Tone Rustøen

• Løvås, Ina; Landmark, Tormod; Rustøen, Tone; Vedul-Kjelsås, Einar; Butler, Stephen H. & Glette, Mari [Vis alle 7 forfattere av denne artikkelen] (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), s. 1–7. doi: 10.1016/j.esmoop.2026.108579. Fulltekst i vitenarkiv
• 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. Fulltekst i vitenarkiv
• Myrenget, Martin Elstad; Sandvik, Reidun Karin Norheim Myhre; Borchgrevink, Petter Christian; Selbæk, Geir; Småstuen, Milada & Rangul, Vegar [Vis alle 10 forfattere av denne artikkelen] (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, s. 1–11. doi: 10.1186/s12877-026-07301-4. Fulltekst i vitenarkiv Vis sammendrag

  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. Fulltekst i vitenarkiv
• 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, s. 26–33. doi: 10.1016/j.hrtlng.2025.09.004. Fulltekst i vitenarkiv
• 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), s. 101484–101484. doi: 10.1016/j.aucc.2025.101484. Fulltekst i vitenarkiv Vis sammendrag

  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. Fulltekst i vitenarkiv Vis sammendrag

  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, s. 1260–1270. doi: 10.1007/s00134-025-07995-x. Fulltekst i vitenarkiv Vis sammendrag

  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. Fulltekst i vitenarkiv Vis sammendrag

  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), s. 701–709. doi: 10.1016/j.aucc.2024.03.003. Fulltekst i vitenarkiv
• 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, s. 1–8. doi: 10.1016/j.iccn.2024.103761. Fulltekst i vitenarkiv Vis sammendrag

  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), s. 111–122. doi: 10.1097/DCC.0000000000000637. Fulltekst i vitenarkiv
• Högvall, Lisa; Herling, Suzanne Forsyth; Egerod, Ingrid; Petosic, Antonija; Danielsen, Mette Elisabeth Riise & Rüdiger, Uta [Vis alle 8 forfattere av denne artikkelen] (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. Fulltekst i vitenarkiv
• 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. Fulltekst i vitenarkiv
• Friberg, Klara Sofia; Hofsø, Kristin; Rustøen, Tone; Ræder, Johan; Hagen, Milada & Puntillo, Kathleen [Vis alle 7 forfattere av denne artikkelen] (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, s. 223–229. doi: 10.1016/j.hrtlng.2024.12.003. Fulltekst i vitenarkiv Vis sammendrag

  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), s. 843–850. doi: 10.1016/j.aucc.2023.11.008. Fulltekst i vitenarkiv
• Myrenget, Martin Elstad; Rustøen, Tone; Myskja, Audun X.; Småstuen, Milada Cvancarova; Rangul, Vegar & Håpnes, Odd Sigfast [Vis alle 11 forfattere av denne artikkelen] (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), s. 1550–1558. doi: 10.1097/j.pain.0000000000003156. Fulltekst i vitenarkiv Vis sammendrag

  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 [Vis alle 7 forfattere av denne artikkelen] (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, s. 1–8. doi: 10.1016/j.hrtlng.2024.02.011. Fulltekst i vitenarkiv Vis sammendrag

  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. Fulltekst i vitenarkiv Vis sammendrag

  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), s. 120–126. doi: 10.1016/j.aucc.2023.07.037. Fulltekst i vitenarkiv
• 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. Fulltekst i vitenarkiv Vis sammendrag

  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. Fulltekst i vitenarkiv Vis sammendrag

  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 [Vis alle 7 forfattere av denne artikkelen] (2023). Self-reported symptoms experienced by intensive care unit patients: a prospective observational multicenter study. Intensive Care Medicine. ISSN 0342-4642. 49(11), s. 1370–1382. doi: 10.1007/s00134-023-07219-0. Fulltekst i vitenarkiv Vis sammendrag

  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. Fulltekst i vitenarkiv
• Dokken, Mette; Rustøen, Tone; Diep, Lien My; Fagermoen, Frode Even; Huse, Rakel Iren & Egerod, Ingrid [Vis alle 7 forfattere av denne artikkelen] (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. Fulltekst i vitenarkiv
• 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. Fulltekst i vitenarkiv
• 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. Fulltekst i vitenarkiv
• 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. s. 1–8. doi: 10.1016/j.aucc.2022.01.006. Fulltekst i vitenarkiv Vis sammendrag

  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 [Vis alle 7 forfattere av denne artikkelen] (2022). Chronic pain conditions and use of analgesics among nursing home patients with dementia. Pain. ISSN 0304-3959. 164(5), s. 1002–1011. doi: 10.1097/j.pain.0000000000002794. Fulltekst i vitenarkiv
• 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), s. 469–478. doi: 10.1002/nop2.1312. Fulltekst i vitenarkiv Vis sammendrag

  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. Fulltekst i vitenarkiv
• 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, s. 1–8. doi: 10.1016/j.rmed.2022.106944. Fulltekst i vitenarkiv Vis sammendrag

  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 [Vis alle 8 forfattere av denne artikkelen] (2021). Iatrogenic withdrawal syndrome frequently occurs in paediatric intensive care without algorithm for tapering of analgosedation. Acta Anaesthesiologica Scandinavica. ISSN 0001-5172. 65(7), s. 928–935. doi: 10.1111/aas.13818. Fulltekst i vitenarkiv
• 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), s. 1–9. doi: 10.1111/aas.14015. Fulltekst i vitenarkiv Vis sammendrag

  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 [Vis alle 9 forfattere av denne artikkelen] (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), s. 618–628. doi: 10.1111/aas.13785. Fulltekst i vitenarkiv Vis sammendrag

  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), s. 1046–1059. doi: 10.1111/jocn.15650. Fulltekst i vitenarkiv Vis sammendrag

  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. Fulltekst i vitenarkiv
• Lindberg, Maren Falch; Aamodt, Arild; Badawy, Mona; Bergvad, Ingvild Buset; Borchgrevink, Petter Chr. & Furnes, Ove Nord [Vis alle 21 forfattere av denne artikkelen] (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, s. 1–14. doi: 10.1186/s12891-021-04924-z. Fulltekst i vitenarkiv Vis sammendrag

  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), s. 1132–1143. doi: 10.1111/jocn.15659. Fulltekst i vitenarkiv Vis sammendrag

  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 [Vis alle 8 forfattere av denne artikkelen] (2021). Occurrence and characteristics of pain after ICU discharge: A longitudinal study. Nursing in Critical Care. ISSN 1362-1017. s. 1–10. doi: 10.1111/nicc.12701. Fulltekst i vitenarkiv
• 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), s. 543–548. doi: 10.1016/j.pmn.2020.05.006. Fulltekst i vitenarkiv Vis sammendrag

  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. s. 1–13. doi: 10.1002/ejp.1703. Fulltekst i vitenarkiv Vis sammendrag

  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. Fulltekst i vitenarkiv Vis sammendrag

  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 [Vis alle 10 forfattere av denne artikkelen] (2020). Hypogammaglobulinemia and risk of exacerbation and mortality in patients with COPD. The International Journal of Chronic Obstructive Pulmonary Disease. ISSN 1176-9106. 15, s. 799–807. doi: 10.2147/COPD.S236656. Fulltekst i vitenarkiv Vis sammendrag

  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), s. 1–10. doi: 10.1111/ecc.13311. Fulltekst i vitenarkiv
• 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), s. 224–231. doi: 10.1002/nop2.621. Fulltekst i vitenarkiv Vis sammendrag

  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 [Vis alle 9 forfattere av denne artikkelen] (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), s. 1218–1225. doi: 10.1097/CCM.0000000000004628. Fulltekst i vitenarkiv Vis sammendrag

  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), s. 663–676. doi: 10.1111/jocn.14662. Fulltekst i vitenarkiv
• 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. Fulltekst i vitenarkiv
• 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), s. 1–9. doi: 10.1136/bmjopen-2018-028192. Fulltekst i vitenarkiv Vis sammendrag

  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), s. E1–E7. doi: 10.1097/NCQ.0000000000000318. Fulltekst i vitenarkiv
• 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. s. 1–12. doi: 10.1016/j.jpainsymman.2019.11.004. Fulltekst i vitenarkiv Vis sammendrag

  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. Fulltekst i vitenarkiv
• 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, s. 753–760. doi: 10.1016/j.jpainsymman.2018.12.334. Fulltekst i vitenarkiv
• Sørensen, Erik Elgaard; Kusk, Kathrine Hoffmann; Athlin, Asa Muntlin; Lode, Kirsten; Rustøen, Tone & Salmela, Susanne [Vis alle 7 forfattere av denne artikkelen] (2019). The role of PhD-prepared, hospital-based nurses: an inter-Nordic study. Journal of Research in Nursing. ISSN 1744-9871. 24(7), s. 470–485. doi: 10.1177/1744987119877213. Fulltekst i vitenarkiv
• Smeland, Anja Hetland; Rustøen, Tone; Næss, Torgun; Nybro, Lill; Lundeberg, Stefan & Reinertsen, Hanne [Vis alle 8 forfattere av denne artikkelen] (2019). Children's views on postsurgical pain in recovery units in Norway: A qualitative study. Journal of Clinical Nursing (JCN). ISSN 0962-1067. 28, s. 2157–2170. doi: 10.1111/jocn.14788. Fulltekst i vitenarkiv Vis sammendrag

  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), s. 3007–3017. doi: 10.1007/s00520-018-4598-y. Fulltekst i vitenarkiv
• Valsø, Åse; Rustøen, Tone; Skogstad, Laila; Bredal, Inger Schou; Ekeberg, Øivind & Småstuen, Milada Cvancarova [Vis alle 9 forfattere av denne artikkelen] (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), s. 117–125. doi: 10.1111/nicc.12466. Fulltekst i vitenarkiv
• 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), s. 490–503. doi: 10.1111/jan.14271. Fulltekst i vitenarkiv
• Bentsen, Signe Berit; Miaskowski, Christine; Cooper, Bruce A.; Christensen, Vivi Lycke; Henriksen, Anne Hildur & Holm, Are Martin [Vis alle 7 forfattere av denne artikkelen] (2018). Distinct pain profiles in patients with chronic obstructive pulmonary disease. The International Journal of Chronic Obstructive Pulmonary Disease. ISSN 1176-9106. 13(13), s. 801–811. doi: 10.2147/COPD.S150114. Fulltekst i vitenarkiv Vis sammendrag

  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, s. 1–10. doi: 10.1186/s12955-018-1025-5. Fulltekst i vitenarkiv Vis sammendrag

  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. Fulltekst i vitenarkiv Vis sammendrag

  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. s. 1–21. doi: 10.4220/sykepleienf.2018.71442. Fulltekst i vitenarkiv Vis sammendrag

  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), s. 48–54. doi: 10.1111/nicc.12330. Fulltekst i vitenarkiv
• 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), s. 724–733. doi: 10.1111/jan.13487. Fulltekst i vitenarkiv

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• Rustøen, Tone & Lerdal, Anners (2021). Klinisk forskning innen helsefag. Fagbokforlaget. ISBN 9788245022926. 256 s. Fulltekst i vitenarkiv

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• Friberg, Klara; Hofsø, Kristin; Rustøen, Tone; Ræder, Johan; Hagen, Milada & Puntillo, Kathleen [Vis alle 7 forfattere av denne artikkelen] (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, s. 83–84. doi: 10.1016/j.hrtlng.2025.04.001. Fulltekst i vitenarkiv
• Rustøen, Tone (2025). Symptomhåndtering er en av de viktigste sykepleieroppgavene. Tidsskriftet sykepleien. ISSN 0806-7511. doi: 10.4220/Sykepleiens.2025.98098. Fulltekst i vitenarkiv
• Debesay, Jonas & Rustøen, Tone (2025). Vi må snakke om vilkårene for de «varme hendene». Sykepleien. ISSN 0039-7628. Fulltekst i vitenarkiv
• 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. Fulltekst i vitenarkiv
• Myrenget, Martin Elstad; Rustøen, Tone; Myskja, Audun; Småstuen, Milada Cvancarova; Rangul, Vegar & Håpnes, Odd Sigfast [Vis alle 11 forfattere av denne artikkelen] (2024). Reply to Kajiwara et al. Pain. ISSN 0304-3959. 165(8), s. 1890–1891. doi: 10.1097/j.pain.0000000000003236. Fulltekst i vitenarkiv
• 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. Fulltekst i vitenarkiv
• 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. Fulltekst i vitenarkiv
• 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? Fulltekst i vitenarkiv
• 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. Fulltekst i vitenarkiv
• 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. Fulltekst i vitenarkiv
• Hofsø, Kristin; Rosseland, Leiv Arne & Rustøen, Tone (2023). Symptoms, post-traumatic stress and quality of life in family caregivers of ICU patients. Fulltekst i vitenarkiv
• Gustad, Lise Tuset; Rustøen, Tone & Debesay, Jonas (2023). Sykepleiere som underviser og forsker, har ikke forlatt yrket. Fulltekst i vitenarkiv
• 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. Fulltekst i vitenarkiv
• 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. Fulltekst i vitenarkiv
• Austenå, Mona; Rustøen, Tone; Småstuen, Milada Cvancarova; Valsø, Åse; Sunde, Kjetil & Tøien, Kirsti (2022). Return to work first year after intensiv care treatment. Fulltekst i vitenarkiv
• 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. Fulltekst i vitenarkiv
• 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), s. e063006–e063006. doi: 10.1136/bmjopen-2022-063006. Fulltekst i vitenarkiv
• Rustøen, Tone & Lerdal, Anners (2021). Finansiering av forskning. I Rustøen, Tone & Lerdal, Anners (Red.), Klinisk forskning innen helsefag. Fagbokforlaget. ISSN 9788245022926. s. 239–247. Fulltekst i vitenarkiv
• Lerdal, Anners & Rustøen, Tone (2021). Hvordan skrive en god forskningssøknad. I Rustøen, Tone & Lerdal, Anners (Red.), Klinisk forskning innen helsefag. Fagbokforlaget. ISSN 9788245022926. s. 225–238. Fulltekst i vitenarkiv
• Lerdal, Anners & Rustøen, Tone (2021). Hvordan bygge formell kompetanse og skrive en CV. I Rustøen, Tone & Lerdal, Anners (Red.), Klinisk forskning innen helsefag. Fagbokforlaget. ISSN 9788245022926. s. 153–159. Fulltekst i vitenarkiv
• Rustøen, Tone & Lerdal, Anners (2021). Noen forskningsdesign ved evaluering av intervensjoner eller kliniske tiltak. I Rustøen, Tone & Lerdal, Anners (Red.), Klinisk forskning innen helsefag. Fagbokforlaget. ISSN 9788245022926. s. 106–123. Fulltekst i vitenarkiv
• Cappelen, Kathrine & Rustøen, Tone (2021). Forskning i kommunale helse- og omsorgstjenester og spesialisthelsetjenesten. I Rustøen, Tone & Lerdal, Anners (Red.), Klinisk forskning innen helsefag. Fagbokforlaget. ISSN 9788245022926. s. 21–36. Fulltekst i vitenarkiv
• Lerdal, Anners & Rustøen, Tone (2021). Formidling av forskning. I Rustøen, Tone & Lerdal, Anners (Red.), Klinisk forskning innen helsefag. Fagbokforlaget. ISSN 9788245022926. s. 52–70. Fulltekst i vitenarkiv
• Rustøen, Tone & Lerdal, Anners (2021). Hvordan bygge opp gode forskningsgrupper og sterke miljøer for forskning. I Rustøen, Tone & Lerdal, Anners (Red.), Klinisk forskning innen helsefag. Fagbokforlaget. ISSN 9788245022926. s. 71–84. Fulltekst i vitenarkiv
• 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. Fulltekst i vitenarkiv
• 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. Fulltekst i vitenarkiv
• Gjeilo, Kari Hanne; Oksholm, Trine; Follestad, Turid; Wahba, Alexander & Rustøen, Tone (2021). Trajectories of pain in patients undergoing lung cancer surgery: a longitudinal study. Fulltekst i vitenarkiv
• 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), s. e4–e5. doi: 10.1016/j.jpainsymman.2020.01.016. Fulltekst i vitenarkiv
• 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. Fulltekst i vitenarkiv
• Lindberg, Maren Falch; Rognsvåg, Turid; Badawy, Mona; Borchgrevink, Petter Chr.; Furnes, Ove & Gay, Caryl [Vis alle 13 forfattere av denne artikkelen] (2019). Optimal behandling av artrosepasienter - en feasibilitystudie (MultiKnee trial). Fulltekst i vitenarkiv
• 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. Fulltekst i vitenarkiv
• Lindberg, Maren Falch; Rustøen, Tone; Rosseland, Leiv Arne & Lerdal, Anners (2018). Preoperative prediktorer for smerteforløp og livskvalitet etter kneproteseoperasjon. Fulltekst i vitenarkiv
• 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. Fulltekst i vitenarkiv Vis sammendrag

  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.

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