocial support and care for patients with previous post-traumatic stress symptoms and mental health problems.

• Brandvold, Malin; Rustøen, Tone; Småstuen, Milada Cvancarova; Stubberud, Jan Egil; Boogaard, Mark van den & Hofsø, Kristin (2024). Inter-rater agreement between patient- and proxy-reported cognitive functioning in intensive care unit patients: A cohort study. Australian Critical Care. ISSN 1036-7314. 37(5), p. 701–709. doi: 10.1016/j.aucc.2024.03.003. Full text in Research Archive
• Hansen, Christin Saltnes; Rustøen, Tone; Beitland, Sigrid; Puntillo, Kathleen; Thoresen, Magne & Hofsø, Kristin (2024). Subgroups of ICU patients identified by self-reported symptoms - A prospective multicenter study. Intensive and Critical Care Nursing. ISSN 0964-3397. 84, p. 1–8. doi: 10.1016/j.iccn.2024.103761. Full text in Research Archive Show summary

  Background: Intensive care unit (ICU) patients experience several symptoms, yet patterns of symptoms and their relationship with demographic and clinical characteristics have not previously been investigated. Objectives: To identify and compare subgroups (i.e. latent symptom classes) of intensive ICU patients based on prevalence of co-occurring symptoms over seven days. Research methodology: Prospective cohort study of adult ICU patients’ self-reports of five symptoms during seven days in ICU. Latent class analysis was applied to identify subgroups of ICU patients. Setting: Multicenter study with patients from six mixed ICUs in Norway. Main Outcome Measures: Patient Symptom Survey was used to assess five symptoms (i.e., thirst, pain, anxiousness, tiredness, shortness of breath). Results: Among 353 included patients, median age was 63 years and 60.3 % were male. Subgroups of patients were identified in a Low class (n = 126, 35.7 %), Middle Class (n = 177, 50.1 %) and High Class (n = 50, 14.2 %) based on reporting of the prevalence of five symptoms. Patients in the Low class had a low prevalence of all symptoms. Middle Class patients had a high prevalence of thirst and tiredness and a low prevalence of pain, anxiousness and shortness of breath. The High class patients had a high prevalence of all symptoms. Symptom prevalence remained stable in the Low and Middle class over time and increased over time in the High class. There were significant differences among symptom classes in use of mechanical ventilation (p = 0.012), analgesics (p < 0.001), alpha-2 agonists (p = 0.004) and fluid restriction (p = 0.006). Patients in the High class received more of these ICU-treatments. Conclusions: Findings suggest that subgroups of ICU patients with distinct symptom experiences can be identified. The High prevalence class patients had consistently high levels of all symptoms across seven ICU days and received more ICU-related interventions. Implication for clinical practice: Some ICU patients experience a consistently high prevalence of co-occurring symptoms. Clinicians should be aware of treatment factors that could be linked to a high burden of symptoms.

• Nyhagen, Ragnhild; Egerod, Ingrid; Rustøen, Tone; Lerdal, Anners & Kirkevold, Marit (2024). Family Members' Engagement in Symptom Communication, Assessment, and Management in the Intensive Care Unit: A Qualitative Study. Dimensions of Critical Care Nursing. ISSN 0730-4625. 43(3), p. 111–122. doi: 10.1097/DCC.0000000000000637. Full text in Research Archive
• Högvall, Lisa; Herling, Suzanne Forsyth; Egerod, Ingrid; Petosic, Antonija; Danielsen, Mette Elisabeth Riise & Rüdiger, Uta [Show all 8 contributors for this article] (2024). The patient experience of a nurse-written ICU-diary intervention: A cross sectional survey. Intensive and Critical Care Nursing. ISSN 0964-3397. 86. doi: 10.1016/j.iccn.2024.103846. Full text in Research Archive
• Flim, Marleen; Rustøen, Tone; Blackwood, Bronagh & Spronk, Peter E. (2024). Thirst in adult patients in the intensive care unit: A scoping review. Intensive and Critical Care Nursing. ISSN 0964-3397. 86. doi: 10.1016/j.iccn.2024.103787. Full text in Research Archive
• Friberg, Klara Sofia; Hofsø, Kristin; Rustøen, Tone; Ræder, Johan; Hagen, Milada & Puntillo, Kathleen [Show all 7 contributors for this article] (2024). The association between posttraumatic stress symptoms and hope following intensive care unit discharge: Findings from a longitudinal cohort study. Heart & Lung. ISSN 0147-9563. 70, p. 223–229. doi: 10.1016/j.hrtlng.2024.12.003. Full text in Research Archive Show summary

  Background: Hope is essential for mental health in general and for recovery following severe illness. However, the associations between post-traumatic stress symptoms (PTSS) and hope among intensive care unit (ICU) survivors has not been investigated. Objectives: To assess hope at 3, 6 and 12 months after ICU admission and examine possible associations between hope and selected demographic data, clinical characteristics, and 3-month PTSS-levels among ICU patients. Methods: ICU-patients from Norway self-reported on hope using Herth Hope Index. Data on demographics and clinical characteristics were collected from patient reports and medical records. PTSS were analysed 3 months after admission, using descriptive statistics and linear mixed model regression analyses. Results: A total of 73 adult ICU survivors were included (male n =45 (61.6%); median age 66 years [IQR:51.0;74.0]). Median hope scores were 41, 40, and 42 at 3, 6 and 12 months, respectively. A clinically minor but statistically significant reduction in hope was registered at 6 months (B=-1.24; 95% confidence interval [CI]: -2.25, -0.23; p=0.016). Lower levels of PTSS 3 months after admission (B=-0.13; 95% CI [-0.23, -0.03]; p=0.015) and being employed before admission (B=5.87; 95% CI [1.85, 9.88]; p=0.004) were significantly associated with higher hope during the first year after admission. A small but statistically significant association was also found between higher hope and a more extended hospital stay (B=0.08; 95% CI [0.00, 0.15]; p= 0.042). Conclusions: Hope scores remained stable during the first year after ICU admission. Lower levels of PTSS at 3 months after admission, being employed prior to admission, and having longer hospital stay were associated with higher hope during the first year after admission. Given the small sample, more research in larger samples is needed to enhance the clinical relevance of these findings.

• Mesina, Renato Jr Santiago; Rustøen, Tone; Småstuen, Milada Cvancarova; Laake, Jon Henrik & Hofsø, Kristin (2024). Long-term functional disabilities in intensive care unit survivors: A prospective cohort study. Australian Critical Care. ISSN 1036-7314. 37(6), p. 843–850. doi: 10.1016/j.aucc.2023.11.008. Full text in Research Archive
• Myrenget, Martin Elstad; Rustøen, Tone; Myskja, Audun X.; Småstuen, Milada Cvancarova; Rangul, Vegar & Håpnes, Odd Sigfast [Show all 11 contributors for this article] (2024). The effect of a music-based caregiving intervention on pain intensity in nursing home patients with dementia: a cluster-randomized controlled study. Pain. ISSN 0304-3959. 165(7), p. 1550–1558. doi: 10.1097/j.pain.0000000000003156. Full text in Research Archive Show summary

  Treatment of chronic pain in patients with dementia is challenging because they have reduced ability to report pain and are particularly vulnerable to side effects of analgesics. Different types of music-based therapy have been recommended and are used as an alternative to analgesics, but the evidence is lacking. Therefore, we performed a cluster-randomized controlled study (RCT) to reduce pain intensity using music-based caregiving (MBC) over 8 weeks in nursing home patients with dementia and chronic pain. We also investigated if the amount of MBC and different chronic pain syndromes would impact on the effect. Of the 645 patients, 498 patients from 36 wards in 12 nursing homes were screened for dementia and pain. Using the Clinical Dementia Rating Scale and the Mobilization-Observation-Behavior-Intensity-Dementia Pain Scale (range 0-10), 279 (71% females, 42% severe dementia) nursing home patients were randomized to intervention group (n = 134, 18 wards) or control group (n = 145, 18 wards). The main outcome was change in pain intensity before and after the intervention. The study did not reveal any effect of MBC on pain intensity when compared with the control group (B = -0.15, 95% CI [-0.72 to 0.43]). No significant difference was found within the intervention group analyzing the impact of intervention time (B = 0.73, 95% CI [-0.55 to 2.02]) or chronic primary vs secondary pain syndromes (B = 0.45, 95% CI [-0.05 to 0.96]). Our data from this first RCT on music and pain intensity in patients with dementia and chronic pain did not find an effect of MBC on pain.

• Friberg, Klara; Hofsø, Kristin; Rustøen, Tone; Ræder, Johan; Småstuen, Milada Cvancarova & Puntillo, Kathleen [Show all 7 contributors for this article] (2024). Patient characteristics associated with posttraumatic stress symptoms in intensive care unit survivors during a one-year follow-up: A multicenter study. Heart & Lung. ISSN 0147-9563. 66, p. 1–8. doi: 10.1016/j.hrtlng.2024.02.011. Full text in Research Archive Show summary

  Background: Intensive care unit (ICU) patients are at risk of suffering from posttraumatic stress symptoms (PTSS) after ICU survival. Objectives: To describe the prevalence of high levels of PTSS the first year after ICU admission. Further, to identify specific combinations of patient characteristics (latent classes based on pre-ICU data, demographics, and clinical characteristics), and to investigate possible associations among these classes and PTSS at 3, 6, and 12 months after ICU admission. Methods: Self-reported PTSS were measured with Impact of Event Scale-Revised (IES-R). PTSS and possible predictive factors (pre-ICU data, demographics, and clinical characteristics) were analyzed using descriptive statistics, latent class analysis, and linear mixed model for repeated measures. Results: High PTSS levels (IES-R ≥ 33) were reported by 14.9 % (95 % confidence interval [CI] [10.0; 21.1]), 16.7 % (95 % CI [11.5; 23.1]), and 18.4 % (95 % CI [12.9; 25.0]) of patients (sample 1, n = 174) at 3, 6, and 12 months, respectively. Three latent classes were identified (sample 2, n = 417). PTSS were significantly associated with class 2 (male with longer hospital stay) at 6 months and class 3 (age≥70, lower level of education, higher Simplified Acute Physiology Score, being mechanically ventilated) at all three measurement times. Conclusions: The prevalence of high levels of PTSS is the greatest 12 months after ICU admission. Health pro- fessionals can use this information to be aware of specific groups of ICU patients reporting PTSS during the first year and follow up on these.

• Bentsen, Signe Berit; Eide, Geir Egil; Wiig, Siri; Rustøen, Tone; Heen, Cathrine & Bjøro, Benedikte (2024). Patient positioning on the operating table and patient safety: A systematic review and meta-analysis. Journal of Advanced Nursing. ISSN 0309-2402. doi: 10.1111/jan.16049. Full text in Research Archive Show summary

  Aim: To identify occurrence of harmful incidents related to patient positioning on operating table. Design: Systematic review and meta-analysis. Data Sources: Eight databases including Ovid, Medline, Embase, CINAHL, the Cochrane Library, Epistemonikos, Scopus, Web of Science and Google Scholar were systematically searched from the inception of the databases to August 2023. Preferred Reporting Items for Systematic Reviews and Meta-Analyses flow diagram depicting the flow information. Review Methods: The Cochrane Risk of Bias Tools were used to assess the risk of bias. Risk of harm with 95% confidence interval (CI) was estimated for each included study, and an overall risk was calculated using meta-analysis. Results: Of the 22 included reports, two were randomized controlled trials (RCTs), five had a prospective cohort design, three had a cross-sectional design, and 12 were register-based studies. Intraoperative peripheral nerve injuries, perioperative pressure ulcers, musculoskeletal injuries, vascular injuries, postoperative pain and eye injuries were related to supine, lithotomy, Trendelenburg, prone and beach chair positioning. Overall risk of any harm was estimated as 0.2%. Studies with patients placed in prone positioning (8 study samples) had the highest risks of harm varying from 0.19 to 0.81, with an overall risk of 0.33. Meta-analysis of the two RCTs showed higher risk of chemosis with head-down positioning than with head in neutral position (overall relative risk = 1.64; 95% CI: [1.25, 2.14]). Conclusions: Harmful incidents related to patient positioning occur and consequences can be severe. The operating room teams should be aware of the harms and prevent and treat them seriously. Impact: This review underlines that research is sparse on patient positioning on operating table and harmful incidents. There is a need for high-quality, well-designed studies that focus on harmful incidents and prevention of harm related to patient positioning.

• Berntzen, Helene; Rustøen, Tone & Kynø, Nina M (2023). “Hope at a crossroads” – Experiences of hope in intensive care patients: A qualitative study. Australian Critical Care. ISSN 1036-7314. 37(1), p. 120–126. doi: 10.1016/j.aucc.2023.07.037. Full text in Research Archive
• Austenå, Mona; Rustøen, Tone; Småstuen, Milada Cvancarova; Valsø, Åse; Sunde, Kjetil & Tøien, Kirsti (2023). Return to work during first year after intensive care treatment and the impact of demographic, clinical and psychosocial factors. Intensive and Critical Care Nursing. ISSN 0964-3397. 76. doi: 10.1016/j.iccn.2023.103384. Full text in Research Archive Show summary

  Objectives To describe work participation in survivors during first year after intensive care unit discharge and examine the impact of selected demographic, clinical and psychosocial factors on return to work 12 months after discharge. Research methodology/Design A predefined sub-study (prospective cohort study) of a randomised controlled trial. Setting A Norwegian single-centre university hospital. Medical and surgical adult intensive care survivors, working/on sick leave before admission, in the intensive care unit ≥24 h, were included. Main outcome measures Return to work three, six and 12 months after discharge, and impact of age, pre-existing comorbidities, previous serious life events, coping ability, hope and social support on return to work 12 months after discharge. Results Included were 284 patients, with mean age 47 years (SD 13.9) and 47 % women. One year after discharge, 69 % were back at work. In the regression analysis, with working at 12 months (yes/no) as the dependent variable, 178 patients, completing questionnaires at three as well as 12 months, were included. Lower age (OR 0.96, 95 % CI [0.93–0.99]), lower pre-existing comorbidities (OR 0.65, 95 % CI [0.43–0.97]), previous serious life events (OR 6.53, 95 % CI [2.14–19.94]), and greater hope at three months (OR 1.09, 95 % CI [1.01–1.17]) were all independently associated with higher odds of returning to work. Conclusion Following intensive care, age, pre-existing comorbidities, experience of previous serious life events and hope all have a significant impact on return to work, and are important variables to consider during intensive care treatment and rehabilitation. Implications for clinical practice Attention must be paid to patients with prior working capability to ensure return to work after intensive care treatment. Older adults with pre-existing comorbidities might benefit from early, individualised rehabilitation to regain previous working capacity. In addition, there is also a need to support patients’ hope during and after critical illness.

• Nyhagen, Ragnhild; Egerod, Ingrid; Rustøen, Tone; Lerdal, Anners & Kirkevold, Marit (2023). Three patterns of symptom communication between patients and clinicians in the intensive care unit: A fieldwork study. Journal of Advanced Nursing. ISSN 0309-2402. doi: 10.1111/jan.16007. Full text in Research Archive Show summary

  Aim: To describe different patterns of communication aimed at preventing, identify- ing and managing symptoms between mechanically ventilated patients and clinicians in the intensive care unit. Design: We conducted a fieldwork study with triangulation of participant observation and individual interviews. Methods: Participant observation of nine patients and 50 clinicians: nurses, physiother- apists and physicians. Subsequent individual face-to-face interviews with nine of the cli- nicians, and six of the patients after they had regained their ability to speak and breathe spontaneously, were fully alert and felt well enough to sit through the interview. Findings: Symptom communication was found to be an integral part of patient care. We identified three communication patterns: (1) proactive symptom communication, (2) reactive symptom communication and (3) lack of symptom communication. The three patterns co-existed in the cases and the first two complemented each other. The third pattern represents inadequate management of symptom distress. Conclusion: Recognition of symptoms in non-speaking intensive care patients is an important skill for clinicians. Our study uncovered three patterns of symptom commu- nication, two of which promoted symptom management. The third pattern suggested that clinicians did not always acknowledge the symptom distress. Implications for Patient Care: Proactive and reactive symptom assessment of non- speaking patients require patient verification when possible. Improved symptom prevention, identification and management require a combination of sound clinical judgement and attentiveness towards symptoms, implementation and use of relevant assessment tools, and implementation and skill building in augmentative and alterna - tive communication. Impact: This study addressed the challenges of symptom communication between mechanically ventilated patients and clinicians in the intensive care unit. Our findings may have an impact on patients and clinicians concerned with symptom management in intensive care units. Reporting Method: We used the consolidated criteria for reporting qualitative research.

• Hansen, Christin Saltnes; Rustøen, Tone; Beitland, Sigrid; Puntillo, Kathleen; Småstuen, Milada Cvancarova & Lerdal, Anners [Show all 7 contributors for this article] (2023). Self-reported symptoms experienced by intensive care unit patients: a prospective observational multicenter study. Intensive Care Medicine. ISSN 0342-4642. 49(11), p. 1370–1382. doi: 10.1007/s00134-023-07219-0. Full text in Research Archive Show summary

  Purpose: The purpose of this study is to describe the prevalence, intensity and distress of five symptoms in intensive care unit (ICU) patients and to investigate possible predictive factors associated with symptom intensity. Methods: This is a prospective cohort study of ICU patients. A symptom questionnaire (i.e., Patient Symptom Survey) was used to describe the prevalence, intensity and distress of pain, thirst, anxiousness, tiredness, and shortness of breath over seven ICU days. Associations between symptom intensity and possible predictive factors were assessed using the general estimating equation (GEE) model. Results: Out of 603 eligible patients, 353 (Sample 2) were included in the present study. On the first ICU day, 195 patients (Sample 1) reported thirst as the most prevalent symptom (66%), with the highest mean intensity score (6.13, 95% confidence interval (CI) [5.7–6.56]). Thirst was the most prevalent (64%) and most intense (mean score 6.05, 95%CI [5.81–6.3]) symptom during seven days in the ICU. Anxiousness was the most distressful (mean score 5.24, 95%CI [4.32–6.15]) symptom on the first day and during seven days (mean score 5.46, 95%CI [4.95–5.98]). During seven days, analgesic administration and sepsis diagnosis were associated with increased thirst intensity. Older age and being mechanically ventilated were associated with decreased pain intensity, and analgesic administration was associated with increased pain intensity. Family visits and female gender were associated with increased intensity of anxiousness and shortness of breath, respectively. Conclusions: Self‑reporting ICU patients experienced a high and consistent symptom burden across seven days. Certain variables were associated with the degree of symptom intensity, but further research is required to better understand these associations.

• Friberg, Klara; Hofsø, Kristin; Ræder, Johan; Rustøen, Tone; Småstuen, Milada Cvancarova & Olsen, Brita Fosser (2023). Prevalence of and predictive factors associated with high levels of post-traumatic stress symptoms 3 months after intensive care unit admission: A prospective study. Australian Critical Care. ISSN 1036-7314. doi: 10.1016/j.aucc.2023.06.005. Full text in Research Archive
• Dokken, Mette; Rustøen, Tone; Diep, Lien My; Fagermoen, Frode Even; Huse, Rakel Iren & Egerod, Ingrid [Show all 7 contributors for this article] (2023). Implementation of an algorithm for tapering analgosedation reduces iatrogenic withdrawal syndrome in pediatric intensive care. Acta Anaesthesiologica Scandinavica. ISSN 0001-5172. doi: 10.1111/aas.14288. Full text in Research Archive
• Högvall, Lisa maria; Egerod, Ingrid; Herling, Suzanne Forsyth; Rustøen, Tone & Berntzen, Helene (2023). Finding the right words: A focus group investigation of nurses' experiences of writing diaries for intensive care patients with a poor prognosis. Australian Critical Care. ISSN 1036-7314. doi: 10.1016/j.aucc.2023.02.002. Full text in Research Archive
• Bjørnøy, Ingrid; Rustøen, Tone; Mesina, Renato Jr Santiago & Hofsø, Kristin (2023). Anxiety and depression in intensive care patients six months after admission to an intensive care unit: A cohort study. Intensive and Critical Care Nursing. ISSN 0964-3397. 78. doi: 10.1016/j.iccn.2023.103473. Full text in Research Archive
• Nyhagen, Ragnhild; Egerod, Ingrid; Rustøen, Tone; Lerdal, Anners & Kirkevold, Marit (2022). Unidentified communication challenges in the intensive care unit: A qualitative study using multiple triangulations. Australian Critical Care. ISSN 1036-7314. p. 1–8. doi: 10.1016/j.aucc.2022.01.006. Full text in Research Archive Show summary

  Background Communication in the intensive care unit is challenged by patients’ inability to speak owing to intubation, treatment, and illness. Research has focused on the use of communication tools or techniques, characteristics of the communication between patients and clinicians, and their experiences of communication challenges. However, few studies have combined the perspectives of patients, family members, and clinicians. We explored communication from different angles and investigated challenges that cannot be explained by ineffective use of aids and communication techniques. Objectives The aim of this study was to explore communication between patients, family members, and nurses and to investigate previously unidentified communication challenges. Methods This study used a case-oriented design with multiple triangulations. It was conducted in two general intensive care units at a Norwegian university hospital. Participant observations were conducted on nine mechanically ventilated patients while communicating with family members and healthcare personnel. Following the observations, individual interviews were conducted with six patients, six family members, and nine healthcare personnel. Findings Communication often seemed uncomplicated at the time of observations, but information from the interviews revealed another picture. We demonstrate what participants emphasised differently when they discussed their experiences, revealing a discrepancy in perceived importance in the situation. Family members had an important role in interpreting signs from the patient, uncovering challenges that would have been unknown to the nurses otherwise. Conclusions This study illustrates how communication challenges in the intensive care unit may not be perceptible to an observer or to all of the participants involved at the time of the communication. Nurses need to be aware of these communication challenges and realise that the patient might face issues that cannot be easily solved without extensive involvement of the patient, family, and nurses, and perhaps not even until a later stage in the patient's recovery process.

• Myrenget, Martin Elstad; Borchgrevink, Petter Chr.; Rustøen, Tone; Butler, Stephen; Thorsvik, Dagfinn & Småstuen, Milada Cvancarova [Show all 7 contributors for this article] (2022). Chronic pain conditions and use of analgesics among nursing home patients with dementia. Pain. ISSN 0304-3959. 164(5), p. 1002–1011. doi: 10.1097/j.pain.0000000000002794. Full text in Research Archive
• Bjøro, Benedikte; Ballestad, Ingvild; Rustøen, Tone; Fosmark, Monica Hetlesæther & Bentsen, Signe Berit (2022). Positioning patients for robotic-assisted surgery: A qualitative study of operating room nurses' experiences. Nursing Open. 10(2), p. 469–478. doi: 10.1002/nop2.1312. Full text in Research Archive Show summary

  Aim One of the challenges of robotic-assisted surgery is related to positioning of the patient on the operating table. Technological developments place increased demands on operating room nurses' competence to prevent positioning injuries and ensuring care quality. Therefore, the aim of the present study was to describe operating room nurses' experiences when positioning the patients for robotic-assisted surgery. Design A descriptive qualitative design. Methods Seven operating room nurses with experience in robotic-assisted surgery were included at a university hospital. Data were obtained through individual interviews and analysed using qualitative content analysis. The Consolidated Criteria for Reporting Qualitative research COREQ checklist was used. Results We identified three categories, (a) patient positioning is challenging during robotic-assisted surgery, (b) operating room nurses take responsibility for patient positioning during robotic-assisted surgery, but teamwork is important and (c) operating room nurses aim to achieve safe patient positioning during robotic-assisted surgery.

• Gjevjon, Edith Roth & Rustøen, Tone (2022). Uten debatt - ingen fagutvikling. Tidsskriftet sykepleien. ISSN 0806-7511. Full text in Research Archive
• Christensen, Vivi Lycke; Rustøen, Tone; Thoresen, Magne; Holm, Are Martin & Bentsen, Signe Berit (2022). Stability of distinct symptom experiences in patients with chronic obstructive pulmonary disease (COPD). Respiratory Medicine. ISSN 0954-6111. 201, p. 1–8. doi: 10.1016/j.rmed.2022.106944. Full text in Research Archive Show summary

  Purpose This study aimed to examine reclassification rates among classes of chronic obstructive pulmonary disease (COPD) patients based on their distinct symptom experiences and to assess how these subgroups differed in symptom scores and health-related quality of life (HRQoL) outcomes over one year. Moreover, we wished to assess how these subgroups differed in demographic and clinical characteristics at 12 months. Patients and methods This is a follow-up study of 267 patients with moderate, severe, and very severe COPD. Based on their distinct symptom experiences using the Memorial Symptom Assessment Scale (MSAS), three subgroups (i.e., “high”, “intermediate”, and “low”) were identified at baseline. In the present study, transitions between the subgroups at three, six, nine, and 12 months were investigated and calculated as reclassification rates. Differences among the subgroups in symptom scores and HRQoL at each time point and demographic and clinical characteristics at 12 months were evaluated using analysis of variance with post hoc comparisons. Results Almost 65% were still in the “high” class after 12 months. At 12 months, pairwise comparisons for respiratory function measurements were not significantly different. Compared to the “intermediate” and “low” class, patients in the “high” class were more likely to be women and had significantly more comorbidities, reported a significantly higher number of symptoms at all time points, and worse HRQoL scores. Conclusion Our findings suggest that the pattern of a high symptom burden in COPD is consistent over time. The patients' individual symptom experiences should be the primary focus of treatment.

• Dokken, Mette; Rustøen, Tone; Diep, Lien My; Fagermoen, Frode Even; Huse, Rakel Iren & Rosland, Gudny Abrahamsen [Show all 8 contributors for this article] (2021). Iatrogenic withdrawal syndrome frequently occurs in paediatric intensive care without algorithm for tapering of analgosedation. Acta Anaesthesiologica Scandinavica. ISSN 0001-5172. 65(7), p. 928–935. doi: 10.1111/aas.13818. Full text in Research Archive
• Stjernberg, Mi; Schlichting, Ellen; Rustøen, Tone; Valeberg, Berit Taraldsen; Småstuen, Milada Cvancarova & Ræder, Johan (2021). Postdischarge pain, nausea and patient satisfaction after diagnostic and breast conserving ambulatory surgery for breast cancer: a cross sectional study. Acta Anaesthesiologica Scandinavica. ISSN 0001-5172. 00(3), p. 1–9. doi: 10.1111/aas.14015. Full text in Research Archive Show summary

  Background: The aims of this study were to assess first day postdischarge pain, nausea and patient satisfaction in ambulatory breast cancer surgical patients, after diagnostic and breast conserving procedures. Methods: A total of 781 women, aged 18–85 years were included in this prospective, cross-sectional study. All patients received standardized multimodal pain prophylaxis with paracetamol, COX-II inhibitor, dexamethasone and wound infiltration with local anaesthetics. Nausea prophylaxis was provided with ondansetron. Most patients received general anaesthesia with propofol and remifentanil. Data were collected using a validated questionnaire during telephone follow-up on the first postoperative day. Results: The response rate was 94.5%. NRS ≥ 4 was reported by 5.3% at rest, by 17% during activity and by 30.7% as the worst pain score. Young age was strongly associated with more pain both at rest, during activity and regarding worst pain since discharge. Postdischarge nausea was present in 17.8%, and vomiting in 1.2%. High pain score during activity and higher level of worst pain, were associated with nausea. There was no association between nausea and age, type of anaesthesia, surgical procedure or pain at rest. Patient satisfaction was high (97.8%–99.7%) regarding information, time for discharge and overall satisfaction. Conclusion: Pain scores and incidence of nausea were generally low on the day after surgery. Young age was a strong predictor for postdischarge pain. A high worst pain score and high pain score during the activity were associated with postdischarge nausea. Patient satisfaction was high.

• Laake, Jon Henrik; Buanes, Eirik A.; Småstuen, Milada C.; Kvåle, Reidar; Olsen, Brita Fosser & Rustøen, Tone [Show all 9 contributors for this article] (2021). Characteristics, management and survival of ICU patients with coronavirus disease-19 in Norway, March-June 2020. A prospective observational study. Acta Anaesthesiologica Scandinavica. ISSN 0001-5172. 65(5), p. 618–628. doi: 10.1111/aas.13785. Full text in Research Archive Show summary

  Background: Norwegian hospitals have operated within capacity during the COVID-19 pandemic. We present patient and management characteristics, and outcomes for the entire cohort of adult (>18 years) COVID-19 patients admitted to Norwegian intensive care units (ICU) from 10 March to 19 June 2020. Methods: Data were collected from The Norwegian intensive care and pandemic registry (NIPaR). Demographics, co-morbidities, management characteristics and outcomes are described. ICU length of stay (LOS) was analysed with linear regression, and associations between risk factors and mortality were quantified using Cox regression. Results: In total, 217 patients were included. The male to female ratio was 3:1 and the median age was 63 years. A majority (70%) had one or more co-morbidities, most frequently cardiovascular disease (39%), chronic lung disease (22%), diabetes mellitus (20%), and obesity (17%). Most patients were admitted for acute hypoxaemic respiratory failure (AHRF) (91%) and invasive mechanical ventilation (MV) was used in 86%, prone ventilation in 38% and 25% of patients received a tracheostomy. Vasoactive drugs were used in 79% and renal replacement therapy in 15%. Median ICU LOS and time of MV was 14.0 and 12.0 days. At end of follow-up 45 patients (21%) were dead. Age, co-morbidities and severity of illness at admission were predictive of death. Severity of AHRF and male gender were associated with LOS. Conclusions: In this national cohort of COVID-19 patients, mortality was low and attributable to known risk factors. Importantly, prolonged length-of-stay must be taken into account when planning for resource allocation for any next surge.

• Reine, Elizabeth; Aase, Karina; Ræder, Johan; Thorud, Anne; Aarsnes, Reidunn & Rustøen, Tone (2021). Exploring postoperative handover quality in relation to patient condition: A mixed methods study. Journal of Clinical Nursing (JCN). ISSN 0962-1067. 30(7-8), p. 1046–1059. doi: 10.1111/jocn.15650. Full text in Research Archive Show summary

  Aims and Objectives To describe postoperative handover reporting and tasks in relation to patient condition and situational circumstances, in order to identify facilitators for best practices. Background High-quality handovers in postoperative settings are important for patient safety and continuity of care. There is a need to explore handover quality in relation to patient condition and other affecting factors. Design Observational mixed methods convergent design. Methods Postoperative patient handovers were observed collecting quantitative (n = 109) and qualitative data (n = 48). Quantitative data were collected using the postoperative handover assessment tool (PoHAT), and a scoring system assessing patient condition. Qualitative data were collected using free-text field notes and an observational guide. The study adheres to the GRAMMS guideline for reporting mixed methods research. Results Information omissions in the handovers observed ranged from 1–13 (median 7). Handovers of vitally stable and comfortable patients were associated with more information omissions in the report. A total of 50 handovers (46%) were subjected to interruptions, and checklist compliance was low (13%, n = 14). Thematic analysis of the qualitative data identified three themes: “adaptation of handover,” “strategies for information transfer” and “contextual and individual factors.” Factors facilitating best practices were related to adaptation of the handover to patient condition and situational circumstances, structured verbal reporting, providing patient assessments and dialogue within the handover team. Conclusions The variations in items reported and tasks performed during the handovers observed were related to patient conditions, situational circumstances and low checklist compliance. Adaptation of the handover to patient condition and situation, structured reporting, dialogue within the team and patient assessments contributed to quality. Relevance to clinical practice It is important to acknowledge that handover quality is related to more than transfer of information. The present study has described how factors related to the patient and situation affect handover quality.

• Smeland, Anja Hetland; Twycross, Alison; Lundeberg, Stefan; Småstuen, Milada C. & Rustøen, Tone (2021). Educational Intervention to Strengthen Pediatric Postoperative Pain Management: A Cluster Randomized Trial. Pain Management Nursing. ISSN 1524-9042. doi: 10.1016/j.pmn.2021.09.007. Full text in Research Archive
• Lindberg, Maren Falch; Aamodt, Arild; Badawy, Mona; Bergvad, Ingvild Buset; Borchgrevink, Petter Chr. & Furnes, Ove Nord [Show all 21 contributors for this article] (2021). The effectiveness of exercise therapy and education plus cognitive behavioral therapy, alone or in combination with total knee arthroplasty in patients with knee osteoarthritis – study protocol for the MultiKnee trial. BMC Musculoskeletal Disorders. 22:1054, p. 1–14. doi: 10.1186/s12891-021-04924-z. Full text in Research Archive Show summary

  Background One in five patients report chronic pain following total knee arthroplasty (TKA) and are considered non-improvers. Psychological interventions such as cognitive behavioral therapy (CBT), combined with exercise therapy and education may contribute to reduced pain an improved function both for patients with OA or after TKA surgery, but the evidence for the effectiveness of such interventions is scarce. This randomized controlled trial with three arms will compare the clinical effectiveness of patient education and exercise therapy combined with internet-delivered CBT (iCBT), evaluated either as a non-surgical treatment choice or in combination with TKA, in comparison to usual treatment with TKA in patients with knee OA who are considered candidates for TKA surgery. Methods The study, conducted in three orthopaedic centers in Norway will include 282 patients between ages 18 and 80, eligible for TKA. Patients will be randomized to receive the exercise therapy + iCBT, either alone or in combination with TKA, or to a control group who will undergo conventional TKA and usual care physiotherapy following surgery. The exercise therapy will include 24 one hour sessions over 12 weeks led by a physiotherapist. The iCBT program will be delivered in ten modules. The physiotherapists will receive theoretical and practical training to advise and mentor the patients during the iCBT program. The primary outcome will be change from baseline to 12 months on the pain sub-scale from the Knee Injury and Osteoarthritis Outcome Score (KOOS). Secondary outcomes include the remaining 4 sub-scales from the KOOS (symptoms, function in daily living, function in sports and recreation, and knee-related quality of life), EQ-5D-5L, the Pain Catastrophizing Scale, the 30-s sit-to-stand test, 40-m walking test and ActiGraph activity measures. A cost-utility analysis will be performed using QALYs derived from the EQ-5D-5L and registry data. Discussion This is the first randomized controlled trial to investigate the effectiveness of exercise therapy and iCBT with or without TKA, to optimize outcomes for TKA patients. Findings from this trial will contribute to evidence-based ersonalized treatment recommendations for a large proportion of OA patients who currently lack an effective treatment option. Trial registration Clinicaltrials.gov: NCT03771430. Registered: Dec 11, 2018.

• Valeberg, Berit Taraldsen; Dihle, Alfhild; Småstuen, Milada Cvancarova; Endresen, Anne & Rustøen, Tone (2021). The effects of a psycho-educational intervention to improve pain management after day surgery: A randomized clinical trial. Journal of Clinical Nursing (JCN). ISSN 0962-1067. 30(7-8), p. 1132–1143. doi: 10.1111/jocn.15659. Full text in Research Archive Show summary

  Aims and objectives To evaluate the effectiveness of a psycho-educational intervention for shoulder and breast day surgery patients in decreasing pain intensity and pain interference with function and strengthening adherence with the analgesic regimen; and further to identify factors that influence average pain intensity and pain interference with function. Background Pain is one of the most prevalent symptoms after day surgery. However, pain management is left to the patients and family, and interventions to help patients are needed. Design Randomised clinical trial with an intervention (n = 101) and a usual care group (n = 119) using multiple measurements during 6 months postoperatively. The CONSORT checklist is used. Methods Patients in the intervention group received a booklet about pain and pain management and coaching by research nurses on postoperative days 2, 3 and 7. Differences between groups were identified using the chi-squared analysis and t tests. Changes with time were identified using a linear mixed model with repeated measures. Results After controlling for covariates, group differences at any time in average pain intensity and pain interference with function were not statistically significant. Changes over time within any one group in average pain intensity and pain interference with function were statistically significant and decreased with time. Higher levels of average pain intensity and pain interference over time were associated with shoulder surgery, female, younger, pain expectation, preoperative pain and poorer adherence. Conclusions No group differences related to the intervention were revealed, and preoperative teaching together with a pain management booklet and coaching may help to strengthen the intervention's effects. Further research on interventions directed towards pain management is needed. Relevance to clinical practice Day surgery patients’ postoperative pain and pain management is not satisfactorily handled. To encourage and educate patients to use the prescribed analgesics in the immediate postoperative days may be necessary to enhance pain management.

• Valsø, Åse; Rustøen, Tone; Småstuen, Milada Cvancarova; Puntillo, Kathleen; Skogstad, Laila & Bredal, Inger Schou [Show all 8 contributors for this article] (2021). Occurrence and characteristics of pain after ICU discharge: A longitudinal study. Nursing in Critical Care. ISSN 1362-1017. p. 1–10. doi: 10.1111/nicc.12701. Full text in Research Archive
• Olsen, Brita Fosser; Rustøen, Tone & Valeberg, Berit Taraldsen (2020). Nurse's Evaluation of a Pain Management Algorithm in Intensive Care Units. Pain Management Nursing. ISSN 1524-9042. 21(6), p. 543–548. doi: 10.1016/j.pmn.2020.05.006. Full text in Research Archive Show summary

  Background: Many patients have memories of pain during intensive care unit stay. To improve pain management, practice guidelines recommend that pain management should be guided by routine pain assessment and suggest an assessment-driven, protocol-based, stepwise approach. This recommendation prompted the development of a pain-management algorithm. Aim: Evaluate the feasibility and clinical utility of this algorithm. Design: A descriptive survey. Settings: One medical/surgical intensive care unit, one surgical intensive care unit, and one postanesthesia care unit at two hospitals in Norway. Participants/Subjects: Nurses working at the three units. Methods: A pain-management algorithm, including three pain assessment tools and a guide to pain assessment and pain management, was developed and implemented in three intensive care units. Nurses working at the three units (n = 129) responded to a questionnaire regarding the feasibility and clinical utility of the algorithm used. Results: Our results suggested that nurses considered the new pain-management algorithm to have relatively high feasibility, but somewhat lower clinical utility. Less than half of respondents thought that pain treatment in clinical practice had become more targeted using the tree pain-assessment tools (45%) and the algorithm for pain assessment and pain management (24%). Conclusions: Pain-management algorithms may be appropriate and useful in clinical practice. However, to increase clinical utility and to achieve more targeted pain treatment, more focus on pain-treatment actions and reassessment of patients’ pain is needed. Further focus in clinical practice on how to implement an algorithm and more focus on pain-treatment action and reassessment of patients’ pain is needed.

• Lindberg, Maren Falch; Miaskowski, Christine; Rustøen, Tone; Cooper, Bruce A.; Aamodt, Arild & Lerdal, Anners (2020). Preoperative risk factors associated with chronic pain profiles following total knee arthroplasty. European Journal of Pain. ISSN 1090-3801. p. 1–13. doi: 10.1002/ejp.1703. Full text in Research Archive Show summary

  Background One in five patients experience chronic pain 12 months following total knee arthroplasty (TKA). This longitudinal study used a person‐centred approach to identify subgroups of patients with distinct chronic pain profiles following TKA and identified preoperative characteristics associated with these profiles. Methods On the day before surgery, 202 patients completed questionnaires that assessed pain, interference with functioning, fatigue, anxiety, depression and illness perceptions. Average and worst pain were assessed prior to surgery, on postoperative day 4, at 6 week and at 3 and 12 months following surgery. Using growth mixture modelling, two subgroups with distinct average and worst pain profiles were identified. Results Patients in the “lower average” and “lower worst” pain classes had moderate preoperative pain scores that decreased over the remaining 9 months following TKA. Patients in the “higher average” and “higher worst” pain classes had relatively higher preoperative pain scores that increased during the first three months and then decreased slightly over the remaining 9 months. Patients in the higher pain classes had higher interference with function scores; used opioids prior to surgery more often, were more likely to receive a continuous nerve block and ketamine; had higher preoperative fatigue severity and interference scores; and had worse perceptions of illness than patients in the lower pain classes. Conclusions These risk factors may be used to identify subgroups of patients at higher risk for more severe pain after TKA. Future studies should test whether modifying these risk factors can improve patients’ outcomes after TKA. Significance statement The present study provides a novel and original analysis of pain profiles following total knee arthroplasty that may contribute to our understanding of the transition from acute to chronic pain. Our results may be used to identify patients at higher risk for poorer outcomes based on preoperative risk factors.

• Bentsen, Signe Berit; Holm, Are Martin; Christensen, Vivi Lycke; Henriksen, Anne Hildur; Småstuen, Milada Cvancarova & Rustøen, Tone (2020). Changes in and predictors of pain and mortality in patients with chronic obstructive pulmonary disease. Respiratory Medicine. ISSN 0954-6111. 171. doi: 10.1016/j.rmed.2020.106116. Full text in Research Archive Show summary

  This longitudinal study of patients with chronic obstructive pulmonary disease (COPD) aimed to investigate changes in pain characteristics (i.e., occurrence, intensity, and interference) and covariates associated with pain from study enrollment to 12 months, and to investigate if the different pain characteristics were associated with 5-year mortality. In total, 267 patients with COPD completed questionnaires five times over 1 year. The mean age of the patients was 63 years (standard deviation: 9.0), 53% were women, and 46% had very severe COPD. Median number of comorbidities was 2.0 (range: 0–11) and 47% of patients reported back/neck pain. Mixed models and Cox regression models were used for analyses. In total, 60% of the patients reported pain at baseline, and 61% at 12 months. The mixed model analyses revealed that those with better forced expiratory volume in 1 s (% predicted), more comorbidities, only primary school education, and more respiratory symptoms reported significantly higher average pain intensity. Moreover, those with more comorbidities, more respiratory symptoms, and more depression reported higher pain interference with function. At the 5-year follow-up, 64 patients (24%) were deceased, and the cumulative 5-year mortality rate was 22% (95% confidence interval [19–25]). Older age, lower forced expiratory volume in 1 s (% predicted), and higher pain interference at enrollment were all independently and significantly associated with higher 5-year mortality. Our findings show that many patients with COPD have persistent pain, and awareness regarding comorbidities and how pain interferes with their lives is needed.

• Holm, Are Martin; Andreassen, Siw Lillevik; Christensen, Vivi Lycke; Kongerud, Johny; Almås, Øystein & Auråen, Henrik [Show all 10 contributors for this article] (2020). Hypogammaglobulinemia and risk of exacerbation and mortality in patients with COPD. The International Journal of Chronic Obstructive Pulmonary Disease. ISSN 1176-9106. 15, p. 799–807. doi: 10.2147/COPD.S236656. Full text in Research Archive Show summary

  Introduction: Chronic obstructive pulmonary disease (COPD) may, in some patients, be characterized by recurring acute exacerbations. Often these exacerbations are associated with airway infections. As immunoglobulins (Ig) are important parts of the immune defence against airway infections, the aim of this study was to relate the levels of circulating immunoglobulins to clinical features in unselected patients with COPD included in a Norwegian multicenter study. Methods: Clinical and biological data, including circulating levels of immunoglobulins, were assessed in 262 prospectively included patients with COPD GOLD stage II–IV at five hospitals in south-eastern Norway. A revisit was done after one year, and survival was assessed after five years. Clinical features and survival of those with immunoglobulin levels below reference values were compared to those with normal levels. Results: In total, 11.5% of all COPD patients and 18.5% of those with GOLD stage IV had IgG concentrations below reference values. These patients were more likely to use inhaled or oral steroids, had lower BMI, and lower FEV1%. Moreover, they had significantly more COPD-related hospital admissions (2.8 vs 0.6), number of prednisolone courses (3.9 vs 1.2), and antibiotic treatments (3.7 vs 1.5) in the preceding year. Importantly, hypogammaglobulinemia was significantly associated with reduced survival in a log-rank analysis. In multivariate regression analysis, we found that the higher risk for acute exacerbations in these patients was independent of other risk factors and was associated with impaired survival. Conclusion: In conclusion, our study suggests that hypogammaglobulinemia may be involved in poor outcome in COPD and may thus be a feasible therapeutic target for interventional studies in COPD.

• Astrup, Guro Lindviksmoen; Hofsø, Kristin; Bjordal, Kristin & Rustøen, Tone (2020). Cancer patients’ diagnosis and symptoms and their family caregivers’ self-efficacy and social support are associated with different caregiver reactions. European Journal of Cancer Care. ISSN 0961-5423. 29:e13311(6), p. 1–10. doi: 10.1111/ecc.13311. Full text in Research Archive
• Olsen, Brita Fosser; Valeberg, Berit Taraldsen; Jacobsen, Morten; Småstuen, Milada Cvancarova; Puntillo, Kathleen & Rustøen, Tone (2020). Pain in intensive care unit patients—A longitudinal study. Nursing Open. 8(1), p. 224–231. doi: 10.1002/nop2.621. Full text in Research Archive Show summary

  Aim: To assess occurrence of pain during the first 6 days of intensive care unit (ICU) stay and evaluate associations between occurrence of pain and selected patient‐related variables. Design: A longitudinal study. Methods: Adult ICU patients from three units were included. Patients' pain was assessed with valid pain assessment tools every 8 hr during their first 6 days in ICU. Possible associations between occurrence of pain and selected patient‐related variables were modelled using multiple logistic regression. Results: When pain was assessed regularly with pain assessment tools, 10% of patients were in pain at rest and 27% were in pain during turning. The proportions of patients who were in pain were significantly higher for patients able to self‐report pain, compared with patients not able to self‐report (p < .001). Several predictors were associated with being in pain. It is important to be aware of these predictors in order to improve pain management.

• Valsø, Åse; Rustøen, Tone; Småstuen, Milada C; Ekeberg, Øivind; Skogstad, Laila & Bredal, Inger Schou [Show all 9 contributors for this article] (2020). Effect of Nurse-Led Consultations on Post-Traumatic Stress and Sense of Coherence in Discharged ICU Patients With Clinically Relevant Post-Traumatic Stress Symptoms-A Randomized Controlled Trial. Critical Care Medicine. ISSN 0090-3493. 48(12), p. 1218–1225. doi: 10.1097/CCM.0000000000004628. Full text in Research Archive Show summary

  Objectives: To investigate the effect of nurse-led consultations on reducing post-traumatic stress symptoms and increasing sense of coherence in discharged ICU patients with clinically relevant post-traumatic stress symptoms and to identify variables associated with symptoms 12 months later. Design: A pragmatic nonblinded randomized controlled trial. Settings: Five surgical and medical ICUs at Oslo University Hospital. Patients: Adult patients treated in the ICU greater than or equal to 24 hours were screened with Post-Traumatic Stress Scale 10 intensive part B after ICU discharge. Those scoring greater than or equal to 25 were included in the study. Intervention: Patients randomized to intervention group were offered three nurse-led consultations within 2 months, and patients in the control group received standard care. Measurements and Main Results: Sense of Coherence Scale 13 and Post-Traumatic Stress Scale 10 intensive part B were completed after inclusion, and reevaluated after 3, 6, and 12 months. Linear mixed model for repeated measures and linear regression analyses were performed. Among 523 screened patients, 111 and 113 were randomized to intervention group and control group, respectively. Mean Post-Traumatic Stress Scale 10 intensive part B score was 37 (±10) before randomization. No differences in post-traumatic stress symptoms or sense of coherence were found between intervention group versus control group, with a mean Post-Traumatic Stress Scale 10 intensive part B score 39 (95% CI, 37–41) versus 37 (95% CI, 35–39), 32 (95% CI, 28–35) versus 32 (95% CI, 29–35), 31 (95% CI, 28–34) versus 30 (95% CI, 27–33), and 31 (95% CI, 28–34) versus 29 (95% CI, 26–33) at baseline, 3, 6, and 12 months, respectively. There was a significantly reduced Post-Traumatic Stress Scale 10 intensive part B score for both groups during the year (p = 0.001). Low sense of coherence, pain, and previous psychiatric problems were associated with increased level of post-traumatic stress symptoms at 12 months. Conclusions: Nurse-led consultations did not reveal any significant effect on post-traumatic stress symptoms or sense of coherence after ICU discharge in patients with clinically relevant symptoms.

• Reine, Elizabeth; Rustøen, Tone; Ræder, Johan & Aase, Karina (2019). Postoperative patient handovers - Variability in perceptions of quality: A qualitative focus group study. Journal of Clinical Nursing (JCN). ISSN 0962-1067. 28(3-4), p. 663–676. doi: 10.1111/jocn.14662. Full text in Research Archive
• Kyte, Kristin; Ekstedt, Mirjam; Rustøen, Tone & Oksholm, Trine (2019). Longing to get back on track: Patients' experiences and supportive care needs after lung cancer surgery. Journal of Clinical Nursing (JCN). ISSN 0962-1067. doi: 10.1111/jocn.14751. Full text in Research Archive
• Hugøy, Therese; Lerdal, Anners; Rustøen, Tone & Oksholm, Trine (2019). Predicting postoperative fatigue in surgically treated lung cancer patients in Norway: a longitudinal 5-month followup study. BMJ Open. 9(9), p. 1–9. doi: 10.1136/bmjopen-2018-028192. Full text in Research Archive Show summary

  Objectives Despite the negative influence of fatigue on quality of life in patients who undergo lung cancer surgery, little is known about the possible predictors of postoperative fatigue. The aim of this study was to examine demographic and clinical characteristics that might predict postoperative fatigue 5 months after lung cancer surgery. Design A prospective longitudinal follow-up study comprising preoperative and postoperative questionnaires, including Lee Fatigue Scale, and sociodemographic and clinical data. Setting Three university hospitals in Norway (eg, Oslo University Hospital, St. Olav University Hospital and Haukeland University Hospital). Participants In total, 196 surgically treated patients who answered the questionnaires both preoperatively and at 5-month follow-up with valid fatigue scores. Results Bivariate analyses showed that preoperative fatigue was associated with comorbidities and the symptoms of shortness of breath, cough, depression, anxiety, sleep disturbance and pain. Only cough was directly associated with preoperative fatigue in a regression model. Comorbidities and the symptoms of shortness of breath, cough, depression and sleep disturbance were associated with postoperative fatigue in the bivariate analyses, but only shortness of breath was associated with postoperative fatigue in the regression model. We did not find any significant correlations between fatigue and any treatment variable. Conclusion Clinicians should pay special attention to lung symptoms and be aware that these may lead to long-term postoperative fatigue. Further research should examine whether interventions reducing lung symptoms, such as shortness of breath and coughing, may prevent development of fatigue in patients undergoing lung cancer surgery.

• Reine, Elizabeth; Ræder, Johan; Manser, Tanja Nicole; Småstuen, Milada C & Rustøen, Tone (2019). Quality in postoperative patient handover: Different perceptions of quality between transferring and receiving nurses. Journal of Nursing Care Quality. ISSN 1057-3631. 34(1), p. E1–E7. doi: 10.1097/NCQ.0000000000000318. Full text in Research Archive
• Gjeilo, Kari Hanne; Oksholm, Trine; Follestad, Turid; Wahba, Alexander & Rustøen, Tone (2019). Trajectories of Pain in Patients Undergoing Lung Cancer Surgery: A Longitudinal Prospective Study. Journal of Pain and Symptom Management. ISSN 0885-3924. p. 1–12. doi: 10.1016/j.jpainsymman.2019.11.004. Full text in Research Archive Show summary

  Context Lung cancer surgery is among the surgical procedures associated with the highest prevalence of pain, but prospective longitudinal studies after the pain trajectory are scarce. Objectives We aimed to describe the pain trajectory in patients undergoing surgery for primary lung cancer and investigate whether distinct groups of patients could be identified based on different pain trajectories. Methods Patients (n = 264; 95% thoracotomies) provided data on the average and worst pain intensity, pain location, and comorbidities before, and at one month and five, nine, and 12 months after surgery. Pain profiles were analyzed by latent class mixed models. Results The occurrence of any pain increased from 40% before surgery to 69% after one month and decreased to 56%, 57%, and 55% at five, nine, and 12 months, respectively. Latent class mixed models identified two classes both for average and worst pain; one class started low with high ratings after one month, then returning to a level slightly higher than baseline. The other class started higher with similar scores through the trajectory. Patients reporting no pain (8%) were placed in a separate class. Higher comorbidity score, preoperative use of both pain and psychotropic medicine characterized the class with overall highest pain for average and/or worst pain. Conclusion Pain was highly prevalent after surgery, and subgroups could be identified based on different pain trajectories. Patients reported both postoperative pain and pain from chronic conditions. Knowledge about vulnerable patients and risk factors for pain is important to tailor interventions and information about pain.

• Røhrl, Kari; Guren, Marianne; Astrup, Guro Lindviksmoen; Småstuen, Milada C & Rustøen, Tone (2019). High symptom burden is associated with impaired quality of life in colorectal cancer patients during chemotherapy:A prospective longitudinal study. European Journal of Oncology Nursing. ISSN 1462-3889. 44. doi: 10.1016/j.ejon.2019.101679. Full text in Research Archive
• Ekstedt, Mirjam & Rustøen, Tone (2019). Factors That Hinder and Facilitate Cancer Patients' Knowledge About Pain Management - A Qualitative Study. Journal of Pain and Symptom Management. ISSN 0885-3924. 57, p. 753–760. doi: 10.1016/j.jpainsymman.2018.12.334. Full text in Research Archive
• Sørensen, Erik Elgaard; Kusk, Kathrine Hoffmann; Athlin, Asa Muntlin; Lode, Kirsten; Rustøen, Tone & Salmela, Susanne [Show all 7 contributors for this article] (2019). The role of PhD-prepared, hospital-based nurses: an inter-Nordic study. Journal of Research in Nursing. ISSN 1744-9871. 24(7), p. 470–485. doi: 10.1177/1744987119877213. Full text in Research Archive
• Smeland, Anja Hetland; Rustøen, Tone; Næss, Torgun; Nybro, Lill; Lundeberg, Stefan & Reinertsen, Hanne [Show all 8 contributors for this article] (2019). Children's views on postsurgical pain in recovery units in Norway: A qualitative study. Journal of Clinical Nursing (JCN). ISSN 0962-1067. 28, p. 2157–2170. doi: 10.1111/jocn.14788. Full text in Research Archive Show summary

  Aims and objectives: To explore children’s postsurgical experiences with pain and pain management in the recovery unit. Background: Children’s pain is underestimated and undertreated. Untreated pain can cause unnecessary suffering, increased complication risks, and may lead to chronic pain. Research exploring children’s experiences with postoperative pain and pain management is limited. Design: A qualitative, exploratory study. The study complied with the Consolidated Criteria for Reporting Qualitative Research (COREQ). Methods: Children (N=20), 8–16 years old, took part in semi-structured interviews about their experiences with pain and postoperative pain management while they were in a recovery unit. Data were collected at two university hospitals in Norway. Content analysis was used to analyse the data. Results: Three themes emerged from the interviews; “children’s experiences of what felt unpleasant and painful”, “children’s experiences with pain management” and “children’s recommendations for future pain management”. About half of the children reported moderate to severe pain while in the recovery unit and they did not always tell their nurses when they had pain. They also reported experiencing pain in places other than their surgical wounds and stated that nausea and vomiting felt unpleasant and painful. The children indicated that pain medications and the use of non-pharmacological methods helped them cope with their pain and provided several recommendations about how to improve pain management. Conclusion: Paediatric postoperative pain management remains suboptimal. The children in our study provided useful information about their pain experiences, how to improve pain management and explained why they did not tell their nurses when they were in pain. Relevance to clinical practice: These findings should direct further improvements in paediatric postoperative pain management, such as increased use of pain assessment tools and preparatory information, as well as more appropriate administration of pain medications.

• Røhrl, Kari; Guren, Marianne; Småstuen, Milada Cvancarova & Rustøen, Tone (2019). Symptoms during chemotherapy in colorectal cancer patients. Supportive Care in Cancer. ISSN 0941-4355. 27(8), p. 3007–3017. doi: 10.1007/s00520-018-4598-y. Full text in Research Archive
• Valsø, Åse; Rustøen, Tone; Skogstad, Laila; Bredal, Inger Schou; Ekeberg, Øivind & Småstuen, Milada Cvancarova [Show all 9 contributors for this article] (2019). Post-traumatic stress symptoms and sense of coherence in proximity to intensive care unit discharge. Nursing in Critical Care. ISSN 1362-1017. 25(2), p. 117–125. doi: 10.1111/nicc.12466. Full text in Research Archive
• Bjøro, Benedikte; Mykkeltveit, Ida Helene; Rustøen, Tone; Altinbas, Bahar Candas; Røise, Olav & Bentsen, Signe Berit (2019). Intraoperative peripheral nerve injury related to lithotomy positioning with steep Trendelenburg in patients undergoing robotic-assisted laparoscopic surgery - A systematic review. Journal of Advanced Nursing. ISSN 0309-2402. 76(2), p. 490–503. doi: 10.1111/jan.14271. Full text in Research Archive
• Bentsen, Signe Berit; Miaskowski, Christine; Cooper, Bruce A.; Christensen, Vivi Lycke; Henriksen, Anne Hildur & Holm, Are Martin [Show all 7 contributors for this article] (2018). Distinct pain profiles in patients with chronic obstructive pulmonary disease. The International Journal of Chronic Obstructive Pulmonary Disease. ISSN 1176-9106. 13(13), p. 801–811. doi: 10.2147/COPD.S150114. Full text in Research Archive Show summary

  Background: Few studies have examined changes in the pain experience of patients with COPD and predictors of pain in these patients. Objectives: The objectives of the study were to examine whether distinct groups of COPD patients could be identified based on changes in the occurrence and severity of pain over 12 months and to evaluate whether these groups differed on demographic, clinical, and pain characteristics, and health-related quality of life (HRQoL). Patients and methods: A longitudinal study of 267 COPD patients with very severe COPD was conducted. Their mean age was 63 years, and 53% were females. The patients completed questionnaires including demographic and clinical variables, the Brief Pain Inventory, and the St Georges Respiratory Questionnaire at enrollment, and 3, 6, 9, and 12 months follow-up. In addition, spirometry and the 6 Minute Walk Test were performed. Latent class analysis was used to identify subgroups of patients with distinct pain profiles based on pain occurrence and worst pain severity. Results: Most of the patients (77%) reported pain occurrence over 12 months. Of these, 48% were in the “high probability of pain” group, while 29% were in the “moderate probability of pain” group. For the worst pain severity, 37% were in the “moderate pain” and 39% were in the “mild pain” groups. Females and those with higher body mass index, higher number of comorbidities, and less education were in the pain groups. Patients in the higher pain groups reported higher pain interference scores, higher number of pain locations, and more respiratory symptoms. Few differences in HRQoL were found between the groups except for the symptom subscale. Conclusion: Patients with COPD warrant comprehensive pain management. Clinicians may use this information to identify those who are at higher risk for persistent pain.

• Rustøen, Tone; Lerdal, Anners; Gay, Caryl & Kottorp, Anders (2018). Rasch analysis of the Herth Hope Index in cancer patients. Health and Quality of Life Outcomes. 16:196, p. 1–10. doi: 10.1186/s12955-018-1025-5. Full text in Research Archive Show summary

  Background The concept of hope has been measured using the Herth Hope Index (HHI) in different samples, but varying factor structures comprising different items from the HHI have been reported. Therefore, further testing with regard to the dimensionality of the instrument is recommended. Rasch modeling can be used to evaluate validity evidence of an instrument’s underlying structure, to identify items with poor fit to the rest of the scale, and to identify items that perform inconsistently across groups. The aim of this study was to assess the HHI’s psychometric properties in a sample of cancer patients using a Rasch model. Adult oncology outpatients (n = 167) with pain from bone metastasis were included, and medical records were reviewed for disease and treatment information. Patients completed the 12-item HHI, which measures various dimensions of hope using a 4-point Likert scale that ranges from 1 (strongly disagree) to 4 (strongly agree). The internal scale validity, person response validity, unidimensionality, and uniform differential item functioning were evaluated by applying a Rasch rating scale model. Results Five (42%) of the twelve items (#3, #4, #5, #6 and #7) did not meet the criterion set for item goodness-of-fit. After removing these 5 items, the resulting 7-item scale demonstrated acceptable item fit to the model, acceptable unidimensionality (52.6% of the variance explained), acceptable person goodness-of-fit, adequate separation, and no differential item function. Conclusion A 7-item version of the HHI had better psychometric properties than the original 12-item version among patients with cancer-related pain. Trial registration The protocol ID is 158,707/V10 and it was registered on ClinicalTrials.gov as NCT00760305 . Registered September 25, 2008.

• Bjørnnes, Ann Kristin; Parry, Monica; Lie, Irene; Falk, Ragnhild Sørum; Leegaard, Marit & Rustøen, Tone (2018). The association between hope, marital status, depression and persistent pain in men and women following cardiac surgery. BMC Women's Health. 18(2). doi: 10.1186/s12905-017-0501-0. Full text in Research Archive Show summary

  Background: Cardiac surgery is a major life event, and outcomes after surgery are associated with men’s and women’s ability to self-manage and cope with their cardiac condition in everyday life. Hope is suggested to impact cardiac health by having a positive effect on how adults cope with and adapt to illness and recommended lifestyle changes. Methods: We did a secondary analysis of 416 individuals (23% women) undergoing elective coronary artery bypass graft and/or valve surgery between March 2012 and September 2013 enrolled in randomized controlled trial. Hope was assessed using The Herth Hope Index (HHI) at three, six and 12 months following cardiac surgery. Linear mixed model analyses were performed to explore associations after cardiac surgery between hope, marital status, depression, persistent pain, and surgical procedure. Results: For the total sample, no statistically significant difference between global hope scores from 3 to 12 months was observed (ranging from 38.3±5.1 at 3 months to 38.7±5.1 at 12 months), and no differences between men and women were observed at any time points. However, 3 out of 12 individual items on the HHI were associated with significantly lower scores in women: #1) I have a positive outlook toward life, #3)I feel all alone, and #6) I feel scared about my future. Over the study period, diminished hope was associated with older age, lower education, depression prior to surgery, and persistent pain at all measurement points. Isolated valve surgery was positively associated with hope. While neither sex nor marital status, as main effects, demonstrated significant associations with hope, women who were divorced/widowed/single were significantly more likely to have lower hope scores over the study period. Conclusion: Addressing pain and depression, and promoting hope, particularly for women living alone may be important targets for interventions to improve outcomes following cardiac surgery.

• Stjernberg, Mi; Rustøen, Tone & Ræder, Johan (2018). Få pasienter opplever postoperativ kvalme etter dagkirurgi med multimodal kvalmestillende behandling. Sykepleien Forskning. ISSN 1890-2936. p. 1–21. doi: 10.4220/sykepleienf.2018.71442. Full text in Research Archive Show summary

  Background: Ambulatory surgery, where the patient is operated on and discharged the same day, accounts for about 60 per cent of all elective surgery in Norway. Postoperative nausea is a known problem after anaesthesia and surgery, and one that can cause discomfort and, at worst, complications for the patient. In an ambulatory surgery setting, postoperative nausea can also lead to a prolonged stay in the postanaesthesia care unit or a need for unplanned hospital admission, which results in increased costs. International studies show that 37–57 per cent of patients report postoperative nausea after arriving home from ambulatory surgery. Objective: To investigate what percentage of our ambulatory surgery patients experience postoperative nausea after discharge. We also wanted to investigate whether any patient groups are particularly vulnerable. Method: The study is a cross-sectional study. Telephone follow-up the day after surgery was used to collect data using a structured questionnaire with set response options. Results: A total of 2952 patients were included in the study and the response rate was 99 per cent. A general anaesthetic was administered to all patients in the form of total intravenous anaesthesia. Based on known risk factors, the majority of the sample had an increased risk of developing postoperative nausea. The study showed an incidence of postoperative nausea the day after the operation of 16 per cent, of which 14 per cent were slightly nauseous and only 2 per cent were very nauseous. Conclusion: The study shows that the incidence of postoperative nausea after ambulatory surgery can probably be reduced through systematic, multimodal antiemetic prophylactic treatment.

• Langerud, Anne Kathrine; Rustøen, Tone; Småstuen, Milada C; Kongsgaard, Ulf & Stubhaug, Audun (2018). Intensive care survivor-reported symptoms: a longitudinal study of survivors' symptoms. Nursing in Critical Care. ISSN 1362-1017. 23(1), p. 48–54. doi: 10.1111/nicc.12330. Full text in Research Archive
• Bjøro, Benedikte; Dalgard, Olav; Midgard, Håvard; Verbaan, Hans; Småstuen, Milada Cvancarova & Rustøen, Tone (2018). Increased hope following successful treatment for hepatitis C infection. Journal of Advanced Nursing. ISSN 0309-2402. 74(3), p. 724–733. doi: 10.1111/jan.13487. Full text in Research Archive
• Alfheim, Hanne Birgit; Småstuen, Milada Cvancarova; Hofsø, Kristin; Tøien, Kirsti; Rosseland, Leiv Arne & Rustøen, Tone (2018). Quality of life in family caregivers of patients in the intensive care unit: A longitudinal study. Australian Critical Care. ISSN 1036-7314. doi: 10.1016/j.aucc.2018.09.005. Full text in Research Archive Show summary

  Background Family caregivers of patients in the intensive care unit (ICU) experience impairments in the quality of life. Previous studies report that psychological quality of life improves over time, but there has been limited longitudinal research, and measurement points have differed. Factors such as age, gender, and posttraumatic stress symptoms have been found to be associated with the quality of life, but level of hope and its associations with the quality of life have not been investigated. Objectives The objective of this study was (1) to evaluate changes in the quality of life in family caregivers during the first year after a patient's admission to the ICU and (2) to identify associations between patients' and family caregivers' background characteristics, posttraumatic stress symptoms, hope, and quality of life. Methods A longitudinal study design with five measurement points was used. Family caregivers completed study questionnaires at enrolment into the study and at 1, 3, 6, and 12 months after the patient's admission to the ICU. The quality of life was measured with the 12-Item Short Form Health Survey. Results Family caregivers (N = 211) reported improved psychological quality of life during the first year after the patient's admission to the ICU, but it was still lower than the psychological quality of life reported in norm-based data. Being on sick leave, consulting healthcare professionals (e.g., general practitioner), and increased level of posttraumatic stress symptoms were significantly associated with psychological quality of life, whereas hope was not. Reported physical quality of life was comparable to norm-based data. Conclusion Family caregivers of patients in the ICU reported impairments in quality of life during the first year after the patient's admission to the ICU. Being on sick leave, consulting healthcare professionals, and reduced posttraumatic stress symptoms may improve mental quality of life. Keywords CaregiversCritical careLongitudinal studiesQuality of life

• Bjørnnes, Ann Kristin; Lie, Irene; Parry, Monica; Falk, Ragnhild Sørum; Leegaard, Marit & Rustøen, Tone [Show all 7 contributors for this article] (2018). Association between self-perceived pain sensitivity and pain intensity after Cardiac surgery. Journal of Pain Research. 11, p. 1425–1432. doi: 10.2147/JPR.S167524. Full text in Research Archive Show summary

  Background and purpose: Cardiac surgical pain remains a clinical challenge affecting about 40% of individuals in the first six months post-cardiac surgery, and continues up to two years after surgery for about 15–20%. Self-perceived sensitivity to pain may help to identify individuals at risk for persistent cardiac surgical pain to optimize health care responses. The purpose of this study was to assess the relationship between self-perceived pain sensitivity assessed by the Pain Sensitivity Questionnaire (PSQ) and postoperative worst pain intensity up to 12 months after cardiac surgery. Sex differences in baseline characteristics and the PSQ scores were also assessed. Methods: This study was performed among 416 individuals (23% women) scheduled for elective coronary artery bypass graft and/or valve surgery between March 2012 and September 2013. A secondary data-analysis was utilized to explore the relationship between preoperative PSQ scores and worst pain intensity rated preoperatively, across postoperative Days 1–4, at 2 weeks, and at 1, 3, 6, and 12 months post-surgery. Linear mixed model analyses were performed to estimate changes in pain intensity during 1-year follow-up. Results: The mean (±standard deviation) PSQ-total score was 3.3±1.4, with similar scores in men and women. The PSQ-total score was significantly associated with higher worst pain intensity ratings adjusted for participant characteristics (p=0.001). Conclusion: Use of the PSQ before surgery may predict cardiac surgical pain intensity. However, previous evidence is limited and not consistent, and more research is needed to substantiate our results.

• Langerud, Anne Kathrine; Rustøen, Tone; Småstuen, Milada C; Kongsgaard, Ulf & Stubhaug, Audun (2018). Health-related quality of life in intensive care survivors: Associations with social support, comorbidity, and pain interference. PLOS ONE. 13:e0199656(6). doi: 10.1371/journal.pone.0199656. Full text in Research Archive Show summary

  Background: Experiences during a stay in the intensive care unit (ICU), including pain, delirium, physical deterioration, and the critical illness itself, may all influence survivors’ health-related quality of life (HRQOL). However, few studies have examined the influence of social support, comorbidity, and pain interference on ICU survivors’ HRQOL. Objectives: To investigate possible associations between social support, number of comorbidities, and pain interference on HRQOL in ICU survivors. Methods: ICU survivors responded to a survey 3 months (n = 118) and 1 year (n = 89) after ICU discharge. HRQOL was measured using the Short Form Health Survey-12 (v1), social support using the revised Social Provision Scale, pain interference using the Brief Pain Inventory– Short Form, and comorbidities using the Self-Administered Comorbidity Questionnaire. Results: Physical and mental HRQOL were reduced at both 3 months and 1 year in ICU survivors compared with the general population. This reduction was more pronounced at 3 months for physical HRQOL, while a small reduction in mental HRQOL was not clinically relevant. Social support was statistical significantly positively associated with mental HRQOL at 3 months, while number of comorbidities was statistical significantly associated with a reduction in physical HRQOL at 3 months and 1 year and mental HRQOL at 1 year. Lastly pain interference was significantly associated with a reduction in physical HRQOL at 3 months and 1 year. Conclusions: ICU survivors primarily report reduced physical HRQOL. Social support was positively associated with mental HRQOL, while number of comorbidities, and pain interference were all significantly associated with a reduction in HRQOL. Pain interference was associated with the largest reduction in HRQOL.

• Langerud, Anne Kathrine; Rustøen, Tone; Brunborg, Cathrine; Kongsgaard, Ulf & Stubhaug, Audun (2018). Prevalence, Location,and Characteristics of Chronic Pain in Intensive Care Survivors. Pain Management Nursing. ISSN 1524-9042. 19(4), p. 366–376. doi: 10.1016/j.pmn.2017.11.005. Full text in Research Archive
• Oksholm, Trine; Rustøen, Tone & Ekstedt, Mirjam (2018). Transfer Between Hospitals Is a Risk Situation for Patients After Lung cancer surgery. Cancer Nursing. ISSN 0162-220X. 41(3), p. E49–E55. doi: 10.1097/NCC.0000000000000497. Full text in Research Archive
• Vistad, Ingvild; Småstuen, Milada Cvancarova; Astrup, Guro Lindviksmoen; Rustøen, Tone & Liavaag, Astrid Helene (2018). Symptom Experience and Self-rated Physical Functioning in Patients with Ovarian Cancer Receiving Chemotherapy: A Longitudinal Study. International Journal of Gynecological Cancer. ISSN 1048-891X. 28(6), p. 1167–1175. doi: 10.1097/IGC.0000000000001287. Full text in Research Archive
• Alfheim, Hanne Birgit; Hofsø, Kristin; Småstuen, Milada Cvancarova; Tøien, Kirsti; Rosseland, Leiv Arne & Rustøen, Tone (2018). Post-traumatic stress symptoms in family caregivers of intensive care unit patients: A longitudinal study. Intensive and Critical Care Nursing. ISSN 0964-3397. doi: 10.1016/j.iccn.2018.05.007. Full text in Research Archive Show summary

  Objectives To describe the prevalence and trajectory of family caregivers’ post-traumatic stress symptoms during the first year after a patient’s admission to the intensive care unit and identify associations between family caregivers’ background characteristics, hope and post-traumatic stress symptoms. Research methodology/designs Family caregivers of intensive care unit patients (n = 211) completed questionnaires at patient admission to the intensive care unit and thereafter at 1, 3, 6, and 12 months. Mixed-model analyses were performed. Setting Four intensive care units in a university hospital in Norway. Main outcome measures Impact of Event Scale—Revised and Herth Hope Index. Results On admission, 54% of family caregivers reported high post-traumatic stress symptom levels, which decreased during the first six  months after patient discharge. Lower levels of hope, being younger, having more comorbidities and being on sick leave were associated with higher post-traumatic stress symptom levels. Being the parent of the patient was associated with decreased post-traumatic stress symptom levels. Conclusions Family caregivers of intensive care unit patients report high levels of post-traumatic stress symptoms. Higher levels of hope were associated with fewer post-traumatic stress symptoms. Keywords Family caregiverHopeIntensive carePost-traumatic stress symptoms

• Smeland, Anja Hetland; Twycross, Alison; Lundeberg, Stefan & Rustøen, Tone (2018). Nurses’ knowledge, attitudes and clinical practice in pediatric postoperative pain management. Pain Management Nursing. ISSN 1524-9042. p. 1–14. doi: 10.1016/j.pmn.2018.04.006. Full text in Research Archive Show summary

  Background: Despite readily available evidence to guide practice, children continue to experience moderate to severe pain in hospital postoperatively. Reasons for this may include attitudes of nurses toward pain management and their lack of knowledge in key areas. Aims: To identify nurses' knowledge and clinical practice of pediatric postoperative pain management and whether there is a link between knowledge and practice. Design and setting: A descriptive cross-sectional study including a questionnaire and observations was conducted in postanesthesia care (recovery) units in six university hospitals in Norway. Methods: Nurses completed the Pediatric Nurses' Knowledge and Attitudes Survey Regarding Pain Questionnaire–Norwegian Version (PNKAS-N). We observed their clinical practices using a structured observational tool and field notes. Results: Nurses completed the PNKAS-N (n = 193) and were observed (n = 138) giving postoperative care to 266 children (70 hours per unit, 416 hours in total). The mean PNKAS-N score was 29 (standard deviation 4.2) of 40. We identified knowledge deficits, mainly in pharmacologic management, such as in risk of addiction and respiratory depression. We found that, overall, pain was assessed using validated tools in 19% of the children; this fell to 9% in children aged <5 years. More than 66% of children received an inadequate dose of morphine postoperatively. Conclusion: Nurses have knowledge deficits about pediatric pain management and do not always use their knowledge in practice, particularly in relation to pain assessment. There is a need to improve nurses’ knowledge of pediatric pain management and to test interventions that support the use of that knowledge in practice.

• Nordheim, Trond; Rustøen, Tone; Solevåg, Anne Lee; Småstuen, Milada C & Nakstad, Britt (2018). Hope in Parents of Very-Low Birth Weight Infants and its Association with Parenting Stress and Quality of Life. Journal of Pediatric Nursing : Nursing Care of Children and Families. ISSN 0882-5963. 38, p. e53–e58. doi: 10.1016/j.pedn.2017.10.006. Full text in Research Archive
• Alfheim, Hanne Birgit; Rosseland, Leiv Arne; Hofsø, Kristin; Småstuen, Milada C & Rustøen, Tone (2017). Multiple symptoms in Family caregivers of intensive care unit patients. Journal of Pain and Symptom Management. ISSN 0885-3924. 55(2), p. 387–394. doi: 10.1016/j.jpainsymman.2017.08.018. Full text in Research Archive
• Astrup, Guro Lindviksmoen; Rustøen, Tone; Hofsø, Kristin; Gran, Jon Michael & Bjordal, Kristin (2017). Symptom burden and patient characteristics: Association with quality of life in patients with head and neck cancer undergoing radiotherapy. Head and Neck. ISSN 1043-3074. 39(10), p. 2114–2126. doi: 10.1002/hed.24875. Full text in Research Archive
• Halle, Ingrid; Westgaard, Therese Krystad; Wahba, Alexander; Oksholm, Trine; Rustøen, Tone & Gjeilo, Kari Hanne (2017). Trajectory of sleep disturbances in patients undergoing lung cancer surgery: A prospective study. Interactive Cardiovascular and Thoracic Surgery. ISSN 1569-9293. 25(2), p. 285–291. doi: 10.1093/icvts/ivx076. Full text in Research Archive Show summary

  OBJECTIVES Patients with lung cancer report sleep difficulties to be frequent and bothersome symptoms. This study describes the trajectory of sleep from before and up to 12 months after surgery for lung cancer. Further, it investigates possible associations between sleep disturbance, demographic and clinical characteristics before surgery. METHODS This study is part of a longitudinal multicentre study. Sleep disturbance was measured by The General Sleep Disturbance Scale (GSDS) that investigates frequencies of sleep difficulties (21 items) and a total sum score ≥43 indicates a clinically meaningful level of sleep disturbance (score range 0–147). Linear mixed models were used to study changes in sleep from baseline to 1, 5, 9 and 12 months after surgery. RESULTS The percentage of patients (n = 264) reporting sleep disturbances was 60.9% at baseline, 68.5% at Month 1, 55.4% at Month 5, 51.3% at Month 9 and 49.7% at Month 12. The increase to and decrease from Month 1 was the only significant alteration in the occurrence of sleep disturbance. The patients reported most problems within the subscales sleep quantity, early awakenings and sleep quality. Factors associated with sleep disturbance were lower age, use of pain medication and psychotropic medication and higher comorbidity score. CONCLUSIONS Lung cancer patients sleep poorly, before as well as after surgery. There is a need to address sleeping disturbance routinely in clinical practice and screening for sleeping problems is indicated. Further studies are warranted concerning factors that contribute to sleep disturbance and how they best can be treated.

• Lindberg, Maren Falch; Rustøen, Tone; Christine, Miaskowski; Rosseland, Leiv Arne & Lerdal, Anners (2017). The relationship between pain with walking and self-rated health 12 months following total knee arthroplasty: a longitudinal study. BMC Musculoskeletal Disorders. 18(1). doi: 10.1186/s12891-017-1430-7. Full text in Research Archive Show summary

  Background A subgroup of patients continue to report pain with walking 12 months after total knee arthroplasty (TKA). The association between walking pain and self-rated health (SRH) after TKA is not known. This prospective longitudinal study aimed to investigate the association between a comprehensive list of preoperative factors, postoperative pain with walking, and SRH 12 months after TKA. Methods Patients (N = 156) scheduled for TKA completed questionnaires that evaluated demographic and clinical characteristics, symptoms, psychological factors, and SRH. SRH was re-assessed 12 months after TKA. Clinical variables were retrieved from medical records. Pain with walking was assessed before surgery, at 6 weeks, 3, and 12 months after TKA. Subgroups with distinct trajectories of pain with walking over time were identified using growth mixture modeling. Multiple linear regression was used to investigate the relationships between pain with walking and other factors on SRH. Results Higher body mass index, a higher number of painful sites at 12 months, recurrent pain with walking group membership, ketamine use, higher depression scores, and poorer preoperative self-rated health were associated with poorer SRH 12 months after TKA. The final model was statistically significant (p = 0.005) and explained 56.1% of the variance in SRH 12 months after surgery. SRH improved significantly over time. Higher C-reactive protein levels, higher number of painful sites before surgery, higher fatigue severity, and more illness concern was associated with poorer preoperative SRH. Conclusions In patients whose walking ability decreases over time, clinicians need to assess for unreleaved pain and decreases in SRH. Additional research is needed on interventions to improve walking ability and SRH.

• Astrup, Guro Lindviksmoen; Hofsø, Kristin; Bjordal, Kristin; Guren, Marianne; Vistad, Ingvild & Cooper, Bruce [Show all 8 contributors for this article] (2017). Patient factors and quality of life outcomes differ among four subgroups of oncology patients based on symptom occurrence. Acta Oncologica. ISSN 0284-186X. 56(3), p. 462–470. doi: 10.1080/0284186X.2016.1273546. Full text in Research Archive
• Bjørnnes, Ann Kristin; Parry, Monica; Lie, Irene; Fagerland, Morten; Watt-Watson, Judy & Rustøen, Tone [Show all 8 contributors for this article] (2017). The impact of an educational pain management booklet intervention on postoperative pain control after discharge from cardiac surgery. European Journal of Cardiovascular Nursing. ISSN 1474-5151. 16(1), p. 18–27. doi: 10.1177/1474515116631680. Full text in Research Archive Show summary

  Background: Relevant discharge information about the use of analgesic medication and other strategies may help patients to manage their pain more effectively and prevent postoperative persistent pain. Aims: To examine patients’ pain characteristics, analgesic intake and the impact of an educational pain management booklet intervention on postoperative pain control after cardiac surgery. Concerns about pain and pain medication prior to surgery will also be described. Methods: From March 2012 to September 2013, 416 participants (23% women) were consecutively enrolled in a randomized controlled trial. The intervention group received usual care plus an educational booklet at discharge with supportive telephone follow-up on postoperative day 10, and the control group received only usual care. The primary outcome was worst pain intensity (The Brief Pain Inventory – Short Form). Data about pain characteristics and analgesic use were collected at 2 weeks and at 1, 3, 6 and 12 months post-surgery. General linear mixed models were used to determine between-group differences over time. Results: Twenty-nine percent of participants reported surgically related pain at rest and 9% reported moderate to severe pain at 12 months post-surgery. Many participants had concerns about pain and pain medication, and analgesic intake was insufficient post-discharge. No statistically significant differences between the groups were observed in terms of the outcome measures following surgery. Conclusion: Postoperative pain and inadequate analgesic use were problems for many participants regardless of group allocation, and the current intervention did not reduce worst pain intensity compared with control. Further examination of supportive follow-up monitoring and/or self-management strategies post-discharge is required.

• Rustøen, Tone (2016). Håp. In Haugan, Gørill & Rannestad, Toril (Ed.), Helsefremming i Spesialisthelsetjenesten. Cappelen Damm Akademisk. ISSN 9788202482619. p. 59–72. Full text in Research Archive
• Lindberg, Maren Kristin Falch; Miaskowski, Christine; Rustøen, Tone; Rosseland, Leiv Arne; Cooper, Bruce A. & Lerdal, Anners (2016). Factors that can predict pain with walking, 12 months after total knee arthroplasty - A trajectory analysis of 202 patients. Acta Orthopaedica. ISSN 1745-3674. 87(6), p. 600–606. doi: 10.1080/17453674.2016.1237440. Full text in Research Archive Show summary

  Background and purpose — Functional limitations after total knee arthroplasty (TKA) are common. In this longitudinal study, we wanted to identify subgroups of patients with distinct trajectories of pain-related interference with walking during the first year after TKA and to determine which demographic, clinical, symptom-related, and psychological characteristics were associated with being part of this subgroup. Patients and methods — Patients scheduled for primary TKA for osteoarthritis (n = 202) completed questionnaires that evaluated perception of pain, fatigue, anxiety, depression, and illness on the day before surgery. Clinical characteristics were obtained from the medical records. Interference of pain with walking was assessed preoperatively, on postoperative day 4, and at 6 weeks, 3 months, and 12 months after TKA.

• Christensen, Vivi Lycke; Holm, Are Martin; Kongerud, Johny; Bentsen, Signe Berit; Paul, Steven M. & Miaskowski, Christine [Show all 7 contributors for this article] (2016). Occurrence, Characteristics, and Predictors of Pain in Patients with Chronic Obstructive Pulmonary Disease. Pain Management Nursing. ISSN 1524-9042. 17(2), p. 107–118. doi: 10.1016/j.pmn.2016.01.002. Full text in Research Archive
• Bjørnnes, Ann Kristin; Rustøen, Tone; Lie, Irene; Watt-Watson, Judy & Leegaard, Marit (2016). Pain characteristics and analgesic intake before and following cardiac surgery. European Journal of Cardiovascular Nursing. ISSN 1474-5151. 15(1), p. 47–54. doi: 10.1177/1474515114550441. Full text in Research Archive
• Valeberg, Berit Taraldsen; Miaskowski, C; Paul, Steven & Rustøen, Tone (2016). Comparison of oncology patients' and their family caregivers' attitudes and concerns toward pain and pain management. Cancer Nursing. ISSN 0162-220X. 39(4), p. 328–334. doi: 10.1097/NCC.0000000000000319. Full text in Research Archive Show summary

  Both cancer patients and their family caregivers (FCs) report concerns about pain and pain management. When dyads share appraisal of the illness context, they may experience better dyadic adjustment.The aim of this study was to compare oncology outpatients' and their FCs' attitudes and concerns toward pain and pain management.In a cross-sectional study, outpatients with pain (n = 71) and their FCs completed the Barriers Questionnaire II, the Brief Pain Inventory, and information about demographic characteristics. Correlations and paired-samples t tests were calculated to evaluate agreement and differences in barrier scores between the patients and their FCs.Congruence was found in patients' and FCs' beliefs about pain and the use of analgesics on 4 of 7 subscales (ie, tolerance, immune system, side effects, distract the medical doctor) and on the Barriers Questionnaire II total score. Both patients and their FCs were most concerned about addiction.The concerns that both patients and their FCs have about pain and the use of analgesics may act as barriers to effective pain management. Fear of addiction may be an important barrier to cancer pain management. Only small differences were found in concerns between the patients and their FCs.Patients and FCs need education about perceived barriers to effective pain management. They should be coached together to maintain or increase the congruence between them.

• Christensen, Vivi Lycke; Holm, Are Martin; Cooper, Bruce; Paul, Steven M.; Miaskowski, Christine & Rustøen, Tone (2016). Differences in Symptom Burden among Patients with Moderate, Severe, or Very Severe Chronic Obstructive Pulmonary Disease. Journal of Pain and Symptom Management. ISSN 0885-3924. 51(5), p. 849–859. doi: 10.1016/j.jpainsymman.2015.12.324. Full text in Research Archive Show summary

  Abstract Context The symptom experience of patients with chronic obstructive pulmonary disease (COPD) is extremely complex. It is characterized by multiple co-occurring symptoms. However, very few studies have described this experience in COPD patients. Objectives The aims of this study were to evaluate for differences in symptom occurrence rates, as well as ratings of symptom severity, frequency, and distress among patients (n = 267) with moderate, severe, and very severe COPD. Methods The Memorial Symptom Assessment Scale was used to evaluate the multiple dimensions of the patient's symptom experience. Binary and ordinal logistic regression analyses with stage of disease as an ordinal predictor variable were used to evaluate for differences in symptom occurrence rates and ratings of symptom severity, frequency, and distress. Results Regardless of the severity of their disease, patients reported an average of 12 co-occurring symptoms. Shortness of breath and lack of energy were the only two symptoms that differed significantly among the three disease severity groups in terms of occurrence, severity, frequency, and distress. Patients with very severe COPD reported the highest ratings for shortness of breath and lack of energy across all four symptom dimensions. Conclusion Regardless of stage of disease, the high symptom burden identified in this study underscores the need for COPD patients to be screened for multiple co-occurring symptoms.

• Nordheim, Trond; Rustøen, Tone; Iversen, Per Ole & Nakstad, Britt (2016). Quality of life in parents of preterm infants in a randomized nutritional intervention trial. Food & Nutrition Research (FNR). ISSN 1654-6628. 60, p. 7–7. doi: 10.3402/fnr.v60.32162. Full text in Research Archive
• Lindberg, Maren Kristin Falch; Miaskowski, Christine; Rustøen, Tone; Rosseland, Leiv Arne; Paul, Steven M. & Cooper, Bruce A. [Show all 7 contributors for this article] (2016). The Impact of Demographic, Clinical, Symptom and Psychological Characteristics on the Trajectories of Acute Postoperative Pain After Total Knee Arthroplasty. Pain medicine (Malden, Mass.). ISSN 1526-2375. doi: 10.1093/pm/pnw080. Full text in Research Archive
• Lindberg, Maren Falch; Miaskowski, Christine; Rustøen, Tone; Rosseland, Leiv Arne; Cooper, Bruce A. & Lerdal, Anners (2016). Factors that can predict pain with walking, 12 months after total knee arthroplasty: A trajectory analysis of 202 patients. Acta Orthopaedica. ISSN 1745-3674. 87(6), p. 600–606. doi: 10.1080/17453674.2016.1237440. Full text in Research Archive
• Bjørnnes, Ann Kristin; Parry, Monica; Lie, Irene; Fagerland, Morten; Watt-Watson, Judy & Rustøen, Tone [Show all 8 contributors for this article] (2016). Pain experiences of men and women after cardiac surgery. Journal of Clinical Nursing (JCN). ISSN 0962-1067. 25(19-20), p. 3058–3068. doi: 10.1111/jocn.13329. Full text in Research Archive
• Lindberg, Maren Kristin Falch; Miaskowski, Christine; Rustøen, Tone; Rosseland, Leiv Arne; Paul, Steven M. & Lerdal, Anners (2016). Preoperative pain, symptoms, and psychological factors related to higher acute pain trajectories during hospitalization for total knee arthroplasty. PLOS ONE. 11(9). doi: 10.1371/journal.pone.0161681. Full text in Research Archive Show summary

  Objectives Unrelieved postoperative pain after total knee arthroplasty (TKA) is a significant problem. This longitudinal study investigated how preoperative pain intensity, as well as a comprehensive list of preoperative and perioperative factors, influenced the severity of acute average and worst pain after TKA. Methods Prior to surgery, 203 patients completed a demographic questionnaire, Lee Fatigue Scale, Fatigue Severity Scale, Hospital Anxiety and Depression Scale, and Brief Illness Perception Questionnaire. Brief Pain Inventory was completed prior to surgery as well as through postoperative days (POD) 0 to 4. Clinical data were extracted from medical records. Results Several factors were associated with higher levels of preoperative and postoperative pain. Lower preoperative average and worst pain intensity scores were associated with increases in average and worst postoperative pain from POD1 to POD4. A higher number of comorbidities, higher C-reactive protein values, and higher pain interference with function were associated with higher preoperative levels of average pain. Older age, higher fatigue levels, and higher scores on identity and emotional responses to osteoarthritis (OA) were associated with higher preoperative levels of worst pain. Lower perceived consequences of OA were associated with higher pain from POD1 to POD4. Males and patients with lower preoperative scores for average pain had higher worst pain following surgery. Discussion Patients at higher risk for more severe postoperative pain can be identified through an assessment of pain and other risk factors identified in this study. Future research needs to test the efficacy of interventions that modify patients’ perceptions of living with OA and pain intensity before surgery on short and long term postoperative outcomes.

• Olsen, Brita Fosser; Rustøen, Tone; Sandvik, Leiv; Jacobsen, Morten & Valeberg, Berit Taraldsen (2016). Results of implementing a pain management algorithm in intensive care unit patients: The impact on pain assessment, length of stay, and duration of ventilation. Journal of Critical Care. ISSN 0883-9441. 36, p. 207–211. doi: 10.1016/j.jcrc.2016.07.011. Full text in Research Archive
• Røhrl, Kari; Guren, Marianne; Miaskowski, Christine; Cooper, Bruce A.; Diep, Lien My & Rustøen, Tone (2016). No Differences in Symptom Burden Between Colorectal Cancer Patients Receiving Curative Versus Palliative Chemotherapy. Journal of Pain and Symptom Management. ISSN 0885-3924. 52(4), p. 539–547. doi: 10.1016/j.jpainsymman.2016.04.008. Full text in Research Archive
• Christensen, Vivi Lycke; Rustøen, Tone; Cooper, Bruce A.; Miaskowski, Christine; Henriksen, Anne Hildur & Bentsen, Signe Berit [Show all 7 contributors for this article] (2016). Distinct symptom experiences in subgroups of patients with COPD. The International Journal of Chronic Obstructive Pulmonary Disease. ISSN 1176-9106. 11(1), p. 1801–1809. doi: 10.2147/COPD.S105299. Full text in Research Archive Show summary

  Background: In addition to their respiratory symptoms, patients with COPD experience multiple, co-occurring symptoms. Objectives: The aims of this study were to identify subgroups of COPD patients based on their distinct experiences with 14 symptoms and to determine how these subgroups differed in demographic and clinical characteristics and disease-specific quality of life. Patients and methods: Patients with moderate, severe, and very severe COPD (n = 267) completed a number of self-report questionnaires. Latent class analysis was used to identify subgroups of patients with distinct symptom experiences based on the occurrence of self-reported symptoms using the Memorial Symptom Assessment Scale. Results: Based on the probability of occurrence of a number of physical and psychological symptoms, three subgroups of patients (ie, latent classes) were identified and named “high”, “intermediate”, and “low”. Across the three latent classes, the pairwise comparisons for the classification of airflow limitation in COPD were not significantly different, which suggests that measurements of respiratory function are not associated with COPD patients’ symptom burden and their specific needs for symptom management. While patients in both the “high” and “intermediate” classes had high occurrence rates for respiratory symptoms, patients in the “high” class had the highest occurrence rates for psychological symptoms. Compared with the “intermediate” class, patients in the “high” class were younger, more likely to be women, had significantly more acute exacerbations in the past year, and reported significantly worse disease-specific quality of life scores. Conclusion: These findings suggest that subgroups of COPD patients with distinct symptom experiences can be identified. Patients with a higher symptom burden warrant more detailed assessments and may have therapeutic needs that would not be identified using current classifications based only on respiratory function.

• Astrup, Guro Lindviksmoen; Rustøen, Tone; Miaskowski, Christine; Paul, Steven M. & Bjordal, Kristin (2015). A longitudinal study of depressive symptoms in patients with head and neck cancer undergoing radiotherapy. Cancer Nursing. ISSN 0162-220X. 38(6), p. 436–446. doi: 10.1097/NCC.0000000000000225. Full text in Research Archive Show summary

  Background: Although patients with head and neck cancer are at increased risk for depressive symptoms compared with other cancer patients, few longitudinal studies have evaluated changes in and predictors of this symptom over time. Objective: The aim of this study was to determine whether levels of depressive symptoms changed over time and whether specific demographic, clinical, symptom, or psychosocial characteristics were associated with depressive symptoms. Methods: In a longitudinal study of patients with head and neck cancer, depressive symptoms were assessed with the Center for Epidemiologic Studies–Depression scale, from the initiation of radiotherapy and for 6 months after. Hierarchical linear modeling was used to evaluate for changes in as well as for potential predictors of interindividual differences in depressive symptoms. Results: The severity of depressive symptoms increased during radiotherapy and then decreased over time. The portion of patients who reported clinically meaningful levels of depressive symptoms at each assessment ranged from 29% to 42%. Several known predictors of pretreatment severity of depressive symptoms (ie, physical symptoms, less social support, dissatisfaction with looks) were corroborated. In addition, having surgery before radiotherapy was associated with lower levels of depressive symptoms at initiation of radiotherapy. Conclusion: A moderate proportion of patients with head and neck cancer reported levels of depressive symptoms that indicated the need for clinical evaluation. Several patient characteristics were associated with depressive symptoms. Implications for Practice: Knowledge on prevalence, time course, and predictors of depressive symptoms from this study can be used to identify patients at higher risk for more severe depressive symptoms. The final version of this research has been published in Cancer Nursing. © Lippincott, Williams & Wilkins.

• Olsen, Brita Fosser; Rustøen, Tone; Sandvik, Leiv; Miaskowski, Christine; Jacobsen, Morten B. & Valeberg, Berit Taraldsen (2015). Development of a pain management algorithm for intensive care units. Heart & Lung. ISSN 0147-9563. 44(6), p. 521–527. doi: 10.1016/j.hrtlng.2015.09.001. Full text in Research Archive
• Astrup, Guro Lindviksmoen; Rustøen, Tone; Miaskowski, Christine; Paul, Steven M & Bjordal, Kristin (2015). Changes in and predictors of pain characteristics in patients with head and neck cancer undergoing radiotherapy. Pain. ISSN 0304-3959. 156(5), p. 967–979. doi: 10.1097/j.pain.0000000000000142. Full text in Research Archive Show summary

  Abstract: Pain is a common symptom in patients with head and neck cancer (HNC) that is associated with significant decrements in physical and psychological functioning. Only 4 studies have evaluated for changes in and predictors of different pain characteristics in these patients. In this longitudinal study of patients with HNC, changes in pain intensity (ie, average pain, worst pain), pain interference with function, and pain relief were evaluated from the initiation of radiotherapy and through the following 6 months. Hierarchical linear modeling was used to evaluate for changes over time in these 4 pain characteristics, as well as to identify predictors of interindividual variability in each characteristic. Overall, pain intensity and interference with function scores were in the mild-to-moderate range, while pain relief scores were in the moderate range. The occurrence of pain, as well as scores for each pain characteristic, increased from the initiation to the completion of radiotherapy, followed by a gradual decrease to near pretreatment levels at 6 months. However, interindividual variability existed in patients' ratings of each pain characteristic. Predictors of more severe pain characteristic scores were more comorbidities, worse physical functioning, not having surgery before radiotherapy, difficulty swallowing, mouth sores, sleep disturbance, fatigue, more energy, and less social support. Patients with more depressive symptoms had better pain relief. Although some of the predictors cannot be modified (eg, occurrence of surgery), other predictors (eg, symptoms) can be treated. Therefore, information about these predictors may result in decreased pain in patients with HNC.

• Oksholm, Trine; Miaskowsky, Christine; Solberg, Steinar; Lie, Irene; Cooper, Bruce & Paul, Steven M. [Show all 8 contributors for this article] (2015). Changes in symptom occurrence and severity before and after lung cancer surgery. Cancer Nursing. ISSN 0162-220X. 38(5), p. 351–357. doi: 10.1097/NCC.0000000000000198. Full text in Research Archive
• Olsen, Brita Fosser; Rustøen, Tone; Sandvik, Leiv; Miaskowski, Christina; Jacobsen, Morten B. & Valeberg, Berit Taraldsen (2015). Implementation of a pain management algorithm in intensive care units and evaluation of nurses' level of adherence with the algorithm. Heart & Lung. ISSN 0147-9563. 44(6), p. 528–533. doi: 10.1016/j.hrtlng.2015.08.001. Full text in Research Archive Show summary

  Objectives: To implement a pain management algorithm in intensive care units (ICU) and to evaluate nurses ’ level of adherence with the algorithm. Background: Many ICU patients experience pain. Therefore, an evidence-based algorithm for pain management was developed. Methods: A pain management algorithm was implemented in three units over three weeks. Nurses ’ level of adherence with the algorithm and associations between level of adherence and patient and unit characteristics over 22 weeks were evaluated using multivariate regression analysis. Results: Nurses ’ level of adherence was 74.6%. Adherence rates were lower on the evening and night shifts compared to the day shift. Males were assessed signi fi cantly less frequently than females. Patients with “ injury, poisoning, or certain other consequences of external causes ” were assessed signi fi cantly less frequently than patients with “ diseases of the respiratory system. ” Conclusions: ICU nurses can use a pain management algorithm consistently. Findings from this study suggest that a pain management algorithm is a useful tool to increase ICU nurses’ adherence with pain assessment

• Dokken, Mette; Rustøen, Tone & Stubhaug, Audun (2015). Indirect calorimetry reveals that better monitoring of nutrition therapy in pediatric intensive care is needed. JPEN - Journal of Parenteral and Enteral Nutrition. ISSN 0148-6071. 39(3), p. 344–352. doi: 10.1177/0148607113511990. Full text in Research Archive
• Oksholm, Trine; Rustøen, Tone; Cooper, Bruce; Paul, Steven M.; Solberg, Steinar & Henriksen, Kari [Show all 8 contributors for this article] (2015). Trajectories of symptom occurrence and severity from before through five months after lung cancer surgery. Journal of Pain and Symptom Management. ISSN 0885-3924. 49(6), p. 995–1015. doi: 10.1016/j.jpainsymman.2014.11.297. Full text in Research Archive
• Rustøen, Tone; Valeberg, Berit Taraldsen; Kolstad, Eva; Wist, Erik; Paul, Steven & Miaskowski, Christine (2014). A Randomized Clinical Trial of the Efficacy of a Self-care Intervention to Improve Cancer Pain Management. Cancer Nursing. ISSN 0162-220X. 37(1), p. 34–43. doi: 10.1097/NCC.0b013e3182948418. Full text in Research Archive
• Schjølberg, Tore Kr.; Dodd, Marylin; Henriksen, Nils Oddbjørn; Asplund, Kenneth; Småstuen, Milada Cvancarova & Rustøen, Tone (2014). Effects of an educational intervention for managing fatigue in women with early stage breast cancer. European Journal of Oncology Nursing. ISSN 1462-3889. 18(3), p. 286–294. doi: 10.1016/j.ejon.2014.01.008. Full text in Research Archive
• Wengström, Yvonne; Geerling, Jenske I. & Rustøen, Tone (2014). European Oncology Nursing Society breakthrough cancer pain guidelines. European Journal of Oncology Nursing. ISSN 1462-3889. 18(2), p. 127–131. doi: 10.1016/j.ejon.2013.11.009. Full text in Research Archive Show summary

  Purpose The overall aim of the project was to update and inform nurses of current best practice based on previously published literature to enable nurses to assess and manage breakthrough cancer pain (BTCP) and thereby to provide optimal management of BTCP. Methods The EONS started a project in 2010 by recruiting a working group and a multidisciplinary advisory board to develop guidelines with the purpose of helping oncology nurses understand and recognise BTCP. Results This paper presents and overview of the guideline. Key recommendations include; using an algorithm for assessment of BTCP, individualise treatment interventions, optimization of analgesia and reassessment of outcomes of interventions. Conclusions By implementing the EONS guidelines nurses will utilise the latest available knowledge in clinical practice and the understanding and management of BTCP will improve assessment and overall management of breakthrough pain in cancer patients.

• Hofsø, Kristin; Bjordal, Kristin; Diep, Lien My & Rustøen, Tone (2014). The relationships between demographic and clinical characteristics and quality of life during and after radiotherapy: in women with breast cancer. Quality of Life Research. ISSN 0962-9343. 23(10), p. 2769–2777. doi: 10.1007/s11136-014-0736-2. Full text in Research Archive

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• Rustøen, Tone & Lerdal, Anners (2021). Klinisk forskning innen helsefag. Fagbokforlaget. ISBN 9788245022926. 256 p. Full text in Research Archive

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• Friberg, Klara; Hofsø, Kristin; Rustøen, Tone; Ræder, Johan; Hagen, Milada & Puntillo, Kathleen [Show all 7 contributors for this article] (2025). Corrigendum to “The association between posttraumatic stress symptoms and hope following intensive care unit discharge: Findings from a longitudinal cohort study” [Heart & Lung Volume 70, MarchApril 2025, Pages 223-229] (Heart & Lung (2025) 70 (223–229), (S0147956324002450), (10.1016/j.hrtlng.2024.12.003)). Heart & Lung. ISSN 0147-9563. 72, p. 83–84. doi: 10.1016/j.hrtlng.2025.04.001. Full text in Research Archive
• Rustøen, Tone (2025). Symptomhåndtering er en av de viktigste sykepleieroppgavene. Tidsskriftet sykepleien. ISSN 0806-7511. doi: 10.4220/Sykepleiens.2025.98098. Full text in Research Archive
• Debesay, Jonas & Rustøen, Tone (2025). Vi må snakke om vilkårene for de «varme hendene». Sykepleien. ISSN 0039-7628. Full text in Research Archive
• Bentsen, Signe Berit; Eide, Geir Egil; Wiig, Siri; Rustøen, Tone; Heen, Cathrine & Bjøro, Benedikte (2024). Patient positioning on operating table and patient safety: A systematic review and meta-analysis. Full text in Research Archive
• Myrenget, Martin Elstad; Rustøen, Tone; Myskja, Audun; Småstuen, Milada Cvancarova; Rangul, Vegar & Håpnes, Odd Sigfast [Show all 11 contributors for this article] (2024). Reply to Kajiwara et al. Pain. ISSN 0304-3959. 165(8), p. 1890–1891. doi: 10.1097/j.pain.0000000000003236. Full text in Research Archive
• Bentsen, Signe Berit; Eide, Geir Egil; Wiig, Siri; Rustøen, Tone; Heen, Cathrine & Bjøro, Benedikte (2024). Patient positioning on the operating table and patient safety: A systematic review and meta-analysis. Full text in Research Archive
• Valsø, Åse; Tøien, Kirsti; Rustøen, Tone; Milada, Cvancarova Småstuen & Sunde, Kjetil (2024). Posttraumatic stress symptoms, sense of coherence and pain after intensive care treatment and the effect of early nurse-led follow-up consultation. Full text in Research Archive
• Helme, Aina Evensen; Bjørnaas, Mari Asphjell; Hofsø, Kristin; Rustøen, Tone; Hagen, Julia & Grimholt, Tine Kristin (2024). Hva trenger pasientene fra oss da de våkner på intensiv etter et selvmordsforsøk? Full text in Research Archive
• Helme, Aina Evensen; Bjørnaas, Mari Asphjell; Grimholt, Tine Kristin; Hofsø, Kristin; Hagen, Julia & Rustøen, Tone (2024). Å våkne uten at det var planen- hva trenger pasientene fra oss da de våkner på intensiv etter et selvmordsforsøk. Full text in Research Archive
• Helme, Aina Evensen; Bjørnaas, Mari Asphjell; Hagen, Julia; Rustøen, Tone; Grimholt, Tine Kristin & Hofsø, Kristin (2024). “Glad to be saved but still longing for death”- The complexity of needs in patients admitted to the ICU after suicide attempt. Full text in Research Archive
• Hofsø, Kristin; Rosseland, Leiv Arne & Rustøen, Tone (2023). Symptoms, post-traumatic stress and quality of life in family caregivers of ICU patients. Full text in Research Archive
• Gustad, Lise Tuset; Rustøen, Tone & Debesay, Jonas (2023). Sykepleiere som underviser og forsker, har ikke forlatt yrket. Full text in Research Archive
• Helme, Aina Evensen; Hagen, Julia; Bjørnaas, Mari Asphjell; Grimholt, Tine Kristin; Hofsø, Kristin & Rustøen, Tone (2023). Patients admitted to ICU after a suicide attempt -A qualitative study about the patients’ experiences with treatment and after care. Full text in Research Archive
• Rustøen, Tone; Kynø, Nina M & Berntzen, Helene (2023). Håp i klinisk praksis kan kartlegges med skalaer og skjemaer. Sykepleien Forskning. ISSN 1890-2936. doi: 10.4220/Sykepleiens.2023.93563. Full text in Research Archive
• Austenå, Mona; Rustøen, Tone; Småstuen, Milada Cvancarova; Valsø, Åse; Sunde, Kjetil & Tøien, Kirsti (2022). Return to work first year after intensiv care treatment. Full text in Research Archive
• Austenå, Mona; Småstuen, Milada Cvancarova; Rustøen, Tone; Valsø, Åse; Sunde, Kjetil & Tøien, Kirsti (2022). Level of hope and associated factors during first year after intensive care treatment. Full text in Research Archive
• Flim, Marleen; Rustøen, Tone; Blackwood, Bronagh & Spronk, Peter (2022). Thirst in adult patients in the intensive care unit: protocol for a scoping review. BMJ Open. 12(11), p. e063006–e063006. doi: 10.1136/bmjopen-2022-063006. Full text in Research Archive
• Rustøen, Tone & Lerdal, Anners (2021). Finansiering av forskning. In Rustøen, Tone & Lerdal, Anners (Ed.), Klinisk forskning innen helsefag. Fagbokforlaget. ISSN 9788245022926. p. 239–247. Full text in Research Archive
• Lerdal, Anners & Rustøen, Tone (2021). Hvordan skrive en god forskningssøknad. In Rustøen, Tone & Lerdal, Anners (Ed.), Klinisk forskning innen helsefag. Fagbokforlaget. ISSN 9788245022926. p. 225–238. Full text in Research Archive
• Lerdal, Anners & Rustøen, Tone (2021). Hvordan bygge formell kompetanse og skrive en CV. In Rustøen, Tone & Lerdal, Anners (Ed.), Klinisk forskning innen helsefag. Fagbokforlaget. ISSN 9788245022926. p. 153–159. Full text in Research Archive
• Rustøen, Tone & Lerdal, Anners (2021). Noen forskningsdesign ved evaluering av intervensjoner eller kliniske tiltak. In Rustøen, Tone & Lerdal, Anners (Ed.), Klinisk forskning innen helsefag. Fagbokforlaget. ISSN 9788245022926. p. 106–123. Full text in Research Archive
• Cappelen, Kathrine & Rustøen, Tone (2021). Forskning i kommunale helse- og omsorgstjenester og spesialisthelsetjenesten. In Rustøen, Tone & Lerdal, Anners (Ed.), Klinisk forskning innen helsefag. Fagbokforlaget. ISSN 9788245022926. p. 21–36. Full text in Research Archive
• Lerdal, Anners & Rustøen, Tone (2021). Formidling av forskning. In Rustøen, Tone & Lerdal, Anners (Ed.), Klinisk forskning innen helsefag. Fagbokforlaget. ISSN 9788245022926. p. 52–70. Full text in Research Archive
• Rustøen, Tone & Lerdal, Anners (2021). Hvordan bygge opp gode forskningsgrupper og sterke miljøer for forskning. In Rustøen, Tone & Lerdal, Anners (Ed.), Klinisk forskning innen helsefag. Fagbokforlaget. ISSN 9788245022926. p. 71–84. Full text in Research Archive
• Lindberg, Maren Falch; Rustøen, Tone; Cooper, Bruce A; Aamodt, Arild & Lerdal, Anners Vetle (2021). Authors’ reply to the comment by Riddle et al. European Journal of Pain. ISSN 1090-3801. doi: 10.1002/ejp.1756. Full text in Research Archive
• Lindberg, Maren Falch; Miaskowski, Christine; Rustøen, Tone; Cooper, Bruce A; Aamodt, Arild & Lerdal, Anners (2021). Chronic pain profiles and associated risk factors following total knee arthroplasty - a prospective observational study. Full text in Research Archive
• Gjeilo, Kari Hanne; Oksholm, Trine; Follestad, Turid; Wahba, Alexander & Rustøen, Tone (2021). Trajectories of pain in patients undergoing lung cancer surgery: a longitudinal study. Full text in Research Archive
• Gjeilo, Kari Hanne; Oksholm, Trine; Follestad, Turid; Wahba, Alexander & Rustøen, Tone (2020). Authors' Response to Estimation of Chronic Post-Surgical Pain After Thoracic Surgery: Case Closed? Journal of Pain and Symptom Management. ISSN 0885-3924. 59(5), p. e4–e5. doi: 10.1016/j.jpainsymman.2020.01.016. Full text in Research Archive
• Valsø, Åse; Rustøen, Tone; Sunde, Kjetil & Tøien, Kirsti (2019). Effect of nurse led follow-up consultations to improve sence of coherence in patients discharged after intensive care treatment. Full text in Research Archive
• Lindberg, Maren Falch; Rognsvåg, Turid; Badawy, Mona; Borchgrevink, Petter Chr.; Furnes, Ove & Gay, Caryl [Show all 13 contributors for this article] (2019). Optimal behandling av artrosepasienter - en feasibilitystudie (MultiKnee trial). Full text in Research Archive
• Valsø, Åse; Rustøen, Tone; Sunde, Kjetil & Tøien, Kirsti (2018). Effect of nurse led intervention to reduce post traumatic stress symptoms in patients discharged after intensive care treatment. Full text in Research Archive
• Lindberg, Maren Falch; Rustøen, Tone; Rosseland, Leiv Arne & Lerdal, Anners (2018). Preoperative prediktorer for smerteforløp og livskvalitet etter kneproteseoperasjon. Full text in Research Archive
• Borchgrevink, Petter Chr. & Rustøen, Tone (2018). The prevalence of recurrent pain in childhood is high and increases with age. Scandinavian Journal of Pain. ISSN 1877-8860. 18(3), p. 341–342. doi: 10.1515/sjpain-2018-0099. Full text in Research Archive
• Skarsvaag, Torhild; Wahba, Alexander; Oksholm, Trine; Rustøen, Tone & Gjeilo, Kari Hanne (2018). Helserelatert livskvalitet ett år etter lungekreftoperasjon - en sammenligning med preoperativ status. Full text in Research Archive
• Lindberg, Maren Falch; Rustøen, Tone; Rosseland, Leiv Arne & Lerdal, Anners (2018). Smerter ved gange og selvrapportert helse etter innsatt kneprotese. Full text in Research Archive
• Tøien, Kirsti; Rustøen, Tone & Sunde, Kjetil (2018). Effect of nurse led intervention to reduce post traumatic stress symptoms in patients discharged after intensive care treatment. Full text in Research Archive
• Rognsvåg, Turid; Lindberg, Maren Falch; Borchgrevink, Petter Chr.; Furnes, Ove; Gay, Caryl & Holm, Inger [Show all 13 contributors for this article] (2018). Multi-Knee Trial. En feasibilty-studie av en intervensjon for artrosepasienter med økt risiko for langvarige smerter etter operasjon med kneprotese. Full text in Research Archive
• Valsø, Åse; Rustøen, Tone; Sunde, Kjetil & Tøien, Kirsti (2017). Association between post traumatic stress symptoms and sense of coherence in intensive care unit patients" (Oral presentation). Full text in Research Archive
• Kyte, Kristin; Rustøen, Tone; Ekstedt, Mirijam & Oksholm, Trine (2017). Social support after Lung Cancer Surgery. Full text in Research Archive
• Astrup, Guro Lindviksmoen & Rustøen, Tone (2017). Symptomprofiler hos pasienter med kreft. Best Practice Onkologi/Hematologi. 7(31), p. 36–38. Full text in Research Archive
• Alfheim, Hanne Birgit; Hofsø, Kristin; Rosseland, Leiv Arne & Rustøen, Tone (2017). Multiple symptoms in family caregivers of intensive care patients. Full text in Research Archive
• Smeland, Anja Hetland; Twycross, Alison; Lundeberg, Stefan; Reinertsen, Hanne; Nybro, Lill & Næss, Torgun [Show all 8 contributors for this article] (2017). Pediatric Postoperative Pain Management. Development of tailored Educational Intervention to Improve Practice. Full text in Research Archive
• Christensen, Vivi Lycke; Holm, Are Martin; Miaskowski, Christine & Rustøen, Tone (2017). Symptomer hos pasienter med kronisk obstruktiv lungesykdom (KOLS). Full text in Research Archive
• Christensen, Vivi Lycke; Holm, Are Martin; Kongerud, Johny; Bentsen, Signe Berit; Paul, Steven M & Miaskowski, Christine [Show all 8 contributors for this article] (2017). Smerter hos pasienter med kronisk obstruktiv lungesykdom (KOLS). Full text in Research Archive
• Smeland, Anja Hetland; Twycross, Alison; Lundeberg, Stefan; Reinertsen, Hanne; Nybro, Lill & Næss, Torgun [Show all 9 contributors for this article] (2017). Pediatric Postoperative Pain Management. Children`s views about pain after surgery: A qualitative study. Full text in Research Archive
• Smeland, Anja Hetland; Twycross, Alison; Lundeberg, Stefan; Reinertsen, Hanne; Nybro, Lill & Næss, Torgun [Show all 8 contributors for this article] (2017). Pediatric Postoperative Pain Management. Nurses`knowledge, Attitudes and Clinical Practice in Recovery Units. Full text in Research Archive
• Tøien, Kirsti; Rustøen, Tone & Sunde, Kjetil (2017). Association between post traumatic stress symptoms and sense of coherence in intensive care unit patients. Full text in Research Archive
• Valsø, Åse; Rustøen, Tone; Sunde, Kjetil & Tøien, Kirsti (2016). "Association between posttraumatic stress symptoms and sense of coherence in intensive care patients". Full text in Research Archive
• Oksholm, Trine & Rustøen, Tone (2016). Social Support and Number of Symptoms One Month after Lung Cancer Surgery. Full text in Research Archive
• Alfheim, Hanne Birgit; Rosseland, Leiv Arne & Rustøen, Tone (2016). Symptombelastning hos pårørende til intensivpasienter. Full text in Research Archive
• Alfheim, Hanne Birgit; Hofsø, Kristin; Rosseland, Leiv Arne & Rustøen, Tone (2016). Symptombelastning hos pårørende til intensivpasienter. Full text in Research Archive
• Lindberg, Maren Falch; Rustøen, Tone; Rosseland, Leiv Arne & Lerdal, Anners (2016). Prediktorer for nedsatt gangfunksjon ett år etter innsatt kneprotese – en subgruppeanalyse. Full text in Research Archive
• Astrup, Guro Lindviksmoen; Rustøen, Tone & Bjordal, Kristin (2016). Depressive symptoms and pain in patients with head and neck cancer who undergo radiotherapy. Full text in Research Archive
• Lindberg, Maren Falch; Kornilov, Nikolai; Saraev, Alexander; Rosseland, Leiv Arne; Rustøen, Tone & Miaskowski, Christine [Show all 8 contributors for this article] (2016). Pain trajectories and patient satisfaction after TKA: results of a two-center Russian-Norwegian study. Full text in Research Archive
• Lindberg, Maren Falch; Miaskowski, Christine; Rustøen, Tone; Rosseland, Leiv Arne; Cooper, Bruce A. & Lerdal, Anners (2016). Trajectories of pain with walking after total knee arthroplasty in two subgroups of patients. Full text in Research Archive
• Rustøen, Tone (2016). Low back pain among nurses: Common cause of lost days at work and contributing to the worldwide shortage of nurses. Scandinavian Journal of Pain. ISSN 1877-8860. 11, p. 135–135. Full text in Research Archive
• Olsen, Brita Fosser; Rustøen, Tone; Jacobsen, Morten B. & Valeberg, Berit Taraldsen (2016). Sykepleiernes bruk av en algoritme for smertebehandling hos intensivpasienter. Full text in Research Archive
• Tøien, Kristine; Rustøen, Tone; Skogstad, Laila; Schou-Bredal, Inger; Sunde, Kjetil & Ekeberg, Øivind [Show all 11 contributors for this article] (2016). Association between posttraumatic stress symptoms and sense of coherence in intensive care patients. Full text in Research Archive
• Tøien, Kirsti; Rustøen, Tone; Skogstad, Laila; Hagen, Milada Småstuen; Sunde, Kjetil & Schou-Bredal, Inger [Show all 8 contributors for this article] (2016). Association between posttraumatic stress symptoms and sense of coherence in intensive care patients. Full text in Research Archive
• Lindberg, Maren Falch; Rustøen, Tone; Rosseland, Leiv Arne & Lerdal, Anners (2016). Smertepåvirkning av gangfunksjon gjennom det første året etter innsatt total kneprotese. Full text in Research Archive
• Lindberg, Maren Falch; Miaskowski, Christine; Rustøen, Tone; Rosseland, Leiv Arne; Paul, Steven M. & Cooper, Bruce A. [Show all 7 contributors for this article] (2016). Trajectories of pain, interference With function and quality of life after total knee arthroplasty. Full text in Research Archive
• Rustøen, Tone (2016). Smerte og smertehåndtering i akutte situasjoner - utfordringer og nye tilnærminger. Full text in Research Archive
• Rustøen, Tone (2016). Sykepleieforskning i Helse Sør-Øst. Full text in Research Archive
• Rustøen, Tone (2016). Smerter hos ulike pasientgrupper. Full text in Research Archive
• Oksholm, Trine & Rustøen, Tone (2015). Symptomer hos lungekreftpasient før og etter operasjon. Best Practice Norge. Onkologi/hemtologi. p. 16–17. Full text in Research Archive
• Westgård, Therese; Halle, Ingrid; Gjeilo, Kari Hanne; Oksholm, Trine; Rustøen, Tone & Wahba, Alexander (2015). Søvn og søvnforstyrrelser hos lungekreftpasienter før og etter kirurgi. Vitenskapelige forhandlinger - De norske kirurgiske foreninger. ISSN 0801-5902. p. 201–201. Full text in Research Archive
• Rustøen, Tone (2015). Smerte og andre symptomer - når helheten blir mer en delene. Full text in Research Archive
• Bjørnnes, Ann Kristin; Lie, Irene; Rustøen, Tone; Stubbhaug, Audun & Leegaard, Marit (2015). A randomized cntrollend trial of the effectiveness of an educational intervention to enhance patients`pain management after Cardiac surgery. Full text in Research Archive
• Valeberg, Berit Taraldsen & Rustøen, Tone (2015). Comparison of Oncology Patients' and Their Family Caregivers' Attitudes and Concerns Toward Pain and Pain Management. Full text in Research Archive
• Rustøen, Tone (2015). Pårørende = pasient-rapporterte mål? Full text in Research Archive
• Rustøen, Tone (2015). Nursing and chronic pain. Full text in Research Archive
• Oksholm, Trine; Rustøen, Tone & Ekstedt, Mirjam (2015). Changes in symptom occurrence rates from before through 12 months following lung cancer surgery. Full text in Research Archive
• Olsen, Brita Fosser; Rustøen, Tone; Sandvik, Leiv; Miaskowski, Christine; Jacobsen, Morten & Valeberg, Berit Taraldsen (2015). Nurses’ adherence with using a pain assessment algorithm in intensive care unit patients. Full text in Research Archive
• Rustøen, Tone (2015). Sykepleieforskning ved OUS. Full text in Research Archive
• Lindberg, Maren Kristin Falch; Miaskowski, Christine; Rustøen, Tone; Rosseland, Leiv Arne; Cooper, Bruce A. & Lerdal, Anners (2015). Pain trajectories after total knee replacement. Full text in Research Archive
• Lindberg, Maren Kristin Falch; Miaskowski, Christine; Rustøen, Tone; Rosseland, Leiv Arne; Paul, Steven M & Cooper, Bruce A. [Show all 7 contributors for this article] (2015). Trajectories of pain, interference with function and quality of life after total knee arthroplasty. Full text in Research Archive
• Røhrl, Kari; Guren, Marianne & Rustøen, Tone (2015). Symptom burden in colorectal cancer patient at start of chemotherapy. Full text in Research Archive
• Rustøen, Tone (2015). Hva har skjedd etter PhD? Har det skjedd endring i pasientbehandlingen? Full text in Research Archive
• Rustøen, Tone (2015). Sykepleieforskning - et sykehusperspektiv. Full text in Research Archive
• Rustøen, Tone (2015). Forskning blant sykepleiere - hva får oss opp om morgenen? Full text in Research Archive
• Rustøen, Tone (2015). Pasienten med smerte og sykepleieren - hvor viktig er relasjonen? Full text in Research Archive
• Rustøen, Tone (2015). Oppbygging av robuste forskningsmiljøer. Full text in Research Archive
• Rustøen, Tone (2015). Hvordan starte og drive forskning blant sykepleiere - og hvordan kan klinikken bruke kompetansen i hverdagen? Full text in Research Archive
• Oksholm, Trine; Rustøen, Tone; Miaskowski, Christine; Paul, Steven; Solberg, Steinar & Cooper, Bruce A. [Show all 7 contributors for this article] (2014). Changes in symptoms from before to five months after lung cancer surgery. Full text in Research Archive
• Rustøen, Tone (2014). Kritisk vurdering av vitenskapelige arbeid. Full text in Research Archive
• Nordheim, Trond; Rustøen, Tone & Nakstad, Britt (2014). Quality of Life for Parents of Very-Low Birth Weight Infants Enrolled in a Clinical Study. Full text in Research Archive
• Astrup, Guro Lindviksmoen; Rustøen, Tone; Bjordal, Kristin; Miaskowski, Christine & Paul, Steven M. (2014). Depressive symptoms in patients with head and neck cancer who undergo radiotherapy. Full text in Research Archive
• Astrup, Guro Lindviksmoen; Rustøen, Tone; Bjordal, Kristin; Miaskowski, Christine & Paul, Steven M. (2014). Pain occurrence, intensity, interference with function, and relief in patients with head and neck cancer who undergo radiotherapy. Full text in Research Archive
• Christensen, Vivi Lycke; Holm, Are Martin; Miaskowski, Christine; Aouizerat, Bradley E & Rustøen, Tone (2014). Characteristics and predictors of pain in patients with chronic obstructive pulmonary disease. Full text in Research Archive
• Rustøen, Tone & Utne, Inger (2014). Herth Hope Index. In Michalos, Alex C. (Eds.), Encyclopedia of Quality of Life and Well-Being Research. Springer. ISSN 9789400707528. p. 2853–2856. Full text in Research Archive
• Nyhagen, Ragnhild; Kirkevold, Marit; Rustøen, Tone & Lerdal, Anners (2025). Symptom Communication in the Intensive Care Unit: An Exploration Through Participant Observation and Individual Interviews with Patients, Family Members, and Clinicians. Universitetet i Oslo. ISSN 9788234806049. Full text in Research Archive Show summary

  Symptom distress is a major concern for patients in intensive care units (ICU), and common symptoms include pain, anxiety, dyspnoea, thirst, and tiredness. Symptoms are subjective experiences that cannot be monitored or measured objectively but must somehow be communicated by the patient. Communication in the ICU is challenged due to intubation, treatment, and illness, and challenges to communication cause challenges to symptom assessment and management. The aim of this fieldwork study was to explore symptom communication between patients, family members, and clinicians in the ICU to identify communication challenges, patterns of symptom communication, and forms of family engagement. Mechanically ventilated patients were observed in interaction with family and clinicians. Following participant observation, the same patients, and a sample of family members and clinicians were interviewed individually, providing a combination of perspectives not previously explored in research on symptom communication in the ICU. This thesis shows how clinicians, through vigilance and behaviour, used clinical expertise to foresee possible symptoms, prevent and manage them when necessary, but it also shows when symptom communication failed to be successful. Family members took an active role in symptom communication, and patients described them as extremely important. The serious condition of patients caused communication challenges beyond lack of speech, some of which were not evident until the findings from the participant observation and interviews with patients, family members, and clinicians were combined. Due to the complexity of symptoms, assessment tools and task-oriented communication are insufficient to provide clinicians with the full symptom experience of patients, and patients are left with unrelieved symptoms.

• Lindberg, Maren Falch; Lerdal, Anners; Rustøen, Tone & Rosseland, Leiv Arne (2017). Factors that predict the trajectories of aucte pain, pain with walking, and self-rated health after total knee arthroplasty - a longitudinal study. Reprosentralen, Universitetet i Oslo. ISSN 9788283771220. Full text in Research Archive
• Oksholm, Trine; Rustøen, Tone & Kongerud, Johny (2016). Patients’ symptom experiences before and after lung cancer surgery - predictors of patients’ symptom burden. Universitetet i Oslo. Full text in Research Archive Show summary

  The purpose of this study was to explore multiple symptoms in lung cancer patients before and after surgery and to identify predictors of patients’ symptom burden (including age). In total, 264 lung cancer patients were recruited from 3 university hospitals. They completed questionnaires preoperatively, and 1 and 5 months after surgery. The study revealed that patients’ experienced a mean of 10 symptoms before surgery, with only small differences in the older patients compared to the younger ones (>65 years). When comparing the occurrence of symptoms before and after surgery, there was a significant increase in the mean number of symptoms at 1 month. However, the only characteristic that was associated with a higher number of symptoms 1 month after surgery was the number of symptoms reported before surgery. At 5 months, the number of symptoms was reduced compared to the 1 month assessment, but it was still significantly higher compared to the preoperative assessment. A total of 79% of the patients experienced shortness of breath (SOB) 5 months after surgery, while 71% experienced lack of energy, and 56% reported pain. Some of the symptoms were intense. Our findings show that patients with more comorbidities and a higher number of preoperative symptoms need special attention, as they tend to experience a higher number of postoperative symptoms. Even though it is recommended in guidelines, only 32% of the patients had physical therapy after surgery and 16% had inpatient rehabilitation. While 30% of the patients were working preoperatively, only 9% worked at 5 months. This study provides important information about the symptom burden of patients that underwent lung cancer surgery, and about the most vulnerable patients. The results can be used to educate patients about the normal course of postoperative recovery. Clinicians need to perform a comprehensive symptom assessment prior to surgery and at regular intervals after surgery.

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