{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,31]],"date-time":"2026-07-31T19:43:05Z","timestamp":1785526985004,"version":"3.56.0"},"reference-count":38,"publisher":"Wiley","issue":"6","license":[{"start":{"date-parts":[[2025,11,17]],"date-time":"2025-11-17T00:00:00Z","timestamp":1763337600000},"content-version":"vor","delay-in-days":16,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2025,11,1]],"date-time":"2025-11-01T00:00:00Z","timestamp":1761955200000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Nursing in Critical Care"],"published-print":{"date-parts":[[2025,11]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Intensive care units (ICUs) often operate near full capacity, limiting flexibility during crises. As geopolitical instability increases in Europe, healthcare systems must be prepared to expand and adapt under extreme pressure.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Aim<\/jats:title>\n                    <jats:p>To explore how ICU staff in Sweden\u2014a country with traditionally low disaster preparedness\u2014managed a near\u2010disaster situation and identify lessons for future crises.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Study Design<\/jats:title>\n                    <jats:p>A qualitative descriptive study using semi\u2010structured interviews and inductive content analysis. Eleven ICU staff members (anaesthesiologists, ICU nurses and nurse assistants) from three Stockholm hospitals were interviewed about their experiences during the 2020 COVID\u201019 surge.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Three main domains emerged: organisational, team and individual levels. Participants described chaotic ICU expansions, limited supplies and unfamiliar equipment. Inconsistent staff continuity and lack of onboarding for redeployed personnel created stress and hindered care. Moral distress was widespread, fuelled by an overwhelming workload and poor recovery conditions. A voluntary emergency contract helped maintain staffing levels and morale. ICU staff took on leadership roles, educated peers and created ad hoc systems to manage extreme conditions\u2014sometimes while wearing military\u2010grade gas masks. While peer support strengthened team cohesion, feelings of isolation and professional fragmentation also emerged.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Near\u2010disaster conditions require visible local leadership, clear communication and a governance model that integrates frontline expertise. Rapid onboarding, scalable mental health support and clearly defined disaster activation protocols are key to system resilience.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Relevance to Clinical Practice<\/jats:title>\n                    <jats:p>ICU staff must be equipped to lead in crisis. Empowering experienced personnel to guide redeployed teams, ensuring rest and recovery opportunities and supporting staff psychologically can mitigate long\u2010term harm. This study provides practical insights for near\u2010disaster preparedness in high\u2010income, low\u2010readiness settings and supports the development of ICU protocols that balance hierarchical leadership with clinical agility.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/nicc.70251","type":"journal-article","created":{"date-parts":[[2025,11,17]],"date-time":"2025-11-17T10:37:21Z","timestamp":1763375841000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Beyond Capacity: Resilience of Intensive Care Staff During the\n                    <scp>COVID<\/scp>\n                    \u201019\u2010Related Near\u2010Disaster in Sweden"],"prefix":"10.1111","volume":"30","author":[{"given":"Per Kolton","family":"Nyberg","sequence":"first","affiliation":[{"name":"Department of Anesthesia and Intensive Care S\u00f6dersjukhuset  Stockholm Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2372-6114","authenticated-orcid":false,"given":"Mattias","family":"G\u00fcnther","sequence":"additional","affiliation":[{"name":"Department of Anesthesia and Intensive Care S\u00f6dersjukhuset  Stockholm Sweden"},{"name":"Department of Clinical Science and Education S\u00f6dersjukhuset, Karolinska Institutet  Stockholm Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9170-581X","authenticated-orcid":false,"given":"Ami","family":"Fagerdahl","sequence":"additional","affiliation":[{"name":"Department of Clinical Science and Education S\u00f6dersjukhuset, Karolinska Institutet  Stockholm Sweden"},{"name":"Wound Centre, S\u00f6dersjukhuset  Stockholm Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5245-7668","authenticated-orcid":false,"given":"Andreas","family":"\u00c4lg\u00e5","sequence":"additional","affiliation":[{"name":"Department of Clinical Science and Education S\u00f6dersjukhuset, Karolinska Institutet  Stockholm Sweden"},{"name":"Department of Surgery S\u00f6dersjukhuset  Stockholm Sweden"},{"name":"Department of Global Public Health Karolinska Institutet  Stockholm Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2025,11,17]]},"reference":[{"key":"e_1_2_15_2_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijdrr.2024.104412"},{"key":"e_1_2_15_3_1","doi-asserted-by":"publisher","DOI":"10.1186\/s13049-020-0701-8"},{"key":"e_1_2_15_4_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00134-023-07117-5"},{"key":"e_1_2_15_5_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00068-022-02170-z"},{"key":"e_1_2_15_6_1","doi-asserted-by":"publisher","DOI":"10.1097\/CCM.0b013e3182326440"},{"issue":"3","key":"e_1_2_15_7_1","first-page":"1","article-title":"Sample Size and Saturation in PhD Studies Using Qualitative Interviews","volume":"11","author":"Mason M.","year":"2010","journal-title":"Forum Qualitative Sozialforschung Forum: Qualitative Social Research"},{"key":"e_1_2_15_8_1","unstructured":"Statistikmyndigheten \u201cFolkm\u00e4ngd i Riket l\u00e4n och kommuner 31 december 2022 och befolkningsf\u00f6r\u00e4ndringar 2022 \u201d(2023) https:\/\/www.scb.se\/hitta\u2010statistik\/statistik\u2010efter\u2010amne\/befolkning\/befolkningens\u2010sammansattning\/befolkningsstatistik\/pong\/tabell\u2010och\u2010diagram\/folkmangd\u2010och\u2010befolkningsforandringar\u2010\u2010\u2010helarsstatistik\/folkmangd\u2010i\u2010riket\u2010lan\u2010och\u2010kommuner\u201031\u2010december\u20102022\u2010och\u2010befolkningsforandringar\u20102022\/."},{"key":"e_1_2_15_9_1","unstructured":"S\u00f6dersjukhuset \u201cFacts About S\u00f6dersjukhuset \u201d(2022) https:\/\/www.sodersjukhuset.se\/om\u2010sos\/fakta\u2010om\u2010sodersjukhuset\/."},{"key":"e_1_2_15_10_1","unstructured":"S.Sjukhus \u201cNow the New S\u00f6dert\u00e4lje Hospital is Inaugurated \u201d(2022) https:\/\/www.sodertaljesjukhus.se\/om\u2010oss\/pressrum\/nyheter\/nu\u2010invigs\u2010nya\u2010sodertalje\u2010sjukhus\/."},{"key":"e_1_2_15_11_1","unstructured":"D.Sjukhus \u201cAbout Us \u201d(2024) https:\/\/www.ds.se\/om\u2010oss\/om\u2010ds\/."},{"key":"e_1_2_15_12_1","unstructured":"Regioner SKo \u201cKrisl\u00e4gesavtal (KLA) \u201d(2023) https:\/\/skr.se\/skr\/arbetsgivarekollektivavtal\/kollektivavtal\/krislagesavtal.32467.html."},{"key":"e_1_2_15_13_1","volume-title":"Qualitative Research & Evaluation Methods","author":"Michael Quinn P.","year":"2002"},{"key":"e_1_2_15_14_1","unstructured":"SIR \u201cCOVID\u201019 in Swedish Intensive Care \u201dhttps:\/\/www.icuregswe.org\/en\/data\u2010\u2010results\/covid\u201019\u2010in\u2010swedish\u2010intensive\u2010care\/."},{"key":"e_1_2_15_15_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.nedt.2003.10.001"},{"key":"e_1_2_15_16_1","doi-asserted-by":"publisher","DOI":"10.5751\/ES-09491-220318"},{"key":"e_1_2_15_17_1","doi-asserted-by":"publisher","DOI":"10.1007\/978-3-319-57801-9"},{"key":"e_1_2_15_18_1","doi-asserted-by":"publisher","DOI":"10.1002\/jhrm.21441"},{"key":"e_1_2_15_19_1","doi-asserted-by":"publisher","DOI":"10.1080\/15265161.2020.1764141"},{"key":"e_1_2_15_20_1","unstructured":"Riksrevisionen \u201cStatens Insatser F\u00f6r Att S\u00e4kra Skyddsutrustning \u201d(2022) https:\/\/www.riksrevisionen.se\/download\/18.16a23c35180abe827e5f1550\/1652691086429\/RiR_2022_10_webb.pdf."},{"key":"e_1_2_15_21_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.aucc.2021.08.007"},{"key":"e_1_2_15_22_1","doi-asserted-by":"publisher","DOI":"10.3390\/ijerph21010029"},{"key":"e_1_2_15_23_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.aucc.2022.10.004"},{"key":"e_1_2_15_24_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12913-023-09209-w"},{"key":"e_1_2_15_25_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.xjep.2022.100550"},{"key":"e_1_2_15_26_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12910-023-00919-8"},{"key":"e_1_2_15_27_1","doi-asserted-by":"publisher","DOI":"10.1177\/1054773820920385"},{"key":"e_1_2_15_28_1","doi-asserted-by":"publisher","DOI":"10.1111\/nicc.12850"},{"key":"e_1_2_15_29_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00420-021-01670-6"},{"key":"e_1_2_15_30_1","doi-asserted-by":"publisher","DOI":"10.1097\/PCC.0000000000003119"},{"issue":"4","key":"e_1_2_15_31_1","first-page":"542","article-title":"Dilemmas of Moral Distress: Moral Responsibility and Nursing Practice","volume":"4","author":"Jameton A.","year":"1993","journal-title":"AWHONN's Clinical Issues in Perinatal and Women's Health Nursing"},{"key":"e_1_2_15_32_1","doi-asserted-by":"publisher","DOI":"10.1177\/0969733017724354"},{"key":"e_1_2_15_33_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.iccn.2022.103206"},{"key":"e_1_2_15_34_1","doi-asserted-by":"publisher","DOI":"10.3390\/ijerph18052258"},{"key":"e_1_2_15_35_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.pnpbp.2021.110299"},{"key":"e_1_2_15_36_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmjoq-2022-002009"},{"key":"e_1_2_15_37_1","doi-asserted-by":"publisher","DOI":"10.1186\/1741-7015-2-29"},{"key":"e_1_2_15_38_1","doi-asserted-by":"publisher","DOI":"10.1007\/s11606-016-3886-9"},{"key":"e_1_2_15_39_1","doi-asserted-by":"publisher","DOI":"10.3390\/ijerph18189453"}],"container-title":["Nursing in Critical Care"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/nicc.70251","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1111\/nicc.70251","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/nicc.70251","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,7,31]],"date-time":"2026-07-31T18:07:34Z","timestamp":1785521254000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1111\/nicc.70251"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,11]]},"references-count":38,"journal-issue":{"issue":"6","published-print":{"date-parts":[[2025,11]]}},"alternative-id":["10.1111\/nicc.70251"],"URL":"https:\/\/doi.org\/10.1111\/nicc.70251","archive":["Portico"],"relation":{},"ISSN":["1362-1017","1478-5153"],"issn-type":[{"value":"1362-1017","type":"print"},{"value":"1478-5153","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,11]]},"assertion":[{"value":"2025-07-29","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2025-10-16","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2025-11-17","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"e70251"}}