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Sample records for care units theory

  1. [Nursing care systematization at the intensive care unit (ICU) based on Wanda Horta's theory].

    Science.gov (United States)

    Amante, Lúcia Nazareth; Rossetto, Annelise Paula; Schneider, Dulcinéia Ghizoni

    2009-03-01

    The purpose of this study was to implement the Nursing Care Systematization--Sistematização da Assistência de Enfermagem (SAE)--with Wanda Aguiar Horta's Theory of Basic Human Necessities and the North American Nursing Diagnosis Association's (NANDA) Nursing Diagnosis as its references. The starting point was the evaluation of the knowledge of the nursing team about the SAE, including their participation in this process. This is a qualitative study, performed in the Intensive Care Unit in a hospital in the city of Brusque, Santa Catarina, from October, 2006 to March, 2007. It was observed that the nursing professionals know little about SAE, but they are greatly interested in learning and developing it in their daily practice. In conclusion, it was possible to execute the healthcare systematization in an easy way, with the use of simple brochures that provided all the necessary information for the qualified development of nursing care.

  2. Using Diffusion of Innovations Theory to implement the confusion assessment method for the intensive care unit.

    Science.gov (United States)

    Bowen, Constance Mary; Stanton, Marietta; Manno, Martin

    2012-01-01

    Routine screening of mechanically ventilated patients for delirium is essential for prompt recognition and management; however, this represents a change in practice. Rogers' Diffusion of Innovations Theory can be useful as a strategy to facilitate adoption of a practice change. This case study describes the effectiveness of identifying barriers to a change in practice and developing strategies, specific to Rogers' innovation decision process, for implementing the Confusion Assessment Method for the intensive care unit. PMID:22367153

  3. The underlying theories of health care reform in the United States--strategy implications for hospitals.

    Science.gov (United States)

    McLaughlin, Daniel B; Militello, Jack

    2011-01-01

    The United State Health Reform (Affordable Care Act) presents health provides with the goals that should be achieved in the reformed health care environment and rationale for those goals. Developing strategies to implement the act's policies by any health care organization must take into account the underlying theories of the act: managed change though payment design and funds flow. Market place competition. To execute strategy effective internal organizational management is a must and can be facilitated through a strong alignment between mission and opperating factors. The mission must relate to the organization's markets. Markets are best addressed through a local perspective where the ACA goals can be applied within a specific community or culture. The systems approach brings as many participants in the system to define their mutual success as it relates to reform. PMID:22235723

  4. Dementia Special Care Units in Residential Care Communities: United States, 2010

    Science.gov (United States)

    ... Order from the National Technical Information Service NCHS Dementia Special Care Units in Residential Care Communities: United ... Facilities Seventeen percent of residential care communities had dementia special care units. Figure 1. Number and percent ...

  5. Pediatric Palliative Care in the Intensive Care Unit.

    Science.gov (United States)

    Madden, Kevin; Wolfe, Joanne; Collura, Christopher

    2015-09-01

    The chronicity of illness that afflicts children in Pediatric Palliative Care and the medical technology that has improved their lifespan and quality of life make prognostication extremely difficult. The uncertainty of prognostication and the available medical technologies make both the neonatal intensive care unit and the pediatric intensive care unit locations where many children will receive Pediatric Palliative Care. Health care providers in the neonatal intensive care unit and pediatric intensive care unit should integrate fundamental Pediatric Palliative Care principles into their everyday practice. PMID:26333755

  6. Incorporating educational theory into critical care orientation.

    Science.gov (United States)

    Rashotte, Judy; Thomas, Margot

    2002-01-01

    This article describes the development and implementation of a critical care total education system, which includes an orientation program. The educational process in this unit reflects Benner's model of novice to expert integrated with Schon's theory of reflective practice and Cranton's transformational learning theory. This program reflects an educational philosophy that facilitates learning on entry into the new workplace, and an established continuum of expected acquisition of knowledge, practice skills, attitudes, and critical thinking abilities promoting the transition from novice to expert. PMID:12046715

  7. Sleep in intensive care unit

    DEFF Research Database (Denmark)

    Boyko, Yuliya; Jennum, Poul; Nikolic, Miki;

    2016-01-01

    PURPOSE: To determine if improving intensive care unit (ICU) environment would enhance sleep quality, assessed by polysomnography (PSG), in critically ill mechanically ventilated patients. MATERIALS AND METHODS: Randomized controlled trial, crossover design. The night intervention "quiet routine......" protocol was directed toward improving ICU environment between 10pm and 6am. Noise levels during control and intervention nights were recorded. Patients on mechanical ventilation and able to give consent were eligible for the study. We monitored sleep by PSG.The standard (American Association of Sleep...... Medicine) sleep scoring criteria were insufficient for the assessment of polysomnograms. Modified classification for sleep scoring in critically ill patients, suggested by Watson et al. (Crit Care Med 2013;41:1958-1967), was used. RESULTS: Sound level analysis showed insignificant effect...

  8. The Living, Dynamic and Complex Environment Care in Intensive Care Unit

    Directory of Open Access Journals (Sweden)

    Marli Terezinha Stein Backes

    2015-06-01

    Full Text Available OBJECTIVE: to understand the meaning of the Adult Intensive Care Unit environment of care, experienced by professionals working in this unit, managers, patients, families and professional support services, as well as build a theoretical model about the Adult Intensive Care Unit environment of care.METHOD: Grounded Theory, both for the collection and for data analysis. Based on theoretical sampling, we carried out 39 in-depth interviews semi-structured from three different Adult Intensive Care Units.RESULTS: built up the so-called substantive theory "Sustaining life in the complex environment of care in the Intensive Care Unit". It was bounded by eight categories: "caring and continuously monitoring the patient" and "using appropriate and differentiated technology" (causal conditions; "Providing a suitable environment" and "having relatives with concern" (context; "Mediating facilities and difficulties" (intervenienting conditions; "Organizing the environment and managing the dynamics of the unit" (strategy and "finding it difficult to accept and deal with death" (consequences.CONCLUSION: confirmed the thesis that "the care environment in the Intensive Care Unit is a living environment, dynamic and complex that sustains the life of her hospitalized patients".

  9. Current physiotherapy approaches in intensive care units

    OpenAIRE

    Yurdalan, S. Ufuk

    2011-01-01

    Physiotherapy is a part of the multidisciplinary treatment in different intensive care units. Respiratory, cardiovascular and neuromusculoskeletal- focused physiotherapy programmes and prevention of the respiratory, neuromuscular complications which may be possible, developing the exercise capacity related to inspiratory muscle function in critically patients internalized and postoperative cases in intensive care unit are clinical targets. It is known that physiotherapy initiated early is rel...

  10. Nosocomial Infections in Neonatal Intensive Care Units

    OpenAIRE

    Ioanna Paulopoulou; Christina Nanou

    2013-01-01

    Neonates, especially prematures, requiring care in Intensive Care Unit are a highly vulnerable population group at increased risk for nosocomial infections. In recent decades become one of the leading causes of morbidity and mortality in the Neonatal Intensive Care Unit. Aim: Highlighting the severity of nosocomial infections for hospitalized infants and the imprinting of risk factors that affects their development. Material-Methods: Searched for studies published in international scientific ...

  11. From stroke unit care to stroke care unit

    NARCIS (Netherlands)

    De Keyser, J; Sulter, G.

    1999-01-01

    In some stroke units continuous monitoring of blood pressure, electrocardiogram, body temperature, and oxygen saturation has become an integral part of the management of acute stroke. In addition, regular measurements of blood glucose are performed. Stroke units equipped with such monitoring facilit

  12. Frequency of candidemias in a tertiary care intensive care unit

    International Nuclear Information System (INIS)

    Objective: To determine the frequency of fungal infections in intensive care unit (ICU) of Military Hospital, Rawalpindi, a tertiary care health facility. Study Design: Cross sectional study. Place and Duration of Study: Intensive Care Department of Military Hospital Rawalpindi from 01 Jan 2012 to 30 Jun 2012. Methodology: A total of 89 patients were screened with stay of more than 5 days in intensive care unit. Thirty cases were enrolled in the study for investigation of fungal infections that had fever even after 05 days of being on broad spectrum antibiotics. Culture was done on blood, urine and catheter tip samples as per clinical condition of a patient. Results: Candida infection was found in 23.4% of study cases. The mean age of study patients was 41.2 +- 20.0 years while 63.4% were female patients as compared to 36.7% males. Conclusion: Fungal infections especially candidemias are quite frequent in the intensive care units. (author)

  13. Organization theory. Analyzing health care organizations.

    Science.gov (United States)

    Cors, W K

    1997-02-01

    Organization theory (OT) is a tool that can be applied to analyze and understand health care organizations. Transaction cost theory is used to explain, in a unifying fashion, the myriad changes being undertaken by different groups of constituencies in health care. Agency theory is applied to aligning economic incentives needed to ensure Integrated Delivery System (IDS) success. By using tools such as OT, a clearer understanding of organizational changes is possible. PMID:10164970

  14. Hyperglycemia in the Intensive Care Unit

    OpenAIRE

    Rainer Lenhardt; Ozan Akca

    2014-01-01

    Hyperglycemia is frequently encountered in the intensive care unit. In this disease, after severe injury and during diabetes mellitus homeostasis is impaired; hyperglycemia, hypoglycemia and glycemic variability may ensue. These three states have been shown to independently increase mortality and morbidity. Patients with diabetics admitted to the intensive care unit tolerate higher blood glucose values without increase of mortality. Stress hyperglycemia may occur in patients with or without d...

  15. Linguistic Units and Speech Production Theory.

    Science.gov (United States)

    MacNeilage, Peter F.

    This paper examines the validity of the concept of linguistic units in a theory of speech production. Substantiating data are drawn from the study of the speech production process itself. Secondarily, an attempt is made to reconcile the postulation of linguistic units in speech production theory with their apparent absence in the speech signal.…

  16. Performance and burnout in intensive care units

    NARCIS (Netherlands)

    Keijsers, GJ; Schaufeli, WB; LeBlanc, P; Zwerts, C; Miranda, DR

    1995-01-01

    The relationship between three different performance measures and burnout was explored in 20 Dutch Intensive Care Units (ICUs). Burnout (i.e. emotional exhaustion and depersonalization) proved to be significantly related to nurses' perceptions of performance as well as to objectively assessed unit p

  17. Understanding nursing units with data and theory.

    Science.gov (United States)

    Diers, Donna; Hendrickson, Karrie; Rimar, Joan; Donovan, Donna

    2013-01-01

    Nursing units are social systems whose function depends on many variables. Available nursing data, combined with a theory of organizational diagnosis, can be used to understand nursing unit performance. One troubled unit served as a case study in organizational diagnosis and treatment using modern methods of data mining and performance improvement. Systems theory did not prescribe how to fix an underbounded system. The theory did suggest, however, that addressing the characteristics of overbounded and underbounded systems can provide some order and structure and identify helpful resources. In this instance, the data analysis served to help define the unit's problems in conjunction with information gained from talking with the nurses and touring the unit, but it was the theory that gave hints for direction for change. PMID:23923239

  18. Nosocomial Infections in Neonatal Intensive Care Units

    Directory of Open Access Journals (Sweden)

    Ioanna Paulopoulou

    2013-10-01

    Full Text Available Neonates, especially prematures, requiring care in Intensive Care Unit are a highly vulnerable population group at increased risk for nosocomial infections. In recent decades become one of the leading causes of morbidity and mortality in the Neonatal Intensive Care Unit. Aim: Highlighting the severity of nosocomial infections for hospitalized infants and the imprinting of risk factors that affects their development. Material-Methods: Searched for studies published in international scientific journals during the period 2004-2013. As a main tool of retraction of bibliography was used the internet. Specific web sites and library databases: PubMed, Cinahl and Google scholar with key-words: "prevent nosocomial infections", "infection control", "neonatal care", "nursing care prematurity", "neonates nosocomial infections", "neonatal intensive care unit" (NICU. Methodology was applied thematic content analysis, which provides a careful reading of the material and recording the recurring risk factors Neonatal Neonatal Unit. Results: All researchers agree that nosocomial infections of hospitalized infants are a result of interaction of intrinsic and extrinsic factors risk. The intrinsic factors predisposing to infection is the immaturity of the immune system, the barriers of the skin and mucous membranes. Furthermore, multiple external factors contribute to the development of infection, such as low birth weight, underlying disease, broad-spectrum antibiotics, prolonged hospitalization, invasive techniques, parenteral nutrition, numerical insufficiency of staff, and poor compliance with medical professionals on hand hygiene. In recent years, the use of protocols and guidelines for each intervention in newborns has dramatically reduce the incidence of nosocomial infections. Conclusions: Nosocomial infections constitute serious threat to the population of the Neonatal Intensive Care Unit. Surveillance of infections and the use of protocols will help control

  19. Intensive care unit nurses' opinions about euthanasia.

    Science.gov (United States)

    Kumaş, Gülşah; Oztunç, Gürsel; Nazan Alparslan, Z

    2007-09-01

    This study was conducted to gain opinions about euthanasia from nurses who work in intensive care units. The research was planned as a descriptive study and conducted with 186 nurses who worked in intensive care units in a university hospital, a public hospital, and a private not-for-profit hospital in Adana, Turkey, and who agreed to complete a questionnaire. Euthanasia is not legal in Turkey. One third (33.9%) of the nurses supported the legalization of euthanasia, whereas 39.8% did not. In some specific circumstances, 44.1% of the nurses thought that euthanasia was being practiced in our country. The most significant finding was that these Turkish intensive care unit nurses did not overwhelmingly support the legalization of euthanasia. Those who did support it were inclined to agree with passive rather than active euthanasia (P = 0.011).

  20. A Review of Visiting Policies in Intensive Care Units.

    Science.gov (United States)

    Khaleghparast, Shiva; Joolaee, Soodabeh; Ghanbari, Behrooz; Maleki, Majid; Peyrovi, Hamid; Bahrani, Naser

    2016-01-01

    Admission to intensive care units is potentially stressful and usually goes together with disruption in physiological and emotional function of the patient. The role of the families in improving ill patients' conditions is important. So this study investigates the strategies, potential challenges and also the different dimensions of visiting hours' policies with a narrative review. The search was carried out in scientific information databases using keywords "visiting policy", "visiting hours" and "intensive care unit" with no time limitation on accessing the published studies in English or Farsi. Of a total of 42 articles, 22 conformed to our study objectives from 1997 to 2013. The trajectory of current research shows that visiting in intensive care units has, since their inception in the 1960s, always considered the nurses' perspectives, patients' preferences and physiological responses, and the outlook for families. However, little research has been carried out and most of that originates from the United States, Europe and since 2010, a few from Iran. It seems that the need to use the research findings and emerging theories and practices is necessary to discover and challenge the beliefs and views of nurses about family-oriented care and visiting in intensive care units. PMID:26755480

  1. Interdisciplinary communication in the intensive care unit

    OpenAIRE

    Reader, Tom W; Flin, R; Mearns, Kathryn; Cuthbertson, Brian H

    2007-01-01

    Background. Patient safety research has shown poor communication among intensive care unit (ICU) nurses and doctors to be a common causal factor underlying critical incidents in intensive care. This study examines whether ICU doctors and nurses have a shared perception of interdisciplinary communication in the UK ICU. Methods. Cross-sectional survey of ICU nurses and doctors in four UK hospitals using a previously established measure of ICU interdisciplinary collaboration. Results. A sample o...

  2. Factors Affecting Intensive Care Units Nursing Workload

    OpenAIRE

    Mohammadkarim BAHADORI; RAVANGARD, Ramin; Raadabadi, Mehdi; Mosavi, Seyed Masod; Gholami Fesharaki, Mohammad; Mehrabian, Fardin

    2014-01-01

    Background: The nursing workload has a close and strong association with the quality of services provided for the patients. Therefore, paying careful attention to the factors affecting nursing workload, especially those working in the intensive care units (ICUs), is very important. Objectives: This study aimed to determine the factors affecting nursing workload in the ICUs of the hospitals affiliated to Tehran University of Medical Sciences. Materials and Methods: This was a cross-sectional a...

  3. Hyperglycemia in the Intensive Care Unit

    Directory of Open Access Journals (Sweden)

    Rainer Lenhardt

    2014-12-01

    Full Text Available Hyperglycemia is frequently encountered in the intensive care unit. In this disease, after severe injury and during diabetes mellitus homeostasis is impaired; hyperglycemia, hypoglycemia and glycemic variability may ensue. These three states have been shown to independently increase mortality and morbidity. Patients with diabetics admitted to the intensive care unit tolerate higher blood glucose values without increase of mortality. Stress hyperglycemia may occur in patients with or without diabetes and has a strong association with increased mortality in the intensive care unit patients. Insulin is the drug of choice to treat hyperglycemia in the intensive care unit. In patients with moderate hyperglycemia a basal–bolus insulin concept can be used. Close glucose monitoring is of paramount importance throughout the intensive care unit stay of the patient. In the guidelines for glycemic control based on meta-analyses it was shown that a tight glycemic control does not have a significant mortality advantage over conventional treatment. Given the controversy about optimal blood glucose goals in the intensive care unit setting, it seems reasonable to target a blood glucose level around 140 mg/dL to avoid episodes of hypoglycemia and minimize glycemic variability. The closed loop system with continuous glucose monitoring and algorithm based insulin application by an infusion pump is a promising new concept with the potential to further reduce mortality and morbidity due to hyperglycemia, hypoglycemia and glycemic variability. The goal of this review was to give a brief overview about pathophysiology of hyperglycemia and to summarize current guidelines for glycemic control in critically ill patients.

  4. Fast Hugs with Intensive Care Unit

    Directory of Open Access Journals (Sweden)

    Nimet Şenoğlu

    2014-12-01

    Full Text Available Mnemonics are commonly used in medical procedures as cognitive aids to guide clinicians all over the world. The mnemonic ‘FAST HUG’ (Feeding, Analgesia, Sedation, Thromboembolic prophylaxis, Head-of-bed elevation, stress Ulcer prevention, and Glycemic control was proposed almost ten years ago for patient care in intensive care units and have been commonly used worldwide. Beside this, new mnemonics were also determined for improving routine care of the critically ill patients. But none of this was accepted as much as “FAST HUGS”. In our clinical practice we delivered an another mnemonic as FAST HUGS with ICU (Feeding, Analgesia, Sedation, Thromboembolic prophylaxis, Head-of-bed elevation, Stress ulcer prevention, and Glucose control, Water balance, Investigation and Results, Therapy, Hypo-hyper delirium, Invasive devices, Check the daily infection parameters, Use a checklist for checking some of the key aspects in the general care of intensive care patients. In this review we summarized these mnemonics.

  5. Performance and burnout in intensive care units

    OpenAIRE

    Keijsers, G.J.; Schaufeli, W.B.; LeBlanc, P; Zwerts, C.; Miranda, D.R.

    1995-01-01

    The relationship between three different performance measures and burnout was explored in 20 Dutch Intensive Care Units (ICUs). Burnout (i.e. emotional exhaustion and depersonalization) proved to be significantly related to nurses' perceptions of performance as well as to objectively assessed unit performance. Subjective performance measures relate negatively to burnout levels of nurses, whereas an objective performance measure relates positively to burnout. Furthermore, subjectively assessed...

  6. [Primary care in the United Kingdom].

    Science.gov (United States)

    Sánchez-Sagrado, T

    2016-03-01

    The inadequate planning of health professionals in Spain has boosted the way out of doctors overseas. The United Kingdom is one of the countries chosen by Spanish doctors to develop their job. The National Health Service is a health system similar to the Spanish one. Health care services are financing mainly through taxes. The right to health care is linked to the citizen condition. The provision of health care is a mix-up of public and private enterprises. Primary Care is much closed to Spanish Primary Care. Doctors are "self-employed like" professionals. They can set their surgeries in a free area previously designed by the government. They have the right to make their own team and to manage their own budget. Medical salary is linked to professional capability and curriculum vitae. The main role of a General Practitioner is the prevention. Team work and coordination within primary and specialised care is more developed than in Spain. The access to diagnostic tests and to the specialist is controlled through waiting lists. General Practitioners work as gate-keepers. Patients may choose freely their doctor and consultations and hospital care are free at the point of use. Within the United Kingdom there are also health regions with problems due to inequalities to access and to treatment. There is a training path and the access to it is by Curricula. The number of training jobs is regulated by the local needs. Continuing education is compulsory and strictly regulated local and nationally. The National Health Service was the example for the Spanish health reform in 1986. While Spanish Primary health care is of quality, the efficiency of the health system would improve if staff in Primary Care settings were managed in a similar way to the British's. PMID:26412408

  7. [Primary care in the United Kingdom].

    Science.gov (United States)

    Sánchez-Sagrado, T

    2016-03-01

    The inadequate planning of health professionals in Spain has boosted the way out of doctors overseas. The United Kingdom is one of the countries chosen by Spanish doctors to develop their job. The National Health Service is a health system similar to the Spanish one. Health care services are financing mainly through taxes. The right to health care is linked to the citizen condition. The provision of health care is a mix-up of public and private enterprises. Primary Care is much closed to Spanish Primary Care. Doctors are "self-employed like" professionals. They can set their surgeries in a free area previously designed by the government. They have the right to make their own team and to manage their own budget. Medical salary is linked to professional capability and curriculum vitae. The main role of a General Practitioner is the prevention. Team work and coordination within primary and specialised care is more developed than in Spain. The access to diagnostic tests and to the specialist is controlled through waiting lists. General Practitioners work as gate-keepers. Patients may choose freely their doctor and consultations and hospital care are free at the point of use. Within the United Kingdom there are also health regions with problems due to inequalities to access and to treatment. There is a training path and the access to it is by Curricula. The number of training jobs is regulated by the local needs. Continuing education is compulsory and strictly regulated local and nationally. The National Health Service was the example for the Spanish health reform in 1986. While Spanish Primary health care is of quality, the efficiency of the health system would improve if staff in Primary Care settings were managed in a similar way to the British's.

  8. Burnout in the intensive care unit professionals

    Directory of Open Access Journals (Sweden)

    Kalpalatha K Guntupalli

    2014-01-01

    Full Text Available Background: Professional burnout has been widely explored in health care. We conducted this study in our hospital intensive care unit (ICU in United States to explore the burnout among nurses and respiratory therapists (RT. Materials and Methods: A survey consisting of two parts was used to assess burnout. Part 1 addressed the demographic information and work hours. Part 2 addressed the Maslach Burnout Inventory-Human Service Survey. Results: The analysis included 213 total subjects; Nurses 151 (71% and RT 62 (29%. On the emotional exhaustion (EE scale, 54% scored "Moderate" to "High" and 40% scored "Moderate" to "High" on the depersonalization (DP scale. Notably 40.6% scored "Low" on personal accomplishment (PA scale. Conclusion: High level of EE, DP and lower PAs were seen among two groups of health care providers in the ICUs.

  9. Neonatal intensive care unit nosocomial bacterial infections

    Directory of Open Access Journals (Sweden)

    Ghazvini

    2008-08-01

    Full Text Available Background: Nosocomial infections increase patients' morbidity, mortality and length of hospital stay especially in neonatal intensive care units (NICUs and have become a matter of major concern. Controlling and preventing nosocomial infections need enough information about epidemiology of these infections. This study aims at estimating the incidence rate and the most frequent bacteria which cause these infections in neonatal intensive care unit of Ghaem university hospital, Mashhad. Methods: In this study which is performed during a twelve month period in 2004 and 2005 at neonatal intensive care unit of Ghaem hospital, 971 hospitalized neonates were studied. Data were collected considering the standard surveillance protocols. Early onset neonatal nosocomial infections and late onset neonatal infections were defined as illness appearing from birth to seven days and from eight to twenty-eight days postnatal age respectively. Statistical analysis was performed using the χ2 test. Results: In this study 32 cases of nosocomial infections were identified so the incidence rate of nosocomial infection in this ward was 3.29%. Fifteen babies identified with early onset neonatal nosocomial infection and the rest have presented with late onset neonatal infections. In order of frequency, the sites of infection were: primary bloodstream (84.4% and pneumonia (15.62%. Coagulase negative staphylococci were the most common bacteria (43.74% isolated in these patients. Other isolated bacteria were Klebsiella pneumonia (31.42% and other gram negative bacilli such as E.coli, Pseudomonas aeroginosa and Acintobacter spp. The mechanical ventilation and umbilical catheter were associated with nosocomial infections as risk factors in our study (p<0.01. Conclusion: Our findings show that the neonatal intensive care unit of Ghaem hospital has low rate of nosocomial infections. However, as neonatal intensive care unit is an area of great concern in terms of nosocomial

  10. Ancillary Care: From Theory to Practice in International Clinical Research.

    Science.gov (United States)

    Pratt, Bridget; Zion, Deborah; Lwin, Khin Maung; Cheah, Phaik Yeong; Nosten, Francois; Loff, Bebe

    2013-07-01

    How international research might contribute to justice in global health has not been substantively addressed by bioethics. This article describes how the provision of ancillary care can link international clinical research to the reduction of global health disparities. It identifies the ancillary care obligations supported by a theory of global justice, showing that Jennifer Ruger's health capability paradigm requires the delivery of ancillary care to trial participants for a limited subset of conditions that cause severe morbidity and mortality. Empirical research on the Shoklo Malaria Research Unit's (SMRU) vivax malaria treatment trial was then undertaken to demonstrate whether and how these obligations might be upheld in a resource-poor setting. Our findings show that fulfilment of the ancillary care obligations is feasible where there is commitment from chief investigators and funders and is strongly facilitated by SMRU's dual role as a research unit and medical non-governmental organization. PMID:23864908

  11. Benefitting From Monitorization in Intensive Care Unit

    Directory of Open Access Journals (Sweden)

    Mois Bahar

    2011-12-01

    Full Text Available The most essential matter about following a patient in intensive care unit is a fine and correct monitorization. While benefitting from monitorization is the main objective of every intensive care physician, it should be discussed how successful we are when we do not take monitorization as a subject of interest sufficiently. This physicians who are both performing medical care and education has a very important role regarding the matter: To question and confirm the correctness of the parameters that are being followed and to use this data for choosing the treatment type. The vital parameters that are found necessary to be followed usually do not present us the sufficient utility. For purpose, implementing monitorization in a way of whole perspective including Examining, Questioning, Reading (Observing, Repeating, Recalling will maintain to receive consequences for the benefit of the patient. (Journal of the Turkish Society Intensive Care 2011; 9: 110-5

  12. Nosocomial Infections in Neonatal Intensive Care Unit

    Directory of Open Access Journals (Sweden)

    Emine Parlak

    2013-04-01

    Full Text Available Introduction: Nosocomial infections are one of the important mortality and morbidity reasons among newborns. For this reason recognition of infection factors and the resistance to antimicrobials in intensive care unit is very important in terms of rational antibiotic use. Materials and Methods: Nosocomial infections seen in our neonatal intensive care unit between 2009 and 2011 were retrospectively analyzed. Isolated strains, antibiotic sensitivities, the use of invasive tool, infectious species and infection rates were determined according to the data provided by National Nosocomial Infections Surveillance Control Unit. Results: A total of 4258 patients were observed for 34625 patient days, 6536 ventilator days, 98 urinary catheter days, 601 central venous catheter days and 590 umbilical catheter days. The infection rate was 3.26% (139/4258 and the incident density was 4.01‰. Pneumonia was on the first rank (61; 43% and it was in ventilator association form. 36 strains were isolated as the infectious agents. The rates of gram negative factors was 23 (63.88%, gram positive factors was 8 (22.22% and Candida spp. was 5 (13.88 %. The most frequently isolated gram negative strains were Klebsiella spp. (7; 19.4% and Pseudomonas spp. (7; 19.4 %. The most effective antibiotics in Enterobactericeae spp. were meropenem and imipenem. In enteric gram-negative rods, extended-spectrum beta-lactamase positivity was 63.64%. In the neonatal intensive care unit, ventilator-associated pneumonia rate was 6.73% and the ventilator use ratio was 19%. Conclusions: In conclusion, each intensive care unit should determne the factors and follow antimicrobial resistant patterns. Empiric antibiotic treatment strategy should be established. Decreasing or totally preventing hospital infections would be possible by active surveillance system, adoption infection control guidelines, limitation of instrument use and rational antibiotic use rules. (The Jo­ur­nal of Cur

  13. Sedation in neurological intensive care unit

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    Birinder S Paul

    2013-01-01

    Full Text Available Analgesia and sedation has been widely used in intensive care units where iatrogenic discomfort often complicates patient management. In neurological patients maximal comfort without diminishing patient responsiveness is desirable. In these patients successful management of sedation and analgesia incorporates a patient based approach that includes detection and management of predisposing and causative factors, including delirium, monitoring using sedation scales, proper medication selection, emphasis on analgesia based drugs and incorporation of protocols or algorithms. So, to optimize care clinician should be familiar with the pharmacokinetic and pharmacodynamic variables that can affect the safety and efficacy of analgesics and sedatives.

  14. Hospital infections in neonatal intensive care units

    OpenAIRE

    Đurišić Jasna; Marković-Denić Ljiljana N.; Ilić Slobodanka; Ramadani Ruždi

    2005-01-01

    Introduction Sick newborn babies in the neonatal intensive care units (NICU) are al increased risk for hospital-acquired infections (HI). The aim of our study was to determine the incidence and localization of neonatal hospital infections in NICU. Material and methods A prospective, six-month study was carried out in a NICU. All patients hospitalized in NICU longer then 48 hours were examined according to their basic descriptive-epidemiological characteristics and the incidence of all hospita...

  15. Diarrhea in neonatal intensive care unit

    Institute of Scientific and Technical Information of China (English)

    Annalisa; Passariello; Gianluca; Terrin; Maria; Elisabetta; Baldassarre; Mario; De; Curtis; Roberto; Paludetto; Roberto; Berni; Canani

    2010-01-01

    AIM:To investigate the frequency,etiology,and current management strategies for diarrhea in newborn.METHODS:Retrospective,nationwide study involving 5801 subjects observed in neonatal intensive care units during 3 years.The main anamnesis and demographic characteristics,etiology and characteristics of diarrhea,nutritional and therapeutic management,clinical outcomes were evaluated.RESULTS:Thirty-nine cases of diarrhea(36 acute,3 chronic) were identified.The occurrence rate of diarrhea was 6.72 per 1000 hosp...

  16. Music Inside an Intensive Care Unit

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    Ana Maria Loureiro De Souza Delabary

    2004-07-01

    Full Text Available This paper reports on the music therapy work performed in the intensive care unit of a university hospital. Clinical practice is inserted with in the hospital psychology department and acts jointly with some of the other health departments in the same hospital. The text presents the employed methodology, techniques, and repertoire, along with some considerations, comments, and observations on the practical side of the treatment. Music therapy imposes itself as a valuable element for the health area and becomes particularly meaningful as a part of the hospital's humanization program which is being developed in the institution. Striving for care quality, all the while it helps integrating all involved personnel interacting with the patients, music can be a powerful stimulus for the improvement of health care, particularly in the reception and support of the difficult situations terminal patients are faced with.

  17. [Intermediate care units and noninvasive ventilation].

    Science.gov (United States)

    Becker, Heinrich F; Schönhofer, Bernd; Vogelmeier, Claus

    2006-04-15

    Intermediate care units (IMC) have been introduced to provide optimal patient management according to disease severity and to bridge the gap between intensive care (ICU) and general wards. Most patients that are referred to an IMC need monitoring and intensive analgetic treatment. Over the past years noninvasive ventilation (NIV) and weaning have emerged as important new forms of active treatment in the IMC. Most studies that have been published so far demonstrate that an IMC improves patient outcome and lowers costs, although randomized controlled trials are missing. NIV reduces mortality, the need for intubation as well as ICU and hospital length of stay in patients with chronic obstructive pulmonary disease (COPD) and other disorders that cause respiratory failure. In many cases NIV can be performed in the IMC, a fact that reduces the number of ICU admissions, lowers costs and improves patient care. The high prevalence of pulmonary diseases and NIV emphasizes the importance of pneumologists as directors of both ICU and IMC.

  18. Dermatology in the Intensive Care Unit

    Directory of Open Access Journals (Sweden)

    Uwe Wollina

    2012-10-01

    Full Text Available Introduction: The intensive care unit (ICU represents a special environment for patients. We analyzed patients in the ICU/ high care unit (HCU with respect to dermatology counselling and skin problems.Setting: Academic Teaching Hospital over a 10 month period.Methods: The total number of patients of the ICU was 1,208 with a mean stay of 4.1 days. In the HCU the mean stay was 16 days. Diagnosis leading to admission were analyzed. All files of dermatological counselling were evaluated in detail.Results: Fifty-five patients with dermatologic problems were identified: 19 women and 26 males. The age ranged from 22 to 90 years of life (mean ± standard deviation: 67.2 ± 17.4 years. The total number of consultations were 85. The range of repeated dermatological consultation ranged from two to ten. The major reasons were skin and soft tissue infections, adverse drug reactions, chronic wounds including pressure sores and skin irritation or dermatitis. Pre-existing skin conditions may complicate the treatment and care during ICU/HCU stay.Conclusion: A tight collaboration between of the medical staff of ICU/HCU and dermatology department will ensure a rapid diagnosis and treatment of various skin conditions in the ICU, without increasing the costs significantly. Interdisciplinary education of nursing staff contributes to improved skin care in the ICU/HCU and helps to prevent acute skin failure.

  19. Rehabilitation starts in the intensive care unit.

    Science.gov (United States)

    Rozeboom, Nathan; Parenteau, Kathy; Carratturo, Daniel

    2012-01-01

    Each year between 10 000 and 12 000 spinal cord injuries occur in the United States. Once injured, many of these patients will receive a portion of their care in an intensive care unit (ICU), where their treatment will begin. Harborview Medical Center in Seattle, Washington, provides comprehensive care to approximately 60 to 70 cervical spinal cord injuries each year. Because of many factors such as hemodynamic instability, pulmonary complications, and risk of infection, patients with cervical spinal cord injuries can spend up to 2 or more weeks in the ICU before they transfer to a rehabilitation unit. To achieve optimal outcomes, it is imperative that members of the interdisciplinary team work together in a consistent, goal-oriented, collaborative manner. This team includes physicians, nurses, respiratory therapists, physical and occupational therapists, speech pathologists, dieticians, and rehabilitation psychologists. An individual plan is developed for each patient and rehabilitation starts in the ICU as soon as the patient is medically stable. This article will highlight the management strategies used in the neuroscience ICU at Harborview Medical Center and will include a case study as an example of the typical experience for our patients with high cervical cord injury.

  20. No theory of justice can ground health care reform.

    Science.gov (United States)

    Trotter, Griffin

    2012-01-01

    This essay argues that no theory or single conception of justice can provide a fundamental grounding for health care reform in the United States. To provide such a grounding, (1) there would need to be widespread support among citizens for a particular conception of justice, (2) citizens would have to apprehend this common conception of justice as providing the strongest available rationale for health care reform, and (3) this rationale would have to overwhelm countervailing values. I argue that neither of the first two conditions is met.

  1. Families' experiences of intensive care unit quality of care

    DEFF Research Database (Denmark)

    Jensen, Hanne Irene; Gerritsen, Rik T; Koopmans, Matty;

    2015-01-01

    PURPOSE: The purpose of the study is to adapt and provide preliminary validation for questionnaires evaluating families' experiences of quality of care for critically ill patients in the intensive care unit (ICU). MATERIALS AND METHODS: This study took place in 2 European ICUs. Based on literature...... and qualitative interviews, we adapted 2 previously validated North American questionnaires: "Family Satisfaction with the ICU" and "Quality of Dying and Death." Family members were asked to assess relevance and understandability of each question. Validation also included test-retest reliability and construct...... validity. RESULTS: A total of 110 family members participated. Response rate was 87%. For all questions, a median of 97% (94%-99%) was assessed as relevant, and a median of 98% (97%-100%), as understandable. Median ceiling effect was 41% (30%-47%). There was a median of 0% missing data (0%-1%). Test...

  2. Rehabilitation in the intensive care unit.

    Science.gov (United States)

    Rochester, Carolyn L

    2009-12-01

    Critical illness has many devastating sequelae, including profound neuromuscular weakness and psychological and cognitive disturbances that frequently result in long-term functional impairments. Early rehabilitation begun in the intensive care unit (ICU) is emerging as an important strategy both to prevent and to treat ICU-acquired weakness, in an effort to facilitate and improve long-term recovery. Rehabilitation may begin with range of motion and bed mobility exercise, then may progress when the patient is fully alert and able to participate actively to include sitting and posture-based exercise, bed to chair transfers, strength and endurance exercises, and ambulation. Electrical muscle stimulation and inspiratory muscle training are additional techniques that may be employed. Studies conducted to date suggest that such ICU-based rehabilitation is feasible, safe, and effective for carefully selected patients. Further research is needed to identify the optimal patient candidates and procedures and for providing rehabilitation in the ICU.

  3. Ethical issues in neonatal intensive care units.

    Science.gov (United States)

    Liu, Jing; Chen, Xin-Xin; Wang, Xin-Ling

    2016-07-01

    On one hand, advances in neonatal care and rescue technology allow for the healthy survival or prolonged survival time of critically ill newborns who, in the past, would have been non-viable. On the other hand, many of the surviving critically ill infants have serious long-term disabilities. If an infant eventually cannot survive or is likely to suffer severe disability after surviving, ethical issues in the treatment process are inevitable, and this problem arises not only in developed countries but is also becoming increasingly prominent in developing countries. In addition, ethical concerns cannot be avoided in medical research. This review article introduces basic ethical guidelines that should be followed in clinical practice, including respecting the autonomy of the parents, giving priority to the best interests of the infant, the principle of doing no harm, and consent and the right to be informed. Furthermore, the major ethical concerns in neonatal intensive care units (NICUs) in China are briefly introduced. PMID:26382713

  4. Factors influencing nursing care in a surgical intensive care unit

    Directory of Open Access Journals (Sweden)

    Raj John

    2006-01-01

    Full Text Available Context: The total time spent in nursing care depends on the type of patient and the patient′s condition. We analysed factors that influenced the time spent in nursing a patient. Aims : To analyse the factors in a patient′s condition that influenced time spent in nursing a patient. Materials and Methods: This study was performed in the Surgical Intensive Care Unit of a tertiary referral centre, over a period of one month. The total time spent on a patient in nursing care for the first 24 hours of admission, was recorded. This time was divided into time for routine nursing care, time for interventions, time for monitoring and time for administering medications. Statistical analysis used: A backward stepwise linear regression analysis using the age, sex, diagnosis, type of admission and ventilatory status as variables, was done. Results: Patients admitted after elective surgery required less time (852.4 ± 234.1 minutes, than those admitted after either emergency surgery (1069.5 ± 187.3 minutes, or directly from the ward or the emergency room (1253.7 ± 42.1 minutes. Patients who were ventilated required more time (1111.5 ± 132.5 minutes, than those brought on a T-piece (732.2 ± 134.8 minutes or extubated (639.5 ± 155.6 minutes. The regression analysis showed that only the type of admission and the ventilatory status significantly affected the time. Conclusions : This study showed that the type of admission and ventilatory status significantly influenced the time spent in nursing care. This will help optimal utilization of nursing resources.

  5. [Nosocomial infections in intensive care units].

    Science.gov (United States)

    Zaragoza, Rafael; Ramírez, Paula; López-Pueyo, María Jesús

    2014-05-01

    Nosocomial infections (NI) still have a high incidence in intensive care units (ICUs), and are becoming one of the most important problems in these units. It is well known that these infections are a major cause of morbidity and mortality in critically ill patients, and are associated with increases in the length of stay and excessive hospital costs. Based on the data from the ENVIN-UCI study, the rates and aetiology of the main nosocomial infections have been described, and include ventilator-associated pneumonia, urinary tract infection, and both primary and catheter related bloodstream infections, as well as the incidence of multidrug-resistant bacteria. A literature review on the impact of different nosocomial infections in critically ill patients is also presented. Infection control programs such as zero bacteraemia and pneumonia have been also analysed, and show a significant decrease in NI rates in ICUs.

  6. Challenges encountered by critical care unit managers in the large intensive care units

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    Mokgadi C. Matlakala

    2014-02-01

    Full Text Available Background: Nurses in intensive care units (ICUs are exposed regularly to huge demands interms of fulfilling the many roles that are placed upon them. Unit managers, in particular, are responsible for the efficient management of the units and have the responsibilities of planning, organising, leading and controlling the daily activities in order to facilitate the achievement of the unit objectives.Objectives: The objective of this study was to explore and present the challenges encountered by ICU managers in the management of large ICUs.Method: A qualitative, exploratory and descriptive study was conducted at five hospital ICUs in Gauteng province, South Africa. Data were collected through individual interviews from purposively-selected critical care unit managers, then analysed using the matic coding.Results: Five themes emerged from the data: challenges related to the layout and structure of the unit, human resources provision and staffing, provision of material resources, stressors in the unit and visitors in the ICU.Conclusion: Unit managers in large ICUs face multifaceted challenges which include the demand for efficient and sufficient specialised nurses; lack of or inadequate equipment that goes along with technology in ICU and supplies; and stressors in the ICU that limit the efficiency to plan, organise, lead and control the daily activities in the unit. The challenges identified call for multiple strategies to assist in the efficient management of large ICUs.

  7. Should health care managers adopt Theory Z?

    Science.gov (United States)

    Safranski, S R; Kwon, I W; Walker, W R; Unger, M

    1986-04-01

    Health care administrators should carefully consider the situations in which they apply management methods used in industry, since such methods may not be effective in motivating certain groups of hospital employees. Physicians, for example, may display little loyalty to the health care organization, even though as a group they exert significant influence on policies, standards, and administration. As a result, management styles such as Theory Z that focus on holistic concern, individual decision-making responsibility, and long-term employment guarantees may fail to interest them. Nurses also may be reluctant to commit themselves to an organization because of the high rate of turnover in their profession in recent years. Support staff, however, probably would be receptive to management techniques that offer security through long-term employment guarantees. Other factors necessary for the effective use of Theory Z industrial management techniques are a clear hierarchy with well-defined reporting relationships, moderately specialized career paths, and trust among employees that the organization's concern for their welfare is genuine. The key consideration, however, in applying any theory is that only those aspects which best serve the organization's needs should be adopted.

  8. Care: from theory to orientation and back.

    Science.gov (United States)

    Little, M O

    1998-04-01

    In this paper, I urge that the very real lessons Carol Gilligan's work in moral psychology offer to moral philosophy can best be appreciated if we take seriously the gap between the two disciplines. The care and justice perspectives Gilligan explores are psychological orientations, and orientations are defined as much by matters of emphasis, selectivity of interpretation, and gestalt as they are by propositional commitment. As such, I argue, their contribution to moral theory is best seen as stances from which to do theory, rather than as constituting ready-made theories themselves. In pursuing this train of thought, I examine how Gilligan's work has developed over time and how, in the end, we should understand the juxtaposition between the two orientations.

  9. Nutrition in the neurocritical care unit

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    Swagata Tripathy

    2015-01-01

    Full Text Available The aim of intensive care is to support the physiology of the body till the treatment or the reparative process of the body kicks in to the rescue. Maintaining an adequate nutrition during this period is of vital importance to counteract the catabolic effect of the critical disease process. The guidelines for nutritional care in the neuro intensive care unit (ICU are sparse. This article collates the current evidence and best practice recommendations as applicable to the critically ill patient in the neuro ICU. The use of screening tests to identify patients at a risk of malnutrition and related complications is presently recommended for all patients with an emphasis on early initiation of caloric support. Over-aggressive feeding in an attempt to revert the catabolic effects of critical illness have not proven beneficial, just as the attempts to improve patient outcomes by altering the routes of nutrition administration. Special patient population such as traumatic brain injury, stroke, subarachnoid haemorrhage or spinal cord injury may have varying nutritional requirements; individualised approach in the neurocritical ICU with the help of the intensivist, nutritionist and pharmacology team may be of benefit.

  10. An Ecological Understanding of Kinship Foster Care in the United States

    Science.gov (United States)

    Hong, Jun Sung; Algood, Carl L.; Chiu, Yu-Ling; Lee, Stephanie Ai-Ping

    2011-01-01

    We review empirical studies on kinship foster care in the United States. We conceptualize kinship foster care within the context of Urie Bronfenbrenner's (1994) most recent ecological systems theory. Because there are multiple levels of influences on the developmental outcomes of children placed in kinship foster home, understanding the…

  11. NOSOCOMIAL ACINETOBACTER INFECTIONS IN INTENSIVE CARE UNIT

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    Nwadike V. Ugochukwu

    2013-01-01

    Full Text Available Acinetobacter plays an important role in the infection of patients admitted to hospitals. Acinetobacter are free living gram-negative coccobacilli that emerge as significant nosocomial pathogens in the hospital setting and are responsible for intermittent outbreaks in the Intensive Care Unit. The aim of this study was to determine the prevalence of Acinetobacter in patients admitted into the Intensive Care Unit and determine their role in infections in the ICU. A total of one hundred patients were recruited for the study, catheter specimen urine, tracheal aspirate and blood culture were collected aseptically from the patients. The specimens were cultured on blood and MacConkey and the organisms identified using Microbact 12E (0xoid. The Plasmid analysis was done using the TENS miniprep method. Fourteen (14% of the 100 patients recruited into the study, developed Acinetobacter infection. Acinetobacter spp constituted 9% of the total number of isolates. Twelve (86% of the isolates were recovered from tracheal aspirate, 1(7% from urine and 1(7% from blood. All of the isolates harbor plasmids of varying molecular sizes. Ten of the fourteen Acinetobacter were isolated at about the same period of time in the ICU with 6(42.7% having plasmid size in the 23.1kb band and all showed similar pattern revealing that the isolates exhibit some relatedness. The clonal nature of the isolates suggest that strict infection control practices must be adopted in ICU, also an antibiotic policy must be developed for the ICU to prevent abuse of antibiotics that may lead to selection of resistant bacteria.

  12. Intensive Care Unit Infections and Antibiotic Use

    Directory of Open Access Journals (Sweden)

    Ayşegül Yeşilkaya

    2011-07-01

    Full Text Available Burn wound infections is the leading cause of morbidity and mortality in burn trauma patients. Although burn wound is sterile at the beginning, because of risk factors such as prolonged hospital stay, immunesuppression and burn affecting large body surface area, colonisation firstly with Staphylococcus aureus and then Pseudomonas aeruginosa will occur later. Delay in wound closure and treatment with broad-spectrum antibiotic will result wound colonisation with antibiotic-resistant bacteria. To control colonization and to prevent burn wound infection topical antimicrobial dressings are used. The criteria used for the diagnosis of sepsis and wound infections are different in burn victims. Surface swabs from burn wounds must be cultured for the early assestment of infection. Although histopathological examination and quantitative culture of wound tissue biopsy has been known as the gold standard for the verification of invasive burn wound infection, many burn centers cannot do histopathological examination. When the traditional treatment modalities such as debridement of necrotic tissue, cleaning of wound and topical antimicrobial dressing application fails in the management of burn patient, cultures must be taken from possible foci of infection for the early diagnosis. After specimen collection, empirical bactericidal systemic antibiotic treatment should be started promptly. Inappropriate utilization of antibiotics may cause selection of resistant bacteria in the flora of the patient and of the burn unit which facilitates an infection or an outbreak at the end. Infection control in the burn unit includes surveillance cultures, cohort patient care staff, standard isolation precautions, strict hand hygiene compliance and appropariate antibiotic utilization. (Journal of the Turkish Society Intensive Care 2011; 9 Suppl: 55-61

  13. Sleep in the intensive care unit.

    Science.gov (United States)

    Pisani, Margaret A; Friese, Randall S; Gehlbach, Brian K; Schwab, Richard J; Weinhouse, Gerald L; Jones, Shirley F

    2015-04-01

    Sleep is an important physiologic process, and lack of sleep is associated with a host of adverse outcomes. Basic and clinical research has documented the important role circadian rhythm plays in biologic function. Critical illness is a time of extreme vulnerability for patients, and the important role sleep may play in recovery for intensive care unit (ICU) patients is just beginning to be explored. This concise clinical review focuses on the current state of research examining sleep in critical illness. We discuss sleep and circadian rhythm abnormalities that occur in ICU patients and the challenges to measuring alterations in circadian rhythm in critical illness and review methods to measure sleep in the ICU, including polysomnography, actigraphy, and questionnaires. We discuss data on the impact of potentially modifiable disruptors to patient sleep, such as noise, light, and patient care activities, and report on potential methods to improve sleep in the setting of critical illness. Finally, we review the latest literature on sleep disturbances that persist or develop after critical illness.

  14. United States and Canadian approaches to justice in health care: a comparative analysis of health care systems and values.

    Science.gov (United States)

    Jecker, N S; Meslin, E M

    1994-06-01

    The purpose of this study is to compare and contrast the basic ethical values underpinning national health care policies in the United States and Canada. We use the framework of ethical theory to name and elaborate ethical values and to facilitate moral reflection about health care reform. Section one describes historical and contemporary social contract theories and clarifies the ethical values associated with them. Sections two and three show that health care debates and health care systems in both countries reflect the values of this tradition; however, each nation interprets the tradition differently. In the U.S., standards of justice for health care are conceived as a voluntary agreement reached by self-interested parties. Canadians, by contrast, interpret the same justice tradition as placing greater emphasis on concern for others and for the community. The final section draws out the implications of these differences for future U.S. and Canadian health care reforms.

  15. Measuring the quality of therapeutic apheresis care in the pediatric intensive care unit.

    Science.gov (United States)

    Sussmane, Jeffrey B; Torbati, Dan; Gitlow, Howard S

    2012-01-01

    Our goal was to measure the quality of care provided in the Pediatric Intensive Care Unit (PICU) during Therapeutic Apheresis (TA). We described the care as a step by step process. We designed a flow chart to carefully document each step of the process. We then defined each step with a unique clinical indictor (CI) that represented the exact task we felt provided quality care. These CIs were studied and modified for 1 year. We measured our performance in this process by the number of times we accomplished the CI vs. the total number of CIs that were to be performed. The degree of compliance, with these clinical indicators, was analyzed and used as a metric for quality by calculating how close the process is running exactly as planned or "in control." The Apheresis Process was in control (compliance) for 47% of the indicators, as measured in the aggregate for the first observational year. We then applied the theory of Total Quality Management (TQM) through our Design, Measure, Analyze, Improve, and Control (DMAIC) model. We were able to improve the process and bring it into control by increasing the compliance to > 99.74%, in the aggregate, for the third and fourth quarter of the second year. We have implemented TQM to increase compliance, thus control, of a highly complex and multidisciplinary Pediatric Intensive Care therapy. We have shown a reproducible and scalable measure of quality for a complex clinical process in the PICU, without additional capital expenditure.

  16. Measuring the quality of therapeutic apheresis care in the pediatric intensive care unit.

    Science.gov (United States)

    Sussmane, Jeffrey B; Torbati, Dan; Gitlow, Howard S

    2012-01-01

    Our goal was to measure the quality of care provided in the Pediatric Intensive Care Unit (PICU) during Therapeutic Apheresis (TA). We described the care as a step by step process. We designed a flow chart to carefully document each step of the process. We then defined each step with a unique clinical indictor (CI) that represented the exact task we felt provided quality care. These CIs were studied and modified for 1 year. We measured our performance in this process by the number of times we accomplished the CI vs. the total number of CIs that were to be performed. The degree of compliance, with these clinical indicators, was analyzed and used as a metric for quality by calculating how close the process is running exactly as planned or "in control." The Apheresis Process was in control (compliance) for 47% of the indicators, as measured in the aggregate for the first observational year. We then applied the theory of Total Quality Management (TQM) through our Design, Measure, Analyze, Improve, and Control (DMAIC) model. We were able to improve the process and bring it into control by increasing the compliance to > 99.74%, in the aggregate, for the third and fourth quarter of the second year. We have implemented TQM to increase compliance, thus control, of a highly complex and multidisciplinary Pediatric Intensive Care therapy. We have shown a reproducible and scalable measure of quality for a complex clinical process in the PICU, without additional capital expenditure. PMID:22095668

  17. Withholding or withdrawing therapy in intensive care units

    DEFF Research Database (Denmark)

    Jensen, Hanne Irene; Ammentorp, Jette; Erlandsen, Mogens;

    2011-01-01

    The purpose of the study was to determine the views of intensive care nurses, intensivists, and primary physicians regarding collaboration and other aspects of withholding and withdrawing therapy in the intensive care unit (ICU).......The purpose of the study was to determine the views of intensive care nurses, intensivists, and primary physicians regarding collaboration and other aspects of withholding and withdrawing therapy in the intensive care unit (ICU)....

  18. VENTILATOR ASSOCIATED PNEUMONIA IN INTENSIVE CARE UNIT

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    Syed Ali

    2015-12-01

    Full Text Available BACKGROUND Knowledge of the incidence of ventilator-associated pneumonia (VAP and its associated risk factors is imperative for the development and use of more effective preventive measures. METHODOLOGY We conducted a prospective cohort study over a period of 12 months to determine the incidence and the risk factors for development of VAP in critically ill adult patients admitted in intensive care units (ICUs in Chalmeda Anand Rao Institute of Medical Sciences, Karimnagar, we included 150 patients, on mechanical ventilation for more than 48 hours. VAP was diagnosed according to the current diagnostic criteria. RESULTS The study cohort comprised of 150 patients of various cases of cerebrovascular accident, poisoning, neurological disorders, sepsis and others. VAP was diagnosed when a score of ≥6 was obtained in the clinical pulmonary infection scoring system having six variables and a maximum score of 12. The mean age of the patients was 40 years. Of the 150 patients, 28 patients developed VAP during the ICU stay. The incidence of VAP in our study was 18.8%. The risk factor in our study was decrease in the PaO2/FiO2 ratio, duration of mechanical ventilation, impaired consciousness, tracheostomy, re-intubation, emergency intubation, nasogastric tube, emergency intubation and intravenous sedatives were found to be the specific risk factors for early onset VAP, while tracheostomy and re-intubation were the independent predictors of late-onset VAP, The most predominant organisms in our study was Pseudomonas (39.2%. CONCLUSIONS Knowledge of these risk factors may be useful in implementing simple and effective preventive measures. Precaution during emergency intubation, minimizing the occurrence of reintubation, avoidance of tracheostomy as far as possible, and minimization of sedation. The ICU clinicians should be aware of the risk factors for VAP, which could prove useful in identifying patients at high risk for VAP, and modifying patient care to

  19. Roy in the postanesthesia care unit.

    Science.gov (United States)

    Jackson, D A

    1990-06-01

    The adaptation model developed by Sister Callista Roy, RN, PhD, was used as the organizing framework for developing a preoperative assessment tool for PACU nurses. The purpose of preoperative assessment of a surgical patient by a PACU nurse is to determine the patient's location on the health-illness continuum. This is done by analyzing data regarding the patient's biopsychosocial needs, evaluating the data, and determining from that information what problems need intervention. Roy's theory advocates assessing the patient's biopsychosocial needs using four different adaptive modes: self-concept, physiological function, role function, and interdependence (level I assessment). After completing the PACU preoperative assessment tool, each mode in level I assessment is identified as either positive (adaptive) or negative (maladaptive) depending on the patient's behavior identified by the tool. If a maladaptive behavior is identified during the preoperative assessment, a level II assessment is made to collect data regarding focal, contextual, and residual stimuli. A nursing diagnosis, expected outcomes, nursing interventions, and evaluation are listed on the patient care plan based on the data obtained from the assessment.

  20. Probiotics in the intensive care unit.

    Science.gov (United States)

    Morrow, Lee E; Gogineni, Vijaya; Malesker, Mark A

    2012-04-01

    Probiotics are living microorganisms that, when ingested in adequate amounts, provide benefits to the host. The benefits include either a shortened duration of infections or decreased susceptibility to pathogens. Proposed mechanisms of beneficial effects include improving gastrointestinal barrier function, modification of the gut flora by inducing host cell antimicrobial peptides and/or local release of probiotic antimicrobial factors, competition for epithelial adherence, and immunomodulation. With increasing intensive care unit (ICU) antibacterial resistance rates and fewer new antibiotics in the research pipeline, focus has been shifted to non-antibiotic approaches for the prevention and treatment of nosocomial infections. Probiotics offer promise to ICU patients for the prevention of antibiotic-associated diarrhea, Clostridium difficile infections, multiple organ dysfunction syndrome, and ventilator-associated pneumonia. Our current understanding of probiotics is confounded by inconsistency in probiotic strains studied, optimal dosages, study durations, and suboptimal sample sizes. Although probiotics are generally safe in the critically ill, adverse event monitoring must be rigorous in these vulnerable patients. Delineation of clinical differences of various effective probiotic strains, their mechanisms of action, and optimal dosing regimens will better establish the role of probiotics in various disorders. However, probiotic research will likely be hindered in the future given a recent ruling by the U.S. Food and Drug Administration.

  1. Aristotle's ethical theory & modern health care.

    Science.gov (United States)

    Majumdar, S K

    1996-01-01

    The Greek physician of antiquity - Hippocrates (460-356 B.C.) is called the Father of Modern Medicine and the Hippocratic Oath to which doctors of modern medicine traditionally and formally express their allegiance, forms the basic foundation of medical ethics. The tradition of Western ethical philosophy began with the ancient Greeks. From Socrates (469-399 B.C.) and his immediate successors, Plato (427-347 B.C.) and Aristotle (384-322 B.C.), there is a clear line of continuity, through Hellenistic period (from the death of Alexander the Great (323 B.C.) to the end of Ptolemic dynasty (30 B.C.) and the Roman annexation of Egypt - broadly post-Aristotelian and medieval thought to the present day. But the society has qualitatively and quantitatively changed since the Industrial Revolution in the late 18th and 19th centuries. Society, today, is just a collection of discrete individuals, each with his or her own purposes and interests. Hence it has become almost imperative to apply the principle of autonomy to issues in the ethics of health care. The aim of this short essay is, therefore, an attempt to explore the relevance, if any, of Aristotelian ethical theory to the modern health care. PMID:11619400

  2. Translating caring theory across the continuum from inpatient to ambulatory care.

    Science.gov (United States)

    Tonges, Mary; McCann, Meghan; Strickler, Jeff

    2014-06-01

    While theory-based practice is a Magnet® characteristic, translating theories to practice remains challenging. As a result, theory-guided practice remains an ideal rather than a realized goal in many organizations. This article provides an overview of a research-derived caring theory, a translational model for theory-driven practice, implementation of a delivery model designed to translate theory across the acute and ambulatory care continuum, and resulting outcomes in oncology clinics and the emergency department.

  3. Strange and scary memories of the intensive care unit

    DEFF Research Database (Denmark)

    Svenningsen, Helle; Egerod, Ingrid; Dreyer, Pia

    2016-01-01

    of the Intensive Care Unit. CONCLUSIONS: Analysis based on Ricoeurian phenomenological hermeneutics provided insights into themes in intensive care unit patients' memories of delusions. More studies are needed to understand the meaning of memories of delusions, the commonality of themes and the association between...

  4. Glucose variability is associated with intensive care unit mortality

    NARCIS (Netherlands)

    J. Hermanides; T.M. Vriesendorp; R.J. Bosman; D.F. Zandstra; J.B. Hoekstra; J.H. DeVries

    2010-01-01

    OBJECTIVE: Mounting evidence suggests a role for glucose variability in predicting intensive care unit (ICU) mortality. We investigated the association between glucose variability and intensive care unit and in-hospital deaths across several ranges of mean glucose. DESIGN: Retrospective cohort study

  5. Inpatient Transfers to the Intensive Care Unit

    Science.gov (United States)

    Young, Michael P; Gooder, Valerie J; McBride, Karen; James, Brent; Fisher, Elliott S

    2003-01-01

    OBJECTIVE To examine if delayed transfer to the intensive care unit (ICU) after physiologic deterioration is associated with increased morbidity and mortality. DESIGN Inception cohort. SETTING Community hospital in Ogden, Utah. PATIENTS Ninety-one consecutive inpatients with noncardiac diagnoses at the time of emergent transfer to the ICU. We determined the time when each patient first met any of 11 pre-specified physiologic criteria. We classified patients as “slow transfer” when patients met a physiologic criterion 4 or more hours before transfer to the ICU. Patients were followed until discharge. INTERVENTIONS None. MEASUREMENTS In-hospital mortality, functional status at hospital discharge, hospital resources. MAIN RESULTS At the time when the first physiologic criterion was met on the ward, slow- and rapid-transfer patients were similar in terms of age, gender, diagnosis, number of days in hospital prior to ICU transfer, prehospital functional status, and APACHE II scores. By the time slow-transfer patients were admitted to the ICU, they had significantly higher APACHE II scores (21.7 vs 16.2; P = .002) and were more likely to die in-hospital (41% vs 11%; relative risk [RR], 3.5; 95% confidence interval [95% CI], 1.4 to 9.5). Slow-transfer patients were less likely to have had their physician notified of deterioration within 2 hours of meeting physiologic criteria (59% vs 31%; P = .001) and less likely to have had a bedside physician evaluation within the first 3 hours after meeting criteria (23% vs 83%; P = .001). CONCLUSIONS Slow transfer to the ICU of physiologically defined high-risk hospitalized patients was associated with increased risk of death. Slow response to physiologic deterioration may explain these findings. PMID:12542581

  6. Repertoire of intensive care unit pneumonia microbiota.

    Directory of Open Access Journals (Sweden)

    Sabri Bousbia

    Full Text Available Despite the considerable number of studies reported to date, the causative agents of pneumonia are not completely identified. We comprehensively applied modern and traditional laboratory diagnostic techniques to identify microbiota in patients who were admitted to or developed pneumonia in intensive care units (ICUs. During a three-year period, we tested the bronchoalveolar lavage (BAL of patients with ventilator-associated pneumonia, community-acquired pneumonia, non-ventilator ICU pneumonia and aspiration pneumonia, and compared the results with those from patients without pneumonia (controls. Samples were tested by amplification of 16S rDNA, 18S rDNA genes followed by cloning and sequencing and by PCR to target specific pathogens. We also included culture, amoeba co-culture, detection of antibodies to selected agents and urinary antigen tests. Based on molecular testing, we identified a wide repertoire of 160 bacterial species of which 73 have not been previously reported in pneumonia. Moreover, we found 37 putative new bacterial phylotypes with a 16S rDNA gene divergence ≥ 98% from known phylotypes. We also identified 24 fungal species of which 6 have not been previously reported in pneumonia and 7 viruses. Patients can present up to 16 different microorganisms in a single BAL (mean ± SD; 3.77 ± 2.93. Some pathogens considered to be typical for ICU pneumonia such as Pseudomonas aeruginosa and Streptococcus species can be detected as commonly in controls as in pneumonia patients which strikingly highlights the existence of a core pulmonary microbiota. Differences in the microbiota of different forms of pneumonia were documented.

  7. Communication skills and error in the intensive care unit

    OpenAIRE

    Reader, Tom W; Flin, Rhona; Cuthbertson, Brian H

    2007-01-01

    Purpose of review: Poor communication in critical care teams has been frequently shown as a contributing factor to adverse events. There is now a strong emphasis on identifying the communication skills that can contribute to, or protect against, preventable medical errors. This review considers communication research recently conducted in the intensive care unit and other acute domains. Recent findings: Error studies in the intensive care unit have shown good communication to be crucial for e...

  8. Nursing workload in a trauma intensive care unit

    OpenAIRE

    Luana Loppi Goulart; Roberta Nazário Aoki; Camila Fernanda Lourençon Vegian; Edinêis de Brito Guirardello

    2014-01-01

    Severely injured patients with multiple and conflicting injuries present themselves to nursing professionals at critical care units faced with care management challenges. The goal of the present study is to evaluate nursing workload and verify the correlation between workload and the APACHE II severity index. It is a descriptive study, conducted in the Trauma Intensive Care Unit of a teaching hospital. We used the Nursing Activities Score and APACHE II as instruments. The sample comprised 32 ...

  9. Care of the newborn in perinatal units in New Brunswick

    OpenAIRE

    Stephen, David L.

    1986-01-01

    A survey of 23 perinatal units in New Brunswick hospitals was conducted by means of a mailed questionnaire to determine the type of care provided to newborns. The results showed various degrees of conformity with published guidelines for the care of newborns. Deficiencies were noted in several areas of care: failing to give or improperly giving vitamin K1 prophylaxis (in 7 of the units), flushing the eyes after silver nitrate prophylaxis (in 10), using hexachlorophene to bathe newborns (in 11...

  10. Nursing management and organizational ethics in the intensive care unit.

    Science.gov (United States)

    Wlody, Ginger Schafer

    2007-02-01

    This article describes organizational ethics issues involved in nursing management of an intensive care unit. The intensive care team and medical center management have the dual responsibility to create an ethical environment in which to provide optimum patient care. Addressing organizational ethics is key to creating that ethical environment in the intensive care unit. During the past 15-20 yrs, increasing costs in health care, competitive markets, the effect of high technology, and global business changes have set the stage for business and healthcare organizational conflicts that affect the ethical environment. Studies show that critical care nurses experience moral distress and are affected by the ethical climate of both the intensive care unit and the larger organization. Thus, nursing moral distress may result in problems related to recruitment and retention of staff. Other issues with organizational ethics ramifications that may occur in the intensive care unit include patient safety issues (including those related to disruptive behavior), intensive care unit leadership style, research ethics, allocation of resources, triage, and other economic issues. Current organizational ethics conflicts are discussed, a professional practice model is described, and multidisciplinary recommendations are put forth. PMID:17242604

  11. Health Care Indicators for the United States

    OpenAIRE

    Donham, Carolyn S.; Maple, Brenda T.; Levit, Katharine R.

    1992-01-01

    Contained in this regular feature of the journal is a section on each of the following four topics community hospital statistics; employment, hours, and earnings in the private health sector; health care prices; and national economic indicators.

  12. Direct and indirect nursing care time in an Intensive Care Unit1

    OpenAIRE

    Luciana Emi Kakushi; Yolanda Dora Martinez Évora

    2014-01-01

    OBJECTIVE: to identify the direct and indirect nursing care time in an Intensive Care Unit. METHOD: a descriptive/exploratory study conducted at a private hospital. The Nursing Activities Score classification system was used to estimate the direct care time, and electronic health records were used to estimate the indirect care time. The data were collected from March to June 2011. RESULTS: the findings indicate that the average nursing care time was 29.5 hours, consisting of 27.4 hou...

  13. Stakeholder theory and care management: An inquiry into social enterprises

    OpenAIRE

    Giuseppe Marcon; Lorenzo Dorigo

    2012-01-01

    This work aims to introduce care management from the moral viewpoint of stakeholder theory. It considers stakeholder theory a useful methodology for managerial descriptions, narratives and theorising of business ethics, and the feminist thought, especially the moral grounding of care, a valuable normative core to earn productive remarks and insights into stakeholder research in modern capitalism. Care leads researchers to meaningful conceptualizations of the firm as a relational entity, both ...

  14. Health care data in the United States.

    Science.gov (United States)

    Rice, D P

    1983-06-01

    This article serves as an introduction to the following article, An Inventory of U.S. Health Care Data Bases. As an introduction, this article-reviews the characteristics of U.lS. Health Care Data. These characteristics include a lack of common definition and uniformity of reporting of observations, systems that are sometimes duplicative, and a resistance to data sharing on the part of collecting agencies, arising from the pluralistic American health care economy. Yet federal, state, and local governments as well as private organizations need health data to operate and evaluate their programs. Moreover, recent shifts to block grants and cutbacks in federal funding without accountability requirements will adversely affect our ability to adequately monitor the impact of these programs on the nation's health. The article discusses these data issues, but also emphasizes the need for coordination between the government and private sectors. PMID:10261971

  15. Reducing medication errors in the neonatal intensive care unit

    OpenAIRE

    Simpson, J.; Lynch, R; Grant, J; Alroomi, L

    2004-01-01

    Background: Medication errors are common in the neonatal intensive care unit (NICU). Various strategies to reduce errors have been described in adult and paediatric patients but there are few published data on their effect in the NICU.

  16. Infants in a neonatal intensive care unit: parental response

    OpenAIRE

    Carter, J; Mulder, R; Bartram, A; Darlow, B

    2005-01-01

    Objective: To compare the psychosocial functioning of the parents (mother and father) of infants admitted to a neonatal intensive care unit (NICU) with the parents of infants born at term and not admitted to the NICU.

  17. Implementation of an electronic logbook for intensive care units.

    OpenAIRE

    Wallace, Carrie J.; Stansfield, Dennis; Gibb Ellis, Kathryn A.; Clemmer, Terry P.

    2002-01-01

    Logbooks of patients treated in acute care units are commonly maintained; the data may be used to justify resource use, analyze patient outcomes, and encourage clinical research. We report herein the conversion of a paper-based logbook to an electronic logbook in three hospital intensive care units. The major difference between the paper logbook and electronic logbook data was the addition of clinician-entered data to the electronic logbook. Despite extensive computerization of patient inform...

  18. Pathophysiology of intensive care unit-acquired anemia

    OpenAIRE

    Fink, Mitchell P.

    2004-01-01

    The formation of red blood cells (RBCs) in the bone marrow is regulated by erythropoietin in response to a cascade of events. Anemia in the intensive care unit can be caused by a host of factors. Patients in the intensive care unit may have decreased RBC production and a blunted response to erythropoietin. Administration of recombinant human erythropoietin may stimulate erythropoiesis, increase hematocrit levels and hemoglobin concentration, and reduce the need for RBC transfusions.

  19. BURNOUT MIDWIVES WORKING IN NEONATAL INTESIVE CARE UNIT

    OpenAIRE

    Nanou, Christina; Gourounti, Kleanthi; Palaska, Ermioni; Mallidou, Anastasia; Sarantaki, Antigoni

    2015-01-01

    Abstract  Introduction: The considerably low proportion of midwives in closed wards in Greek hospitals in combination with the highly stressful environment may lead to burnout syndrome (BS).  Aim: It was to explore burnout syndrome (BS) that experience midwives working in Neonatal Intensive Care Units (NICU) and the factors associated with its' occurrence.  Methods: The sample studied consisted of midwives working in Νeonatal Intensive Care Unit in hospitals ...

  20. Respiratory virology and microbiology in intensive care units

    DEFF Research Database (Denmark)

    Østby, Anne-Cathrine; Gubbels, Sophie; Baake, Gerben;

    2013-01-01

    Our aim was to determine the frequency of 12 common respiratory viruses in patients admitted to intensive care units with respiratory symptoms, evaluate the clinical characteristics and to compare the results to routine microbiological diagnostics. Throat swabs from 122 intensive care-patients >18...

  1. Physical Therapy Intervention in the Neonatal Intensive Care Unit

    Science.gov (United States)

    Byrne, Eilish; Garber, June

    2013-01-01

    This article presents the elements of the Intervention section of the Infant Care Path for Physical Therapy in the Neonatal Intensive Care Unit (NICU). The types of physical therapy interventions presented in this path are evidence-based and the suggested timing of these interventions is primarily based on practice knowledge from expert…

  2. [The organization of a post-intensive care rehabilitation unit].

    Science.gov (United States)

    Barnay, Claire; Luauté, Jacques; Tell, Laurence

    2015-01-01

    When a patient is admitted to a post-intensive care rehabilitation unit, the functional outcome is the main objective of the care. The motivation of the team relies on strong cohesion between professionals. Personalised support provides a heightened observation of the patient's progress. Listening and sharing favour a relationship of trust between the patient, the team and the families. PMID:26365639

  3. [The difficulties of staff retention in neonatal intensive care units].

    Science.gov (United States)

    Deparis, Corinne

    2015-01-01

    Neonatal intensive care units attract nurses due to the technical and highly specific nature of the work. However, there is a high turnover in these departments. Work-related distress and the lack of team cohesion are the two main causes of this problem. Support from the health care manager is essential in this context. PMID:26183101

  4. Perceptions of Appropriateness of Care Among European and Israeli Intensive Care Unit Nurses and Physicians

    NARCIS (Netherlands)

    Piers, Ruth D.; Azoulay, Elie; Ricou, Bara; Ganz, Freda DeKeyser; Decruyenaere, Johan; Max, Adeline; Michalsen, Andrej; Maia, Paulo Azevedo; Owczuk, Radoslaw; Rubulotta, Francesca; Depuydt, Pieter; Meert, Anne-Pascale; Reyners, Anna K.; Aquilina, Andrew; Bekaert, Maarten; Van den Noortgate, Nele J.; Schrauwen, Wim J.; Benoit, Dominique D.

    2011-01-01

    Context Clinicians in intensive care units (ICUs) who perceive the care they provide as inappropriate experience moral distress and are at risk for burnout. This situation may jeopardize patient quality of care and increase staff turnover. Objective To determine the prevalence of perceived inappropr

  5. Environmental Design for Patient Families in Intensive Care Units

    OpenAIRE

    Rashid, Mahbub

    2010-01-01

    The purpose of this paper is to define the role of environmental design in improving family integration with patient care in Intensive Care Units (ICUs). It argues that it is necessary to understand family needs, experience and behavioral responses in ICUs to develop effective models for family integration. With its two components—the “healing culture” promoting effective relationships between caregivers and care seekers, and the “environmental design” supporting the healing culture—a “healin...

  6. Management practices and the quality of care in cardiac units

    OpenAIRE

    McConnell, K. John; Lindrooth, Richard C; Wholey, Douglas R; Maddox, Thomas M.; Bloom, Nicholas

    2013-01-01

    Importance:- To improve the quality of health care, many researchers have suggested that health care institutions adopt management approaches that have been successful in the manufacturing and technology sectors. However, relatively little information exists about how these practices are disseminated in hospitals and whether they are associated with better performance. Objectives:- To describe the variation in management practices among a large sample of hospital cardiac care units; asses...

  7. (Dis) connections between management and care in a surgical intensive care unit

    OpenAIRE

    Borges, Maria Cristina Leite Araujo; Silva, Lucilane Maria Sales da

    2013-01-01

    Objective: The objective was to understand the perception of the nursing team on the (dis)connections between management actions and care performed by nurses in a surgical intensive care unit. Method: Exploratory research with qualitative approach carried out in a surgical intensive care unit of a hospital in the public net of Fortaleza-CE, Brazil. Data was collected between March and July 2011, through semi-structured interviews and systematic observations, with 20 nursing ...

  8. Family-Centered Care in Neonatal Intensive Care Unit: A Concept Analysis

    Science.gov (United States)

    Ramezani, Tahereh; Hadian Shirazi, Zahra; Sabet Sarvestani, Raheleh; Moattari, Marzieh

    2014-01-01

    Background: The concept of family- centered care in neonatal intensive care unit has changed drastically in protracted years and has been used in various contexts differently. Since we require clarity in our understanding, we aimed to analyze this concept. Methods: This study was done on the basis of developmental approach of Rodgers’s concept analysis. We reviewed the existing literature in Science direct, PubMed, Google Scholar, Scopus, and Iran Medex databases from 1980 to 2012. The keywords were family-centered care, family-oriented care, and neonatal intensive care unit. After all, 59 out of 244 English and Persian articles and books (more than 20%) were selected. Results: The attributes of family-centered care in neonatal intensive care unit were recognized as care taking of family (assessment of family and its needs, providing family needs), equal family participation (participation in care planning, decision making, and providing care from routine to special ones), collaboration (inter-professional collaboration with family, family involvement in regulating and implementing care plans), regarding family’s respect and dignity (importance of families’ differences, recognizing families’ tendencies), and knowledge transformation (information sharing between healthcare workers and family, complete information sharing according to family learning style). Besides, the recognized antecedents were professional and management-organizational factors. Finally, the consequences included benefits related to neonate, family, and organization. Conclusion: The findings revealed that family centered-care was a comprehensive and holistic caring approach in neonatal intensive care. Therefore, it is highly recommended to change the current care approach and philosophy and provide facilities for conducting family-centered care in neonatal intensive care unit.  PMID:25349870

  9. Elderly care with alzheimer disease: a focus on the theory of cultural care

    OpenAIRE

    Jose Lúcio Costa Ramos; Maria do Rosário de Menezes

    2012-01-01

    This report was aimed in reflecting on care for the elderly with Alzheimer disease, through family care, focused on Madeleine Leininger’s Theory of Diversity and Universality of Cultural Care. Qualitative study, with 20 home care workers looking after elderly people in Salvador, BA, Brazil, was performed between June and August of 2010.Four categories emerged: characterization of family caregivers of elders with Alzheimer's disease, knowledge about the disease to the practice of caring for th...

  10. Nutrition in the intensive care unit

    OpenAIRE

    Weissman, Charles

    1999-01-01

    Nutritional support has become a routine part of the care of the critically ill patient. It is an adjunctive therapy, the main goal of which is to attenuate the development of malnutrition, yet the effectiveness of nutritional support is often thwarted by an underlying hostile metabolic milieu. This requires that these metabolic changes be taken into consideration when designing nutritional regimens for such patients. There is also a need to conduct large, multi-center studies to acquire more...

  11. Clinical risk assessment in intensive care unit

    Directory of Open Access Journals (Sweden)

    Saeed Asefzadeh

    2013-01-01

    Full Text Available Background: Clinical risk management focuses on improving the quality and safety of health care services by identifying the circumstances and opportunities that put patients at risk of harm and acting to prevent or control those risks. The goal of this study is to identify and assess the failure modes in the ICU of Qazvin′s Social Security Hospital (Razi Hospital through Failure Mode and Effect Analysis (FMEA. Methods: This was a qualitative-quantitative research by Focus Discussion Group (FDG performed in Qazvin Province, Iran during 2011. The study population included all individuals and owners who are familiar with the process in ICU. Sampling method was purposeful and the FDG group members were selected by the researcher. The research instrument was standard worksheet that has been used by several researchers. Data was analyzed by FMEA technique. Results: Forty eight clinical errors and failure modes identified, results showed that the highest risk probability number (RPN was in respiratory care "Ventilator′s alarm malfunction (no alarm" with the score 288, and the lowest was in gastrointestinal "not washing the NG-Tube" with the score 8. Conclusions: Many of the identified errors can be prevented by group members. Clinical risk assessment and management is the key to delivery of effective health care.

  12. Intensive care unit telemedicine: review and consensus recommendations.

    Science.gov (United States)

    Cummings, Joseph; Krsek, Cathleen; Vermoch, Kathy; Matuszewski, Karl

    2007-01-01

    Intensive care unit telemedicine involves nurses and physicians located at a remote command center providing care to patients in multiple, scattered intensive care units via computer and telecommunication technology. The command center is equipped with a workstation that has multiple monitors displaying real-time patient vital signs, a complete electronic medical record, a clinical decision support tool, a high-resolution radiographic image viewer, and teleconferencing for every patient and intensive care unit room. In addition to communication functions, the video system can be used to view parameters on ventilator screens, infusion pumps, and other bedside equipment, as well as to visually assess patient conditions. The intensivist can conduct virtual rounds, communicate with on-site caregivers, and be alerted to important patient conditions automatically via software-monitored parameters. This article reviews the technology's background, status, significance, clinical literature, financial effect, implementation issues, and future developments. Recommendations from a University HealthSystem Consortium task force are also presented. PMID:17656728

  13. Desenvolvimento e validação de teoria fundamentada em dados sobre o ambiente de unidade de terapia intensiva Desarrollo y validación de la teoría fundamentada sobre el medio ambiente de la unidad de cuidado intensivo Development and validation of the theory based on data about the environment of the intensive care unit

    Directory of Open Access Journals (Sweden)

    Marli Terezinha Stein Backes

    2011-12-01

    diferentes tecnologías y profesionales cualificados, que trabajan en equipo, vivir con familiares angustiados, con tensión y conflictos, y con la dificultad para hacer frente a la muerte.Qualitative study, merged from the issue: how the theories and models of nursing care have being constructed, focusing on the process of building a substantive theory based on the Thesis that had as objectives to comprehend the meaning of the environment of care in the Intensive Care Unit and to construct a theoretical model about it. The method used was the Grounded Theory. Thirty-nine interviews were conducted with forty-seven differentiated subjects from three Adult Intensive Care Units in Florianópolis/SC, Santa Maria/RS and Pelotas/RS between June of 2009 and September of 2010. It was possible to construct the theory "Sustaining life in the complex care environment of the Intensive Care Unit", delimited by eight categories. Sustain life on the environment of care in the Intensive Care Unit means investing intensively in the care of patients admitted who are in an unstable situation, with the help of different technologies and skilled professionals who work in teams, coexists with relatives distressed, with stress and conflict, and the difficulty to deal with the death.

  14. [Analysis of humanistic theory and interpersonal relations of nurses in newborn care].

    Science.gov (United States)

    Rolim, Karla Maria Carneiro; Pagliuca, Lorita Marlena Freitag; Leitão Cardoso, Maria Vera Lúcia M

    2005-01-01

    Theories are propositions created to evaluate nursing care, allowing nurses to consider and incorporate them in their professional practice. This Masters study was aimed at thinking critically about the practical usefulness of the concepts of Humanistic Nursing Theory. This descriptive-reflexive study was carried out in 2004 and used Meleis' model for the analysis of theories. The "critique of theory" segment was taken from this model to be used as an analytical tool, with emphasis on the "usefulness" parameter. The critical analysis revealed the notorious "usefulness" of interpersonal relations and dialogue, which can be used in daily practice at the Newborn Intensive Care Unit, valuing the human affective relations, which are essential for nursing care. Nursing practice should be guided by theoretical, philosophical, and methodological reference frameworks, responsible for making professionals reflect critically on themselves and their practice.

  15. COPD self-management supportive care: chaos and complexity theory.

    Science.gov (United States)

    Cornforth, Amber

    This paper uses the emergent theories of chaos and complexity to explore the self-management supportive care of chronic obstructive pulmonary disease (COPD) patients within the evolving primary care setting. It discusses the concept of self-management support, the complexity of the primary care context and consultations, smoking cessation, and the impact of acute exacerbations and action planning. The author hopes that this paper will enable the acquisition of new insight and better understanding in this clinical area, as well as support meaningful learning and facilitate more thoughtful, effective and high quality patient-centred care within the context of primary care.

  16. Modeling Safety Outcomes on Patient Care Units

    Science.gov (United States)

    Patil, Anita; Effken, Judith; Carley, Kathleen; Lee, Ju-Sung

    In its groundbreaking report, "To Err is Human," the Institute of Medicine reported that as many as 98,000 hospitalized patients die each year due to medical errors (IOM, 2001). Although not all errors are attributable to nurses, nursing staff (registered nurses, licensed practical nurses, and technicians) comprise 54% of the caregivers. Therefore, it is not surprising, that AHRQ commissioned the Institute of Medicine to do a follow-up study on nursing, particularly focusing on the context in which care is provided. The intent was to identify characteristics of the workplace, such as staff per patient ratios, hours on duty, education, and other environmental characteristics. That report, "Keeping Patients Safe: Transforming the Work Environment of Nurses" was published this spring (IOM, 2004).

  17. Improved nurse-parent communication in neonatal intensive care unit

    DEFF Research Database (Denmark)

    Weis, Janne; Zoffmann, Vibeke; Egerod, Ingrid

    2014-01-01

    and adjustment of nurse adherence to guided family-centred care was conducted by monitoring (1) knowledge, (2) delivery, (3) practice uptake and (4) certification. RESULTS: Implementation was improved by the development of a strategic framework and by adjusting the framework according to the real-life context...... family-centred care was developed to facilitate person-centred communication by bridging the gap between theory and practice in family-centred care. Main mechanisms of guided family-centred care are structured dialogue, reflection and person-centred communication. DESIGN: Qualitative and quantitative...... data were used to monitor participatory implementation of a systematic approach to training and certification of nurses delivering guided family-centred care. METHODS: Systematic implementation of guided family-centred care included workshops, supervised delivery and certification. Evaluation...

  18. Parental involvement and kangaroo care in European neonatal intensive care units

    DEFF Research Database (Denmark)

    Pallás-Alonso, Carmen R; Losacco, Valentina; Maraschini, Alice;

    2012-01-01

    To compare, in a large representative sample of European neonatal intensive care units, the policies and practices regarding parental involvement and holding babies in the kangaroo care position as well as differences in the tasks mothers and fathers are allowed to carry out.......To compare, in a large representative sample of European neonatal intensive care units, the policies and practices regarding parental involvement and holding babies in the kangaroo care position as well as differences in the tasks mothers and fathers are allowed to carry out....

  19. Measurement of muscle strength in the intensive care unit.

    Science.gov (United States)

    Bittner, Edward A; Martyn, Jeevendra A; George, Edward; Frontera, Walter R; Eikermann, Matthias

    2009-10-01

    Traditional (indirect) techniques, such as electromyography and nerve conduction velocity measurement, do not reliably predict intensive care unit-acquired muscle weakness and its clinical consequences. Therefore, quantitative assessment of skeletal muscle force is important for diagnosis of intensive care unit-acquired motor dysfunction. There are a number of ways for assessing objectively muscle strength, which can be categorized as techniques that quantify maximum voluntary contraction force and those that assess evoked (stimulated) muscle force. Important factors that limit the repetitive evaluation of maximum voluntary contraction force in intensive care unit patients are learning effects, pain during muscular contraction, and alteration of consciousness.The selection of the appropriate muscle is crucial for making adequate predictions of a patient's outcome. The upper airway dilators are much more susceptible to a decrease in muscle strength than the diaphragm, and impairment of upper airway patency is a key mechanism of extubation failure in intensive care unit patients. Data suggest that the adductor pollicis muscle is an appropriate reference muscle to predict weakness of muscles that are typically affected by intensive care unit-acquired weakness, i.e., upper airway as well as extremity muscles. Stimulated (evoked) force of skeletal muscles, such as the adductor pollicis, can be assessed repetitively, independent of brain function, even in heavily sedated patients during high acuity of their disease. PMID:20046117

  20. Anaesthesia for procedures in the intensive care unit.

    Science.gov (United States)

    Chollet-Rivier, M; Chioléro, R L

    2001-08-01

    Taking in charge severely ill patients in the intensive care environment to manage complex procedures is a performance requiring highly specific knowledge. Close collaboration between anaesthetists and intensive care specialists is likely to improve the safety and quality of medical care. Three forms of anaesthetic care should be considered in clinical practice: sedation and analgesia; monitored anaesthetic care; and general anaesthesia or conduction block anaesthesia. Even in the field of sedation and analgesia, the anaesthesiologist can offer expertise on new anaesthetic techniques like: the most recent concepts of balanced anaesthesia in terms of pharmacokinetics and dynamics, favouring the use of short-acting agents and of sedative-opioid combinations. New modes of administration and monitoring intravenous anaesthesia have been developed, with potential application in the intensive care unit. These include the use of target-controlled administration of intravenous drugs, and of electroencephalographic signals to monitor the level of sedation.

  1. The Care Pathway Concept: concepts and theories: an introduction

    NARCIS (Netherlands)

    Schrijvers, Guus J.P.; Hoorn, Arjan van; Huiskes, Nicolette

    2012-01-01

    This article addresses first the definition of a (care) pathway, and then follows a description of theories since the fifties of the last century.  It ends with a discussion of theoretical advantages and disadvantages of care pathways for patients and professionals. The objective of this paper is to

  2. Perceptions and experiences with nursing care: a study of Pakistani (Urdu) communities in the United Kingdom.

    Science.gov (United States)

    Cortis, J D

    2000-04-01

    The population of the United Kingdom reflects rich cultural diversity. Hence, nursing must respond to the challenges of meeting the needs of different ethnic groups and fulfilL the requirements of the Code of Professional Conduct. This article presents the findings of a study using grounded theory to explore the lived experience of Pakistani (Urdu-speaking) communities that received nursing care in a hospital setting in the United Kingdom. The study reflects national initiatives toward "consumer led" health care delivery. The findings illustrate a lack of congruence between the group's expectations and their experiences. Nurses were perceived to have a poor understanding of ethnic needs, portraying ethnocentric attitudes and behaviour. The participants attributed the lack of congruence mainly to the presence of racism in British health care systems. The author suggests possible changes at the strategic, managerial, and educational levels of health care delivery. PMID:11982043

  3. Transfusional profile in different types of intensive care units

    Directory of Open Access Journals (Sweden)

    Ilusca Cardoso de Paula

    2014-06-01

    Full Text Available Background and objectives: anemia is a common clinical finding in intensive care units. The red blood cell transfusion is the main form of treatment, despite the associated risks. Thus, we proposed to evaluate the profile of transfusional patients in different intensive care units. Methods: prospective analysis of patients admitted in the intensive care units of a tertiary university hospital with an indication for transfusion of packed red blood cells. Demographic profile and transfusional profile were collected, a univariate analysis was done, and the results were considered significant at p = 0.05. Results: 408 transfusions were analyzed in 71 patients. The mean hemoglobin concentration on admission was 9.7 ± 2.3 g/dL and the pre-transfusional concentration was 6.9 ± 1.1 g/dL. The main indications for transfusion were hemoglobin concentration (49% and active bleeding (32%. The median number of units transfused per episode was 2 (1-2 and the median storage time was 14 (7-21 days. The number of patients transfused with hemoglobin levels greater than 7 g/dL and the number of bags transfused per episode were significantly different among intensive care units. Patients who received three or more transfusions had longer mechanical ventilation time and intensive care unit stay and higher mortality after 60 days. There was an association of mortality with disease severity but not with transfusional characteristics. Conclusions: the practice of blood products transfusion was partially in agreement with the guidelines recommended, although there are differences in behavior between the different profiles of intensive care units. Transfused patients evolved with unfavorable outcomes. Despite the scarcity of blood in blood banks, the mean storage time of the bags was high.

  4. [Antibiotic multiresistance in critical care units].

    Science.gov (United States)

    López-Pueyo, M J; Barcenilla-Gaite, F; Amaya-Villar, R; Garnacho-Montero, J

    2011-01-01

    The presence of microorganisms with acquired resistance to multiple antibiotics complicates the management and outcome of critically ill patients. The intensivist, in his/her daily activity, is responsible for the prevention and control of the multiresistance and the challenge of prescribing the appropriate treatment in case of an infection by these microorganisms. We have reviewed the literature regarding the definition, important concepts related to transmission, recommendations on general measures of control in the units and treatment options. We also present data on the situation in our country known primarily through the ENVIN-UCI register. Addressing the multiresistance not only requires training but also teamwork with other specialists and adaptation to the local environment. PMID:21215489

  5. Measuring technical efficiency of output quality in intensive care units.

    Science.gov (United States)

    Junoy, J P

    1997-01-01

    Presents some examples of the implications derived from imposing the objective of maximizing social welfare, subject to limited resources, on ethical care patients management in respect of quality performance of health services. Conventional knowledge of health economics points out that critically ill patients are responsible for increased use of technological resources and that they receive a high proportion of health care resources. Attempts to answer, from the point of view of microeconomics, the question: how do we measure comparative efficiency in the management of intensive care units? Analyses this question through data from an international empirical study using micro-economic measures of productive efficiency in public services (data envelopment analysis). Results show a 28.8 per cent level of technical inefficiency processing data from 25 intensive care units in the USA. PMID:10169231

  6. Neonatal intensive care unit lighting: update and recommendations.

    Science.gov (United States)

    Rodríguez, Roberto G; Pattini, Andrea E

    2016-08-01

    Achieving adequate lighting in neonatal intensive care units is a major challenge: in addition to the usual considerations of visual performance, cost, energy and aesthetics, there appear different biological needs of patients, health care providers and family members. Communicational aspects of light, its role as a facilitator of the visual function of doctors and nurses, and its effects on the newborn infant physiology and development were addressed in order to review the effects of light (natural and artificial) within neonatal care with a focus on development. The role of light in regulating the newborn infant circadian cycle in particular and the therapeutic use of light in general were also reviewed. For each aspect, practical recommendations were specified for a proper well-lit environment in neonatal intensive care units. PMID:27399015

  7. Perception of nurses regarding risk classification in emergency care units

    Directory of Open Access Journals (Sweden)

    Carmen Lúcia Mottin Duro

    2014-09-01

    Full Text Available This study aimed to assess nurses’ perception regarding the risk classification in emergency care units. It is a descriptive study that used a qualitative approach and that was conducted with 55 nurses from emergency care units in the south of Brazil. Data were collected between July and October, 2011, through open questions, answered in writing. The data collected were submitted to the thematic analysis technique. Results indicate that the risk classification contributes to the organization of the service flow provided to patients, intervening in severe cases and preventing sequelae. Difficulties were described, such as: inadequate physical installations, overcrowding, disagreement in the definition of priorities among doctors and nurses and lack of articulation between the emergency care network and basic health care. It is highlighted the need to improve the physical structure, the quantity of human resources and the implementation of public policies to overcome these challenges.

  8. What Makes a Good Palliative Care Physician? A Qualitative Study about the Patient's Expectations and Needs when Being Admitted to a Palliative Care Unit.

    Directory of Open Access Journals (Sweden)

    Eva K Masel

    Full Text Available The aims of the study were to examine a patients' knowledge of palliative care, b patients' expectations and needs when being admitted to a palliative care unit, and c patient's concept of a good palliative care physician.The study was based on a qualitative methodology, comprising 32 semistructured interviews with advanced cancer patients admitted to the palliative care unit of the Medical University of Vienna. Interviews were conducted with 20 patients during the first three days after admission to the unit and after one week, recorded digitally, and transcribed verbatim. Data were analyzed using NVivo 10 software, based on thematic analysis enhanced with grounded theory techniques.The results revealed four themes: (1 information about palliative care, (2 supportive care needs, (3 being treated in a palliative care unit, and (4 qualities required of palliative care physicians. The data showed that patients lack information about palliative care, that help in social concerns plays a central role in palliative care, and attentiveness as well as symptom management are important to patients. Patients desire a personal patient-physician relationship. The qualities of a good palliative care physician were honesty, the ability to listen, taking time, being experienced in their field, speaking the patient's language, being human, and being gentle. Patients experienced relief when being treated in a palliative care unit, perceived their care as an interdisciplinary activity, and felt that their burdensome symptoms were being attended to with emotional care. Negative perceptions included the overtly intense treatment.The results of the present study offer an insight into what patients expect from palliative care teams. Being aware of patient's needs will enable medical teams to improve professional and individualized care.

  9. Developing a team performance framework for the intensive care unit

    OpenAIRE

    Reader, Tom W; Flin, Rhona; Mearns, Kathryn; Cuthbertson, Brian H

    2009-01-01

    Objective: There is a growing literature on the relationship between teamwork and patient outcomes in intensive care, providing new insights into the skills required for effective team performance. The purpose of this review is to consolidate the most robust findings from this research into an intensive care unit (ICU) team performance framework. Data Sources: Studies investigating teamwork within the ICU using PubMed, Science Direct, and Web of Knowledge databases. Study Selection: Studies i...

  10. Symptomatic and asymptomatic candidiasis in a pediatric intensive care unit

    OpenAIRE

    Arslankoylu Ali Ertug; Kuyucu Necdet; Yilmaz Berna; Erdogan Semra

    2011-01-01

    Abstract Introduction This study aimed to examine the incidence, epidemiology, and clinical characteristics of symptomatic and asymptomatic candidiasis in a pediatric intensive care unit (PICU), and to determine the risk factors associated with symptomatic candidiasis. Methods This retrospective study included 67 patients from a 7-bed PICU in a tertiary care hospital that had Candida-positive cultures between April 2007 and July 2009. Demographic and clinical characteristics of the patients, ...

  11. Integrated patient unit care in schizophrenia population vs a non-integrated patient unit care

    Directory of Open Access Journals (Sweden)

    Waago-Hansen C

    2013-01-01

    Full Text Available Background: Several studies have described the benefits of integrated care in chronic conditions. Keeping the patients out of hospital is considered to increase value to the patient and is also benefit to the society and the healthcare provider.As we have an increase in the treatment options, costs, age and demand, an optimized treatment model is required if we want to maintain or obtain a sustainable system. The objective of this study was to describe how costs of treatment and value to the patient, to the hospital and the society differs in a non integrated patient unit (IPU vs an IPU system.Methods: Contact data of schizophrenic patients (n=51 from the hospital's electronic medical records (EMRs was accessed (from October 2010 till March 2012 and analyzed. All financial data was obtained from the finance department. Time driven activity based costing (TDABC as used to calculate the costs.Results: The study examined 1,149 out-patient consultations and 4,386 days of occupancy. By adopting an IPU approach, the costs were significantly reduced compared to the non-IPU approach. Increased complexity benefitted significantly from IPU. These patients had a higher frequency of contact but lower degrees of admission, whilst the non-IPU had significantly higher admission rates and duration of stay.Conclusions: This study shows a striking difference in the resources used on patients treated with an IPU vs a non-IPU approach. In almost every aspect, the IPU approach is by far superior to the non-IPU approach.

  12. The case against segregation in "specialized" care units.

    Science.gov (United States)

    Lines, R

    Canadian public officials are demanding that prisons segregate HIV-positive individuals and require mandatory HIV testing similar to the procedures used in correctional institutions in the United States. These measures have been consistently rejected as ineffective and punitive in Canada. The commissioner of the Correctional Service of Canada (CSC) does not consider forced testing or segregation as a useful part of their HIV/AIDS strategy. The issue raises concerns about prisoners' rights. Proponents of segregation say that creating specialized care units in some Federal institutions would guarantee state-of-the-art care; others charge that it is an admission of substandard care throughout the system. Voluntary segregation forces prisoners to choose between health care and proximity to family. It also deters voluntary testing, as some prisoners will decline testing if they do not want to be moved to another facility. Segregation stigmatizes everyone associated with an institution that has a specialized care unit. There are also problems associated with combining prisoners of varying security levels in the same unit. Compassionate release is preferable to segregation. PMID:11365291

  13. Economic analysis of the cost of Intensive Care Units

    Directory of Open Access Journals (Sweden)

    Mazetas D.

    2014-04-01

    Full Text Available The cost of Intensive Care Units has the greatest impact on overall medical costs and the overall cost for the health of a country and an increasing number of studies from around the world presenting the quantification of these costs. Aim: Review of the Economic Analysis of the Cost of Intensive Care Units. Method: Search was made in the SCOPUS, MEDLINE and CINAHL databases using the key-words “Intensive Care Units (ICU”, “Cost”, “Cost Analysis”, “Health Care Costs”, “Health Resources”, “ICU resources”. The study was based on articles published in English from 2000 to 2011 investigating the Economic Analysis of the Cost of Intensive Care Units. Results: The cost of ICU is a significant percentage of gross domestic product in developed countries. Most cost analysis studies that relate to plans that include the study of staff costs, duration of stay in the ICU, the clinical situations of hospitalized patients, engineering support, medications and diagnostic tests costing scales and in relation to the diagnostic criteria. Conclusions: most studies conclude that the remuneration of staff, particularly nurses, in the ICU is the largest cost of ICU, while for the duration of stay in the ICU results are conflicting. The analysis on the cost-effectiveness of ICU can help to better apply these findings to the therapeutic context of ICU.

  14. Oral care in patients on mechanical ventilation in intensive care unit: literature review

    Directory of Open Access Journals (Sweden)

    Selma Atay

    2014-06-01

    Full Text Available intensive care patients needs to oral assessment and oral care for avoid complications caused by orafarengeal bacteria. In this literature review, it is aimed to determine the practice over oral hygiene in mechanical ventilator patients in intensive care unit. For the purpose of collecting data, Medline/pub MED and EBSCO HOST databases were searched with the keywords and lsquo;oral hygiene, oral hygiene practice, mouth care, mouth hygiene, intubated, mechanical ventilation, intensive care and critical care and rdquo; between the years of 2000- 2012. Inclusion criteria for the studies were being performed in adult intensive care unit patients on mechanical ventilation, published in peer-reviewed journals in English between the years of 2000-2012, included oral care practice and presence of a nurse among researchers. A total of 304 articles were identified. Six descriptive evaluation studies, three randomised controlled trials, four literature reviews, three meta-Analysis randomized clinical trials, one qualitative study and one semi-experimental study total 18 papers met all of the inclusion criteria. Oral care is emphasized as an infection control practice for the prevention of Ventilator-Associated Pneumonia (VAP. In conclusion, we mention that oral care is an important nursing practice to prevent VAP development in intensive care unit patients; however, there is no standard oral evaluation tool and no clarity on oral care practice frequency, appropriate solution and appropriate material. It can be recommended that the study projects on oral care in intensive care patients to have high proof level and be experimental, and longitudinal. [Int J Res Med Sci 2014; 2(3.000: 822-829

  15. Fighting antibiotic resistance in the intensive care unit using antibiotics.

    Science.gov (United States)

    Plantinga, Nienke L; Wittekamp, Bastiaan H J; van Duijn, Pleun J; Bonten, Marc J M

    2015-01-01

    Antibiotic resistance is a global and increasing problem that is not counterbalanced by the development of new therapeutic agents. The prevalence of antibiotic resistance is especially high in intensive care units with frequently reported outbreaks of multidrug-resistant organisms. In addition to classical infection prevention protocols and surveillance programs, counterintuitive interventions, such as selective decontamination with antibiotics and antibiotic rotation have been applied and investigated to control the emergence of antibiotic resistance. This review provides an overview of selective oropharyngeal and digestive tract decontamination, decolonization of methicillin-resistant Staphylococcus aureus and antibiotic rotation as strategies to modulate antibiotic resistance in the intensive care unit.

  16. Acinetobacter septicemia in neonates admitted to intensive care units

    Directory of Open Access Journals (Sweden)

    Vishal B Shete

    2009-01-01

    Results: A total of 26 Acinetobacter septicemia cases were identified by blood culture. Acb complex strains predominated. Institutional birth and preterm birth were identified as the most frequent significant risk factors. 11.3% mortality rate was recorded. Acb complex strains exhibited a multi-drug resistant pattern. No carbapenem resistance was observed. Conclusion: Acinetobacter should be added to the list of organisms causing severe nosocomial infection in neonatal intensive care units. Continuous bacteriological surveillance, implementation of infection control policies, careful disinfection of intensive care equipment, and rational antibiotic use are required for control of such infections.

  17. [Systematization of nursing assistance in critical care unit].

    Science.gov (United States)

    Truppel, Thiago Christel; Meier, Marineli Joaquim; Calixto, Riciana do Carmo; Peruzzo, Simone Aparecida; Crozeta, Karla

    2009-01-01

    This is a methodological research, which aimed at organizing the systematization of nursing assistance in a critical care unit. The following steps were carried out: description of the nursing practice; transcription of nursing diagnoses; elaboration of a protocol for nursing diagnosis based in International Classification for Nursing Practice (ICNP); determination of nursing prescriptions and the elaboration of guidelines for care and procedures. The nursing practice and care complexity in ICU were characterized. Thus, systematization of nursing assistance is understood as a valuable tool for nursing practice.

  18. Education of trainees in the intensive care unit.

    Science.gov (United States)

    Croley, W Christopher; Rothenberg, David M

    2007-02-01

    The focus on improving education in critical care medicine must begin early in medical school training and further be promoted during residency if there is to be an increase in intensivists in the hospital workforce. This is "critical" to healthcare reform movements that are endorsing full-time critical care coverage in U.S. urban intensive care units. There is, therefore, a need for more novel approaches in educating trainees in critical care medicine to better prepare future physicians to manage acutely ill patients and improve patient safety. This article will review methods to improve educational designs in teaching critical care medicine to medical students, residents, and fellows, including the use of simulation technology to enhance cognition and procedural skills. PMID:17242600

  19. The Leapfrog initiative for intensive care unit physician staffing and its impact on intensive care unit performance: a narrative review.

    Science.gov (United States)

    Gasperino, James

    2011-10-01

    The field of critical care has changed markedly in recent years to accommodate a growing population of chronically critically ill patients. New administrative structures have evolved to include divisions, departments, and sections devoted exclusively to the practice of critical care medicine. On an individual level, the ability to manage complex multisystem critical illnesses and to introduce invasive monitoring devices defines the intensivist. On a systems level, critical care services managed by an intensivist-led multidisciplinary team are now recognized by their ability to efficiently utilize hospital resources and improve patient outcomes. Due to the numerous cost and quality issues related to the delivery of critical care medicine, intensive care unit physician staffing (IPS) has become a charged subject in recent years. Although the federal government has played a large role in regulating best practices by physicians, other third parties have entered the arena. Perhaps the most influential of these has been The Leapfrog Group, a consortium representing 130 employers and 65 Fortune 500 companies that purchase health care for their employees. This group has proposed specific regulatory guidelines for IPS that are purported to result in substantial cost containment and improved quality of care. This narrative review examines the impact of The Leapfrog Group's recommendations on critical care delivery in the United States.

  20. Prevalence of Hospital Acquired Infections in Anesthesiology Intensive Care Unit

    OpenAIRE

    ÇELİK, İlhami; İNCİ, Nuran; Denk, Affan; SEVİM, Erol; YAŞAR, Demet; YAŞAR, M. Akif

    2005-01-01

    Objectives: To determine the prevalence of infections, predominant organisms and their resistance pattern. Materials and Methods: Prospective cohort study. All patients over 16 years old were occupying an intensive care unit bed over a 24-hour period. All patients admitted to the unit were evaluated on a daily basis for nosocomial infections in compliance with National Nosocomial Infections Surveillance System (NNISS) methodology. Infection site definitions were in agreement with Center fo...

  1. Caregiver distress. Related to disruptive behaviors on special care units versus traditional long-term care units.

    Science.gov (United States)

    Middleton, J I; Stewart, N J; Richardson, J S

    1999-03-01

    The link between staff stress and exposure to disruptive behaviors is an important issue in long-term care settings. This study compared the perceptions of two groups of formal caregivers (staff) regarding their distress from the behaviors of residents in their care. Staff on special care units for dementia were less distressed with disruptive behaviors than comparable staff on traditional units, although they reported higher exposure to these behaviors. These results were related to different perceptions of intent to harm and expectations of physical aggression as "part of the job." Implications for nursing include education and support for staff to enhance the quality of life for residents and staff on units where disruptive behaviors occur. PMID:10362970

  2. Assessment of collaboration in U.S. health care delivery: a perspective from systems theory.

    Science.gov (United States)

    McCovery, Jarred; Matusitz, Jonathan

    2014-01-01

    This analysis applies the core principles of systems theory to health care delivery in the United States. Particularly examined is the role of collaboration between health care agencies/organizations in the United States. This includes cooperation and teamwork among health professionals (i.e., nurses, technicians, physicians, and laboratory staff). By and large, systems theory posits that (a) all singular units within a system are interconnected and (b) the whole is more than the sum of its parts. This analysis identifies areas within the U.S. public health system where it is essential to embody elements of cooperation and collaboration, not only to bolster physical and financial support, but also to ensure a substantial impact within the community. PMID:25068610

  3. Human-centered environment design in intensive care unit

    NARCIS (Netherlands)

    Li, Y.; Albayrak, A.; Goossens, R.H.M.; Xiao, D.; Jakimowicz, J.J.

    2013-01-01

    Because of high risk and instability of the patients in Intensive care unit(ICU), the design of ICU is very difficult. ICU design, auxiliary building design, lighting design, noise control and other aspects can also enhance its management. In this paper, we compare ICU design in China and Holland ba

  4. Importance of recognizing and managing delirium in intensive care unit

    Institute of Scientific and Technical Information of China (English)

    XIE Guo-hao; FANG Xiang-ming

    2009-01-01

    @@ Delirium is an acute and fluctuating change in mental status, with inattention and altered levels of consciousness. It is a common comorbidity in intensive care units (ICU), resulting in delayed withdrawal of mechanical ventilation, prolonged length of stay in ICU, increased ICU mortality and impaired long-term cognitive function of the survivors.

  5. Pet Care Teaching Unit: 1st-3rd Grades.

    Science.gov (United States)

    Peninsula Humane Society, San Mateo, CA.

    Activities in this unit are designed to familiarize primary grade students with the responsibilities involved in pet ownership. Teaching plans are provided for a total of 12 lessons involving social studies, language arts, math, and health sciences. Activities adaptable for readers and non-readers focus on pet overpopulation, care of pets when…

  6. [Benefits of aromatherapy in dementia special care units].

    Science.gov (United States)

    Bilien, Corinne; Depas, Nathalie; Delaporte, Ghislaine; Baptiste, Nathalie

    2016-01-01

    Aromatherapy is classed as a non-pharmacological treatment, recognised as a therapy for certain disorders. This practice was the subject of a study in a special care unit for patients with dementia. The objective was to demonstrate the benefit of aromatherapy diffusion on major behavioural disorders. PMID:27173630

  7. Sleep in the Intensive Care Unit measured by polysomnography

    DEFF Research Database (Denmark)

    Andersen, J H; Boesen, Hans Christian Toft; Olsen, Karsten Skovgaard

    2013-01-01

    Sleep deprivation has deleterious effects on most organ systems. Patients in the Intensive care unit (ICU) report sleep deprivation as the second worst experience during their stay only superseded by pain. The aim of the review is to provide the clinician with knowledge of the optimal sleep-frien...

  8. Glucocorticoid-induced myopathy in the intensive care unit

    DEFF Research Database (Denmark)

    Eddelien, Heidi Shil; Hoffmeyer, Henrik Westy; Lund, Eva Charlotte Løbner;

    2015-01-01

    Glucocorticoids (GC) are used for intensive care unit (ICU) patients on several indications. We present a patient who was admitted to the ICU due to severe respiratory failure caused by bronchospasm requiring mechanical ventilation and treated with methylprednisolone 240 mg/day in addition to ant......, and muscle strength gradually returned. The patient made full recovery from the quadriplegia a few months later....

  9. Fighting antibiotic resistance in the intensive care unit using antibiotics

    NARCIS (Netherlands)

    Plantinga, Nienke L.; Wittekamp, Bastiaan H J; Van Duijn, Pleun J.; Bonten, Marc J M

    2015-01-01

    Antibiotic resistance is a global and increasing problem that is not counterbalanced by the development of new therapeutic agents. The prevalence of antibiotic resistance is especially high in intensive care units with frequently reported outbreaks of multidrug-resistant organisms. In addition to cl

  10. Increasing fungal infections in the intensive care unit

    NARCIS (Netherlands)

    Pauw, B.E. de

    2006-01-01

    BACKGROUND: Yeasts and molds now rank among the most common pathogens in intensive care units. Whereas the incidence of Candida infections peaked in the late 1970s, aspergillosis is still increasing. METHOD: Review of the pertinent English-language literature. RESULTS: Most factors promoting an inva

  11. Review of noise in neonatal intensive care units - regional analysis

    Energy Technology Data Exchange (ETDEWEB)

    Alvarez Abril, A [National Technological University, Regional Bioengineering Institute, Mendoza (Argentina); Terron, A; Boschi, C [National Technological University, Regional Bioengineering Institute, Mendoza (Argentina); Gomez, M [National Technological University, La Rioja (Argentina)

    2007-11-15

    This work is about the problem of noise in neonatal incubators and in the environment in the neonatal intensive care units. Its main objective is to analyse the impact of noise in hospitals of Mendoza and La Rioja. Methodology: The measures were taken in different moments in front of higher or lower severity level in the working environment. It is shown that noise produces severe damages and changes in the behaviour and the psychological status of the new born babies. Results: The noise recorded inside the incubators and the neonatal intensive care units together have many components but the noise of motors, opening and closing of access gates have been considered the most important ones. Values above 60 db and and up to 120 db in some cases were recorded, so the need to train the health staff in order to manage the new born babies, the equipment and the instruments associated with them very carefully is revealed.

  12. Caring as emancipatory nursing praxis: the theory of relational caring complexity.

    Science.gov (United States)

    Ray, Marilyn A; Turkel, Marian C

    2014-01-01

    In the culture of health care, nurses are challenged to understand their values and beliefs as humanistic within complex technical and economically driven bureaucratic systems. This article outlines the language of social justice and human rights and the advance of a Theory of Relational Caring Complexity, which offers insights into caring as emancipatory nursing praxis. Recommendations provide knowledge of the struggle to balance economics, technology, and caring. As nurses practice from a value-driven, philosophical, and ethical social justice framework, they will find "their voice" and realize the full potential that the power of caring has on patient and organizational outcomes.

  13. Implementation of an electronic logbook for intensive care units.

    Science.gov (United States)

    Wallace, Carrie J.; Stansfield, Dennis; Gibb Ellis, Kathryn A.; Clemmer, Terry P.

    2002-01-01

    Logbooks of patients treated in acute care units are commonly maintained; the data may be used to justify resource use, analyze patient outcomes, and encourage clinical research. We report herein the conversion of a paper-based logbook to an electronic logbook in three hospital intensive care units. The major difference between the paper logbook and electronic logbook data was the addition of clinician-entered data to the electronic logbook. Despite extensive computerization of patient information extant in the participating units, there was considerable reluctance to replace the paper-based logbook. The project's success can be attributed to the use of feedback from the clinical users in the development and implementation process to create accessible, high quality data. These data provide clinicians with the capability to monitor trends in a variety of patient groups. Advantages of the electronic logbook include more efficient data access, higher data quality and increased ability to conduct quality improvement and clinical research activities. PMID:12463943

  14. Candida bloodstream infections in intensive care units: analysis of the extended prevalence of infection in intensive care unit study

    NARCIS (Netherlands)

    Kett, D.H.; Azoulay, E.; Echeverria, P.M.; Vincent, J.L.; Pickkers, P.

    2011-01-01

    OBJECTIVES: To provide a global, up-to-date picture of the prevalence, treatment, and outcomes of Candida bloodstream infections in intensive care unit patients and compare Candida with bacterial bloodstream infection. DESIGN: A retrospective analysis of the Extended Prevalence of Infection in the I

  15. Reflecting on healthcare and self-care in the Intensive Care Unit: our story

    Directory of Open Access Journals (Sweden)

    Allan Peterkin

    2014-12-01

    Full Text Available Health care professionals working in Intensive Care Units (ICUs are exposed to high levels of stress-provoking stimuli. Some may unconsciously employ negative coping skill s which may contribute to burnout and negatively affect patient care. We chose to explore ways of facilitating and encouraging self-reflective practice in an effort to increase empathic traits and enhance communication. A narrative medicine series, which included six sessions that were focused on different narrative approaches, was organized for staff of an academic teaching hospital. Totally, 132 interdisciplinary ICU staff attended the sessions. They were generally open to exploring the selected approaches and discussing their reflections within the interdisciplinary environment. The narrative medicine series provided tools for health care professionals to enhance self-reflective skills utilizing a team-based learning approach. The anticipated outcomes were improved self-care, increased empathy and communication skills, enhanced team functioning, which all contribute to better patient care at the bedside.

  16. Intensive care unit research ethics and trials on unconscious patients.

    Science.gov (United States)

    Gillett, G R

    2015-05-01

    There are widely acknowledged ethical issues in enrolling unconscious patients in research trials, particularly in intensive care unit (ICU) settings. An analysis of those issues shows that, by and large, patients are better served in units where research is actively taking place for several reasons: i) they do not fall prey to therapeutic prejudices without clear evidential support, ii) they get a chance of accessing new and potentially beneficial treatments, iii) a climate of careful monitoring of patients and their clinical progress is necessary for good clinical research and affects the care of all patients and iv) even those not in the treatment arm of a trial of a new intervention must receive best current standard care (according to international evidence-based treatment guidelines). Given that we have discovered a number of 'best practice' regimens of care that do not optimise outcomes in ICU settings, it is of great benefit to all patients (including those participating in research) that we are constantly updating and evaluating what we do. Therefore, the practice of ICU-based clinical research on patients, many of whom cannot give prospective informed consent, ticks all the ethical boxes and ought to be encouraged in our health system. It is very important that the evaluation of protocols for ICU research should not overlook obvious (albeit probabilistic) benefits to patients and the acceptability of responsible clinicians entering patients into well-designed trials, even though the ICU setting does not and cannot conform to typical informed consent procedures and requirements.

  17. How the United States exports managed care to developing countries.

    Science.gov (United States)

    Waitzkin, H; Iriart, C

    2001-01-01

    As their expansion slows in the United States, managed care organizations will continue to enter new markets abroad. Investors view the opening of managed care in Latin America as a lucrative business opportunity. As public-sector services and social security funds are cut back, privatized, and reorganized under managed care, with the support of international lending agencies such as the World Bank, the effects of these reforms on access to preventive and curative services will hold great importance throughout the developing world. Many groups in Latin America are working on alternative projects that defend health as a public good, and similar movements have begun in Africa and Asia. Increasingly, this organizing is being recognized not only as part of a class struggle but also as part of a struggle against economic imperialism--which has now taken on the new appearance of rescuing less developed countries from rising health care costs and inefficient bureaucracies through the imposition of neoliberal managed-care solutions exported from the United States. PMID:11562002

  18. Sistematização da Assistência de Enfermagem em Unidade de Terapia Intensiva sustentada pela Teoria de Wanda Horta Sistematización de la asistencia de enfermería en una unidad de terapia intensiva basada en la Teoría de Wanda Horta Nursing care systematization at the intensive care unit (ICU based on Wanda Horta's theory

    Directory of Open Access Journals (Sweden)

    Lúcia Nazareth Amante

    2009-03-01

    desarrollo calificado del cuidado de enfermería.The purpose of this study was to implement the Nursing Care Systematization - Sistematização da Assistência de Enfermagem (SAE - with Wanda Aguiar Horta's Theory of Basic Human Necessities and the North American Nursing Diagnosis Association's (NANDA Nursing Diagnosis as its references. The starting point was the evaluation of the knowledge of the nursing team about the SAE, including their participation in this process. This is a qualitative study, performed in the Intensive Care Unit in a hospital in the city of Brusque, Santa Catarina, from October, 2006 to March, 2007. It was observed that the nursing professionals know little about SAE, but they are greatly interested in learning and developing it in their daily practice. In conclusion, it was possible to execute the healthcare systematization in an easy way, with the use of simple brochures that provided all the necessary information for the qualified development of nursing care.

  19. Uporabnost teorij etike v zdravstveni negi: Application of ethical theories in nursing care:

    OpenAIRE

    Šmitek, Jana

    2004-01-01

    Two ethical theories are in more detail explained in the article: deontology as principle based ethics and ethics of care as a theory related to fundamental value of nursing caring. Joan Tronto's presentation of care and ethics of care is exposed as well as it's direct relation to nursing care. Theauthor exposes the need for ethics of care theory to be implemented into nursing educational programmes and also into educational programmes of other health care professionals.

  20. Taiwanese nurses' appraisal of a lecture on spiritual care for patients in critical care units.

    Science.gov (United States)

    Shih, F J; Gau, M L; Mao, H C; Chen, C H

    1999-04-01

    The purpose of this study is to develop a lecture on spiritual care for adult critical care trainees, and to evaluate the trainees' appraisal of the effectiveness of this lecture in preparing them to provide spiritual care for their clients in a critical care setting. A between-method triangulation research design encompassing a questionnaire and descriptive qualitative content analysis was used. A convenience sample consisting of 64 registered nurses who attended an adult critical care nurse training programme in a leading medical centre in northern Taiwan were invited to participate in this study. A total of 64 female participants completed the questionnaire. Ninety-two per cent (59) of the subjects considered the lecture on spiritual care to be helpful in assisting them to provide holistic care for critically ill patients in the Intensive Care Unit (ICU). Three types of help were identified by the subjects: (1) help in clarifying the abstract concepts related to spiritual care (86%); (2) help in self-disclosing the nurses' personal beliefs and values regarding life goals, nursing, and spiritual needs (67%); (3) help in learning how to provide spiritual care to patients in a critical care setting (34%). Twenty per cent of the subjects thought that inclusion of the following content in the lecture would have been helpful to provide a more comprehensive picture of spiritual care: religious practices and rituals (11%); the culturally bonded nursing care plan (9%); the development of human spirituality (3%); patients' families' spiritual needs in the ICU (3%); and resources for nurses in providing spiritual care (2%). Thirteen per cent of the subjects suggested that the instructor might employ the following strategies to improve the quality of teaching: providing more empirical examples (5%); discussion with the students in classes of smaller size following the lecture or extending the instruction time (5%); and providing a syllabus with detailed information (3%).

  1. Status of neonatal intensive care units in India.

    Directory of Open Access Journals (Sweden)

    Fernandez A

    1993-04-01

    Full Text Available Neonatal mortality in India accounts for 50% of infant mortality, which has declined to 84/1000 live births. There is no prenatal care for over 50% of pregnant women, and over 80% deliver at home in unsafe and unsanitary conditions. Those women who do deliver in health facilities are unable to receive intensive neonatal care when necessary. Level I and Level II neonatal care is unavailable in most health facilities in India, and in most developing countries. There is a need in India for Level III care units also. The establishment of neonatal intensive care units (NICUs in India and developing countries would require space and location, finances, equipment, staff, protocols of care, and infection control measures. Neonatal mortality could be reduced by initially adding NICUs at a few key hospitals. The recommendation is for 30 NICU beds per million population. Each bed would require 50 square feet per cradle and proper climate control. Funds would have to be diverted from adult care. The largest expenses would be in equipment purchase, maintenance, and repair. Trained technicians would be required to operate and monitor the sophisticated ventilators and incubators. The nurse-patient ratio should be 1:1 and 1:2 for other infants. Training mothers to work in the NICUs would help ease the problems of trained nursing staff shortages. Protocols need not be highly technical; they could include the substitution of radiant warmers and room heaters for expensive incubators, the provision of breast milk, and the reduction of invasive procedures such as venipuncture and intubation. Nocosomial infections should be reduced by vacuum cleaning and wet mopping with a disinfectant twice a day, changing disinfectants periodically, maintaining mops to avoid infection, decontamination of linen, daily changing of tubing, and cleaning and sterilizing oxygen hoods and resuscitation equipment, and maintaining an iatrogenic infection record book, which could be used to

  2. Taxonomy for complexity theory in the context of maternity care

    NARCIS (Netherlands)

    Nieuwenhuize, M.; Downe, S.; Gottfreðsdóttir, H.; Rijnders, M.; Preez, A. du; Vaz Rebelo, P.

    2015-01-01

    Background The linear focus of ‘normal science’ is unable toadequately take account of the complex interactions that direct health care systems. There is a turn towards complexity theory as a more appropriate framework for understanding system behaviour. However, a comprehensive taxonomy for complex

  3. The Care Pathway Concept: concepts and theories: an introduction

    Directory of Open Access Journals (Sweden)

    Guus Schrijvers

    2012-09-01

    Full Text Available This article addresses first the definition of a (care pathway, and then follows a description of theories since the fifties of the last century.  It ends with a discussion of theoretical advantages and disadvantages of care pathways for patients and professionals. The objective of this paper is to provide a theoretical base for empirical studies on care pathways. The knowledge for this chapter is based on several books on pathways, which we found by searching in the digital encyclopedia Wikipedia. Although this is not usual in scientific publications, this method was used because books are not searchable by databases as Pubmed. . From 2005, we performed a literature search on Pubmed and other literature databases, and with the keywords integrated care pathway, clinical pathway, critical pathway, theory, research, and evaluation. One of the inspirational sources was the website of the European Pathway Association (EPA and its journal International Journal of Care Pathways. The authors visited several sites for this paper. These are mentioned as illustration of a concept or theory. Most of them have English websites with more information. The URL's of these websites are not mentioned in this paper as a reference, because the content of them changes fast, sometimes every day.

  4. The Care Pathway Concept: concepts and theories: an introduction

    Directory of Open Access Journals (Sweden)

    Guus Schrijvers

    2012-09-01

    Full Text Available This article addresses first the definition of a (care pathway, and then follows a description of theories since the fifties of the last century.  It ends with a discussion of theoretical advantages and disadvantages of care pathways for patients and professionals. The objective of this paper is to provide a theoretical base for empirical studies on care pathways.  The knowledge for this chapter is based on several books on pathways, which we found by searching in the digital encyclopedia Wikipedia. Although this is not usual in scientific publications, this method was used because books are not searchable by databases as Pubmed. '. 'From 2005, we performed a literature search on 'Pubmed' and other literature databases, and with the keywords integrated care pathway, clinical pathway, critical pathway, theory, research, and evaluation. One of the inspirational sources was the website of the European Pathway Association (EPA and its journal 'International Journal of Care Pathways.' The authors visited several sites for this paper. These are mentioned as illustration of a concept or theory. Most of them have English websites with more information. The URL's of these websites are not mentioned in this paper as a reference, because the content of them changes fast, sometimes every day.

  5. Procalcitonin use in a pediatric intensive care unit.

    Science.gov (United States)

    Cies, Jeffrey J; Chopra, Arun

    2014-09-01

    We evaluated whether procalcitonin (PCT) might aid diagnosing serious bacterial infections in a general pediatric intensive care unit population. Two-hundred and one patients accounted for 332 PCT samples. A PCT ≥1.45 ng/mL had a positive predictive value of 30%, a negative predictive value of 93% and a sensitivity of 72% and a specificity of 75%. These data suggest PCT can assist in identifying patients without serious bacterial infections and limit antimicrobial use.

  6. Intensive Care Unit Acquired Weakness: Under or Overdiagnosed?

    OpenAIRE

    Morgado, S; Moura, S.

    2010-01-01

    Intensive care unit-acquired weakness (ICU-AW) is recognized as an important and common clinical problem, associated with an increased morbidity in critical ill patients. This muscle weakness has been described in a wide range of clinical settings and therefore, has many different terminologies such as “critical illness myopathy – CIM”, “critical illness polyneuropathy - CIP”, “acute quadriplegic myopathy”, among others. Nowadays, these designations are considered somewhat restric...

  7. Human-centered environment design in intensive care unit

    OpenAIRE

    Li, Y.; Albayrak, A.; Goossens, R.H.M.; D. Xiao; Jakimowicz, J.J.

    2013-01-01

    Because of high risk and instability of the patients in Intensive care unit(ICU), the design of ICU is very difficult. ICU design, auxiliary building design, lighting design, noise control and other aspects can also enhance its management. In this paper, we compare ICU design in China and Holland based on related standards. We also premeditate the indoor environment from planning perspective, analyze patients, their families, medical staff and space requirement to conduct research in ICU desi...

  8. Post-traumatic pulmonary embolism in the intensive care unit

    OpenAIRE

    Mabrouk Bahloul; Anis Chaari; Hassen Dammak; Fatma Medhioub; Leila Abid; Hichem Ksibi; Sondes Haddar; Hatem Kallel; Hedi Chelly; Chokri Ben Hamida; Mounir Bouaziz

    2011-01-01

    Objective: To determine the predictive factors, clinical manifestations, and the outcome of patients with post-traumatic pulmonary embolism (PE) admitted in the intensive care unit (ICU). Methods: During a four-year prospective study, a medical committee of six ICU physicians prospectively examined all available data for each trauma patient in order to classify patients according to the level of clinical suspicion of pulmonary thromboembolism. During the study period, all trauma patients ...

  9. Causes Of Microbial Carriers During Admission To Intensive Care Unit

    OpenAIRE

    Panagiotopoulou, Efthymia; Nteves, Ioannis; Kadda, Olga; Kapadohos, Theodore; Vasilopoulos, Georgios; Marvaki, Christina

    2016-01-01

    Introduction: The recording of microbial agent upon patients admission in the Intensive Care Unit (ICU) can be useful for the prevention and reduction of dispersion, forecasting new colonization or infection respectively bacteria and guide empirical antimicrobial therapy. Aim: The aim of the present study was to investigate the factors associated with microbial colonization of patients admitting to ICU. Material and Method: The studied sample consisted of 72 patients admitted to the I...

  10. Bedside Neonatal Intensive Care Unit Surgery- Myth or Reality!

    OpenAIRE

    Shandip Kumar Sinha; Sujoy Neogi

    2013-01-01

    Neonatal transport is associated with complications, more so in sick and unstable neonates who need immediate emergency surgery. To circumvent these problems, surgery in Neonatal intensive care unit (NICU) is proposed for these neonates. This article reviews the literature regarding feasibility of this novel concept and based on the generated evidence, suggest the NICU planners to always include infrastructure for this. Also neonatal surgical team can be developed that could be transported.

  11. Nutritional support of children in the intensive care unit.

    OpenAIRE

    Seashore, J. H.

    1984-01-01

    Nutritional support is an integral and essential part of the management of 5-10 percent of hospitalized children. Children in the intensive care unit are particularly likely to develop malnutrition because of the nature and duration of their illness, and their inability to eat by mouth. This article reviews the physiology of starvation and the development of malnutrition in children. A method of estimating the nutritional requirements of children is presented. The techniques of nutritional su...

  12. Mobility decline in patients hospitalized in an intensive care unit

    Science.gov (United States)

    de Jesus, Fábio Santos; Paim, Daniel de Macedo; Brito, Juliana de Oliveira; Barros, Idiel de Araujo; Nogueira, Thiago Barbosa; Martinez, Bruno Prata; Pires, Thiago Queiroz

    2016-01-01

    Objective To evaluate the variation in mobility during hospitalization in an intensive care unit and its association with hospital mortality. Methods This prospective study was conducted in an intensive care unit. The inclusion criteria included patients admitted with an independence score of ≥ 4 for both bed-chair transfer and locomotion, with the score based on the Functional Independence Measure. Patients with cardiac arrest and/or those who died during hospitalization were excluded. To measure the loss of mobility, the value obtained at discharge was calculated and subtracted from the value obtained on admission, which was then divided by the admission score and recorded as a percentage. Results The comparison of these two variables indicated that the loss of mobility during hospitalization was 14.3% (p < 0.001). Loss of mobility was greater in patients hospitalized for more than 48 hours in the intensive care unit (p < 0.02) and in patients who used vasopressor drugs (p = 0.041). However, the comparison between subjects aged 60 years or older and those younger than 60 years indicated no significant differences in the loss of mobility (p = 0.332), reason for hospitalization (p = 0.265), SAPS 3 score (p = 0.224), use of mechanical ventilation (p = 0.117), or hospital mortality (p = 0.063). Conclusion There was loss of mobility during hospitalization in the intensive care unit. This loss was greater in patients who were hospitalized for more than 48 hours and in those who used vasopressors; however, the causal and prognostic factors associated with this decline need to be elucidated. PMID:27410406

  13. Renal replacement therapy in the intensive care unit

    OpenAIRE

    Pannu, Neesh; Gibney, RT Noel

    2005-01-01

    Acute renal failure is a common complication in the intensive care unit (ICU). Over the last 25 years, there have been significant technological advances in the delivery of renal replacement therapy, particularly as it pertains to the critically ill patient population. Despite these advances, acute renal failure in critically ill patients continues to carry a poor prognosis. In this article, we review the current literature about timing and initiation of renal replacement therapy in the ICU a...

  14. Non-invasive respiratory monitoring in paediatric intensive care unit.

    OpenAIRE

    Nadkarni U; Shah A; Deshmukh C

    2000-01-01

    Monitoring respiratory function is important in a Paediatrics Intensive Care Unit (PICU), as majority of patients have cardio-respiratory problems. Non-invasive monitoring is convenient, accurate, and has minimal complications. Along with clinical monitoring, oxygen saturation using pulse oximetry, transcutaneous oxygenation (PtcO2) and transcutaneous PCO2 (PtcCO2) using transcutaneous monitors and end-tidal CO2 using capnography are important and routine measurements done in most PICUs. Cons...

  15. Physiotherapy practices in Intensive Care Units across Maharashtra

    OpenAIRE

    Ujwal Lakshman Yeole; Ankita Ramesh Chand; Nandi, Biplab B.; Pravin P Gawali; Adkitte, Roshan G.

    2015-01-01

    Purpose: To find out the current physiotherapy practices in Intensive Care Unit (ICU) across Maharashtra. Materials and Methods: Study design was exploratory cross-sectional survey. Questionnaires were sent to the physiotherapists working in hospitals across Maharashtra state, India. Four weeks for completion of questionnaire was given in an attempt to ensure good response rates. Result: Of 200, 73 questionnaires were received representing a 36% response rate. The study revealed that 76% of t...

  16. What Does Change with Nutrition Team in Intensive Care Unit?

    OpenAIRE

    Ahmet Fatih Yılmaz; Ertuğrul Kılıç; Sema Gürsel; Nazlı Tiryaki

    2016-01-01

    Intrroduction: Clinical nutrition is the nutrition support therapy provided to patients under medical supervision at the hospital or home setting. It is a multidisciplinary task performed under the control of the physician, dietician, pharmacist and nurse. In this study, the changes in the patient admission statistics to the general intensive care unit (GICU), the exitus ratios, decubitus ulcer formation rates, albumin use rates, duration of the hospital stay, Acute Physiology and Chronic Hea...

  17. Eye injury treatment in intensive care unit patients

    OpenAIRE

    L. K. Moshetova; S. A. Kochergin; A. S. Kochergin

    2015-01-01

    Aim. To describe eye injuries in intensive care unit (ICU) patients with multitrauma, to study conjunctival microflora in these patients, and to develop etiologically and pathogenically targeted treatment and prevention of wound complications.Materials and methods. Study group included 50 patients (54 eyes) with combined mechanical cerebral and eye injury. All patients underwent possible ophthalmological examination (biomicroscopy, ophthalmoscopy and ocular fundus photographing with portative...

  18. Stress ulcer prophylaxis in the intensive care unit

    DEFF Research Database (Denmark)

    Krag, Morten Brøgger; Perner, A; Wetterslev, J;

    2013-01-01

    Stress ulcer prophylaxis (SUP) is regarded as standard of care in the intensive care unit (ICU). However, recent randomized, clinical trials (RCTs) and meta-analyses have questioned the rationale and level of evidence for this recommendation. The aim of the present systematic review was to evaluate...... Grading of Recommendations Assessment, Development, and Evaluation, and risk of random errors in cumulative meta-analyses was assessed with trial sequential analysis. A total of 57 studies were included in the review. The literature on SUP in the ICU includes limited trial data and methodological weak...... intervention?; (4) Do intensive care patients benefit from SUP with proton pump inhibitors as compared with other SUP interventions? Systematic reviews of possible interventions and well-powered observational studies and RCTs are needed....

  19. Postpartum depression on the neonatal intensive care unit: current perspectives

    Directory of Open Access Journals (Sweden)

    Tahirkheli NN

    2014-11-01

    Full Text Available Noor N Tahirkheli,1 Amanda S Cherry,1 Alayna P Tackett,2 Mary Anne McCaffree,3 Stephen R Gillaspy11Section of General and Community Pediatrics, Department of Pediatrics, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA; 2Department of Psychology, Oklahoma State University, Stillwater, OK, USA; 3Section of Neonatal-Perinatal Medicine, Department of Pediatrics, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USAAbstract: As the most common complication of childbirth affecting 10%–15% of women, postpartum depression (PPD goes vastly undetected and untreated, inflicting long-term consequences on both mother and child. Studies consistently show that mothers of infants in the neonatal intensive care unit (NICU experience PPD at higher rates with more elevated symptomatology than mothers of healthy infants. Although there has been increased awareness regarding the overall prevalence of PPD and recognition of the need for health care providers to address this health issue, there has not been adequate attention to PPD in the context of the NICU. This review will focus on an overview of PPD and psychological morbidities, the prevalence of PPD in mothers of infants admitted to NICU, associated risk factors, potential PPD screening measures, promising intervention programs, the role of NICU health care providers in addressing PPD in the NICU, and suggested future research directions.Keywords: neonatal intensive care unit, postpartum depression, mothers

  20. Primary nursing in Intensive Care Unit: measuring nurses' attitudes

    Directory of Open Access Journals (Sweden)

    Zetta, S.

    2010-07-01

    Full Text Available Intensive Care Units have been identified as having advantages for the use of primary nursing. Nursing staff play an important role οn the successful implementation of primary nursing. It is important to know in advance of the implementation plan the attitudes and opinions of the nurses. Such knowledge would adequately inform the management and enable them to use the right approaches to achieve successful implementation. Aim and Method The current study is a non-experimental, cross-sectional descriptive research design aiming to identify nurses’ attitudes towards primary nursing. The study was conducted in an 8-beded Intensive Care Unit (ICU part of a University Hospital in Scotland. The sample consisted of all 38 registered and enrolled nurse working at the unit at the time. Results Results indicated that nurses were aware and identified benefits and shortcomings of primary nursing which have been seen in the primary care literature. Nurses’ attitudes towards implementation of primary nursing were positive and appeared to agree with the positive impact of primary nursing to the patients either in term of patient satisfaction or patient autonomy. Conclusions Primary nursing advocates a shift away from the traditional system of hierarchical task allocation. Nurses are willing to change and want to learn more in order to improve patients’ outcomes.

  1. [Nurses' perspective on interprofessional communication on an intensive care unit].

    Science.gov (United States)

    Knoll, Martin; Lendner, Ilka

    2008-10-01

    The aim of this qualitative study was to explore experience in nurses' interdisciplinary/interprofessional communication on an intensive care unit. The structure of communication and influencing factors were shown and interpreted from the perspective of the nurses. Nurses working on an internal medical intensive care unit at a teaching facility in central Germany were questioned by means of semi-structured interviews. One main result was that for nurses the culture of communication in the investigation unit was characterized primarily by hierarchical structures imposed by the physicians. This dominance was identified in all nursing activities resulting in a considerable adverse effect on the flow of information concerning the patient between nurses and physicians. Especially within the context of daily rounds nurses were confronted with barriers to participate actively with their knowledge and professional competence in the process of decision-making. The problems described are well known in everyday nursing practice and have been dealt with in the English research literature. However, this study's aim is to present and summarize the gained insights and to transfer them in a practice-oriented way into a selected field of work. Possible solutions for the problems of inter-professional communication are suggested in subsequent work steps in order to optimize patient care. PMID:18850538

  2. Cultural care of older Greek Canadian widows within Leininger's theory of culture care.

    Science.gov (United States)

    Rosenbaum, J N

    1990-01-01

    Cultural care themes were abstracted from a large scale study of older Greek Canadian widows conceptualized within Leininger's theory of Cultural Care Diversity and Universality. Ethnonursing, ethnographic, and life health-care history methods were used. Data were collected using observation-participation and interviews in three Greek Canadian communities with 12 widowed key informants and 30 general informants. Enabling tools used were interview inquiry guides, Leininger's Life History Health Care Protocol, Leininger's Acculturation Rating and Profile Scale of Traditional and Non-Traditional Lifeways, and field journal recordings. Data were analyzed using Leininger's phases of analysis for qualitative data. The two major cultural care themes which were abstracted from the raw data and patterns were: (1) Cultural care for Greek Canadian widows meant responsibility for, reciprocation, concern, love, companionship, family protection, hospitality, and helping, primarily derived from their kinship, religious, and cultural beliefs, and values, and (2) Cultural care continuity diminished the spousal care void and contributed to the health of Greek Canadian widows. These findings will stimulate future nursing research related to cultural care of diverse populations and guide nursing practice to provide culturally congruent care which will assist widows to reduce their spousal care void. The author thanks Dr. Madeleine Leininger, Dr. Judith Floyd, Dr. Marjorie Isenberg, and Dr. Bernice Kaplan for their guidance in completing the large scale study on which this article is based.

  3. Cultural care of older Greek Canadian widows within Leininger's theory of culture care.

    Science.gov (United States)

    Rosenbaum, J N

    1990-01-01

    Cultural care themes were abstracted from a large scale study of older Greek Canadian widows conceptualized within Leininger's theory of Cultural Care Diversity and Universality. Ethnonursing, ethnographic, and life health-care history methods were used. Data were collected using observation-participation and interviews in three Greek Canadian communities with 12 widowed key informants and 30 general informants. Enabling tools used were interview inquiry guides, Leininger's Life History Health Care Protocol, Leininger's Acculturation Rating and Profile Scale of Traditional and Non-Traditional Lifeways, and field journal recordings. Data were analyzed using Leininger's phases of analysis for qualitative data. The two major cultural care themes which were abstracted from the raw data and patterns were: (1) Cultural care for Greek Canadian widows meant responsibility for, reciprocation, concern, love, companionship, family protection, hospitality, and helping, primarily derived from their kinship, religious, and cultural beliefs, and values, and (2) Cultural care continuity diminished the spousal care void and contributed to the health of Greek Canadian widows. These findings will stimulate future nursing research related to cultural care of diverse populations and guide nursing practice to provide culturally congruent care which will assist widows to reduce their spousal care void. The author thanks Dr. Madeleine Leininger, Dr. Judith Floyd, Dr. Marjorie Isenberg, and Dr. Bernice Kaplan for their guidance in completing the large scale study on which this article is based. PMID:2264941

  4. The Impact of Multiple Master Patient Index Records on the Business Performance of Health Care Organizations: A Qualitative Grounded Theory Study

    Science.gov (United States)

    Banton, Cynthia L.

    2014-01-01

    The purpose of this qualitative grounded theory study was to explore and examine the factors that led to the creation of multiple record entries, and present a theory on the impact the problem has on the business performance of health care organizations. A sample of 59 health care professionals across the United States participated in an online…

  5. Family, caring and ageing in the United Kingdom.

    Science.gov (United States)

    Gilbert, Tony; Powell, Jason L

    2005-03-01

    This paper provides a critical exploration of the assumptions and narratives underpinning the development of social policy initiatives targeting caring relationships based upon family ties. Using a narrative approach attention is drawn to the ways in which family identities are open to a far greater range of negotiation than is assumed by policy. Drawing on the United Kingdom as a case example, questions are posed about intergenerational relations and the nature of late life citizenship. The comparatively recent invention of narratives supporting 'informal care' and the link with neo-liberal and 'third way' notions of active citizenship are explored. As is the failure of policy developments to take into account the diversity of care giving styles and the complexity of caring relationships. It is argued that the uneven and locally specific ways in which policy develops enables the co-existence of a complex range of narratives about family, caring and ageing which address diverse aspects of the family life of older people in often contradictory ways.

  6. Insurance coverage for male infertility care in the United States.

    Science.gov (United States)

    Dupree, James M

    2016-01-01

    Infertility is a common condition experienced by many men and women, and treatments are expensive. The World Health Organization and American Society of Reproductive Medicine define infertility as a disease, yet private companies infrequently offer insurance coverage for infertility treatments. This is despite the clear role that healthcare insurance plays in ensuring access to care and minimizing the financial burden of expensive services. In this review, we assess the current knowledge of how male infertility care is covered by insurance in the United States. We begin with an appraisal of the costs of male infertility care, then examine the state insurance laws relevant to male infertility, and close with a discussion of why insurance coverage for male infertility is important to both men and women. Importantly, we found that despite infertility being classified as a disease and males contributing to almost half of all infertility cases, coverage for male infertility is often excluded from health insurance laws. Excluding coverage for male infertility places an undue burden on their female partners. In addition, excluding care for male infertility risks missing opportunities to diagnose important health conditions and identify reversible or irreversible causes of male infertility. Policymakers should consider providing equal coverage for male and female infertility care in future health insurance laws. PMID:27030084

  7. Insurance coverage for male infertility care in the United States

    Directory of Open Access Journals (Sweden)

    James M Dupree

    2016-01-01

    Full Text Available Infertility is a common condition experienced by many men and women, and treatments are expensive. The World Health Organization and American Society of Reproductive Medicine define infertility as a disease, yet private companies infrequently offer insurance coverage for infertility treatments. This is despite the clear role that healthcare insurance plays in ensuring access to care and minimizing the financial burden of expensive services. In this review, we assess the current knowledge of how male infertility care is covered by insurance in the United States. We begin with an appraisal of the costs of male infertility care, then examine the state insurance laws relevant to male infertility, and close with a discussion of why insurance coverage for male infertility is important to both men and women. Importantly, we found that despite infertility being classified as a disease and males contributing to almost half of all infertility cases, coverage for male infertility is often excluded from health insurance laws. Excluding coverage for male infertility places an undue burden on their female partners. In addition, excluding care for male infertility risks missing opportunities to diagnose important health conditions and identify reversible or irreversible causes of male infertility. Policymakers should consider providing equal coverage for male and female infertility care in future health insurance laws.

  8. Managed care, deficit financing, and aggregate health care expenditure in the United States: a cointegration analysis.

    Science.gov (United States)

    Murthy, N R; Okunade, A A

    2000-09-01

    We applied a battery of cointegration tests comprising those of Johansen and Juselius [19], Phillips and Hansen [35], and Engle and Granger [6], to model aggregate health care expenditure using 1960-96 US data. The existence of a stable long-run economic relationship or cointegration is confirmed, in the United States, between aggregate health care expenditure and real GDP, population age distribution, managed care enrollment, number of practicing physicians, and government deficits. The evidence of cointegration among these variables, chosen on the theoretical basis of prior studies, implies that while they are individually non-stationary in levels, together they are highly correlated and move, in the long run to form an economic equilibrium relationship of US aggregate health care expenditure. More specifically, and for the first time in this line of inquiry, (i) managed care enrollment is found to be negatively associated with the level of health care spending, (ii) supply disinduced demand effects of physicians tend to moderate health expenditure, and (iii) government deficit financing is positively related to health care spending. The observed sign and magnitude of the income coefficient are consistent with health care being a luxury good.

  9. Nurses' experiences of futile care at intensive care units: a phenomenological study.

    Science.gov (United States)

    Yekefallah, Leili; Ashktorab, Tahereh; Manoochehri, Houman; Hamid, Alavi Majd

    2015-01-01

    The concept and meaning of futile care depends on the existing culture, values, religion, beliefs, medical achievements and emotional status of a country. We aimed to define the concept of futile care in the viewpoints of nurses working in intensive care units (ICUs). In this phenomenological study, the experiences of 25 nurses were explored in 11 teaching hospitals affiliated to Social Security Organization in Ghazvin province in the northwest of Iran. Personal interviews and observations were used for data collection. All interviews were recorded as well as transcribed and codes, subthemes and themes were extracted using Van Manen's analysis method. Initially, 191 codes were extracted. During data analysis and comparison, the codes were reduced to 178. Ultimately, 9 sub-themes and four themes emerged: uselessness, waste of resources, torment, and aspects of futility.Nurses defined futile care as "useless, ineffective care giving with wastage of resources and torment of both patients and nurses having nursing and medical aspects" As nurses play a key role in managing futile care, being aware of their experiences in this regard could be the initial operational step for providing useful care as well as educational programs in ICUs. Moreover, the results of this study could help nursing managers adopt supportive approaches to reduce the amount of futile care which could in turn resolve some of the complications nurses face at these wards such as burnout, ethical conflicts, and leave. PMID:25946928

  10. Managed care, deficit financing, and aggregate health care expenditure in the United States: a cointegration analysis.

    Science.gov (United States)

    Murthy, N R; Okunade, A A

    2000-09-01

    We applied a battery of cointegration tests comprising those of Johansen and Juselius [19], Phillips and Hansen [35], and Engle and Granger [6], to model aggregate health care expenditure using 1960-96 US data. The existence of a stable long-run economic relationship or cointegration is confirmed, in the United States, between aggregate health care expenditure and real GDP, population age distribution, managed care enrollment, number of practicing physicians, and government deficits. The evidence of cointegration among these variables, chosen on the theoretical basis of prior studies, implies that while they are individually non-stationary in levels, together they are highly correlated and move, in the long run to form an economic equilibrium relationship of US aggregate health care expenditure. More specifically, and for the first time in this line of inquiry, (i) managed care enrollment is found to be negatively associated with the level of health care spending, (ii) supply disinduced demand effects of physicians tend to moderate health expenditure, and (iii) government deficit financing is positively related to health care spending. The observed sign and magnitude of the income coefficient are consistent with health care being a luxury good. PMID:11105414

  11. Confronting youth gangs in the intensive care unit.

    Science.gov (United States)

    Akiyama, Cliff

    2015-01-01

    Youth gang violence has continued its upward trend nationwide. It was once thought that gangs convened only in selected areas, which left churches, schools, and hospitals as "neutral" territory. Unfortunately, this is a fallacy. The results of gang violence pour into hospitals and into intensive care units regularly. The media portrays California as having a gang violence problem; however, throughout the United States, gang violence has risen more than 35% in the past year. Youth gang violence continues to rise dramatically with more and more of our youth deciding to join gangs each day. Sadly, every state has gangs, and the problem is getting much worse in areas that would never have thought about gangs a year ago. These "new generation" of gang members is younger, much more violent, and staying in the gang longer. Gangs are not just an urban problem. Gang activity is a suburban and rural problem too. There are more than 25 500 gangs in the United States, with a total gang membership of 850 000. Ninety-four percent of gang members are male and 6% are female. The ethnic composition nationwide includes 47% Latino, 31% African American, 13% White, 7% Asian, and 2% "mixed," according to the Office of Juvenile Justice and Delinquency Prevention of the U.S. Department of Justice. As a result of the ongoing proliferation of youth street gangs in our communities, it is imperative that critical care nurses and others involved with the direct care become educated about how to identify gang members, their activities, and understand their motivations. Such education and knowledge will help provide solutions to families and the youth themselves, help eradicate the problem of gang violence, and keep health care professionals safe.

  12. Confronting youth gangs in the intensive care unit.

    Science.gov (United States)

    Akiyama, Cliff

    2015-01-01

    Youth gang violence has continued its upward trend nationwide. It was once thought that gangs convened only in selected areas, which left churches, schools, and hospitals as "neutral" territory. Unfortunately, this is a fallacy. The results of gang violence pour into hospitals and into intensive care units regularly. The media portrays California as having a gang violence problem; however, throughout the United States, gang violence has risen more than 35% in the past year. Youth gang violence continues to rise dramatically with more and more of our youth deciding to join gangs each day. Sadly, every state has gangs, and the problem is getting much worse in areas that would never have thought about gangs a year ago. These "new generation" of gang members is younger, much more violent, and staying in the gang longer. Gangs are not just an urban problem. Gang activity is a suburban and rural problem too. There are more than 25 500 gangs in the United States, with a total gang membership of 850 000. Ninety-four percent of gang members are male and 6% are female. The ethnic composition nationwide includes 47% Latino, 31% African American, 13% White, 7% Asian, and 2% "mixed," according to the Office of Juvenile Justice and Delinquency Prevention of the U.S. Department of Justice. As a result of the ongoing proliferation of youth street gangs in our communities, it is imperative that critical care nurses and others involved with the direct care become educated about how to identify gang members, their activities, and understand their motivations. Such education and knowledge will help provide solutions to families and the youth themselves, help eradicate the problem of gang violence, and keep health care professionals safe. PMID:25463004

  13. Different Nursing Care Methods for Prevention of Keratopathy Among Intensive Care Unit Patients

    Science.gov (United States)

    Kalhori, Reza Pourmirza; Ehsani, Sohrab; Daneshgar, Farid; Ashtarian, Hossein; Rezaei, Mansour

    2016-01-01

    Background: Patients with reduced consciousness level suffer from eye protection disorder and Keratopathy. This study was conducted to compare effect of three eye care techniques in prevention of keratopathy in the patients hospitalized in intensive care unit of Kermanshah. Methods: This clinical trial was conducted in 2013 with sample size of 96 persons in three random groups. Routine care included washing of eyes with normal saline and three eye care methods were conducted with poly ethylene cover, liposic ointment, and artificial tear drop randomly on one eye of each sample and a comparison was made with the opposite eye as the control. Eyes were controlled for 5 days in terms of keratopathy. Data collection instrument was keratopathy severity index. Data statistical analysis was performed with SPSS-16 software and chi-squared test, Fisher’s exact test, ANOVA and Kruskal–Wallis one-way analysis of variance. Findings: The use of poly ethylene cover (0.59±0.665) was significantly more effective in prevention of keratopathy than other methods (P=0.001). There was no statistically significant difference between two care interventions of liposic ointment and artificial tear drop (P=0.844) but the results indicated the more effective liposic ointment (1.13±0.751) than the artificial tear drop (1.59±0.875) in prevention of corneal abrasion (Phospitalized in intensive care unit.

  14. Platelet counts and outcome in the pediatric intensive care unit

    Directory of Open Access Journals (Sweden)

    Agrawal Shruti

    2008-01-01

    Full Text Available Objectives: Thrombocytopenia is commonly observed in critically ill patients. This study was undertaken to evaluate the variation in platelet counts and the risk factors associated with thrombocytopenia and mortality in pediatric intensive care patients. In addition, prognostic value of platelet counts for outcome in pediatric intensive care unit was studied. Study Design: Prospective, observational cohort analysis. Setting: 8- bedded pediatric intensive care unit of a tertiary care teaching hospital. Patients: All consecutively admitted patients (n=138 staying in the pediatric intensive care unit (PICU for at least 48h over a 7 months period were studied. Measurements and Main Results: Thrombocytopenia was defined as platelet counts < 150.0/nL. Median 1 st day Pediatric Risk of Mortality Score (PRISM was 5 (range 0-30 and median ICU stay was 4 days (range 2-98 days. Twenty five percent patients had at least one episode of thrombocytopenia during the stay. Twenty percent of these patients had thrombocytopenia on admission and rest (80% developed it during the PICU stay. Seventy one percent (19 of the patients developed thrombocytopenia by fourth day of admission. Patients with PICU acquired thrombocytopenia had statistically significant lower baseline, nadir and 4th day platelet counts and a significantly higher drop in platelet counts (56% vs. 6% P< 0.001 as compared to non thrombocytopenic patients. PRISM score, long PICU stay, sepsis, coagulopathy, and creatinine levels were significantly associated with occurrence of thrombocytopenia. Patients with thrombocytopenia had higher probability of bleeding (34% vs. 15%, P=0.01. Higher platelet counts on admission were associated with significantly reduced risk of thrombocytopenia (P=0.00 Baseline, nadir and day-4 platelet counts, presence of thrombocytopenia on admission, sepsis, coagulopathy and a higher mean PRISM score on univariate analysis were significantly associated with mortality

  15. The Use of Modafinil in the Intensive Care Unit.

    Science.gov (United States)

    Gajewski, Michal; Weinhouse, Gerald

    2016-02-01

    As patients recover from their critical illness, the focus of intensive care unit (ICU) care becomes rehabilitation. Fatigue, excessive daytime somnolence (EDS), and depression can delay their recovery and potentially worsen outcomes. Psychostimulants, particularly modafinil (Provigil), have been shown to alleviate some of these symptoms in various patient populations, and as clinical trials are underway exploring this novel use of the drug, we present a case series of 3 patients in our institution's Thoracic Surgery Intensive Care Unit. Our 3 patients were chosen as a result of their fatigue, EDS, and/or depression, which prolonged their ICU stay and precluded them from participating in physical therapy, an integral component of the rehabilitative process. The patients were given 200 mg of modafinil each morning to increase patient wakefulness, encourage their participation, and enable a more restful sleep during the night. Although the drug was undoubtedly not the sole reason why our patients became more active, the temporal relationship between starting the drug and our patients' clinical improvement makes it likely that it contributed. Based on our observations with these patients, the known effects of modafinil, its safety profile, and the published experiences of others, we believe that modafinil has potential benefits when utilized in some critically ill patients and that the consequences of delayed patient recovery and a prolonged ICU stay may outweigh the risks of potential modafinil side effects.

  16. Costing of consumables: use in an intensive care unit.

    Science.gov (United States)

    Mann, S A

    1999-08-01

    In 1991, the Intensive Care Unit (ICU) at Middlemore Hospital manually costed the treatment and care of asthmatic patients. This was long-winded and labour-intensive, but provided hard data to support anecdotal beliefs that intensive care patients are more expensive than was currently believed or accepted. It is a known problem that funder and provider organizations see a huge disparity on the funding issue. With additional accurate information on the actual cost of individual patients, which can be grouped into disease categories, funding applications can be backed with accurate, up-to-date quantitative data. After a long preparation time, we are now costing individual patient stays in the ICU. Each individual resource was established, costed and entered into an MS ACCESS computerized database. Schedules have been prepared for updating prices, as these change. The final report available gives a detailed list of resource use within certain categories. Some items proved to be impractical to cost on an individual patient basis, and these have been grouped together, costed, and divided by the number of patient days for the last year, and assigned to each individual patient as an hourly unit cost. Believed to be a world-first, this information now forms the basis for variance reporting and pricing. PMID:10786509

  17. The Use of Modafinil in the Intensive Care Unit.

    Science.gov (United States)

    Gajewski, Michal; Weinhouse, Gerald

    2016-02-01

    As patients recover from their critical illness, the focus of intensive care unit (ICU) care becomes rehabilitation. Fatigue, excessive daytime somnolence (EDS), and depression can delay their recovery and potentially worsen outcomes. Psychostimulants, particularly modafinil (Provigil), have been shown to alleviate some of these symptoms in various patient populations, and as clinical trials are underway exploring this novel use of the drug, we present a case series of 3 patients in our institution's Thoracic Surgery Intensive Care Unit. Our 3 patients were chosen as a result of their fatigue, EDS, and/or depression, which prolonged their ICU stay and precluded them from participating in physical therapy, an integral component of the rehabilitative process. The patients were given 200 mg of modafinil each morning to increase patient wakefulness, encourage their participation, and enable a more restful sleep during the night. Although the drug was undoubtedly not the sole reason why our patients became more active, the temporal relationship between starting the drug and our patients' clinical improvement makes it likely that it contributed. Based on our observations with these patients, the known effects of modafinil, its safety profile, and the published experiences of others, we believe that modafinil has potential benefits when utilized in some critically ill patients and that the consequences of delayed patient recovery and a prolonged ICU stay may outweigh the risks of potential modafinil side effects. PMID:25716122

  18. Structure and Function: Planning a New Intensive Care Unit to Optimize Patient Care

    Directory of Open Access Journals (Sweden)

    Jozef Kesecioğlu

    2014-08-01

    Full Text Available To survey the recent medical literature reporting effects of intensive care unit (ICU design on patients’ and family members’ well-being, safety and functionality. Features of ICU design linked to the needs of patients and their family are single-rooms, privacy, quiet surrounding, exposure to daylight, views of nature, prevention of infection, a family area and open visiting hours. Other features such as safety, working procedures, ergonomics and logistics have a direct impact on the patient care and the nursing and medical personnel. An organization structured on the needs of the patient and their family is mandatory in designing a new intensive care. The main aims in the design of a new department should be patient centered care, safety, functionality, innovation and a future-proof concept.

  19. 76 FR 13209 - United States and State of Texas v. United Regional Health Care System; Proposed Final Judgment...

    Science.gov (United States)

    2011-03-10

    ... an intensive care unit, OB suite, and cardiology department. Today, Kell West has 41 beds. As alleged... beds and additional services, such as additional intensive care capabilities, cardiology services,...

  20. The anatomy of health care in the United States.

    Science.gov (United States)

    Moses, Hamilton; Matheson, David H M; Dorsey, E Ray; George, Benjamin P; Sadoff, David; Yoshimura, Satoshi

    2013-11-13

    Health care in the United States includes a vast array of complex interrelationships among those who receive, provide, and finance care. In this article, publicly available data were used to identify trends in health care, principally from 1980 to 2011, in the source and use of funds ("economic anatomy"), the people receiving and organizations providing care, and the resulting value created and health outcomes. In 2011, US health care employed 15.7% of the workforce, with expenditures of $2.7 trillion, doubling since 1980 as a percentage of US gross domestic product (GDP) to 17.9%. Yearly growth has decreased since 1970, especially since 2002, but, at 3% per year, exceeds any other industry and GDP overall. Government funding increased from 31.1% in 1980 to 42.3% in 2011. Despite the increases in resources devoted to health care, multiple health metrics, including life expectancy at birth and survival with many diseases, shows the United States trailing peer nations. The findings from this analysis contradict several common assumptions. Since 2000, (1) price (especially of hospital charges [+4.2%/y], professional services [3.6%/y], drugs and devices [+4.0%/y], and administrative costs [+5.6%/y]), not demand for services or aging of the population, produced 91% of cost increases; (2) personal out-of-pocket spending on insurance premiums and co-payments have declined from 23% to 11%; and (3) chronic illnesses account for 84% of costs overall among the entire population, not only of the elderly. Three factors have produced the most change: (1) consolidation, with fewer general hospitals and more single-specialty hospitals and physician groups, producing financial concentration in health systems, insurers, pharmacies, and benefit managers; (2) information technology, in which investment has occurred but value is elusive; and (3) the patient as consumer, whereby influence is sought outside traditional channels, using social media, informal networks, new public sources

  1. The anatomy of health care in the United States.

    Science.gov (United States)

    Moses, Hamilton; Matheson, David H M; Dorsey, E Ray; George, Benjamin P; Sadoff, David; Yoshimura, Satoshi

    2013-11-13

    Health care in the United States includes a vast array of complex interrelationships among those who receive, provide, and finance care. In this article, publicly available data were used to identify trends in health care, principally from 1980 to 2011, in the source and use of funds ("economic anatomy"), the people receiving and organizations providing care, and the resulting value created and health outcomes. In 2011, US health care employed 15.7% of the workforce, with expenditures of $2.7 trillion, doubling since 1980 as a percentage of US gross domestic product (GDP) to 17.9%. Yearly growth has decreased since 1970, especially since 2002, but, at 3% per year, exceeds any other industry and GDP overall. Government funding increased from 31.1% in 1980 to 42.3% in 2011. Despite the increases in resources devoted to health care, multiple health metrics, including life expectancy at birth and survival with many diseases, shows the United States trailing peer nations. The findings from this analysis contradict several common assumptions. Since 2000, (1) price (especially of hospital charges [+4.2%/y], professional services [3.6%/y], drugs and devices [+4.0%/y], and administrative costs [+5.6%/y]), not demand for services or aging of the population, produced 91% of cost increases; (2) personal out-of-pocket spending on insurance premiums and co-payments have declined from 23% to 11%; and (3) chronic illnesses account for 84% of costs overall among the entire population, not only of the elderly. Three factors have produced the most change: (1) consolidation, with fewer general hospitals and more single-specialty hospitals and physician groups, producing financial concentration in health systems, insurers, pharmacies, and benefit managers; (2) information technology, in which investment has occurred but value is elusive; and (3) the patient as consumer, whereby influence is sought outside traditional channels, using social media, informal networks, new public sources

  2. Intermittent Demand Forecasting in a Tertiary Pediatric Intensive Care Unit.

    Science.gov (United States)

    Cheng, Chen-Yang; Chiang, Kuo-Liang; Chen, Meng-Yin

    2016-10-01

    Forecasts of the demand for medical supplies both directly and indirectly affect the operating costs and the quality of the care provided by health care institutions. Specifically, overestimating demand induces an inventory surplus, whereas underestimating demand possibly compromises patient safety. Uncertainty in forecasting the consumption of medical supplies generates intermittent demand events. The intermittent demand patterns for medical supplies are generally classified as lumpy, erratic, smooth, and slow-moving demand. This study was conducted with the purpose of advancing a tertiary pediatric intensive care unit's efforts to achieve a high level of accuracy in its forecasting of the demand for medical supplies. On this point, several demand forecasting methods were compared in terms of the forecast accuracy of each. The results confirm that applying Croston's method combined with a single exponential smoothing method yields the most accurate results for forecasting lumpy, erratic, and slow-moving demand, whereas the Simple Moving Average (SMA) method is the most suitable for forecasting smooth demand. In addition, when the classification of demand consumption patterns were combined with the demand forecasting models, the forecasting errors were minimized, indicating that this classification framework can play a role in improving patient safety and reducing inventory management costs in health care institutions. PMID:27562485

  3. Intermittent Demand Forecasting in a Tertiary Pediatric Intensive Care Unit.

    Science.gov (United States)

    Cheng, Chen-Yang; Chiang, Kuo-Liang; Chen, Meng-Yin

    2016-10-01

    Forecasts of the demand for medical supplies both directly and indirectly affect the operating costs and the quality of the care provided by health care institutions. Specifically, overestimating demand induces an inventory surplus, whereas underestimating demand possibly compromises patient safety. Uncertainty in forecasting the consumption of medical supplies generates intermittent demand events. The intermittent demand patterns for medical supplies are generally classified as lumpy, erratic, smooth, and slow-moving demand. This study was conducted with the purpose of advancing a tertiary pediatric intensive care unit's efforts to achieve a high level of accuracy in its forecasting of the demand for medical supplies. On this point, several demand forecasting methods were compared in terms of the forecast accuracy of each. The results confirm that applying Croston's method combined with a single exponential smoothing method yields the most accurate results for forecasting lumpy, erratic, and slow-moving demand, whereas the Simple Moving Average (SMA) method is the most suitable for forecasting smooth demand. In addition, when the classification of demand consumption patterns were combined with the demand forecasting models, the forecasting errors were minimized, indicating that this classification framework can play a role in improving patient safety and reducing inventory management costs in health care institutions.

  4. Nurses Empathy and Family Needs in the Intensive Care Units

    Directory of Open Access Journals (Sweden)

    Sima Moghaddasian

    2013-08-01

    Full Text Available Introduction: The patients’ families in intensive care units (ICUs experience excessive stress which may disrupt their performance in daily life. Empathy is basic to the nursing role and has been found to be associated with improved patient outcomes and greater satisfaction with care in patient and his/her family. However, few studies have investigated the nursing empathy with ICU patients. This study aimed to assess nursing empathy and its relationship with the needs, from the perspective of families of patients in ICU.Methods: In this cross-sectional study, 418 subjects were selected among families of patients admitted to ICUs in Tabriz, Iran, by convenience sampling, from May to August 2012. Data were collected through Barrett-Lennard Relationship inventory (BLRI empathy scale and Critical Care Family Needs Intervention (CCFNI inventories and were analyzed using descriptive and inferential statistical tests. Results: Findings showed that most of the nurses had high level of empathy to the patients (38.8%. There was also statistically significant relationship between nurses’ empathy and needs of patients’ families (p < 0.001. Conclusion: In this study we found that by increasing the nurse’s empathy skills, we would be able to improve providing family needs. Through empathic communication, nurses can encourage family members to participate in planning for the care of their patients. However, further studies are necessary to confirm the results.

  5. Multitensor lifting and strictly unital higher category theory

    OpenAIRE

    Batanin, Michael; Cisinski, Denis-Charles; Weber, Mark

    2013-01-01

    In this article we extend the theory of lax monoidal structures, also known as multitensors, and the monads on categories of enriched graphs that they give rise to. Our first principal result -- the lifting theorem for multitensors -- enables us to see the Gray tensor product of 2-categories and the Crans tensor product of Gray categories as part of this framework. We define weak n-categories with strict units by means of a notion of reduced higher operad, using the theory of algebraic weak f...

  6. Acceptable long-term outcome in elderly intensive care unit patients

    DEFF Research Database (Denmark)

    Schrøder, Morten; Poulsen, Jesper Brøndum; Perner, Anders

    2011-01-01

    The number of elderly intensive care unit (ICU) patients is increasing. We therefore assessed the long-term outcome in the elderly following intensive care.......The number of elderly intensive care unit (ICU) patients is increasing. We therefore assessed the long-term outcome in the elderly following intensive care....

  7. Embedding effective depression care: using theory for primary care organisational and systems change

    Directory of Open Access Journals (Sweden)

    Gunn Jane M

    2010-08-01

    Full Text Available Abstract Background Depression and related disorders represent a significant part of general practitioners (GPs daily work. Implementing the evidence about what works for depression care into routine practice presents a challenge for researchers and service designers. The emerging consensus is that the transfer of efficacious interventions into routine practice is strongly linked to how well the interventions are based upon theory and take into account the contextual factors of the setting into which they are to be transferred. We set out to develop a conceptual framework to guide change and the implementation of best practice depression care in the primary care setting. Methods We used a mixed method, observational approach to gather data about routine depression care in a range of primary care settings via: audit of electronic health records; observation of routine clinical care; and structured, facilitated whole of organisation meetings. Audit data were summarised using simple descriptive statistics. Observational data were collected using field notes. Organisational meetings were audio taped and transcribed. All the data sets were grouped, by organisation, and considered as a whole case. Normalisation Process Theory (NPT was identified as an analytical theory to guide the conceptual framework development. Results Five privately owned primary care organisations (general practices and one community health centre took part over the course of 18 months. We successfully developed a conceptual framework for implementing an effective model of depression care based on the four constructs of NPT: coherence, which proposes that depression work requires the conceptualisation of boundaries of who is depressed and who is not depressed and techniques for dealing with diffuseness; cognitive participation, which proposes that depression work requires engagement with a shared set of techniques that deal with depression as a health problem; collective action

  8. [Information system at Department of Cardiac Surgery Intensive Care Unit].

    Science.gov (United States)

    Dokozić, Josipa

    2014-03-01

    This paper analyzes the aspects of using computer technology in nursing practice. Transfer and managing of data, information and knowledge in nursing is enabled by using modern technology and suitable applications. Cardio applications at the Intensive Care Unit of Department of Cardiac Surgery in Osijek enables nurses/technicians to gain insight into patient personal data, medical history, microbiological findings, interventions that have been made as well as those scheduled in the field of health care, all this by using a few simple connections. Nurses/technicians are those who enter patient data into his/her Electronic Health Record. There are multiple contributions of cardiac system. In comparison with previous paper-based managing of nursing documentation, this program has considerably facilitated and improved nursing practice.

  9. Acinetobacter baumannii Infection in the Neonatal Intensive Care Unit

    Directory of Open Access Journals (Sweden)

    AMK AL Jarousha

    2008-09-01

    Full Text Available Background: To perform a prospective case control study of blood stream infection to determine the infection rate of Acine­tobac­ter baumannii and the risk factors associated with mortality."nMethods:   From February 2004 to January 2005, 579 consecutive episodes of blood stream infection were obtained at two neo­na­tal intensive care units Al Nasser and Al Shifa hospitals in Gaza City. Forty (6.9% isolates of A. baumannii were ob­tained from the neonates under 28 d. Most of the isolates (92% were from hospitalized patients in the intensive care units."nResults: Community acquired infection was 8%.  Sixty three percent of the patients were males. The isolates of A. bauman­nii were resistant to commonly used antibiotics while being sensitive to meropenem (92.5%, imipenem (90%, chloram­pheni­col (80%, ciprofloxacin (75%, gentamicin (57.5%, ceftriaxone (50%, amikacin (37.5%, cefuroxime and ce­fo­taxime (35%. Over all crude mortality rate was 20% with much higher crude mortality among patients with noso­co­mial infec­tion.  Based on logistic regression, the following factors were statistically significant: weight < 1500g, age < 7 d, mean of hospitalization equal 20 days, antibiotic use, and mechanical ventilation, when compared to the control group (P< 0.05."nConclusion:  Infection rate of nosocomial blood stream infection was considerable and alarming in neonatal intensive care unit infants and associated with a significant excess length of NICU stay and a significant economic burden.  

  10. The influence of care interventions on the continuity of sleep of intensive care unit patients

    Directory of Open Access Journals (Sweden)

    Fernanda Luiza Hamze

    2015-10-01

    Full Text Available Objective: to identify care interventions, performed by the health team, and their influence on the continuity of sleep of patients hospitalized in the Intensive Care Unit.Method: descriptive study with a sample of 12 patients. A filming technique was used for the data collection. The awakenings from sleep were measured using the actigraphy method. The analysis of the data was descriptive, processed using the Statistical Package for the Social Sciences software.Results: 529 care interventions were identified, grouped into 28 different types, of which 12 (42.8% caused awakening from sleep for the patients. A mean of 44.1 interventions/patient/day was observed, with 1.8 interventions/patient/hour. The administration of oral medicine and food were the interventions that caused higher frequencies of awakenings in the patients.Conclusion: it was identified that the health care interventions can harm the sleep of ICU patients. It is recommended that health professionals rethink the planning of interventions according to the individual demand of the patients, with the diversification of schedules and introduction of new practices to improve the quality of sleep of Intensive Care Unit patients.

  11. Theories of human violence: implications for health care safety.

    Science.gov (United States)

    Flannery, Raymond B

    2004-01-01

    Violence is a complex, multifactorial entity with no single source of explanation. Although much research is underway into the nature and causes of violence, much of this research is done in isolation and published in highly specialized journals. Thus, there has been no journal review article for the administrator, clinician, or safety officer in health care settings who must address issues of safety on a daily basis. This paper provides that review by examining major cultural, biological, sociological, and psychological theories of violence. The review includes risk management strategies for, and the role of, health care facilities as societal institutions to curb violence. Many of the risk management strategies noted for health care settings may also be fielded in schools, courts, businesses, and other settings in which emergency services personnel are asked to respond.

  12. Stress ulcer prophylaxis in the intensive care unit

    DEFF Research Database (Denmark)

    Krag, M; Perner, A; Wetterslev, J;

    2015-01-01

    frequent reason for discontinuing SUP, but 19% (18/97) continued SUP upon ICU discharge. The majority expressed concern about nosocomial pneumonia and Clostridium difficile infection with the use of SUP. CONCLUSIONS: In this international survey, most participating ICUs reported using SUP, primarily proton......BACKGROUND: Stress ulcer prophylaxis (SUP) may decrease the incidence of gastrointestinal bleeding in patients in the intensive care unit (ICU), but the risk of infection may be increased. In this study, we aimed to describe SUP practices in adult ICUs. We hypothesised that patient selection...

  13. Assessment of brain death in the neurocritical care unit.

    Science.gov (United States)

    Hwang, David Y; Gilmore, Emily J; Greer, David M

    2013-07-01

    This article reviews current guidelines for death by neurologic criteria and addresses topics relevant to the determination of brain death in the intensive care unit. The history of brain death as a concept leads into a discussion of the evolution of practice parameters, focusing on the most recent 2010 update from the American Academy of Neurology and the practice variability that exists worldwide. Proper transition from brain death determination to possible organ donation is reviewed. This review concludes with a discussion regarding ethical and religious concerns and suggestions on how families of patients who may be brain dead might be optimally approached. PMID:23809039

  14. Non-invasive respiratory monitoring in paediatric intensive care unit.

    Directory of Open Access Journals (Sweden)

    Nadkarni U

    2000-04-01

    Full Text Available Monitoring respiratory function is important in a Paediatrics Intensive Care Unit (PICU, as majority of patients have cardio-respiratory problems. Non-invasive monitoring is convenient, accurate, and has minimal complications. Along with clinical monitoring, oxygen saturation using pulse oximetry, transcutaneous oxygenation (PtcO2 and transcutaneous PCO2 (PtcCO2 using transcutaneous monitors and end-tidal CO2 using capnography are important and routine measurements done in most PICUs. Considering the financial and maintenance constraints pulse oximetry with end tidal CO2 monitoring can be considered as most feasible.

  15. 76 FR 35017 - United States et al. v. United Regional Health Care System; Public Comments and Response on...

    Science.gov (United States)

    2011-06-15

    ... effectively prevented insurers from contracting with United Regional's competitors (``exclusionary contracts... entry of its competitors, likely leading to higher health-care costs and higher health insurance... competitors. The Complaint sought to enjoin United Regional from entering exclusionary contracts with...

  16. Target value design: applications to newborn intensive care units.

    Science.gov (United States)

    Rybkowski, Zofia K; Shepley, Mardelle McCuskey; Ballard, H Glenn

    2012-01-01

    There is a need for greater understanding of the health impact of various design elements in neonatal intensive care units (NICUs) as well as cost-benefit information to make informed decisions about the long-term value of design decisions. This is particularly evident when design teams are considering the transition from open-bay NICUs to single-family-room (SFR) units. This paper introduces the guiding principles behind target value design (TVD)-a price-led design methodology that is gaining acceptance in healthcare facility design within the Lean construction methodology. The paper also discusses the role that set-based design plays in TVD and its application to NICUs.

  17. Target value design: applications to newborn intensive care units.

    Science.gov (United States)

    Rybkowski, Zofia K; Shepley, Mardelle McCuskey; Ballard, H Glenn

    2012-01-01

    There is a need for greater understanding of the health impact of various design elements in neonatal intensive care units (NICUs) as well as cost-benefit information to make informed decisions about the long-term value of design decisions. This is particularly evident when design teams are considering the transition from open-bay NICUs to single-family-room (SFR) units. This paper introduces the guiding principles behind target value design (TVD)-a price-led design methodology that is gaining acceptance in healthcare facility design within the Lean construction methodology. The paper also discusses the role that set-based design plays in TVD and its application to NICUs. PMID:23224803

  18. Arterial pulmonary hypertension in noncardiac intensive care unit

    Directory of Open Access Journals (Sweden)

    Mykola V Tsapenko

    2008-10-01

    Full Text Available Mykola V Tsapenko1,5, Arseniy V Tsapenko2, Thomas BO Comfere3,5, Girish K Mour1,5, Sunil V Mankad4, Ognjen Gajic1,51Division of Pulmonary and Critical Care Medicine; 3Division of Critical Care Medicine; 4Division of Cardiovascular Diseases, Mayo Epidemiology and Translational Research in Intensive Care (M.E.T.R.I.C, Mayo Clinic, Rochester, MN, USA; 2Division of Pulmonary and Critical Care Medicine, Brown University, Miriam Hospital, Providence, RI, USAAbstract: Pulmonary artery pressure elevation complicates the course of many complex disorders treated in a noncardiac intensive care unit. Acute pulmonary hypertension, however, remains underdiagnosed and its treatment frequently begins only after serious complications have developed. Significant pathophysiologic differences between acute and chronic pulmonary hypertension make current classification and treatment recommendations for chronic pulmonary hypertension barely applicable to acute pulmonary hypertension. In order to clarify the terminology of acute pulmonary hypertension and distinguish it from chronic pulmonary hypertension, we provide a classification of acute pulmonary hypertension according to underlying pathophysiologic mechanisms, clinical features, natural history, and response to treatment. Based on available data, therapy of acute arterial pulmonary hypertension should generally be aimed at acutely relieving right ventricular (RV pressure overload and preventing RV dysfunction. Cases of severe acute pulmonary hypertension complicated by RV failure and systemic arterial hypotension are real clinical challenges requiring tight hemodynamic monitoring and aggressive treatment including combinations of pulmonary vasodilators, inotropic agents and systemic arterial vasoconstrictors. The choice of vasopressor and inotropes in patients with acute pulmonary hypertension should take into consideration their effects on vascular resistance and cardiac output when used alone or in

  19. [DEVELOPMENTAL CARE IN THE NEONATAL INTENSIVE CARE UNIT ACCORDING TO NEWBORN INDIVIDUALIZED DEVELOPMENTAL CARE AND ASSESSMENT PROGRAM (NIDCAP)].

    Science.gov (United States)

    Silberstein, Dalia; Litmanovitz, Ita

    2016-01-01

    During hospitalization in the neonatal intensive care unit (NICU), the brain of the preterm infant undergoes a particularly vulnerable and sensitive period of development. Brain development might be negatively influenced by direct injury as well as by complications of prematurity. Over the past few years, stress has come to be increasingly recognized as a potential risk factor. The NICU environment contains numerous stress factors due to maternal deprivation and over-stimulation, such as light, sound and pain, which conflict with the brain's developmental requirements. Developmental care is a caregiving approach that addresses the early developmental needs of the preterm infant as an integral component of quality neonatal care. NIDCAP (Newborn Individualized Developmental Care and Assessment Program) is a comprehensive program that aims to reduce environmental stress, to support the infant's neuro-behavioral maturation and organization, and to promote early parent-infant relationships. The implementation of developmental care based on NIDCAP principles is a gradual, in-depth systems change process, which affects all aspects of care in the NICU. This review describes the theoretical basis of the NIDCAP approach, summarizes the scientific evidence and addresses some of the implications of the transition from a traditional to a developmental care NICU.

  20. Nurses’ Burnout in Oncology Hospital Critical Care Unit

    Directory of Open Access Journals (Sweden)

    Yeliz İrem Tunçel

    2014-08-01

    Full Text Available Objective: Burnout is common in intensive care units (ICU because of high demands and difficult working conditions. The aim of this study was to analyse nurses’ burnout in our oncology ICU and to determine which factors are associated with. Material and Method: The study was carried out in Ankara Oncology Hospital ICU. A self- reporting questionnaire in an envelope was used for the evaluation of burnout (Turkish- language version of Maslach Burnout Inventory and depression (Beck Depression Scale. Results: From a total of 37 ICU nurses, 35 participated in the study (%94,5 response rate. High levels of emotional exhaustion in 82% and depersonalization in 51,4% of nurses was determined. Personal accomplishment was higher at 80%. Mild to moderate emotional state and mild anxiety was revealed. Years in profession,finding salary insufficient, finding the profession in its proper, choosing the profession of his own accord, work environment satisfaction and finding the social activity adequate were associated with burnout (p≤0.05. Conclusion: In our study, intensive care unit nurses’ burnout scores were found to be higher. Burnout was rare in nurses that choose the profession of his own accord, find the nursing profession in its proper, and social activity adequate and are satisfied with the work environment. Therefore, we believe that attention should be given to individual needs and preferences in the selection of ICU staff.

  1. Arterial waveform analysis in anesthesia and critical care: Theory, practical applications, and use in goal-directed strategies

    OpenAIRE

    Montenij, L.J.

    2016-01-01

    Cardiac output and preload are important variables in the hemodynamic optimization of critically ill patients in the operating room and intensive care unit. Arterial waveform analysis (AWA) enables continuous, minimally invasive measurement of CO from an arterial line, and provides dynamic assessment of cardiac preload. The present thesis investigates the theory and current applications of AWA in anesthesia and critical care, explores the methodological challenges in CO method comparison rese...

  2. [Treatment in the Intensive Care Unit: continue or withdraw?].

    Science.gov (United States)

    Savelkoul, Claudia; de Graeff, Nienke; Kompanje, Erwin J O; Tjan, Dave H T

    2016-01-01

    End-of-life decision-making in the Intensive Care Unit is a common and complex process. The step-by-step process of decision-making leading to withdrawal of life-sustaining treatment is illustrated in this paper by a clinical case. A variety of factors influences the decision to adjust the initial curative treatment policy towards withdrawal of life-sustaining therapy and the pursuit of comfort care. For a smooth decision-making process, it is necessary to make a prognosis and obtain consensus amongst the healthcare team. Withdrawal of life-sustaining treatment is ultimately a medical decision and a consensual decision should be reached by all medical staff and nurses, and preferably also by the patient and family. Timely involvement of a legal representative of the patient is essential for an uncomplicated decision-making process. Advance care planning and advance directives provide opportunities for patients to express their preferences beforehand. It is important to realise that end-of-life decisions are significantly influenced by personal and cultural values. PMID:27050494

  3. Let Them In: Family Presence during Intensive Care Unit Procedures.

    Science.gov (United States)

    Beesley, Sarah J; Hopkins, Ramona O; Francis, Leslie; Chapman, Diane; Johnson, Joclynn; Johnson, Nathanael; Brown, Samuel M

    2016-07-01

    Families have for decades advocated for full access to intensive care units (ICUs) and meaningful partnership with clinicians, resulting in gradual improvements in family access and collaboration with ICU clinicians. Despite such advances, family members in adult ICUs are still commonly asked to leave the patient's room during invasive bedside procedures, regardless of whether the patient would prefer family to be present. Physicians may be resistant to having family members at the bedside due to concerns about trainee education, medicolegal implications, possible effects on the technical quality of procedures due to distractions, and procedural sterility. Limited evidence from parallel settings does not support these concerns. Family presence during ICU procedures, when the patient and family member both desire it, fulfills the mandates of patient-centered care. We anticipate that such inclusion will increase family engagement, improve patient and family satisfaction, and may, on the basis of studies of open visitation, pediatric ICU experience, and family presence during cardiopulmonary resuscitation, decrease psychological distress in patients and family members. We believe these goals can be achieved without compromising the quality of patient care, increasing provider burden significantly, or increasing risks of litigation. In this article, we weigh current evidence, consider historical objections to family presence at ICU procedures, and report our clinical experience with the practice. An outline for implementing family procedural presence in the ICU is also presented. PMID:27104301

  4. Central nervous system infections in the intensive care unit

    Directory of Open Access Journals (Sweden)

    B. Vengamma

    2014-04-01

    Full Text Available Neurological infections constitute an uncommon, but important aetiological cause requiring admission to an intensive care unit (ICU. In addition, health-care associated neurological infections may develop in critically ill patients admitted to an ICU for other indications. Central nervous system infections can develop as complications in ICU patients including post-operative neurosurgical patients. While bacterial infections are the most common cause, mycobacterial and fungal infections are also frequently encountered. Delay in institution of specific treatment is considered to be the single most important poor prognostic factor. Empirical antibiotic therapy must be initiated while awaiting specific culture and sensitivity results. Choice of empirical antimicrobial therapy should take into consideration the most likely pathogens involved, locally prevalent drug-resistance patterns, underlying predisposing, co-morbid conditions, and other factors, such as age, immune status. Further, the antibiotic should adequately penetrate the blood-brain and blood- cerebrospinal fluid barriers. The presence of a focal collection of pus warrants immediate surgical drainage. Following strict aseptic precautions during surgery, hand-hygiene and care of catheters, devices constitute important preventive measures. A high index of clinical suspicion and aggressive efforts at identification of aetiological cause and early institution of specific treatment in patients with neurological infections can be life saving.

  5. [Nursing care systematization according to the nurses' view: a methodological approach based on grounded theory].

    Science.gov (United States)

    de Medeiros, Ana Lúcia; dos Santos, Sérgio Ribeiro; de Cabral, Rômulo Wanderley Lima

    2012-09-01

    This study was aimed at understanding, from the nurses' perspective, the experience of going through the Systematization of nursing care (SNC) in an obstetric service unit. We used grounded theory as the theoretical and methodological framework. The subjects of this study consisted of thirteen nurses from a public hospital in the city of João Pessoa, in the state of Paraíba. The data analysis resulted in the following phenomenon. "perceiving SNC as a working method that organizes, directs and improves the quality of care by bringing visibility and providing security for the nursing staff" The nurses expressed the extent of knowledge about the SNC experienced in obstetrics as well as considered the nursing process as a decision-making process, which guides the reasoning of nurses in the planning of nursing care in obstetrics. It was concluded that nurses perceive the SNC as an instrument of theoretical-practical articulation leading to personalized assistance.

  6. The importance of parents in the neonatal intensive care units

    Directory of Open Access Journals (Sweden)

    Hercília Guimarães

    2015-10-01

    Full Text Available The premature birth and the hospitalization in a neonatal intensive care unit (NICU are potential risk factors for the development and behavior of the newborn, as has been shown in recent studies. Premature birth of an infant is a distressing event for the family. Several feelings are experienced by parents during hospitalization of their baby in the NICU. Feelings of guilt, rejection, stress and anxiety are common. Also the attachment processes have the potential to be disrupted or delayed as a result of the initial separation of the premature newborn and the mother after the admission to the NICU. Added to these difficulties, there is the distortion of infant’s “ideal image”, created by the family, in contrast with the real image of the preterm. This relationship-based family-centered approach, the Neonatal Individualized Developmental Care and Assessment Program (NIDCAP, promotes the idea that infants and their families are collaborators in developing an individualized program to maximize physical, mental, and emotional growth and health and to improve long-term outcomes for the high risk newborns. The presence of parents in NICUs and their involvement caring their babies, in a family centered care philosophy, is vital to improve the outcome of their infants and the relationships within each family. Proceedings of the 11th International Workshop on Neonatology and Satellite Meetings · Cagliari (Italy · October 26th-31st, 2015 · From the womb to the adultGuest Editors: Vassilios Fanos (Cagliari, Italy, Michele Mussap (Genoa, Italy, Antonio Del Vecchio (Bari, Italy, Bo Sun (Shanghai, China, Dorret I. Boomsma (Amsterdam, the Netherlands, Gavino Faa (Cagliari, Italy, Antonio Giordano (Philadelphia, USA

  7. Theory of Inpatient Circadian Care (TICC): A Proposal for a Middle-Range Theory.

    Science.gov (United States)

    Camargo-Sanchez, Andrés; Niño, Carmen L; Sánchez, Leonardo; Echeverri, Sonia; Gutiérrez, Diana P; Duque, Andrés F; Pianeta, Oscar; Jaramillo-Gómez, Jenny A; Pilonieta, Martin A; Cataño, Nhora; Arboleda, Humberto; Agostino, Patricia V; Alvarez-Baron, Claudia P; Vargas, Rafael

    2015-01-01

    The circadian system controls the daily rhythms of a variety of physiological processes. Most organisms show physiological, metabolic and behavioral rhythms that are coupled to environmental signals. In humans, the main synchronizer is the light/dark cycle, although non-photic cues such as food availability, noise, and work schedules are also involved. In a continuously operating hospital, the lack of rhythmicity in these elements can alter the patient's biological rhythms and resilience. This paper presents a Theory of Inpatient Circadian Care (TICC) grounded in circadian principles. We conducted a literature search on biological rhythms, chronobiology, nursing care, and middle-range theories in the databases PubMed, SciELO Public Health, and Google Scholar. The search was performed considering a period of 6 decades from 1950 to 2013. Information was analyzed to look for links between chronobiology concepts and characteristics of inpatient care. TICC aims to integrate multidisciplinary knowledge of biomedical sciences and apply it to clinical practice in a formal way. The conceptual points of this theory are supported by abundant literature related to disease and altered biological rhythms. Our theory will be able to enrich current and future professional practice. PMID:25767632

  8. Optimal physicians schedule in an Intensive Care Unit

    Science.gov (United States)

    Hidri, L.; Labidi, M.

    2016-05-01

    In this paper, we consider a case study for the problem of physicians scheduling in an Intensive Care Unit (ICU). The objective is to minimize the total overtime under complex constraints. The considered ICU is composed of three buildings and the physicians are divided accordingly into six teams. The workload is assigned to each team under a set of constraints. The studied problem is composed of two simultaneous phases: composing teams and assigning the workload to each one of them. This constitutes an additional major hardness compared to the two phase's process: composing teams and after that assigning the workload. The physicians schedule in this ICU is used to be done manually each month. In this work, the studied physician scheduling problem is formulated as an integer linear program and solved optimally using state of the art software. The preliminary experimental results show that 50% of the overtime can be saved.

  9. End-of-life decisions in the intensive care unit

    DEFF Research Database (Denmark)

    Jensen, Hanne Irene

    2012-01-01

    Background When making end-of-life decisions in intensive care units, the different staff groups have different roles in the decision-making process and may not always assess the situation identically. Practice recommendations for withholding or withdrawing therapy state that decisions should...... regarding considerations of: o What should induce withholding or withdrawing therapy. o The multidisciplinary collaboration regarding end-of-life decisions. o Interventions that may improve collaboration and decision-making. • Examine and evaluate different methods to improve interdisciplinary collaboration...... and decision-making. Hypotheses • Nurses, intensivists, and primary physicians have different experiences of interdisciplinary collaboration regarding end-of-life decision-making in the ICU. • Specific interventions targeting end-of-life decision-making in the ICU, such as interdisciplinary audits...

  10. Chest roentgenology in the intensive care unit: an overview

    Energy Technology Data Exchange (ETDEWEB)

    Maffessanti, M. [Istituto di Radiologia, Universita di Trieste, Ospedale di Cattinara, I-34 100 Trieste (Italy); Berlot, G. [Istituto di Anestesia e Rianimazione, Universita di Trieste, Ospedale di Cattinara, I-34 100 Trieste (Italy); Bortolotto, P. [Servizio di Radiologia, Ospedale Maggiore, I-34 100 Trieste (Italy)

    1998-02-01

    Chest roentgenology in the intensive care unit is a real challenge for the general radiologist. Beyond the basic disease, the critically ill is at risk for developing specific cardiopulmonary disorders, all presenting as chest opacities, their diagnosis often being impossible if based only on the radiological aspect. To make things harder, their appearance can vary with the subject`s position and the mechanical ventilation. Patients require a continuous monitoring of the vital functions and their mechanical and pharmacological support, for which they are connected to different instruments. The radiologist should know the normal position of these devices, and promptly recognize when they are misplaced or when complications from their insertion occurred. Our aim is to suggest for each of the above-mentioned conditions a guideline of interpretation based not only on the radiological aspect and distribution of the lesions, but also on the physiopathological and clinical grounds. (orig.) With 13 figs., 58 refs.

  11. Difficult airway management from Emergency Department till Intensive Care Unit

    Directory of Open Access Journals (Sweden)

    Debasis Pradhan

    2015-01-01

    Full Text Available We report a case of "can ventilate but can′t intubate" situation which was successfully managed in the Emergency Department and Intensive Care Unit by the use of ProSeal laryngeal mask airway and Frova Intubating Introducer as bridging rescue devices. Use of appropriate technique while strictly following the difficult airway algorithm is the mainstay of airway management in unanticipated difficult airway situations. Although the multiple airway devices were used but each step took not more than 2 min and "don′t struggle, skip to the next step principle" was followed. With the availability of many advanced airway management tools, the intensivists should have a training and experience along with preparedness in order to perform such lifesaving airway managements.

  12. Peripartum Cardiomyopathy in Intensive Care Unit: An Update

    Science.gov (United States)

    Dinic, Vesna; Markovic, Danica; Savic, Nenad; Kutlesic, Marija; Jankovic, Radmilo J.

    2015-01-01

    Peripartum cardiomyopathy (PPCM) is a systolic heart failure that occurs during the last month of pregnancy or within 5 months after delivery. It is an uncommon disease of unknown etiopathogenesis and has a very high rate of maternal mortality. Because of similarity between symptoms of PPCM and physiological discomforts during pregnancy, the early diagnosis of PPCM presents a major challenge. Since hemodynamic changes during PPCM can vitally jeopardize the mother and the fetus, patients with severe forms of PPCM require a multidisciplinary approach in intensive care units. This review summarizes the current state of knowledge about the diagnosis, monitoring, and the treatment of PPCM. Having reviewed the recent researches, it gives insight into the new treatment strategies of this rare disease. PMID:26636086

  13. Acute renal failure in the intensive care unit.

    Science.gov (United States)

    Weisbord, Steven D; Palevsky, Paul M

    2006-06-01

    Acute renal failure (ARF) is a common complication in critically ill patients, with ARF requiring renal replacement therapy (RRT) developing in approximately 5 to 10% of intensive care unit (ICU) patients. Epidemiological studies have demonstrated that ARF is an independent risk factor for mortality. Interventions to prevent the development of ARF are currently limited to a small number of settings, primarily radiocontrast nephropathy and rhabdomyolysis. There are no effective pharmacological agents for the treatment of established ARF. Renal replacement therapy remains the primary treatment for patients with severe ARF; however, the data guiding selection of modality of RRT and the optimal timing of initiation and dose of therapy are inconclusive. This review focuses on the epidemiology and diagnostic approach to ARF in the ICU and summarizes our current understanding of therapeutic approaches including RRT.

  14. Supporting Neonatal Intensive Care Unit Parents Through Social Media.

    Science.gov (United States)

    Dzubaty, Dolores R

    2016-01-01

    Parents of infants in the neonatal intensive care unit may often find themselves seeking healthcare information from online and social media sources. Social media applications are available to healthcare consumers and their families, as well as healthcare providers, in a variety of formats. Information that parents gather on their own, and information that is explained by providers, is then used when parents make healthcare decisions regarding their infants. Parents also seek support from peers and family while making healthcare decisions. The combination of knowledge obtained and social support given may empower the parent to feel more confident in their decision making. Healthcare professionals can guide parents to credible resources. The exchange of information between providers and parents can occur using a variety of communication methods. Misperceptions can be corrected, support given, open sharing of information occurs, and parent empowerment may result. PMID:27465452

  15. MRSA infection in the neonatal intensive care unit.

    Science.gov (United States)

    Giuffrè, Mario; Bonura, Celestino; Cipolla, Domenico; Mammina, Caterina

    2013-05-01

    Methicillin-resistant Staphylococcus aureus (MRSA) is well known as one of the most frequent etiological agents of healthcare-associated infections. The epidemiology of MRSA is evolving with emergence of community-associated MRSA, the clonal spread of some successful clones, their spillover into healthcare settings and acquisition of antibacterial drug resistances. Neonatal intensive care unit (NICU) patients are at an especially high risk of acquiring colonization and infection by MRSA. Epidemiology of MRSA in NICU can be very complex because outbreaks can overlap endemic circulation and make it difficult to trace transmission routes. Moreover, increasing prevalence of community-associated MRSA can jeopardize epidemiological investigation, screening and effectiveness of control policies. Surveillance, prevention and control strategies and clinical management have been widely studied and are still the subject of scientific debate. More data are needed to determine the most cost-effective approach to MRSA control in NICU in light of the local epidemiology.

  16. Modes of death in neonatal intensive care units.

    LENUS (Irish Health Repository)

    Finan, E

    2006-04-01

    With the ever-increasing availability of aggressive medical treatment and technical support, neonatologists are offered an increasing ability to prolong life. While "end-of-life" decisions within NICUs have been studied internationally, there is limited data available for Ireland. Through the auspices of the Irish Faculty of Paediatrics 2002 Neonatal Mortality Ouestionnaire, decisions made around the time of death in Irish Neonatal Intensive Care Units were examined. The overall response rate to the questionnaire was 96% (n=25). One hundred and eighty seven deaths were reported for 2002. Information pertaining to the mode of death was available in 53% of cases. Seventy seven percent of those paediatricians who answered this question, reported either withdrawing or withholding treatment in babies thought to have a hopeless outcome, with the greatest proportion of these deaths occurring in premature infants (n=30) and babies with congenital defects (n=40).

  17. Heart rate dynamics preceding hemorrhage in the intensive care unit.

    Science.gov (United States)

    Moss, Travis J; Clark, Matthew T; Lake, Douglas E; Moorman, J Randall; Calland, J Forrest

    2015-01-01

    Occult hemorrhage in surgical/trauma intensive care unit (STICU) patients is common and may lead to circulatory collapse. Continuous electrocardiography (ECG) monitoring may allow for early identification and treatment, and could improve outcomes. We studied 4,259 consecutive admissions to the STICU at the University of Virginia Health System. We collected ECG waveform data captured by bedside monitors and calculated linear and non-linear measures of the RR interbeat intervals. We tested the hypothesis that a transfusion requirement of 3 or more PRBC transfusions in a 24 hour period is preceded by dynamical changes in these heart rate measures and performed logistic regression modeling. We identified 308 hemorrhage events. A multivariate model including heart rate, standard deviation of the RR intervals, detrended fluctuation analysis, and local dynamics density had a C-statistic of 0.62. Earlier detection of hemorrhage might improve outcomes by allowing earlier resuscitation in STICU patients. PMID:26342251

  18. Pilot Study of Behavioral Treatment in Dementia Care Units.(practice Concepts)(author Abstract)

    Science.gov (United States)

    Lichtenberg, Peter A.; Kemp-Havican, Julie; MacNeill, Susan E.; Johnson, Amanda Schafer

    2005-01-01

    Purpose: This article reports on the development and use of behavioral treatment as a well-being intervention for individuals with dementia residing at special care units in a nursing home. Design and Methods: The project took place upon the construction and opening of two new homelike units for dementia care in a rural community-care center.…

  19. Associations of Special Care Units and Outcomes of Residents with Dementia: 2004 National Nursing Home Survey

    Science.gov (United States)

    Luo, Huabin; Fang, Xiangming; Liao, Youlian; Elliott, Amanda; Zhang, Xinzhi

    2010-01-01

    Purpose: We compared the rates of specialized care for residents with Alzheimer's disease or dementia in special care units (SCUs) and other nursing home (NH) units and examined the associations of SCU residence with process of care and resident outcomes. Design and Methods: Data came from the 2004 National Nursing Home Survey. The indicators of…

  20. Ethics of drug research in the pediatric intensive care unit.

    Science.gov (United States)

    Kleiber, Niina; Tromp, Krista; Mooij, Miriam G; van de Vathorst, Suzanne; Tibboel, Dick; de Wildt, Saskia N

    2015-02-01

    Critical illness and treatment modalities change pharmacokinetics and pharmacodynamics of medications used in critically ill children, in addition to age-related changes in drug disposition and effect. Hence, to ensure effective and safe drug therapy, research in this population is urgently needed. However, conducting research in the vulnerable population of the pediatric intensive care unit (PICU) presents with ethical challenges. This article addresses the main ethical issues specific to drug research in these critically ill children and proposes several solutions. The extraordinary environment of the PICU raises specific challenges to the design and conduct of research. The need for proxy consent of parents (or legal guardians) and the stress-inducing physical environment may threaten informed consent. The informed consent process is challenging because emergency research reduces or even eliminates the time to seek consent. Moreover, parental anxiety may impede adequate understanding and generate misconceptions. Alternative forms of consent have been developed taking into account the unpredictable reality of the acute critical care environment. As with any research in children, the burden and risk should be minimized. Recent developments in sample collection and analysis as well as pharmacokinetic analysis should be considered in the design of studies. Despite the difficulties inherent to drug research in critically ill children, methods are available to conduct ethically sound research resulting in relevant and generalizable data. This should motivate the PICU community to commit to drug research to ultimately provide the right drug at the right dose for every individual child.

  1. Bedside Diagnosis in the Intensive Care Unit. Is Looking Overlooked?

    Science.gov (United States)

    Metkus, Thomas S; Kim, Bo Soo

    2015-10-01

    Bedside diagnosis, including but not limited to the physical examination, can be lifesaving in the setting of critical illness and is a core competency in both medical school and at the postgraduate level. Data as to the clinical usefulness of bedside diagnosis in the modern intensive care unit (ICU) is sparse, however, and there are no clinical guidelines addressing performance, interpretation, and usefulness of the bedside assessment in critically ill patients. Bedside assessment and physical examination are used in a heterogeneous manner across institutions and even across ICUs within the same institution, which has implications for medical education, patient care, and the overuse/misuse of diagnostic testing. In this commentary, we review the existing data addressing bedside diagnosis in the ICU, describe various models of bedside assessment use in the ICU based on our clinical practice and on the limited evidence base, share our practical "checklist-based" approach to bedside assessment in the critically ill patient, and advocate for more formal study of physical examination and bedside assessment in the ICU to enhance clinical practice. PMID:26389653

  2. [Neonatal intensive care unit--therapeutical success and what next?].

    Science.gov (United States)

    Swietliński, Janusz; Sitko-Rudnicka, Magdalena; Maruniak-Chudek, Iwona

    2004-01-01

    The increasing number of successfully treated newborns with disturbances of the adaptive period can measure effectiveness of neonatal intensive care units (NICU). The authors summarized some health problems of the former NICU patients. Central nervous system (CNS) of the premature, especially low (LBW) and very low birth weight (VLBW) infant, is in serious danger of improper development. The lack of neurological disturbances in early infancy does not exclude further pathological events and such patients require long-term observation and follow-up. High-risk newborns are of great need of precise imaging and diagnosis of CNS, which should be performed before discharge. Early stimulation and developmental care program are the crucial points in the management of newborns with neurological abnormalities. Sensorial problems, especially the rate of vision and hearing impairments, can be significantly reduced when prophylactic schedule is applied. Both, etiological factors leading to respiratory insufficiency and some iatrogenic effects of the therapy, can influence respiratory system. Symptoms of different intensity--from sneezing caused by nasal mucous membrane edema to the severe forms of bronchopulmonary dysplasia (BPD)--may last for a long time and influence the child's general condition. The surgical closure of Botall's duct (persistent ductus arteriosus--PDA) usually normalizes the circulatory system. In serious heart defects or isolated shunt-type defects, the compensation of the circulatory system can easily be disturbed. Digestive tract problems belong to the two main groups: first--connected with the prematurity and immature interstitial functioning (necrotizing enterocolitis, digestive and absorption abnormalities, hepatic cholestasis), and second--caused by congenital defects requiring immediate surgical intervention. Despite different types of the diseases, the treatment and care have to be focused on necessary for the growing organism, optimal nutrients and

  3. Quality improvement in radiography in a neonatal intensive care unit

    Energy Technology Data Exchange (ETDEWEB)

    Loovere, L.; Boyle, E.M. [Dept. of Pediatrics, McMaster Univ., Hamilton, Ontario (Canada); Blatz, S. [Dept. of Pediactrics, McMaster Children' s Hospital, Hamilton Health Sciences, Hamilton, Ontario (Canada); Bowslaugh, M.; Kereliuk, M. [Dept. of Radiology, Diagnostic Imaging, Hamilton Health Sciences, Hamilton, Ontario (Canada); Paes, B. [Dept. of Pediatrics, McMaster Univ., Hamilton, Ontario (Canada)], E-mail: paes@mcmaster.ca

    2008-10-15

    The primary objective of this study was to ensure that X-rays performed consistently adhere to established technological quality standards and are achieved without compromising patient care while minimizing exposure risks. The secondary objective was to evaluate whether educational sessions targeting areas deemed suboptimal would facilitate improvement. A retrospective, 1-week review of all neonatal X-rays and documentation of clinical information on X-ray requisitions (n = 132) was completed in a tertiary care neonatal intensive care unit (NICU), by a single observer. Standards for X-ray evaluation were defined a priori based on radiographic principles and essential documented medical information for correct interpretation. Targeted areas for improvement were identified and addressed through brief educational sessions and printed pamphlets. The review was repeated after recommendations were implemented. 1 month (n = 93) and 1 year (n = 76) later. Improvements were evident in both the completion of X-ray requisitions and image quality. In particular, there was a statistically significant improvement in requisition legibility (P = 0.019), completeness of the medical history (P < 0.001), reduction in X-ray rotation (P < 0.001), collimation to the specific area of interest (P <0.001), gonadal shielding (P < 0.001), and decrease in monitor leads or artifacts obscuring views (P < 0.001). These improvements were sustained both 1 month and 1 year following the educational sessions. A neonatal X-ray audit is a simple, effective way to evaluate radiographic technique and encourage provision of basic clinical information for diagnostic interpretation by radiologists and neonatologists. As well, structured, collaborative educational sessions between radiology and neonatology staff appear to be a successful and sustainable method to effect overall improvement. (author)

  4. Quality improvement in radiography in a neonatal intensive care unit

    International Nuclear Information System (INIS)

    The primary objective of this study was to ensure that X-rays performed consistently adhere to established technological quality standards and are achieved without compromising patient care while minimizing exposure risks. The secondary objective was to evaluate whether educational sessions targeting areas deemed suboptimal would facilitate improvement. A retrospective, 1-week review of all neonatal X-rays and documentation of clinical information on X-ray requisitions (n = 132) was completed in a tertiary care neonatal intensive care unit (NICU), by a single observer. Standards for X-ray evaluation were defined a priori based on radiographic principles and essential documented medical information for correct interpretation. Targeted areas for improvement were identified and addressed through brief educational sessions and printed pamphlets. The review was repeated after recommendations were implemented. 1 month (n = 93) and 1 year (n = 76) later. Improvements were evident in both the completion of X-ray requisitions and image quality. In particular, there was a statistically significant improvement in requisition legibility (P = 0.019), completeness of the medical history (P < 0.001), reduction in X-ray rotation (P < 0.001), collimation to the specific area of interest (P <0.001), gonadal shielding (P < 0.001), and decrease in monitor leads or artifacts obscuring views (P < 0.001). These improvements were sustained both 1 month and 1 year following the educational sessions. A neonatal X-ray audit is a simple, effective way to evaluate radiographic technique and encourage provision of basic clinical information for diagnostic interpretation by radiologists and neonatologists. As well, structured, collaborative educational sessions between radiology and neonatology staff appear to be a successful and sustainable method to effect overall improvement. (author)

  5. Protocolized eye care prevents corneal complications in ventilated patients in a medical intensive care unit

    Directory of Open Access Journals (Sweden)

    Mohammad Feroz Azfar

    2013-01-01

    Full Text Available Background: Eye care is an essential component in the management of critically ill patients. Standardized eye care can prevent corneal complications in ventilated patients. Objective: This study was designed to compare old and new practices of corneal care for reduction in corneal complications in ventilated patients. Methods: This study was done in three phases each of six month duration. Phase 1 was the ongoing practice of eye care in the unit. Before the start of phase 2, a new protocol was made for eye care. Corneal complications were observed in terms of haziness, dryness, and ulceration. All nursing staffs were educated and made compliant with the new protocol. In phase 2, a follow-up audit was done to check the effectiveness and compliance to protocol. In phase 3, a follow-up audit was started 3 months after phase 2. Results: In phase 1, total ventilated patients were 40 with 240 ventilator days. The corneal dryness rate was 40 per 1000 ventilator days while the haziness and ulceration rate was 16 per 1000 ventilator days each. In the second phase 2, total ventilated patients were 53 making 561 ventilator days. The rate of corneal haziness and dryness was 3.52 and 1.78 per 1000 ventilator days, respectively, with no case of corneal ulceration. In phase 3, the number of ventilated patients was 91 with 1114 ventilator days. The corneal dryness rate was 2.69 while the haziness and ulceration rate was 1.79 each. Conclusion: Protocolized eye care can reduce the risk of corneal complications in ventilated patients.

  6. Microeconomic surplus in health care: Applied economic theory in health care in four European countries

    Directory of Open Access Journals (Sweden)

    Stefan eWalzer

    2013-02-01

    Full Text Available Introduction: In economic theory economic surplus refers to two related quantities: Consumer and producer surplus. Applying this theory to health care convenience could be one way how consumer benefits might manifest itself. Methods: Various areas of economic surplus were identified and subsequently screened and analysed in Germany, Spain, The Netherlands and the UK: Caesarean births, emergency room visits (nights or weekends, drug availability after test results, and response surplus. A targeted literature search was being conducted to identify the associated costs. Finally the economic surplus (convenience value was calculated.Results: The economic surplus for different health care areas was being calculated. The highest economic surplus was obtained for the example of response surplus IVF-treatments in The Netherlands.Conclusions: The analyzed examples in this article support the underlying hypothesis for this research: Value of convenience defined as the consumer surplus in health care can be shown in different health care settings. Again, this hypothesis should be accepted as a starting point in this research area and hence further primary research is strongly recommended in order to fully proof this concept.

  7. Two-factor theory – at the intersection of health care management and patient satisfaction

    Directory of Open Access Journals (Sweden)

    Bohm J

    2012-10-01

    Full Text Available Josef BohmHealth Services Administration, New York City College of Technology, City University of New York, Brooklyn, NY, USAAbstract: Using data obtained from the 2004 Joint Canadian/United States Survey of Health, an analytic model using principles derived from Herzberg’s motivational hygiene theory was developed for evaluating patient satisfaction with health care. The analysis sought to determine whether survey variables associated with consumer satisfaction act as Hertzberg factors and contribute to survey participants' self-reported levels of health care satisfaction. To validate the technique, data from the survey were analyzed using logistic regression methods and then compared with results obtained from the two-factor model. The findings indicate a high degree of correlation between the two methods. The two-factor analytical methodology offers advantages due to its ability to identify whether a factor assumes a motivational or hygienic role and assesses the influence of a factor within select populations. Its ease of use makes this methodology well suited for assessment of multidimensional variables.Keywords: two-factor theory, behavioral theory, sociology of health care, patient satisfaction

  8. Benefits of High-Intensity Intensive Care Unit Physician Staffing under the Affordable Care Act

    Directory of Open Access Journals (Sweden)

    Sachin Logani

    2011-01-01

    Full Text Available The Affordable Care Act signed into law by President Obama, with its value-based purchasing program, is designed to link payment to quality processes and outcomes. Treatment of critically ill patients represents nearly 1% of the gross domestic product and 25% of a typical hospital budget. Data suggest that high-intensity staffing patterns in the intensive care unit (ICU are associated with cost savings and improved outcomes. We evaluate the literature investigating the cost-effectiveness and clinical outcomes of high-intensity ICU physician staffing as recommended by The Leapfrog Group (a consortium of companies that purchase health care for their employees and identify ways to overcome barriers to nationwide implementation of these standards. Hospitals that have implemented the Leapfrog initiative have demonstrated reductions in mortality and length of stay and increased cost savings. High-intensity staffing models appear to be an immediate cost-effective way for hospitals to meet the challenges of health care reform.

  9. Bloodstream Infections in a Neonatal Intensive Care Unit

    Directory of Open Access Journals (Sweden)

    Mehmet Sah Ižpek

    2014-12-01

    Full Text Available Aim: To determine the pattern of bloodstream infections (BSIs and antimicrobial susceptibility of pathogens in a neonatal intensive care unit (NICU.Material and Method: Positive hemoculture of neonates diagnosed with nosocomial sepsis from March 2011 to March 2014 in the NICU of Diyarbakir Maternity and Children%u2019s Hospital, in the southeastern region of Anatolia, Turkey, were retrospectively reviewed. Results: A total of 148 pathogens were isolated in 142 neonates. The most common microorganisms isolated were Klebsiella pneumoniae (40.5% and Acinetobacter baumannii (29.7% which was a result of a hospital outbreak. Multi-drug resistant (MDR strains accounted for 20.0% of K. pneumoniae isolates and 93.2% of A. baumannii isolates. The sepsis-attributable mortality rate was higher in cases infected with MDR strains than in cases infected without MDR strains or Candida spp (24% vs. 9.7%, p=0.032. Discussion: In our unit, BSIs were more often caused by Gram negative bacteria. BSIs caused by MDR strains were associated with a higher rate of sepsis-attributable mortality.

  10. 29 CFR 103.30 - Appropriate bargaining units in the health care industry.

    Science.gov (United States)

    2010-07-01

    ... 29 Labor 2 2010-07-01 2010-07-01 false Appropriate bargaining units in the health care industry... Appropriate Bargaining Units § 103.30 Appropriate bargaining units in the health care industry. (a) This... such by either Joint Committee on Accreditation of Healthcare Organizations or by Commission...

  11. Care of the gut in the surgical intensive care unit: fact or fashion?

    Science.gov (United States)

    Steinmetz, O K; Meakins, J L

    1991-06-01

    The traditional approach to the care of the gastrointestinal tract in the intensive care unit has been one of neglect. However, recent evidence has linked enteric flora to the generation of clinical sepsis in the absence of other infectious foci. The role of the bowel as an efficient barrier to the invasion of its own flora is addressed in this paper. A variety of insults disrupt the integrity of the barrier function of the gut, allowing the entry of bowel organisms or endotoxins, or both, into the portal and systemic circulatory systems. In animal and early clinical studies, a number of interventions, aimed at altering the enteric flora and enhancing the bowel's barrier function, have been shown to modulate the host's resistance to different insults and may even improve clinical outcome. Such interventions include maintenance of enteral feeding, glutamine supplementation of hyperalimentation solutions and selective bacterial decontamination of the bowel.

  12. Primary care and ophthalmology in the United Kingdom

    OpenAIRE

    Riad, S F; Dart, J K G; Cooling, R J

    2003-01-01

    The National Health Service is now primary care led. There are different definitions for primary care and in this review they are analysed and related to ophthalmology to produce a working definition for ophthalmic primary care, summarised as the provision of first contact care for all ophthalmic conditions and follow up, preventive, and rehabilitative care of selected ophthalmic conditions, in a variety of settings, by a diverse workforce. The attributes of primary care are first contact, ac...

  13. Leadership theory: implications for developing dental surgeons in primary care?

    Science.gov (United States)

    Willcocks, S

    2011-02-12

    The development of leadership in healthcare has been seen as important in recent years, particularly at the clinical level. There have been various specific initiatives focusing on the development of leadership for doctors, nurses and other health care professions: for example, a leadership competency framework for doctors, the LEO programme and the RCN clinical leadership programme for nurses. The NHS has set up a Leadership Council to coordinate further developments. However, there has not been the same focus in dentistry, although the recent review of NHS dental services (Steele review) has proposed a need for leadership initiatives in NHS dentistry as a medium-term action. Central to this will be a need to focus on the leadership role for dental surgeons. Leadership is all the more important in dentistry, given the change of government and the policy of retrenchment, major public sector reform, the emergence of new organisations such as new commissioning consortia, possible changes to the dental contract, new ways of working, and changes to the profession such as the requirements for the revalidation of dental surgeons. The question is: which leadership theory or approach is best for dental surgeons working in primary care? This paper builds on earlier work exploring this question in relation to doctors generally, and GPs, in particular, and planned work on nurses. It will seek to address this question in relation to dental surgeons working in primary care.

  14. Full-cost determination of different levels of care in the intensive care unit. An activity-based costing approach.

    Science.gov (United States)

    Doyle, J J; Casciano, J P; Arikian, S R; Mauskopf, J; Paul, J E

    1996-10-01

    We applied an activity-based costing methodology to determine the full cost of intensive care service at a community hospital, a university hospital and a health maintenance organisation (HMO)-affiliated hospital. A total of 5 patient care units were analysed: the intensive care unit (ICU) and surgical ICU (SICU) at the university setting, the ICU at the community setting, and the SICU and cardiac care unit at the HMO setting. The selection of the different ICU types was based on the types of critical care units that were found in each setting (e.g. the HMO did not have an ICU). Institution-specific cost data and clinical management parameters were collected through surveys and site visits from the 3 respective organisation types. The analysis revealed a marked increase in patient-minute cost associated with mechanical ventilation. Higher costs associated with prolonged neuromuscular blockade have important economic implications with respect to selection of an appropriate neuromuscular blocking agent.

  15. Oral care practices for patients in Intensive Care Units: A pilot survey

    Directory of Open Access Journals (Sweden)

    Alexandre Franco Miranda

    2016-01-01

    Full Text Available Objective: To assess the level of knowledge and difficulties concerning hospitalized patients regarding preventive oral health measures among professionals working in Intensive Care Units (ICUs. Study Population and Methods: A cross-sectional survey was conducted among 71 health professionals working in the ICU. A self-administered questionnaire was used to determine the methods used, frequency, and attitude toward oral care provided to patients in Brazilian ICUs. The variables were analyzed using descriptive statistics (percentages. A one-sample t-test between proportions was used to assess significant differences between percentages. t-statistics were considered statistically significant for P < 0.05. Bonferroni correction was applied to account for multiple testing. Results: Most participants were nursing professionals (80.3% working 12-h shifts in the ICU (70.4%; about 87.3% and 66.2% reported having knowledge about coated tongue and nosocomial pneumonia, respectively (P < 0.05. Most reported using spatulas, gauze, and toothbrushes (49.3% or only toothbrushes (28.2% with 0.12% chlorhexidine (49.3% to sanitize the oral cavity of ICU patients (P < 0.01. Most professionals felt that adequate time was available to provide oral care to ICU patients and that oral care was a priority for mechanically ventilated patients (80.3% and 83.1%, respectively, P < 0.05. However, most professionals (56.4% reported feeling that the oral cavity was difficult to clean (P < 0.05. Conclusion: The survey results suggest that additional education is necessary to increase awareness among ICU professionals of the association between dental plaque and systemic conditions of patients, to standardize oral care protocols, and to promote the oral health of patients in ICUs.

  16. Protocol on the constipation in an oncology palliative care unit

    Directory of Open Access Journals (Sweden)

    Montserrat Cordero Ponce

    2008-07-01

    Full Text Available Constipation is a problem relatively common even in healthy people, mainly in the western world, influenced mainly by the nutritional diets and the diminution of the physical activity. It is a symptom of difficult valuation by its subjective nature and the difficulty to establish a normality pattern.The incidence is high. It is observed in a 70 - 80% of the patients in terminal situation, the 40 - 50% of the patients with disease outpost and in 90% of the patients dealing with opiate.As nurses in of a palliative care unit we detected the high number of patients which they present/display the symptom and the time that takes in its diagnose and treatment, increasing the incidence-appearance of fecal impactación and intestinal obstruction. It is one of the symptoms that worry to our patients more.We take too frequently the “rectal measures,” being more painful and a little shameful for these patients, instead of using preventive measures, precocious oral treatment and continuous evaluation of the symptom. The knowledge that these patients have of the constipation is in many deficient cases. In order to be able to educate and to take care of to the oncology terminal patient in terminal state with constipation it is essential that we know its physiopathology, causes and complications. Also we will deepen in the most suitable treatment according to the consistency, the effort that the patient must make when defecating and the symptoms that presents/displays, trying that the treatment is customized and individual, although starting off of a previous protocol of performance decided by the health professionals who are going to treat the patient.

  17. Hemodynamic monitoring in the intensive care unit: a Brazilian perspective

    Science.gov (United States)

    Dias, Fernando Suparregui; Rezende, Ederlon Alves de Carvalho; Mendes, Ciro Leite; Silva Jr., João Manoel; Sanches, Joel Lyra

    2014-01-01

    Objective In Brazil, there are no data on the preferences of intensivists regarding hemodynamic monitoring methods. The present study aimed to identify the methods used by national intensivists, the hemodynamic variables they consider important, the regional differences, the reasons for choosing a particular method, and the use of protocols and continued training. Methods National intensivists were invited to answer an electronic questionnaire during three intensive care events and later, through the Associação de Medicina Intensiva Brasileira portal, between March and October 2009. Demographic data and aspects related to the respondent preferences regarding hemodynamic monitoring were researched. Results In total, 211 professionals answered the questionnaire. Private hospitals showed higher availability of resources for hemodynamic monitoring than did public institutions. The pulmonary artery catheter was considered the most trusted by 56.9% of the respondents, followed by echocardiograms, at 22.3%. Cardiac output was considered the most important variable. Other variables also considered relevant were mixed/central venous oxygen saturation, pulmonary artery occlusion pressure, and right ventricular end-diastolic volume. Echocardiography was the most used method (64.5%), followed by pulmonary artery catheter (49.3%). Only half of respondents used treatment protocols, and 25% worked in continuing education programs in hemodynamic monitoring. Conclusion Hemodynamic monitoring has a greater availability in intensive care units of private institutions in Brazil. Echocardiography was the most used monitoring method, but the pulmonary artery catheter remains the most reliable. The implementation of treatment protocols and continuing education programs in hemodynamic monitoring in Brazil is still insufficient. PMID:25607264

  18. Attitude of resident doctors towards intensive care units' alarm settings.

    Science.gov (United States)

    Garg, Rakesh; Bhalotra, Anju R; Goel, Nitesh; Pruthi, Amit; Bhadoria, Poonam; Anand, Raktima

    2010-11-01

    Intensive care unit (ICU) monitors have alarm options to intimate the staff of critical incidents but these alarms needs to be adjusted in every patient. With this objective in mind, this study was done among resident doctors, with the aim of assessing the existing attitude among resident doctors towards ICU alarm settings. This study was conducted among residents working at ICU of a multispeciality centre, with the help of a printed questionnaire. The study involved 80 residents. All residents were in full agreement on routine use of ECG, pulse oximeter, capnograph and NIBP monitoring. 86% residents realised the necessity of monitoring oxygen concentration, apnoea monitoring and expired minute ventilation monitoring. 87% PGs and 70% SRs routinely checked alarm limits for various parameters. 50% PGs and 46.6% SRs set these alarm limits. The initial response to an alarm among all the residents was to disable the alarm temporarily and try to look for a cause. 92% of PGs and 98% of SRs were aware of alarms priority and colour coding. 55% residents believed that the alarm occurred due to patient disturbance, 15% believed that alarm was due to technical problem with monitor/sensor and 30% thought it was truly related to patient's clinical status. 82% residents set the alarms by themselves, 10% believed that alarms should be adjusted by nurse, 4% believed the technical staff should take responsibility of setting alarm limits and 4% believed that alarm levels should be pre-adjusted by the manufacturer. We conclude that although alarms are an important, indispensable, and lifesaving feature, they can be a nuisance and can compromise quality and safety of care by frequent false positive alarms. We should be familiar of the alarm modes, check and reset the alarm settings at regular interval or after a change in clinical status of the patient. PMID:21224968

  19. Acinetobacter infections as an emerging threat in intensive care units

    International Nuclear Information System (INIS)

    Nosocomial infections caused by Acinetobacter species (Spp.) is an emerging threat in health care setups especially intensive care units (ICU). The objective of this observational study was to determine the pattern of Acinetobacter infections and its association with length of stay in patients admitted to our medical ICU from January to August 2011. Methods: All patients above 16 years of age with stay of more than 48 hours were checked for any development of new infections not present or incubating at the time of admission. Nosocomial infections were documented in the light of clinical findings and lab results. Data was analysed using statistical software SPSS 15.0. Results: A total of 146 patients had a stay of at least 48 hours; frequency of nosocomial infection was 30.8% out of which 57.8% were Acinetobacter infections. Respiratory system was most commonly involved. Acinetobacter Spp showed high resistance (96.2%) to penicillins, cephalosporins and even extended spectrum antibiotics including carbepenems, quinolones and piperacillin plus tazobactam. Extended drug resistance was seen in 92.3% isolates; while we found high susceptibility to tigecycline (88.5%) and polymyxins (100%). Acinetobacter Spp. infected patients had mean length of stay (LOS) of 12.92 days when compared to patients with other nosocomial infections and no infection with mean LOS of 7.05 days (p=0.05) and 4.86 days (p=0.00) respectively. Conclusions: Acinetobacter Spp infections increase with longer duration of stay in ICU. Emergence of multi-drug and extended-drug resistant Acinetobacter Spp is alarming and overwhelming at this rate for already stretched out health system with its economic and health implications. (author)

  20. Impact of clinical pharmacist in an Indian Intensive Care Unit

    Directory of Open Access Journals (Sweden)

    Mohamed Hisham

    2016-01-01

    Full Text Available Background and Objectives: A critically ill patient is treated and reviewed by physicians from different specialties; hence, polypharmacy is a very common. This study was conducted to assess the impact and effectiveness of having a clinical pharmacist in an Indian Intensive Care Unit (ICU. It also evaluates the clinical pharmacist interventions with a focus on optimizing the quality of pharmacotherapy and patient safety. Materials and Methods: The prospective, observational study was carried out in medical and surgical/trauma ICU over a period of 1 year. All detected drug-related problems and interventions were categorized based on the Pharmaceutical Care Network Europe system. Results: During the study period, average monthly census of 1032 patients got treated in the ICUs. A total of 986 pharmaceutical interventions due to drug-related problems were documented, whereof medication errors accounted for 42.6% (n = 420, drug of choice problem 15.4% (n = 152, drug-drug interactions were 15.1% (n = 149, Y-site drug incompatibility was 13.7% (n = 135, drug dosing problems were 4.8% (n = 47, drug duplications reported were 4.6% (n = 45, and adverse drug reactions documented were 3.8% (n = 38. Drug dosing adjustment done by the clinical pharmacist included 140 (11.9% renal dose, 62 (5.2% hepatic dose, 17 (1.4% pediatric dose, and 104 (8.8% insulin dosing modifications. A total of 577 drug and poison information queries were answered by the clinical pharmacist. Conclusion: Clinical pharmacist as a part of multidisciplinary team in our study was associated with a substantially lower rate of adverse drug event caused by medication errors, drug interactions, and drug incompatibilities.

  1. Intraocular infections in the neonatal intensive care unit

    Directory of Open Access Journals (Sweden)

    Sisk RA

    2012-05-01

    Full Text Available Hassan A Aziz1, Audina M Berrocal1,2, Robert A Sisk1, Kristin Hartley1, Magaly Diaz-Barbosa2, Rose A Johnson2, Ditte Hess1, Sander R Dubovy1, Timothy G Murray1, Harry W Flynn Jr11Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, 2Jackson Memorial Hospital, Miami, FL, USABackground: The purpose of this study was to report on the incidence and treatment outcomes of endogenous endophthalmitis among newborns in the neonatal intensive care unit (NICU of a single medical center.Methods: This was a noncomparative, retrospective case series of endogenous endophthalmitis among infants at the Jackson Memorial Hospital NICU treated between March 1, 2002 and March 1, 2007.Results: Of 4323 infants admitted to the NICU, seven eyes of six (0.139% infants (two males, four females were diagnosed with endophthalmitis during the study period. Four patients were born prematurely with a mean gestational age of 27.5 weeks and a mean birth weight of 1153 g. Retinopathy of prematurity was reported in two of the six patients. Mean follow-up was 3.5 years. The diagnosis was confirmed by positive cultures or polymerase chain reaction testing at a median age of 34 postnatal days. Positive cultures included Candida albicans (n = 4, Pseudomonas aeruginosa (n = 1, and Herpes simplex type 2 (n = 1. All patients received systemic treatment and five received adjunctive ophthalmic interventions, including intravitreal antibiotics in five eyes of four patients and vitrectomy with pars plana lensectomy in three eyes. One patient underwent primary enucleation and another had delayed evisceration. In the remaining five eyes, there was a normal appearing posterior segment and normal intraocular pressures at last follow-up.Conclusion: Endogenous endophthalmitis is a rare complication in infants in the NICU, but may occur in patients with candidemia, bacteremia, retinopathy of prematurity, and low birth weight. Despite early and

  2. Are managed care organizations in the United States impeding the delivery of primary care by nurse practitioners? A 2012 update on managed care organization credentialing and reimbursement practices.

    Science.gov (United States)

    Hansen-Turton, Tine; Ware, Jamie; Bond, Lisa; Doria, Natalie; Cunningham, Patrick

    2013-10-01

    In 2014, the Affordable Care Act will create an estimated 16 million newly insured people. Coupled with an estimated shortage of over 60,000 primary care physicians, the country's public health care system will be at a challenging crossroads, as there will be more patients waiting to see fewer doctors. Nurse practitioners (NPs) can help to ease this crisis. NPs are health care professionals with the capability to provide important and critical access to primary care, particularly for vulnerable populations. However, despite convincing data about the quality of care provided by NPs, many managed care organizations (MCOs) across the country do not credential NPs as primary care providers, limiting the ability of NPs to be reimbursed by private insurers. To assess current credentialing practices of health plans across the United States, a brief telephone survey was administered to 258 of the largest health maintenance organizations (HMOs) in the United States, operated by 98 different MCOs. Results indicated that 74% of these HMOs currently credential NPs as primary care providers. Although this represents progress over prior assessments, findings suggest that just over one fourth of major HMOs still do not recognize NPs as primary care providers. Given the documented shortage of primary care physicians in low-income communities in the United States, these credentialing policies continue to diminish the ability of NPs to deliver primary care to vulnerable populations. Furthermore, these policies could negatively impact access to care for thousands of newly insured Americans who will be seeking a primary care provider in 2014.

  3. Framing the issue of ageing and health care spending in Canada, the United Kingdom and the United States.

    Science.gov (United States)

    Gusmano, Michael K; Allin, Sara

    2014-07-01

    Political debates about the affordability of health care programmes in high-income countries often point to population ageing as a threat to sustainability. Debates in the United States, in particular, highlight concerns about intergenerational equity, whereby spending on older people is perceived as a threat to spending on the young. This paper compares how the problem of health spending is defined in Canada, the United Kingdom and the United States by presenting the results of a content analysis of print media during the period 2005-2010. We found that population ageing was cited as an important source of health care cost increases in all three countries but was cited less frequently in Canadian newspapers than in the UK or US papers. Direct claims about intergenerational equity are infrequent among the articles we coded, but newspaper articles in the United States were more likely than those in Canada and the United Kingdom to claim that of high health care spending on older people takes resources away from younger people. In Canada a much larger percentage of articles in our sample either claimed that high health care spending is crowding out other types of government expenditure. Finally, we found that almost no articles in the United States challenged the view that population ageing causes health care spending, whereas in both Canada and the United Kingdom a small, but steady stream of articles challenged the idea that population ageing is to blame for health care spending increases. PMID:24759155

  4. Two-factor theory – at the intersection of health care management and patient satisfaction

    Science.gov (United States)

    Bohm, Josef

    2012-01-01

    Using data obtained from the 2004 Joint Canadian/United States Survey of Health, an analytic model using principles derived from Herzberg’s motivational hygiene theory was developed for evaluating patient satisfaction with health care. The analysis sought to determine whether survey variables associated with consumer satisfaction act as Hertzberg factors and contribute to survey participants’ self-reported levels of health care satisfaction. To validate the technique, data from the survey were analyzed using logistic regression methods and then compared with results obtained from the two-factor model. The findings indicate a high degree of correlation between the two methods. The two-factor analytical methodology offers advantages due to its ability to identify whether a factor assumes a motivational or hygienic role and assesses the influence of a factor within select populations. Its ease of use makes this methodology well suited for assessment of multidimensional variables. PMID:23055755

  5. Two-factor theory - at the intersection of health care management and patient satisfaction.

    Science.gov (United States)

    Bohm, Josef

    2012-01-01

    Using data obtained from the 2004 Joint Canadian/United States Survey of Health, an analytic model using principles derived from Herzberg's motivational hygiene theory was developed for evaluating patient satisfaction with health care. The analysis sought to determine whether survey variables associated with consumer satisfaction act as Hertzberg factors and contribute to survey participants' self-reported levels of health care satisfaction. To validate the technique, data from the survey were analyzed using logistic regression methods and then compared with results obtained from the two-factor model. The findings indicate a high degree of correlation between the two methods. The two-factor analytical methodology offers advantages due to its ability to identify whether a factor assumes a motivational or hygienic role and assesses the influence of a factor within select populations. Its ease of use makes this methodology well suited for assessment of multidimensional variables.

  6. Stigma in abortion care: application to a grounded theory study.

    Science.gov (United States)

    Lipp, Allyson

    2011-02-01

    A recent research study found that being more directly involved in medical abortion places greater demands on the nurses. The demands required by nurses working in abortion care may be increased by the stigma attached to such an antisocial action. This paper presents an application of stigma theory, as espoused by Goffman, based on a qualitative research study on abortion. It is argued that women attending for abortion are stigmatised and nurses, although 'wise', have an affiliate stigma through their close association with the procedure. It is proposed that the situation can be ameliorated by addressing stigma at policy, local and personal levels. Examples from other areas of practice are outlined for possible application to practice.

  7. Karakteristik Dengue Berat yang Dirawat di Pediatric Intensive Care Unit

    Directory of Open Access Journals (Sweden)

    Dzulfikar D. Lukmanul Hakim

    2012-09-01

    Full Text Available Dengue viral infections affect all age groups and produce a spectrum of clinical illness that ranges from asymptomatic to severe and occasionally fatal disease. Severe dengue characterized by plasma leakage, hemoconcentration, and hemostatic disorder. The aim of this study was to know the characteristic of severe dengue patients admitted to Pediatric Intensive Care Unit (PICU Dr. Hasan Sadikin Hospital Bandung during January 2009 to December 2010. This was a retrospective descriptive study based on the data collected from the medical records. Twenty-one severe dengue cases in two years were admitted 15/21 girls and 6/21 boys, and 5/21 of them died during hospitalization because of dengue shock syndrome (DSS and disseminated intravascular coagulation (DIC. Most of them were 1−5 years old with good nutritional status. Hepatomegaly was found in all cases with mean hematocrit was 38%. In this research, the most manifestation of severe dengue were DSS (15/21, DIC (11/21, encephalopathy (6/21, pleural effusion (5/21, myocarditis (3/21, and acute respiratory distress syndrome (3/21. In conclusions, severe dengue are more common in girls, 1–5 years old, and well-nourished children. The most common clinical manifestation of severe dengue are shock, disseminated intravascular coagulation, and encephalopathy.

  8. Eye injury treatment in intensive care unit patients

    Directory of Open Access Journals (Sweden)

    L. K. Moshetova

    2015-03-01

    Full Text Available Aim. To describe eye injuries in intensive care unit (ICU patients with multitrauma, to study conjunctival microflora in these patients, and to develop etiologically and pathogenically targeted treatment and prevention of wound complications.Materials and methods. Study group included 50 patients (54 eyes with combined mechanical cerebral and eye injury. All patients underwent possible ophthalmological examination (biomicroscopy, ophthalmoscopy and ocular fundus photographing with portative fundus camera, tonometry, cranial CT and MRT, and bacteriological study of conjunctival smears. Results. Modern methods of ophthalmological examination of ICU patients provided correct diagnosis and prediction of wound healing. Eye injury treatment schedule provided maximum possible results in all ICU patients. Hospitalacquired infection results in asymptomatic dissemination of pathogenic microbes on ocular surface. Conclusions. 14-day topical treatment with antimicrobials, steroids, and NSAIDs reduces posttraumatic inflammation caused by mechanical eye injuries in ICU patients. Bacteriological studies of conjunctival smears demonstrate the presence of pathogenic flora in ICU patients. In these patients, the most effective antibacterial agents are third-generation fluoroquinolones. 

  9. Candida colonization in intensive care unit patients' urine

    Directory of Open Access Journals (Sweden)

    Xisto Sena Passos

    2005-12-01

    Full Text Available The objective of this study was to identify possible predisposing factors for candiduria in intensive care unit (ICU patients from Hospital das Clínicas, Universidade Federal de Goiás, Goiânia, Brazil, during one year. Urine samples from 153 ICU patients were obtained by catheterization on admission day and every seven days. Data such as sex, age, antifungal therapy, and variables as antibiotics, underlying diseases or comorbid conditions and stay in the hospital, were collected from patients who had at least one urine culture that yielded > 10³ yeast colonies/ml. Candiduria was recovered in 68 patients and the commonest predisposing factors were antibiotic therapy (100% and indwelling urinary catheter (92.6%. The percentage of Candida spp. isolation increased during the extended periods in which patients remained in the ICU. C. albicans was isolated in 69.1%, and the other species non-albicans as C. glabrata, C. kefyr, C. parapsilosis, C. famata, C. guilliermondii, C. krusei, and C. tropicalis were isolated in lower percentage. The high frequency of candiduria and the possible predisposing factors found in ICU patients show that candiduria surveillance should be performed to help reducing nosocomial infections.

  10. Antimicrobial usage in an intensive care unit: a prospective analysis.

    LENUS (Irish Health Repository)

    Conrick-Martin, I

    2012-01-31

    Antimicrobial therapies in the Intensive Care Unit (ICU) need to be appropriate in both their antimicrobial cover and duration. We performed a prospective observational study of admissions to our semi-closed ICU over a three-month period and recorded the indications for antimicrobial therapy, agents used, duration of use, changes in therapy and reasons for changes in therapy. A change in therapy was defined as the initiation or discontinuation of an antimicrobial agent. There were 51 patients admitted during the three-month study period and all received antimicrobial therapy. There were 135 changes in antimicrobial therapy. 89 (66%) were made by the ICU team and 32 (24%) were made by the primary team. Changes were made due to a deterioration or lack of clinical response in 41 (30%) cases, due to the completion of prescribed course in 36 (27%) cases, and in response to a sensitivity result in 25 (19%) cases. Prophylactic antibiotic courses (n=24) were of a duration greater than 24 hours in 15 (63%) instances. In conclusion, the majority of changes in antimicrobial therapy were not culture-based and the duration of surgical prophylaxis was in excess of current recommended guidelines.

  11. Elective open bedside tracheostomy in the neurosurgical intensive care unit

    Directory of Open Access Journals (Sweden)

    Niran Maharjan

    2015-09-01

    Full Text Available JCMSBackground and Objectives: Tracheostomy is electively performed in critically ill patients requiring prolonged respiratory support. The risk of transporting, the increasing associated cost and operative room schedule are some of the obstacles for wider acceptance of this procedure. The use of rigid selection criteria exclude many patients who would benefit of this approach. The present study was designed to determine the safety of open bedside tracheostomy (OBT as a routine intensive care units (ICU procedure without any selection criteria, considering its peri and postoperative complications.Materials & Methods: Retrospective medical chart review of all patients that underwent elective tracheostomy between June 2014 and January 2015.Results: The study group comprised 52 patients with a mean age of 40.4±15.1 years. The incidence of intra-procedure complications was 5.7% and post-procedure complications was 3.8%.Conclusions: Open bedside tracheostomy seems to be a safe and simple procedure, even when performed by a trained resident under controlled circumstances, and should be considered as an option for ICU patients.JCMS Nepal. 2015;11(1: 9-11

  12. Eye injury treatment in intensive care unit patients

    Directory of Open Access Journals (Sweden)

    L. K. Moshetova

    2015-01-01

    Full Text Available Aim. To describe eye injuries in intensive care unit (ICU patients with multitrauma, to study conjunctival microflora in these patients, and to develop etiologically and pathogenically targeted treatment and prevention of wound complications.Materials and methods. Study group included 50 patients (54 eyes with combined mechanical cerebral and eye injury. All patients underwent possible ophthalmological examination (biomicroscopy, ophthalmoscopy and ocular fundus photographing with portative fundus camera, tonometry, cranial CT and MRT, and bacteriological study of conjunctival smears. Results. Modern methods of ophthalmological examination of ICU patients provided correct diagnosis and prediction of wound healing. Eye injury treatment schedule provided maximum possible results in all ICU patients. Hospitalacquired infection results in asymptomatic dissemination of pathogenic microbes on ocular surface. Conclusions. 14-day topical treatment with antimicrobials, steroids, and NSAIDs reduces posttraumatic inflammation caused by mechanical eye injuries in ICU patients. Bacteriological studies of conjunctival smears demonstrate the presence of pathogenic flora in ICU patients. In these patients, the most effective antibacterial agents are third-generation fluoroquinolones. 

  13. [Nurses' knowledge about Nursing Care Systematization: from theory to practice].

    Science.gov (United States)

    Silva, Elisama Gomes Correia; de Oliveira, Viviane Carla; Neves, Giselda Bezerra Correia; Guimarães, Tânia Maria Rocha

    2011-12-01

    The objective of this study is to analyze the knowledge that nurses from a large hospital in Recife, Pernambuco, have about Nursing Care Systematization (NCS). This is a descriptive, exploratory, quantitative study. The study population consisted of 107 clinical nurses, with a sample of 73 (68%). Data collection was performed in June 2008, using a semi-structured questionnaire that was filled out by the subjects. We found that 50 (69%) nurses had no knowledge about NCS, especially about nursing diagnoses. We identified the absence of forms in most hospitalization units. The nurses gave several justifications for their not working with NCS, including work overload and the scarcity of forms. We concluded that there is a need for more incentives by the institution and through policies, so as to permit nurses a greater autonomy in their practice.

  14. Nurses’ Patient-Centeredness and Perceptions of Care among Medicaid Patients in Hospital Obstetrical Units

    Directory of Open Access Journals (Sweden)

    Stephen J. Aragon

    2013-01-01

    Full Text Available Objective. This study examined to what degree patient-centeredness—measured as an underlying ability of obstetrical nurses—influenced Medicaid patients’ satisfaction with care in hospital obstetrical units. Design. Multigroup structural equation modeling design, using three cross-sectional random samples (n=300 each from the 2003 Press Ganey National Inpatient Database. Setting. Self-administered mail surveys. Participants. 900 Medicaid recipients recently discharged from inpatient hospital obstetrical units across the United States. Methods. Multigroup structural equation modeling was used to test the goodness of fit between a hypothesized model based on the Primary Provider Theory and patients’ ratings of nurses. Results. The model fitted the data well, was stable across three random samples, and was sustained when compared to a competing model. The patient-centeredness of nurses significantly influenced overall patient satisfaction and explained 66% of its variability. When nurses’ patient-centeredness increased by one standard deviation, patients’ satisfaction increased by 0.80 standard deviation. Conclusion. This study offers a novel approach to the measurement of the patient-centeredness of nurses and a paradigm for increasing it and its influence on Medicaid patients’ satisfaction in hospital obstetrical units.

  15. Nurses' Patient-Centeredness and Perceptions of Care among Medicaid Patients in Hospital Obstetrical Units.

    Science.gov (United States)

    Aragon, Stephen J; Richardson, Liana J; Lawrence, Wanda; Gesell, Sabina B

    2013-01-01

    Objective. This study examined to what degree patient-centeredness-measured as an underlying ability of obstetrical nurses-influenced Medicaid patients' satisfaction with care in hospital obstetrical units. Design. Multigroup structural equation modeling design, using three cross-sectional random samples (n = 300 each) from the 2003 Press Ganey National Inpatient Database. Setting. Self-administered mail surveys. Participants. 900 Medicaid recipients recently discharged from inpatient hospital obstetrical units across the United States. Methods. Multigroup structural equation modeling was used to test the goodness of fit between a hypothesized model based on the Primary Provider Theory and patients' ratings of nurses. Results. The model fitted the data well, was stable across three random samples, and was sustained when compared to a competing model. The patient-centeredness of nurses significantly influenced overall patient satisfaction and explained 66% of its variability. When nurses' patient-centeredness increased by one standard deviation, patients' satisfaction increased by 0.80 standard deviation. Conclusion. This study offers a novel approach to the measurement of the patient-centeredness of nurses and a paradigm for increasing it and its influence on Medicaid patients' satisfaction in hospital obstetrical units.

  16. Challenges of Rural Cancer Care in the United States.

    Science.gov (United States)

    Charlton, Mary; Schlichting, Jennifer; Chioreso, Catherine; Ward, Marcia; Vikas, Praveen

    2015-09-01

    Rural cancer patients face many challenges in receiving care, including limited availability of cancer treatments and cancer support providers (oncologists, social workers, mental healthcare providers, palliative care specialists, etc), transportation barriers, financial issues, and limited access to clinical trials. Oncologists and other cancer care providers experience parallel challenges in delivering care to their rural cancer patients. Although no one approach fully addresses the many challenges of rural cancer care, a number of promising strategies and interventions have been developed that transcend the issues associated with long travel distances. These include outreach clinics, virtual tumor boards, teleoncology and other telemedicine applications, workforce recruitment and retention initiatives, and provider and patient education programs. Given the projected increase in demand for cancer care due to the aging population and increasing number of Americans with health insurance through the Affordable Care Act, expansion of these efforts and development of new approaches are critical to ensure access to high-quality care. PMID:26384798

  17. Chicken pox outbreak in the Intensive Care Unit of a tertiary care hospital: Lessons learnt the hard way

    OpenAIRE

    Sarit Sharma; Shruti Sharma; Deepinder Chhina; Chhina, R. S.

    2015-01-01

    Varicella-zoster virus (VZV) causes 2 clinically and epidemiologically distinct forms of diseases. Chickenpox (varicella) is the disease that results from primary infection with the VZV. Herpes zoster (HZ) results from the reactivation of VZV latently infecting the dorsal root ganglia. We are reporting an outbreak of varicella infection among the health care workers (HCWs) in the Intensive Care Unit (ICU) of a tertiary care hospital. We found transmission of varicella among eight HCWs of pulm...

  18. Healthcare associated infections in Paediatric Intensive Care Unit of a tertiary care hospital in India: Hospital stay & extra costs

    OpenAIRE

    Jitender Sodhi; Sidhartha Satpathy; D K Sharma; Rakesh Lodha; Arti Kapil; Nitya Wadhwa; Shakti Kumar Gupta

    2016-01-01

    Background & objectives: Healthcare associated infections (HAIs) increase the length of stay in the hospital and consequently costs as reported from studies done in developed countries. The current study was undertaken to evaluate the impact of HAIs on length of stay and costs of health care in children admitted to Paediatric Intensive Care Unit (PICU) of a tertiary care hospital in north India.Methods: This prospective study was done in the seven bedded PICU of a large multi-specialty tertia...

  19. Healthcare associated infections in Paediatric Intensive Care Unit of a tertiary care hospital in India: Hospital stay & extra costs

    OpenAIRE

    Sodhi, Jitender; Satpathy, Sidhartha; D K Sharma; Lodha, Rakesh; Kapil, Arti; Wadhwa, Nitya; Gupta, Shakti Kumar

    2016-01-01

    Background & objectives: Healthcare associated infections (HAIs) increase the length of stay in the hospital and consequently costs as reported from studies done in developed countries. The current study was undertaken to evaluate the impact of HAIs on length of stay and costs of health care in children admitted to Paediatric Intensive Care Unit (PICU) of a tertiary care hospital in north India. Methods: This prospective study was done in the seven bedded PICU of a large multi-specialty terti...

  20. Closed-loop control for cardiopulmonary management and intensive care unit sedation using digital imaging

    Science.gov (United States)

    Gholami, Behnood

    This dissertation introduces a new problem in the delivery of healthcare, which could result in lower cost and a higher quality of medical care as compared to the current healthcare practice. In particular, a framework is developed for sedation and cardiopulmonary management for patients in the intensive care unit. A method is introduced to automatically detect pain and agitation in nonverbal patients, specifically in sedated patients in the intensive care unit, using their facial expressions. Furthermore, deterministic as well as probabilistic expert systems are developed to suggest the appropriate drug dose based on patient sedation level. Patients in the intensive care unit who require mechanical ventilation due to acute respiratory failure also frequently require the administration of sedative agents. The need for sedation arises both from patient anxiety due to the loss of personal control and the unfamiliar and intrusive environment of the intensive care unit, and also due to pain or other variants of noxious stimuli. In this dissertation, we develop a rule-based expert system for cardiopulmonary management and intensive care unit sedation. Furthermore, we use probability theory to quantify uncertainty and to extend the proposed rule-based expert system to deal with more realistic situations. Pain assessment in patients who are unable to verbally communicate is a challenging problem. The fundamental limitations in pain assessment stem from subjective assessment criteria, rather than quantifiable, measurable data. The relevance vector machine (RVM) classification technique is a Bayesian extension of the support vector machine (SVM) algorithm which achieves comparable performance to SVM while providing posterior probabilities for class memberships and a sparser model. In this dissertation, we use the RVM classification technique to distinguish pain from non-pain as well as assess pain intensity levels. We also correlate our results with the pain intensity

  1. Volume of activity and occupancy rate in intensive care units. Association with mortality

    NARCIS (Netherlands)

    Iapichino, G; Gattinoni, L; Radrizzani, D; Simini, B; Bertolini, G; Ferla, L; Mistraletti, G; Porta, F; Miranda, DR

    2004-01-01

    Objective. Mortality after many procedures is lower in centers where more procedures are done. It is controversial whether this is true for intensive care units, too. We examined the relationship between the volume of activity of intensive care units (ICUs) and mortality by a measure of risk-adjuste

  2. Intensive care unit-acquired weakness: early diagnosis, symptomatology and prognosis

    NARCIS (Netherlands)

    L. Wieske

    2014-01-01

    During admission to an intensive care unit (ICU), many critically ill patients develop generalized muscle weakness, a condition called intensive care unit-acquired weakness (ICU-AW). ICU-AW can be caused by muscle problems, peripheral nerve problems or a combination of both. As the name of the condi

  3. Hypophosphatemia on the intensive care unit: individualized phosphate replacement based on serum levels and distribution volume.

    NARCIS (Netherlands)

    Bech, A.; Blans, M.; Raaijmakers, M.; Mulkens, C.; Telting, D.; Boer, H. de

    2013-01-01

    BACKGROUND: Hypophosphatemia occurs in about 25% of patients admitted to the intensive care unit. To date, a safe and validated phosphate replacement protocol is not available. OBJECTIVE: To evaluate an individualized phosphate replacement regimen. DESIGN: Fifty consecutive intensive care unit patie

  4. [Choice of Expiration for Cancer Patients under Home Medical Care - Palliative Care Unit or Home].

    Science.gov (United States)

    Okino, Takashi; Okagaki, Tetsuya; Nakamura, Hiromi; Okino, Akie

    2015-12-01

    Kohka Public Hospital(KPH)was rebuilt at a new place in April 2013. The Palliative Care Unit(PCU)was newly constructed during renovation. We examined the will and outcome of cancer patients, especially on expiration. A 123 patients died in 2014: 27 died at the PCU, and the remaining 7 at home. Of 27 patients, 20 were willing to die at the PCU, and one patient visited the hospital after judgment by the Visiting Nurse Center. Other 6 patients were admitted finally after their families experienced fatigue. Six of seven patients who died at home, showed a strong will to stay at home. We think that patients' will drives the clinical course, especially in their end-stage. In this context, the majority of the patients decided their terminal place based on their will. On the contrary, there were several cases whose requests were not fulfilled. To overcome the problem, we should discuss cancer patients' will to make a choice regarding death at the end-stage of their lives and the place of expiration in advance. We including the staff of social care and regional medical resources, should co-operate and share information on these patients to solve the problems. PMID:26809413

  5. Pneumothoraces in a Neonatal Tertiary Care Unit: Case Series

    Directory of Open Access Journals (Sweden)

    Rehan Ali

    2013-01-01

    Full Text Available Objective: Neonatal pneumothoraces are associated with high mortality. Prompt recognition to minimize its complications is paramount for ultimate outcome of these babies.Methods: A retrospective case series study was carried out at Aga khan University Hospital, from January 2010 to December 2010 to determine the etiology and outcome of neonates with pneumothorax in a neonatal tertiary care unit.Results: Ten neonates diagnosed radiologically with pneumothoraces were included. M: F ratio was 1:2.3. Birth weight ranged from 1750-3600 grams with a mean of 2100 grams. The occurrence of pneumothoraces was 50% on the left side, 20% on right, and 30% were bilateral. Primary etiology included pneumonia and sepsis (30%, hyaline membrane disease (20%, meconium aspiration syndrome (20% and congenital diaphragmatic hernia (10%. Spontaneous pneumothoraces were present in 20% of cases. In our study, the incidence of neonatal pneumothoraces was 2.5/1000 births compared to 10-15/1000 in Denmark, 10-20/1000 in Turkey and 6.3/1000 from Vermont Oxford Group. Despite the small number of cases, one incidental finding was the occurrence of pneumothorax, which declined in elective cesarean section after 37 weeks gestation i.e., 1.3 of 1000 births. Mortality was 60% determined mainly by the primary etiology and other co-morbid conditions.Conclusion: The study showed a higher number of mortality cases (60%. Although, it was difficult to draw a conclusion from the limited number of cases, there may be a benefit on neonatal respiratory outcome to be obtained by better selection of mothers and by waiting until 37 weeks before performing elective cesarean section. Adequate clinician training in soft ventilation strategies will reduce the occurrence of pneumothoraces.

  6. Fatigue in Family Caregivers of Adult Intensive Care Unit Survivors

    Science.gov (United States)

    Choi, JiYeon; Tate, Judith A.; Hoffman, Leslie A.; Schulz, Richard; Ren, Dianxu; Donahoe, Michael P.; Given, Barbara A.; Sherwood, Paula R.

    2014-01-01

    Context Family caregivers are a vital resource in the recovery of intensive care unit (ICU) survivors. Of concern, the stress associated with this role can negatively affect caregiver health. Fatigue, an important health indicator, has been identified as a predictor of various illnesses, greater use of health services, and early mortality. Examining the impact of fatigue on caregivers’ physical health can assist in identifying critical time points and potential targets for intervention. Objectives To describe self-reported fatigue in caregivers of ICU survivors from patients’ ICU admission to ≤ two weeks, two- and four-months post-ICU discharge. Methods Patient-caregiver pairs were enrolled from a medical ICU. Caregiver fatigue was measured using the Short-Form-36 Health Survey Vitality subscale (SF-36 Vitality). Caregiver psychobehavioral stress responses included depressive symptoms, burden, health risk behaviors, and sleep quality. Patient data included self-reported physical symptoms and disposition (home vs. institution). Results Forty seven patient-caregiver pairs were initially enrolled. Clinically significant fatigue (SF-36 Vitality ≤ 45) was reported by 43% to 53% of caregivers across the time points and these caregivers reported worse scores in measures of depressive symptoms, burden, health risk behaviors and sleep quality, and patients’ symptom burden. In 26 caregivers with data for all time points (55% of the total sample), SF-36 Vitality scores showed trends of improvement when the patient returned home and greater impairment when institutionalization continued. Conclusion In caregivers of ICU survivors, fatigue is common and potentially linked with poor psychobehavioral responses. Worsening fatigue was associated with greater symptom distress and long-term patient institutionalization. PMID:24439845

  7. Physiotherapy practices in Intensive Care Units across Maharashtra

    Directory of Open Access Journals (Sweden)

    Ujwal Lakshman Yeole

    2015-01-01

    Full Text Available Purpose: To find out the current physiotherapy practices in Intensive Care Unit (ICU across Maharashtra. Materials and Methods: Study design was exploratory cross-sectional survey. Questionnaires were sent to the physiotherapists working in hospitals across Maharashtra state, India. Four weeks for completion of questionnaire was given in an attempt to ensure good response rates. Result: Of 200, 73 questionnaires were received representing a 36% response rate. The study revealed that 76% of the respondents were bachelors qualified, 15% were masters in physiotherapy with only 4% specialized in cardio-respiratory physiotherapy; 82% had <5 years experience in ICU. Almost 19% had not at all attended any seminars/workshops related to ICU management while 61% attended up to three within last 2 years. The availability of a physiotherapist during the night was affirmed by 63%, 58% responded initiation of physiotherapy to be "always physician referred" and 39% mentioned "physiotherapist initiated." Almost 80% performed chest wall techniques, 86% positioning, 27% postural drainage, 5% manual hyperinflation, 12% application of nebulizer, and 56% bedsores management. Only 5% reported involvement in ventilator setting, 11% had their opinion sought before weaning from ventilator, 29% practiced noninvasive ventilation, 11% were involved in decision-making for extubation and 44% reported involvement in patient family education. Conclusion: The study showed that physiotherapists among the responding ICUs surveyed lack in experience and updated knowledge. Physician reference is necessary to initiate physiotherapy and there exists no established criteria for physiotherapy treatment in ICU. All physiotherapists were routinely involved in chest physiotherapy, mobilization, and positioning.

  8. Is fumigation enough for air conditioning units in operation theatres and Intensive care units?

    Directory of Open Access Journals (Sweden)

    Anasua Deb

    2016-05-01

    Full Text Available Background: Strict asepsis is necessary in operating theatres (OT and intensive care units (ICU as the patients undergo invasive procedures. The filters of contaminated air conditioning (AC units provide a niche for proliferation of fungi and production of fungal spores. Methods: The routine procedure for maintenance of sterile atmosphere in our hospital, i.e. fumigation and mopping walls with disinfectants often fail to address these fungal spores of the AC filters. We therefore carried out a surveillance of the ACs in ICUs and OTs to find the level of contamination with fungal spores and also to improvise on intervention strategies to tackle the problem. Over 3 months period, 34 ACs from 7 OTs and 2 ICUs were screened by taking 2 swabs from each AC which were then tested for the presence of fungal spores as per standard methods. Results: The contamination rate was 88.2% before fumigation and 76.9% after fumigation. The fungal spore contamination rate was reduced to 20% (1 out of 5 ACs after servicing of the ACs was done. Aspergillus spp. was the most common fungal isolate. Conclusion: Based on the observations, we recommend regular servicing of the ACs as well as wet mopping of the ducts with sporicidal solution at regular intervals. [Int J Res Med Sci 2016; 4(5.000: 1583-1589

  9. Applying Lean Six Sigma for innovative change to the post-anesthesia care unit.

    Science.gov (United States)

    Haenke, Roger; Stichler, Jaynelle F

    2015-04-01

    Many healthcare organizations are building or renovating patient care facilities. Using Lean Six Sigma methods, nurse leaders can eliminate unnecessary waste and improve work and patient care environments. Starting with a key department like the post-anesthesia care unit is a good way to expose staff and leaders to the potential of Lean.

  10. The Eldicus prospective, observational study of triage decision making in European intensive care units. Part II: Intensive care benefit for the elderly

    DEFF Research Database (Denmark)

    Sprung, Charles L; Artigas, Antonio; Kesecioglu, Jozef;

    2012-01-01

    for intensive care unit admission. INTERVENTIONS:: Admission or rejection to intensive care unit. MEASUREMENTS AND MAIN RESULTS:: Demographic, clinical, hospital, physiologic variables, and 28-day mortality were obtained on consecutive patients. There were 8,472 triages in 6,796 patients, 5,602 (82%) were......RATIONALE:: Life and death triage decisions are made daily by intensive care unit physicians. Admission to an intensive care unit is denied when intensive care unit resources are constrained, especially for the elderly. OBJECTIVE:: To determine the effect of intensive care unit triage decisions...... on mortality and intensive care unit benefit, specifically for elderly patients. DESIGN:: Prospective, observational study of triage decisions from September 2003 until March 2005. SETTING:: Eleven intensive care units in seven European countries. PATIENTS:: All patients >18 yrs with an explicit request...

  11. Nurses' experiences of caring for critically ill, non-sedated, mechanically ventilated patients in the Intensive Care Unit

    DEFF Research Database (Denmark)

    Laerkner, Eva; Egerod, Ingrid; Hansen, Helle Ploug

    2015-01-01

    closeness. CONCLUSION: Despite the complexity of care, nurses preferred to care for more awake rather than sedated patients and appreciated caring for just one patient at a time. The importance of close collaboration between nurses and doctors to ensure patient comfort during mechanical ventilation......OBJECTIVE: The objective was to explore nurses' experiences of caring for non-sedated, critically ill patients requiring mechanical ventilation. DESIGN AND SETTING: The study had a qualitative explorative design and was based on 13 months of fieldwork in two intensive care units in Denmark where...... intubated patients included unpredictability, ambiguous needs and complex actions, while the rewarding aspects included personal interaction. Three sub-themes were identified: (i) caring for and with the patient, (ii) negotiating relational and instrumental care and (iii) managing physical and emotional...

  12. Scarcity in the intensive care unit: principles of justice for rationing ICU beds.

    Science.gov (United States)

    Swenson, M D

    1992-05-01

    Difficult dilemmas arise when resources become scarce in intensive care units (ICUs). When there are fewer beds available than patients who need them, how are those beds to be distributed? In this report, I discuss such rationing dilemmas from the context of John Rawls' theory of justice. Principles of justice can be chosen by clinicians and used to set priorities in the distribution of scarce ICU beds. These principles consist of a ranking of patients based on available prognostic data. Such a ranking would be the most fair way of distributing scarce ICU beds within a Rawlsian conception of justice. It is a ranking that would be chosen by the patients themselves, were they able to consider the matter from a rational and impartial perspective.

  13. Implementing New Practices: An Empirical Study of Organizational Learning in Hospital Intensive Care Units

    OpenAIRE

    Tucker, Anita L; Nembhard, Ingrid M.; Amy C. Edmondson

    2007-01-01

    This paper contributes to research on organizational learning by investigating specific learning activities undertaken by improvement project teams in hospital intensive care units and proposing an integrative model to explain implementation success. Organizational learning is important in this context because medical knowledge changes constantly and hospital care units must learn new practices if they are to provide high-quality care. To develop a model of factors affecting improvement proje...

  14. Filipino Child Health in the United States: Do Health and Health Care Disparities Exist?

    OpenAIRE

    Javier, Joyce R.; Huffman, Lynne C; Mendoza, Fernando S

    2007-01-01

    Introduction Filipinos are the second largest Asian subgroup in the United States, but few studies have examined health and health care disparities in Filipino children. The objectives of this review are 1) to appraise current knowledge of Filipino children's health and health care and 2) to present the implications of these findings for research, clinical care, and policy. Methods We identified articles for review primarily via a Medline search emphasizing the terms Filipino and United State...

  15. Psychosocial factors and prevalence of burnout syndrome among nursing workers in intensive care units

    OpenAIRE

    da Silva, Jorge Luiz Lima; Soares, Rafael da Silva; Costa, Felipe dos Santos; Ramos, Danusa de Souza; Lima, Fabiano Bittencourt; Teixeira, Liliane Reis

    2015-01-01

    Objective To evaluate the prevalence of burnout syndrome among nursing workers in intensive care units and establish associations with psychosocial factors. Methods This descriptive study evaluated 130 professionals, including nurses, nursing technicians, and nursing assistants, who performed their activities in intensive care and coronary care units in 2 large hospitals in the city of Rio de Janeiro, Brazil. Data were collected in 2011 using a self-reported questionnaire. The Maslach Burnout...

  16. End-of-life care in the United States: policy issues and model programs of integrated care

    Directory of Open Access Journals (Sweden)

    Joshua M. Wiener

    2003-05-01

    Full Text Available Background: End-of-life care financing and delivery in the United States is fragmented and uncoordinated, with little integration of acute and long-term care services. Objective: To assess policy issues involving end-of-life care, especially involving the hospice benefit, and to analyse model programs of integrated care for people who are dying. Methods: The study conducted structured interviews with stakeholders and experts in end-of-life care and with administrators of model programs in the United States, which were nominated by the experts. Results: The two major public insurance programs—Medicare and Medicaid—finance the vast majority of end-of-life care. Both programs offer a hospice benefit, which has several shortcomings, including requiring physicians to make a prognosis of a six month life expectancy and insisting that patients give up curative treatment—two steps which are difficult for doctors and patients to make—and payment levels that may be too low. In addition, quality of care initiatives for nursing homes and hospice sometimes conflict. Four innovative health systems have overcome these barriers to provide palliative services to beneficiaries in their last year of life. Three of these health systems are managed care plans which receive capitated payments. These providers integrate health, long-term and palliative care using an interdisciplinary team approach to management of services. The fourth provider is a hospice that provides palliative services to beneficiaries of all ages, including those who have not elected hospice care. Conclusions: End-of-life care is deficient in the United States. Public payers could use their market power to improve care through a number of strategies.

  17. Musculoskeletal problems in intensive care unit patients post discharge

    OpenAIRE

    Devine, H.; MacTavish, P.; Quasim, T.; Kinsella, J; McPeake, J.; Daniel, M

    2016-01-01

    Introduction: The aim of this study was to examine the incidence of musculoskeletal problems (i.e. pain, weakness, decreased joint range of movement) in critical care patients post discharge. Post intensive care syndrome (PICS) is now a widely used term to describe the collection of problems patients develop due to their stay in intensive care. ICU survivors have been found to have a high risk of developing not only psychological problems but physical problems such as Int...

  18. Application of Jean Piaget's theory of human development for nursing children in an adult intensive therapy unit.

    Science.gov (United States)

    Green, A

    1991-12-01

    Piaget (1964) believed that interaction with the environment has a large part to play in human development. Matthew (1986) states that in an ideal world critically ill children should be cared for by staff trained in paediatrics, within designated paediatric intensive therapy units. Unfortunately, there are only 28 paediatric intensive therapy units in Great Britain (CMA Medical Data, 1987), consequently each year a third of children requiring intensive care are admitted to adult intensive therapy units (ITU). A knowledge and understanding of developmental psychology can therefore be beneficial to nurses in assessing which stage of development a child has reached, in order to plan the correct level of stimulation, and hence facilitate progress rather than regression in the accomplishment of developmental tasks. The psychological and social processes involved in Jean Piaget's (1896-1980) theory of human development are discussed with regard to nursing children requiring intubation and ventilation in an adult ITU. PMID:1765639

  19. Arterial pulmonary hypertension in noncardiac intensive care unit

    OpenAIRE

    Tsapenko, Mykola

    2008-01-01

    Mykola V Tsapenko1,5, Arseniy V Tsapenko2, Thomas BO Comfere3,5, Girish K Mour1,5, Sunil V Mankad4, Ognjen Gajic1,51Division of Pulmonary and Critical Care Medicine; 3Division of Critical Care Medicine; 4Division of Cardiovascular Diseases, Mayo Epidemiology and Translational Research in Intensive Care (M.E.T.R.I.C), Mayo Clinic, Rochester, MN, USA; 2Division of Pulmonary and Critical Care Medicine, Brown University, Miriam Hospital, Providence, RI, USAAbstract: Pulmonary artery pressure elev...

  20. PATIENT DATA MANAGEMENT SYSTEM IN INTENSIVE CARE UNIT (ICU) USING LABVIEW

    OpenAIRE

    Amritjot Kaur*, Shimi S. L

    2016-01-01

    This paper proposes a new system that takes the benefits of data flow technology. Its objective is to collect the data from monitoring system in the intensive care unit (ICU) and store that data for further analysis. Then it will be available for medical personnel to analyze data and take the suitable medication for patients. In fact, the monitoring system in intensive care unit provides a large amount of data quickly and continuously. Most units operate with a very limited storage capacity w...

  1. Evaluation of functional independence after discharge from the intensive care unit

    OpenAIRE

    Curzel, Juliane; Forgiarini Junior, Luiz Alberto; Rieder, Marcelo de Mello

    2013-01-01

    Objective 1) To evaluate the functional independence measures immediately after discharge from an intensive care unit and to compare these values with the FIMs 30 days after that period. 2) To evaluate the possible associated risk factors. Methods The present investigation was a prospective cohort study that included individuals who were discharged from the intensive care unit and underwent physiotherapy in the unit. Functional independence was evaluated using the functional independence meas...

  2. Introduction of a team-based care model in a general medical unit

    OpenAIRE

    Hastings, Stephanie E.; Suter, Esther; Bloom, Judy; Sharma, Krishna

    2016-01-01

    Background Alberta Health Services is a provincial health authority responsible for healthcare for more than four million people. The organization recognized a need to change its care delivery model to make care more patient- and family-centred and use its health human resources more effectively by enhancing collaborative practice. A new care model including changes to how providers deliver care and skill mix changes to support the new processes was piloted on a medical unit in a large urban ...

  3. Integrating palliative care within acute stroke services: developing a programme theory of patient and family needs, preferences and staff perspectives

    Directory of Open Access Journals (Sweden)

    Burton Christopher R

    2012-11-01

    Full Text Available Abstract Background Palliative care should be integrated early into the care trajectories of people with life threatening illness such as stroke. However published guidance focuses primarily on the end of life, and there is a gap in the evidence about how the palliative care needs of acute stroke patients and families should be addressed. Synthesising data across a programme of related studies, this paper presents an explanatory framework for the integration of palliative and acute stroke care. Methods Data from a survey (n=191 of patient-reported palliative care needs and interviews (n=53 exploring experiences with patients and family members were explored in group interviews with 29 staff from 3 United Kingdom stroke services. A realist approach to theory building was used, constructed around the mechanisms that characterise integration, their impacts, and mediating, contextual influences. Results The framework includes two cognitive mechanisms (the legitimacy of palliative care and individual capacity, and behavioural mechanisms (engaging with family; the timing of intervention; working with complexity; and the recognition of dying through which staff integrate palliative and stroke care. A range of clinical (whether patients are being ‘actively treated’, and prognostic uncertainty and service (leadership, specialty status and neurological focus factors appear to influence how palliative care needs are attended to. Conclusions Our framework is the first, empirical explanation of the integration of palliative and acute stroke care. The specification in the framework of factors that mediate integration can inform service development to improve the outcomes and experiences of patients and families.

  4. Linkage in the chain of care: a grounded theory of professional cooperation between antenatal care, postpartum care and child health care

    Directory of Open Access Journals (Sweden)

    Mia Barimani

    2008-12-01

    Full Text Available Purpose: The purpose of this article is to present a Swedish study exploring health care professionals’ cooperation in the chain of care for expectant and new parents between antenatal care (AC, postpartum care (PC and child health care (CHC. Furthermore, the rationale was to conceptualise barriers and facilitators of cooperation in order to generate a comprehensive theoretical model which may explain variations in the care providers’ experiences. Methods: Thirty-two midwives and CHC nurses were interviewed in five focus group – and two individual interviews in a suburb of a large Swedish city. Grounded Theory was applied as the research methodology. Results: One core category was discerned: linkage in the chain of care, including six categories with subcategories. Despite the fact that midwives as well as CHC nurses have common visions about linkage, cooperation is not achieved because of interacting barriers that have different influences on the three links in the chain. Conclusions: Barriers to linkage are lack of professional gain, link perspective and first or middle position in the chain, while facilitators are chain perspective, professional gain and last position in the chain. As the last link, CHC nurses promote a linkage most strongly and have the greatest gain from such linking.

  5. Attachment theory and spirituality: two threads converging in palliative care?

    Science.gov (United States)

    Loetz, Cécile; Müller, Jakob; Frick, Eckhard; Petersen, Yvonne; Hvidt, Niels Christian; Mauer, Christine

    2013-01-01

    The aim of this paper is to discuss and explore the interrelation between two concepts, attachment theory and the concept of spirituality, which are important to palliative care and to founding a multivariate understanding of the patient's needs and challenges. Both concepts have been treated by research in diverse and multiform ways, but little effort has yet been made to integrate them into one theoretical framework in reference to the palliative context. In this paper, we begin an attempt to close this scientific gap theoretically. Following the lines of thought in this paper, we assume that spirituality can be conceptualized as an adequate response of a person's attachment pattern to the peculiarity of the palliative situation. Spirituality can be seen both as a recourse to securely based relationships and as an attempt to explore the ultimate unknown, the mystery of one's own death. Thus, spirituality in the palliative context corresponds to the task of attachment behavior: to transcend symbiosis while continuing bonds and thus to explore the unknown environment independently and without fear. Spiritual activity is interpreted as a human attachment behavior option that receives special quality and importance in the terminal stage of life. Implications for clinical practice and research are discussed in the final section of the paper.

  6. Attachment Theory and Spirituality: Two Threads Converging in Palliative Care?

    Directory of Open Access Journals (Sweden)

    Cécile Loetz

    2013-01-01

    Full Text Available The aim of this paper is to discuss and explore the interrelation between two concepts, attachment theory and the concept of spirituality, which are important to palliative care and to founding a multivariate understanding of the patient’s needs and challenges. Both concepts have been treated by research in diverse and multiform ways, but little effort has yet been made to integrate them into one theoretical framework in reference to the palliative context. In this paper, we begin an attempt to close this scientific gap theoretically. Following the lines of thought in this paper, we assume that spirituality can be conceptualized as an adequate response of a person’s attachment pattern to the peculiarity of the palliative situation. Spirituality can be seen both as a recourse to securely based relationships and as an attempt to explore the ultimate unknown, the mystery of one’s own death. Thus, spirituality in the palliative context corresponds to the task of attachment behavior: to transcend symbiosis while continuing bonds and thus to explore the unknown environment independently and without fear. Spiritual activity is interpreted as a human attachment behavior option that receives special quality and importance in the terminal stage of life. Implications for clinical practice and research are discussed in the final section of the paper.

  7. Post-traumatic pulmonary embolism in the intensive care unit

    Directory of Open Access Journals (Sweden)

    Mabrouk Bahloul

    2011-01-01

    Full Text Available Objective: To determine the predictive factors, clinical manifestations, and the outcome of patients with post-traumatic pulmonary embolism (PE admitted in the intensive care unit (ICU. Methods: During a four-year prospective study, a medical committee of six ICU physicians prospectively examined all available data for each trauma patient in order to classify patients according to the level of clinical suspicion of pulmonary thromboembolism. During the study period, all trauma patients admitted to our ICU were classified into two groups. The first group included all patients with confirmed PE; the second group included patients without clinical manifestations of PE. The diagnosis of PE was confirmed either by a high-probability ventilation/perfusion (V/Q scan or by a spiral computed tomography (CT scan showing one or more filling defects in the pulmonary artery or its branches. Results: During the study period, 1067 trauma patients were admitted in our ICU. The diagnosis of PE was confirmed in 34 patients (3.2%. The mean delay of development of PE was 11.3 ± 9.3 days. Eight patients (24% developed this complication within five days of ICU admission. On the day of PE diagnosis, the clinical examination showed that 13 patients (38.2% were hypotensive, 23 (67.7% had systemic inflammatory response syndrome (SIRS, three (8.8% had clinical manifestations of deep venous thrombosis (DVT, and 32 (94% had respiratory distress requiring mechanical ventilation. In our study, intravenous unfractionated heparin was used in 32 cases (94% and low molecular weight heparin was used in two cases (4%. The mean ICU stay was 31.6 ± 35.7 days and the mean hospital stay was 32.7 ± 35.3 days. The mortality rate in the ICU was 38.2% and the in-hospital mortality rate was 41%. The multivariate analysis showed that factors associated with poor prognosis in the ICU were the presence of circulatory failure (Shock (Odds ratio (OR = 9.96 and thrombocytopenia (OR = 32

  8. Circumstances surrounding dying in the paediatric intensive care unit

    Directory of Open Access Journals (Sweden)

    Plötz Frans B

    2006-08-01

    Full Text Available Abstract Background Death is inevitable in the paediatric intensive care unit (PICU. We aimed to describe the circumstances surrounding dying in a PICU. Method The chart records of all patients less than 18 years of age who died at the PICU between January first 2000 and July first 2005 were retrospectively analyzed. Information regarding sex, age, length of stay, admission, diagnosis, and the way a patient died was registered. Post mortem information regarding natural versus unnatural death, autopsy and donation was obtained. Non-survivors were allocated in five groups: do-not-resuscitate (DNR, withholding and/or withdrawal of therapy (W/W, failed cardiopulmonary resuscitation (failed CPR, brain death (BD, and terminal organ failure (TOF. Results During the study period 87 (4.4% of the 1995 admitted patients died. Non-survivors were more often admitted during the day (54% and the week (68%. W/W was found in 27.6%, TOF in 26.4%, BD in 23.0%, failed CPR in 18.4%, and DNR in 4.6%. Forty-three percent died in the first two days, of which BD (40.5% and failed CPR (37.8% were most common. Seventy-five children (86% died due to a natural cause. Autopsy permission was obtained in 19 of 54 patients (35%. The autopsies confirmed the clinical diagnosis in 11 patients, revealed new information in 5 patients, and in 3 patients the autopsy did not provide additional information. Nine patients were medically suitable for organ donation and 24 patients for tissue donation, whereas consent was only obtained in 2 cases in both groups. Conclusion We observed that 43% of the patients died within the first two days of admission due to BD and failed CPR, whereas after 4 days most patients died after W/W. Autopsy remains an useful tool to confirm clinical diagnoses or to provide new information. Only a small percentage of the deceased children is suitable for organ donation.

  9. What Does Change with Nutrition Team in Intensive Care Unit?

    Directory of Open Access Journals (Sweden)

    Ahmet Fatih Yılmaz

    2016-08-01

    Full Text Available Intrroduction: Clinical nutrition is the nutrition support therapy provided to patients under medical supervision at the hospital or home setting. It is a multidisciplinary task performed under the control of the physician, dietician, pharmacist and nurse. In this study, the changes in the patient admission statistics to the general intensive care unit (GICU, the exitus ratios, decubitus ulcer formation rates, albumin use rates, duration of the hospital stay, Acute Physiology and Chronic Health Evaluation (APACHE II scores, rate of usege of parenteral and enteral products, and the change in expenses per patient within the first year of activity of the nutrition team in comparison to the previous year was presented. Material and Method: In this study a 6-bed GICU was used. The patients who was admitted through retrospective file scanning between 1 January 2012 and 31 December 2012 and between 1 January 2013 and 31 December 2013 were compared. Results: The number of the patients admitted to the GICU was 341 in 2012 and 369 in 2013. The number of the patients who died in 2012 was 86 (25.2%, while it was 106 in 2013 (28.7%. In 2012, 122 patients (35.7% had decubitus ulcers, while this number was 92 (24.7% in 2013. Human albumin usage was reduced by 23% for the 100 mL (225 in 2012, 175 in 2013 and by 33% for the 50 mL doses (122 in 2012, 82 in 2013. Duration of stay in the hospital was 6.3±0.9 vs. 5.8±0.9 (days (p=0.06. The mean APACHE II scores were observed to be 24.7±6.9 vs. 30.5±11.4 (p=0.03. When the distribution of product types were analyzed, it was observed that the ratio of parenteral products: enteral products was 2:1 in 2012, however the ratio of enteral products to parenteral products was 2:1 in 2013. The daily expense of a patient decreased from 100 TL to 55 TL. Conclusion: The nutrition team directly influences the clinical process outcomes of patients under treatment in the ICU. It was thought that using appropriate nutritional

  10. Quality of life after stay in surgical intensive care unit

    Directory of Open Access Journals (Sweden)

    Castro Maria A

    2007-07-01

    Full Text Available Abstract Background In addition to mortality, Health Related Quality of Life (HRQOL has increasingly been claimed as an important outcome variable. The aim of this study was to assess HRQOL and independence in activities of daily living (ADL six months after discharge from an Intensive Care Unit (ICU, and to study its determinants. Methods All post-operative adult patients admitted to a surgical ICU between October 2004 and July 2005, were eligible for the study. The following variables were recorded on admission: age, gender, American Society of Anesthesiologists physical status (ASA-PS, type and magnitude of surgical procedure, ICU and hospital length of stay (LOS, mortality and Simplified Acute Physiology Score II (SAPS II. Six months after discharge, a Short Form-36 questionnaire (SF-36 and a questionnaire to assess dependency in ADL were sent to all survivors. Descriptive statistics was used to summarize data. Patient groups were compared using non-parametric tests. A logistic regression analysis was performed to identify covariate effects of each variable on dependency in personal and instrumental ADL, and for the change-in-health question of SF-36. Results Out of 333 hospital survivors, 226 completed the questionnaires. Fifty-nine percent reported that their general level of health was better on the day they answered the questionnaire than 12 months earlier. Patients with greater co-morbidities (ASA-PS III/IV, had lower SF-36 scores in all domains and were more frequently dependent in instrumental and personal ADL. Logistic regression showed that SAPS II was associated with changes in general level of health (OR 1.06, 95%CI, 1.01 – 1.11, p = 0,016. Six months after ICU discharge, 60% and 34% of patients, respectively, were dependent in at least one activity in instrumental ADL (ADLI and personal ADL (ADLP. ASA-PS (OR 3.00, 95%CI 1.31 – 6.87, p = 0.009 and age (OR 2.36, 95%CI, 1.04 – 5.34, p = 0.04 were associated with dependency in

  11. Compassion fatigue, moral distress, and work engagement in surgical intensive care unit trauma nurses: a pilot study.

    Science.gov (United States)

    Mason, Virginia M; Leslie, Gail; Clark, Kathleen; Lyons, Pat; Walke, Erica; Butler, Christina; Griffin, Martha

    2014-01-01

    Preparation for replacing the large proportion of staff nurses reaching retirement age in the next few decades in the United States is essential to continue delivering high-quality nursing care and improving patient outcomes. Retaining experienced critical care nurses is imperative to successfully implementing the orientation of new inexperienced critical care nurses. It is important to understand factors that affect work engagement to develop strategies that enhance nurse retention and improve the quality of patient care. Nurses' experience of moral distress has been measured in medical intensive care units but not in surgical trauma care units, where nurses are exposed to patients and families faced with sudden life-threatening, life-changing patient consequences.This pilot study is a nonexperimental, descriptive, correlational design to examine the effect of compassion satisfaction, compassion fatigue, moral distress, and level of nursing education on critical care nurses' work engagement. This is a partial replication of Lawrence's dissertation. The study also asked nurses to describe sources of moral distress and self-care strategies for coping with stress. This was used to identify qualitative themes about the nurse experiences. Jean Watson's theory of human caring serves as a framework to bring meaning and focus to the nursing-patient caring relationship.A convenience sample of 26 of 34 eligible experienced surgical intensive care unit trauma nurses responded to this survey, indicating a 77% response rate. Twenty-seven percent of the nurses scored high, and 73% scored average on compassion satisfaction. On compassion fatigue, 58% scored average on burnout and 42% scored low. On the secondary traumatic stress subscale, 38% scored average, and 62% scored low. The mean moral distress situations subscale score was 3.4, which is elevated. The mean 9-item Utrecht Work Engagement Scale total score, measuring work engagement, was 3.8, which is considered low

  12. Dutch care innovation units in elderly care: A qualitative study into students' perspectives and workplace conditions for learning.

    Science.gov (United States)

    Snoeren, Miranda; Volbeda, Patricia; Niessen, Theo J H; Abma, Tineke A

    2016-03-01

    To promote workplace learning for staff as well as students, a partnership was formed between a residential care organisation for older people and several nursing faculties in the Netherlands. This partnership took the form of two care innovation units; wards where qualified staff, students and nurse teachers collaborate to integrate care, education, innovation and research. In this article, the care innovation units as learning environments are studied from a student perspective to deepen understandings concerning the conditions that facilitate learning. A secondary analysis of focus groups, held with 216 nursing students over a period of five years, revealed that students are satisfied about the units' learning potential, which is formed by various inter-related and self-reinforcing affordances: co-constructive learning and working, challenging situations and activities, being given responsibility and independence, and supportive and recognisable learning structures. Time constraints had a negative impact on the units' learning potential. It is concluded that the learning potential of the care innovation units was enhanced by realising certain conditions, like learning structures and activities. The learning potential was also influenced, however, by the non-controllable and dynamic interaction of various elements within the context. Suggestions for practice and further research are offered. PMID:26694313

  13. Dutch care innovation units in elderly care: A qualitative study into students' perspectives and workplace conditions for learning.

    Science.gov (United States)

    Snoeren, Miranda; Volbeda, Patricia; Niessen, Theo J H; Abma, Tineke A

    2016-03-01

    To promote workplace learning for staff as well as students, a partnership was formed between a residential care organisation for older people and several nursing faculties in the Netherlands. This partnership took the form of two care innovation units; wards where qualified staff, students and nurse teachers collaborate to integrate care, education, innovation and research. In this article, the care innovation units as learning environments are studied from a student perspective to deepen understandings concerning the conditions that facilitate learning. A secondary analysis of focus groups, held with 216 nursing students over a period of five years, revealed that students are satisfied about the units' learning potential, which is formed by various inter-related and self-reinforcing affordances: co-constructive learning and working, challenging situations and activities, being given responsibility and independence, and supportive and recognisable learning structures. Time constraints had a negative impact on the units' learning potential. It is concluded that the learning potential of the care innovation units was enhanced by realising certain conditions, like learning structures and activities. The learning potential was also influenced, however, by the non-controllable and dynamic interaction of various elements within the context. Suggestions for practice and further research are offered.

  14. Japanese Bereaved Family Members' Perspectives of Palliative Care Units and Palliative Care: J-HOPE Study Results.

    Science.gov (United States)

    Kinoshita, Satomi; Miyashita, Mitsunori; Morita, Tatsuya; Sato, Kazuki; Shoji, Ayaka; Chiba, Yurika; Miyazaki, Tamana; Tsuneto, Satoru; Shima, Yasuo

    2016-06-01

    The study purpose was to understand the perspectives of bereaved family members regarding palliative care unit (PCU) and palliative care and to compare perceptions of PCU before admission and after bereavement. A cross-sectional questionnaire survey was conducted, and the perceptions of 454 and 424 bereaved family members were obtained regarding PCU and palliative care, respectively. Family members were significantly more likely to have positive perceptions after bereavement (ranging from 73% to 80%) compared to before admission (ranging from 62% to 71%). Bereaved family members who were satisfied with medical care in the PCU had a positive perception of the PCU and palliative care after bereavement. Respondents younger than 65 years of age were significantly more likely to have negative perceptions of PCU and palliative care.

  15. Japanese Bereaved Family Members' Perspectives of Palliative Care Units and Palliative Care: J-HOPE Study Results.

    Science.gov (United States)

    Kinoshita, Satomi; Miyashita, Mitsunori; Morita, Tatsuya; Sato, Kazuki; Shoji, Ayaka; Chiba, Yurika; Miyazaki, Tamana; Tsuneto, Satoru; Shima, Yasuo

    2016-06-01

    The study purpose was to understand the perspectives of bereaved family members regarding palliative care unit (PCU) and palliative care and to compare perceptions of PCU before admission and after bereavement. A cross-sectional questionnaire survey was conducted, and the perceptions of 454 and 424 bereaved family members were obtained regarding PCU and palliative care, respectively. Family members were significantly more likely to have positive perceptions after bereavement (ranging from 73% to 80%) compared to before admission (ranging from 62% to 71%). Bereaved family members who were satisfied with medical care in the PCU had a positive perception of the PCU and palliative care after bereavement. Respondents younger than 65 years of age were significantly more likely to have negative perceptions of PCU and palliative care. PMID:25852202

  16. Quality of care for hypertension in the United States

    Directory of Open Access Journals (Sweden)

    LaPuerta Pablo

    2005-01-01

    Full Text Available Abstract Background Despite heavy recent emphasis on blood pressure (BP control, many patients fail to meet widely accepted goals. While access and adherence to therapy certainly play a role, another potential explanation is poor quality of essential care processes (QC. Yet little is known about the relationship between QC and BP control. Methods We assessed QC in 12 U.S. communities by reviewing the medical records of a randomly selected group of patients for the two years preceding our study. We included patients with either a diagnosis of hypertension or two visits with BPs of ≥140/90 in their medical records. We used 28 process indicators based on explicit evidence to assess QC. The indicators covered a broad spectrum of care and were developed through a modified Delphi method. We considered patients who received all indicated care to have optimal QC. We defined control of hypertension as BP Results Of 1,953 hypertensive patients, only 57% received optimal care and 42% had controlled hypertension. Patients who had received optimal care were more likely to have their BP under control at the end of the study (45% vs. 35%, p = .0006. Patients were more likely to receive optimal care if they were over age 50 (76% vs. 63%, p Conclusions Higher QC for hypertensive patients is associated with better BP control. Younger patients without cardiac risk factors are at greatest risk for poor care. Quality measurement systems like the one presented in this study can guide future quality improvement efforts.

  17. Neonatal Intensive Care Unit Nurses Working in an Open Ward: Stress and Work Satisfaction.

    Science.gov (United States)

    Lavoie-Tremblay, Mélanie; Feeley, Nancy; Lavigne, Geneviève L; Genest, Christine; Robins, Stéphanie; Fréchette, Julie

    2016-01-01

    There is some research on the impact of open-ward unit design on the health of babies and the stress experienced by parents and nurses in neonatal intensive care units. However, few studies have explored the factors associated with nurse stress and work satisfaction among nurses practicing in open-ward neonatal intensive care units. The purpose of this study was to examine what factors are associated with nurse stress and work satisfaction among nurses practicing in an open-ward neonatal intensive care unit. A cross-sectional correlational design was used in this study. Participants were nurses employed in a 34-bed open-ward neonatal intensive care unit in a major university-affiliated hospital in Montréal, Quebec, Canada. A total of 94 nurses were eligible, and 86 completed questionnaires (91% response rate). Descriptive statistics were computed to describe the participants' characteristics. To identify factors associated with nurse stress and work satisfaction, correlational analysis and multiple regression analyses were performed with the Nurse Stress Scale and the Global Work Satisfaction scores as the dependent variables. Different factors predict neonatal intensive care unit nurses' stress and job satisfaction, including support, family-centered care, performance obstacles, work schedule, education, and employment status. In order to provide neonatal intensive care units nurses with a supportive environment, managers can provide direct social support to nurses and influence the culture around teamwork. PMID:27455363

  18. Neonatal Intensive Care Unit Nurses Working in an Open Ward: Stress and Work Satisfaction.

    Science.gov (United States)

    Lavoie-Tremblay, Mélanie; Feeley, Nancy; Lavigne, Geneviève L; Genest, Christine; Robins, Stéphanie; Fréchette, Julie

    2016-01-01

    There is some research on the impact of open-ward unit design on the health of babies and the stress experienced by parents and nurses in neonatal intensive care units. However, few studies have explored the factors associated with nurse stress and work satisfaction among nurses practicing in open-ward neonatal intensive care units. The purpose of this study was to examine what factors are associated with nurse stress and work satisfaction among nurses practicing in an open-ward neonatal intensive care unit. A cross-sectional correlational design was used in this study. Participants were nurses employed in a 34-bed open-ward neonatal intensive care unit in a major university-affiliated hospital in Montréal, Quebec, Canada. A total of 94 nurses were eligible, and 86 completed questionnaires (91% response rate). Descriptive statistics were computed to describe the participants' characteristics. To identify factors associated with nurse stress and work satisfaction, correlational analysis and multiple regression analyses were performed with the Nurse Stress Scale and the Global Work Satisfaction scores as the dependent variables. Different factors predict neonatal intensive care unit nurses' stress and job satisfaction, including support, family-centered care, performance obstacles, work schedule, education, and employment status. In order to provide neonatal intensive care units nurses with a supportive environment, managers can provide direct social support to nurses and influence the culture around teamwork.

  19. Climate and cultural aspects in intensive care units

    OpenAIRE

    Guidet, Bertrand; González-Romá, Vicente

    2011-01-01

    Research carried out in the field of work and organisational psychology shows that work unit climate and culture are important determinants of work unit performance. We briefly summarise what we have learnt about the climate-performance relationship in work units distinct from ICUs. Then, we show how the ICU culture can be measured, and summarise research on the culture-performance relationship in ICUs.

  20. Residents Living in Residential Care Facilities: United States, 2010

    Science.gov (United States)

    ... population with a high burden of functional and cognitive impairment. Residential care is an important component of ... RCF and the month and year of the interview. Medicaid beneficiary : A resident who, during the 30 ...

  1. Competition and primary care in the United States: separating fact from fancy.

    Science.gov (United States)

    Siminoff, L

    1986-01-01

    Competitive strategies have been advocated as the solution for the economic ills of the U.S. economy. During the 1980s many economists and health care practitioners are arguing that a competitive strategy will bring down health care costs; these plans emphasize the existence of perverse incentives which reward cost reducing behavior with less revenue. Competitive strategies assume the existence of a "health care marketplace." Historically, the United States health care sector has not conformed to the ideal of the competitive market because of the special characteristics involved in the production and consumption of health care. Consumers have the least power in the health care sector and yet most competitive proposals are explicitly directed at changing consumer behavior, especially in the area of primary care. Much evidence indicates that competitive plans inhibit consumers from using primary care services, increase long-term health care costs, and ultimately require more government regulatory action.

  2. Grounded Theory of Barriers and Facilitators to Mandated Implementation of Mental Health Care in the Primary Care Setting

    Directory of Open Access Journals (Sweden)

    Justin K. Benzer

    2012-01-01

    Full Text Available Objective. There is limited theory regarding the real-world implementation of mental health care in the primary care setting: a type of organizational coordination intervention. The purpose of this study was to develop a theory to conceptualize the potential causes of barriers and facilitators to how local sites responded to this mandated intervention to achieve coordinated mental health care. Methods. Data from 65 primary care and mental health staff interviews across 16 sites were analyzed to identify how coordination was perceived one year after an organizational mandate to provide integrated mental health care in the primary care setting. Results. Standardized referral procedures and communication practices between primary care and mental health were influenced by the organizational factors of resources, training, and work design, as well as provider-experienced organizational boundaries between primary care and mental health, time pressures, and staff participation. Organizational factors and provider experiences were in turn influenced by leadership. Conclusions. Our emergent theory describes how leadership, organizational factors, and provider experiences affect the implementation of a mandated mental health coordination intervention. This framework provides a nuanced understanding of the potential barriers and facilitators to implementing interventions designed to improve coordination between professional groups.

  3. Quality of stroke care at an Irish Regional General Hospital and Stroke Rehabilitation Unit.

    LENUS (Irish Health Repository)

    Walsh, T

    2012-01-31

    BACKGROUND: Robust international data support the effectiveness of stroke unit (SU) care. Despite this, most stroke care in Ireland are provided outside of this setting. Limited data currently exist on the quality of care provided. AIM: The aim of this study is to examine the quality of care for patients with stroke in two care settings-Regional General Hospital (RGH) and Stroke Rehabilitation Unit (SRU). METHODS: A retrospective analysis of the stroke records of consecutive patients admitted to the SRU between May-November 2002 and April-November 2004 was performed applying the UK National Sentinel Audit of Stroke (NSAS) tool. RESULTS: The results of the study reveal that while SRU processes of care was 74% compliant with standards; compliance with stroke service organisational standards was only 15 and 43% in the RGH and SRU, respectively. CONCLUSION: The quality of stroke care in our area is deficient. Comprehensive reorganisation of stroke services is imperative.

  4. Caring for our youngest: public attitudes in the United States.

    Science.gov (United States)

    Sylvester, K

    2001-01-01

    Families make choices about employment and care for their children in a context that is shaped by public policies and colored by public opinion. Debates over whether the government should increase funding for child care or do more to help parents stay home with their children reflect tensions among strongly held ideas about family life, work, and the role of government. This article summarizes the results of public opinion polls that probe attitudes about parent and government roles and responsibilities with respect to children's care. The polling findings yield three main lessons: The American public believes that parents should be the primary influence in their children's lives and that it is best if mothers can be home to care for the very young. The public also values family self-sufficiency and understands that low-income families may need child care assistance to balance child rearing and employment responsibilities. However, skepticism about the appropriateness of government involvement in family life limits public support for proposals that the government act directly to provide or improve child care. From these lessons, the author draws several conclusions for policymakers: Policies focused on caregiving should respect the rights of parents to raise their children by ensuring that an array of options is available. Public programs should help families who are struggling economically to balance their obligations to work and family. Rather than directly providing child care services, government should fund community-based child care programs, and provide flexible assistance to help families secure the services they need and want. PMID:11712455

  5. Reflection in action in caring for the dying: applying organizational learning theory to improve communications in terminal care.

    Science.gov (United States)

    Cherin, D; Enguidanos, S; Brumley, R

    2001-01-01

    Currently, single loop learning is the predominant method of problem solving orientation engaged in by healthcare institutions. This mode of learning is not conductive to fostering needed communications between health care providers and terminal patients. Reflection in action, second loop learning, focuses on deep listening and dialogue and can be critical in opening communications paths between the dying patient and his or her caregivers. This article discusses organizational learning theory and applies the theories double loop learning technique of reflection in action to end-of-life care. The article further explores an exemplar of reflection in action in a Palliative Care Program, and end-of-life home care program at Kaiser Permanente. In order to more effectively meet the needs of terminally ill patients, greater efforts are needed to incorporate second loop learning into the practice of those caring for these patients.

  6. Frequency of admission in Intensive Care Unit due to road accident

    OpenAIRE

    Vasilios Tziallas; Dimitrios Karagiorgis; Stergios Voutos; Othon Vlachopoulos; Dimitrios Tziallas; Mariana Ntokou

    2011-01-01

    During recent years, it has been noticed a remarkable increase in admission of the young in Intensive Care Unit due to road accident. The aim of the present study was to explore the injuries, the special conditions of admission of young 18-40 years old that were admitted to Intensive Care Unit due to road accident. Method and material: The sample studied consisted of young individuals 18-40 years old that were admitted in the Intensive Care Unit (ICU) of public hospitals in the area of Attica...

  7. Symptom severity of patients with advanced cancer in palliative care unit: longitudinal assessments of symptoms improvement

    OpenAIRE

    Tai, Shu-Yu; Lee, Chung-Yin; Wu, Chien-Yi; Hsieh, Hui-ya; Huang, Joh-Jong; Huang, Chia-Tsuan; Chien, Chen-Yu

    2016-01-01

    Background This study assessed the symptom severity of patients with advanced cancer in a palliative care unit and explored the factors associated with symptom improvement. Methods This study was conducted in a palliative care unit in Taiwan between October 2004 and December 2009. Symptom intensity was measured by the “Symptom Reporting Form”, and graded on a scale of 0 to 4 (0 = none, and 4 = extreme). These measures were assessed on the 1st, 3rd, 5th, and 7th Day in the palliative care unit...

  8. The establishment of a primary spine care practitioner and its benefits to health care reform in the United States

    Directory of Open Access Journals (Sweden)

    Donald Murphy R

    2011-07-01

    Full Text Available Abstract It is widely recognized that the dramatic increase in health care costs in the United States has not led to a corresponding improvement in the health care experience of patients or the clinical outcomes of medical care. In no area of medicine is this more true than in the area of spine related disorders (SRDs. Costs of medical care for SRDs have skyrocketed in recent years. Despite this, there is no evidence of improvement in the quality of this care. In fact, disability related to SRDs is on the rise. We argue that one of the key solutions to this is for the health care system to have a group of practitioners who are trained to function as primary care practitioners for the spine. We explain the reasons we think a primary spine care practitioner would be beneficial to patients, the health care system and society, some of the obstacles that will need to be overcome in establishing a primary spine care specialty and the ways in which these obstacles can be overcome.

  9. Demographic profile and utilization statistics of a Canadian inpatient palliative care unit within a tertiary care setting

    OpenAIRE

    Napolskikh, J.; Selby, D.; Bennett, M.; Chow, E.; Harris, K; Sinclair, E.; Myers, J.

    2009-01-01

    Background Canadian data describing inpatient palliative care unit (pcu) utilization are scarce. In the present study, we performed a quality assessment of a 24-bed short-term pcu with a 3-months-or-less life expectancy policy in a tertiary care setting. Methods Using a retrospective chart review, we explored wait time (wt) for admission (May 2005 to April 2006), length of stay [los (February 2005 to January 2006)], and patient demographics. Results The wt data showed 508 referrals, with 242 ...

  10. The Eldicus prospective, observational study of triage decision making in European intensive care units: Part I-European Intensive Care Admission Triage Scores (EICATS)

    DEFF Research Database (Denmark)

    Sprung, Charles L; Baras, Mario; Iapichino, Gaetano;

    2012-01-01

    OBJECTIVE:: Life and death triage decisions are made daily by intensive care unit physicians. Scoring systems have been developed for prognosticating intensive care unit mortality but none for intensive care unit triage. The objective of this study was to develop an intensive care unit triage...... decision rule based on 28-day mortality rates of admitted and refused patients. DESIGN:: Prospective, observational study of triage decisions from September 2003 until March 2005. SETTING:: Eleven intensive care units in seven European countries. PATIENTS:: All patients >18 yrs with a request for intensive...... care unit admission. INTERVENTIONS:: Admission or rejection to an intensive care unit. MEASUREMENTS AND MAIN RESULTS:: Clinical, laboratory, and physiological variables and data from severity scores were collected. Separate scores for accepted and rejected patients with 28-day mortality end point were...

  11. The organizational context of ethical dilemmas: a role-playing simulation for the intensive care unit.

    Science.gov (United States)

    Strosberg, M A

    2001-01-01

    The allocation of health care resources often requires decision makers to balance conflicting ethical principles. The resource-constrained intensive care unit (ICU) provides an ideal setting to study how decision makers go about their balancing act in a complex and dynamic environment. The author presents a role-playing simulation exercise which models ICU admission and discharge decision making. Designed for the class-room, the simulation engages a variety of ethical, managerial, and public policy issues including end-of-life decision making, triage, and rationing. The simulation is based on a sequence of scenarios or "decision rounds" delineating conditions in the ICU in terms of disposition of ICU patients, number of available ICU beds, prognoses of candidates for admission, and other physiological and organizational information. Students, playing the roles of attending physician, hospital administrator, nurse manager, triage officer, and ethics committee member, are challenged to reach consensus in the context of multiple power centers and conflicting goals. An organization theory perspective, incorporated into the simulation, provides insight on how decisions are actually made and stimulates discussion on how decision making might be improved.

  12. Use of analgesic agents for invasive medical procedures in pediatric and neonatal intensive care units.

    Science.gov (United States)

    Bauchner, H; May, A; Coates, E

    1992-10-01

    The purpose of this study was to assess the use of analgesic agents for invasive medical procedures in pediatric and neonatal intensive care units. The directors of 38 pediatric units and 31 neonatal units reported that analgesics were infrequently used for intravenous cannulation (10%), suprapubic bladder aspiration (8%), urethral catheterization (2%), or venipuncture (2%). Analgesics were used significantly more regularly in pediatric than in neonatal intensive care units for arterial line placement, bone marrow aspiration, central line placement, chest tube insertion, paracentesis, and lumbar puncture. PMID:1403404

  13. Percutaneous dilatational tracheostomy without fiber optic bronchoscopy-Evaluation of 80 intensive care units cases

    NARCIS (Netherlands)

    J.A. Calvache (Jose Andrés); R.A. Molina García (Rodrigo); A.L. Trochez (Adolfo); J. Benitez (Javier); L.A. Flga (Lucía Arroyo)

    2013-01-01

    textabstractBackground: The development of percutaneous dilatational tracheostomy techniques (PDT) has facilitated the procedure in Intensive Care Units (ICU). Objective: To describe the early intra and post-operative complications in ICU patients requiring percutaneous dilatational tracheostomy usi

  14. Auditing the standard of anaesthesia care in obstetric units.

    Science.gov (United States)

    Mörch-Siddall, J; Corbitt, N; Bryson, M R

    2001-04-01

    We undertook an audit of 15 obstetric units in the north of England over a 10-month period to ascertain to what extent they conformed to the Obstetric Anaesthetists' Association 'Recommended Minimum Standards for Obstetric Anaesthetic Services' using a quality assurance approach. We demonstrated that all units conformed to the majority of standards but did not conform in at least one major and minor area. PMID:15321622

  15. Vulnerabilities of children admitted to a pediatric inpatient care unit

    OpenAIRE

    Larissa Natacha de Oliveira; Márcia Koja Breigeiron; Sofia Hallmann; Maria Carolina Witkowski

    2014-01-01

    OBJECTIVE: To identify the vulnerabilities of children admitted to a pediatric inpatient unit of a university hospital.METHODS: Cross-sectional, descriptive study from April to September 2013 with36 children aged 30 days to 12 years old, admitted to medical-surgical pediatric inpatient units of a university hospital and their caregivers. Data concerning sociocultural, socioeconomic and clinical context of children and their families were collected by interview with the child caregiver and fro...

  16. Anglo-American nursing theory, individualism and mental health care: a social conflict perspective.

    Science.gov (United States)

    Leighton, Kevin

    2004-01-01

    This paper uses social conflict theory to reconsider the relationship of American nursing theory and individualised mental health care in the UK. It is argued that nursing theory has developed within a context of 'American dream' individualism, and that this ideology may be problematic for some UK mental health nurses and service users whose values and beliefs are those of different socio-political traditions. The paper explores the historical background of Anglo-American nursing theory, and then uses conflict theory to generate challenging propositions about the culture bias and political instrumentality of individualised care in mental health settings. In so doing, it critiques the 'scientific' and 'liberal' preconceptions of individualised care which have dominated mental health care policy for over a decade.

  17. Prevalence rates of infection in intensive care units of a tertiary teaching hospital

    Directory of Open Access Journals (Sweden)

    Toufen Junior Carlos

    2003-01-01

    Full Text Available OBJECTIVE: To determine the prevalence rates of infections among intensive care unit patients, the predominant infecting organisms, and their resistance patterns. To identify the related factors for intensive care unit-acquired infection and mortality rates. DESIGN: A 1-day point-prevalence study. SETTING:A total of 19 intensive care units at the Hospital das Clínicas - University of São Paulo, School of Medicine (HC-FMUSP, a teaching and tertiary hospital, were eligible to participate in the study. PATIENTS: All patients over 16 years old occupying an intensive care unit bed over a 24-hour period. The 19 intensive care unit s provided 126 patient case reports. MAIN OUTCOME MEASURES: Rates of infection, antimicrobial use, microbiological isolates resistance patterns, potential related factors for intensive care unit-acquired infection, and death rates. RESULTS: A total of 126 patients were studied. Eighty-seven patients (69% received antimicrobials on the day of study, 72 (57% for treatment, and 15 (12% for prophylaxis. Community-acquired infection occurred in 15 patients (20.8%, non- intensive care unit nosocomial infection in 24 (33.3%, and intensive care unit-acquired infection in 22 patients (30.6%. Eleven patients (15.3% had no defined type. The most frequently reported infections were respiratory (58.5%. The most frequently isolated bacteria were Enterobacteriaceae (33.8%, Pseudomonas aeruginosa (26.4%, and Staphylococcus aureus (16.9%; [100% resistant to methicillin]. Multivariate regression analysis revealed 3 risk factors for intensive care unit-acquired infection: age > 60 years (p = 0.007, use of a nasogastric tube (p = 0.017, and postoperative status (p = 0.017. At the end of 4 weeks, overall mortality was 28.8%. Patients with infection had a mortality rate of 34.7%. There was no difference between mortality rates for infected and noninfected patients (p=0.088. CONCLUSION: The rate of nosocomial infection is high in intensive care

  18. Communicating Chaplains' Care: Narrative Documentation in a Neuroscience-Spine Intensive Care Unit.

    Science.gov (United States)

    Johnson, Rebecca; Wirpsa, M Jeanne; Boyken, Lara; Sakumoto, Matthew; Handzo, George; Kho, Abel; Emanuel, Linda

    2016-01-01

    Chaplaincy care is different for every patient; a growing challenge is to ensure that electronic health records function to support personalized care. While ICU health care teams have advanced clinical practice guidelines to identify and integrate relevant aspects of the patient's story into whole person care, recommendations for documentation are rare. This qualitative study of over 400 free-text EHR notes offers unique insight into current use of free-text documentation in ICU by six chaplains integrated into the healthcare team. Our research provides insight into the phenomena chaplains record in the electronic record. Content analysis shows recurrent report of patient and family practices, beliefs, coping mechanisms, concerns, emotional resources and needs, family and faith support, medical decision making and medical communications. These findings are important for health care team discussions of factors deemed essential to whole person care in ICUs, and, by extension have the potential to support the development of EHR designs that aim to advance personalized care.

  19. Psychosocial factors and mental work load: a reality perceived by nurses in intensive care units1

    OpenAIRE

    Paula Ceballos-Vásquez; Gladys Rolo-González; Estefanía Hérnandez-Fernaud; Dolores Díaz-Cabrera; Tatiana Paravic-Klijn; Mónica Burgos-Moreno

    2015-01-01

    OBJECTIVE: To analyse the perception of psychosocial factors and mental workload of nurses who work in intensive care units. It is hypothesised that nurses in these units could perceive psychosocial risks, manifesting in a high mental work load. The psychosocial dimension related to the position's cognitive demands is hypothesised to mostly explain mental work load. METHOD: Quantitative study, with a descriptive, cross-sectional, and comparative design. A total of 91% of the intensive care un...

  20. Sedation and memories of patients subjected to mechanical ventilation in an intensive care unit

    OpenAIRE

    Jaquilene Barreto da Costa; Sonia Silva Marcon; Claudia Rejane Lima de Macedo; Amaury Cesar Jorge; Péricles Almeida Delfino Duarte

    2014-01-01

    Objective To investigate the relationship between sedation and the memories reported by patients subjected to mechanical ventilation following discharge from the intensive care unit. Methods This prospective, observational, cohort study was conducted with individuals subjected to mechanical ventilation who remained in the intensive care unit for more than 24 hours. Clinical statistics and sedation records were extracted from the participants' clinical records; the data relative to the partici...

  1. Practice patterns of physiotherapists in neonatal intensive care units: A national survey

    OpenAIRE

    Chokshi, Tejas; Alaparthi, Gopala Krishna; Krishnan, Shyam; Vaishali, K; Zulfeequer, C.P.

    2013-01-01

    Objective: To determine practice pattern of physiotherapists in the neonatal intensive care units (ICUs) in India with regards to cardiopulmonary and neuromuscular physiotherapy. Materials and Methods: A cross-sectional survey was conducted across India, in which 285 questionnaires were sent via e-mail to physiotherapists working in neonatal intensive care units. Results: A total of 139 completed questionnaires were returned with a response rate of 48.7%, with a majority of responses from Kar...

  2. Enteral nutrition practices in the intensive care unit: Understanding of nursing practices and perspectives

    OpenAIRE

    Babita Gupta; Pramendra Agrawal; Soni, Kapil D; Vikas Yadav; Roshni Dhakal; Shally Khurana; M C Misra

    2012-01-01

    Background: Adequate nutritional support is important for the comprehensive management of patients in intensive care units (ICUs). Aim: The study was aimed to survey prevalent enteral nutrition practices in the trauma intensive care unit, nurses′ perception, and their knowledge of enteral feeding. Study Design: The study was conducted in the ICU of a level 1 trauma center, Jai Prakash Narayan Apex Trauma Centre, AIIMS, New Delhi, India. The study design used an audit. Materials...

  3. Monitoring of health care personnel employee and occupational health immunization program practices in the United States.

    Science.gov (United States)

    Carrico, Ruth M; Sorrells, Nikka; Westhusing, Kelly; Wiemken, Timothy

    2014-01-01

    Recent studies have identified concerns with various elements of health care personnel immunization programs, including the handling and management of the vaccine. The purpose of this study was to assess monitoring processes that support evaluation of the care of vaccines in health care settings. An 11-question survey instrument was developed for use in scripted telephone surveys. State health departments in all 50 states in the United States and the District of Columbia were the target audience for the surveys. Data from a total of 47 states were obtained and analyzed. No states reported an existing monitoring process for evaluation of health care personnel immunization programs in their states. Our assessment indicates that vaccine evaluation processes for health care facilities are rare to nonexistent in the United States. Identifying existing practice gaps and resultant opportunities for improvements may be an important safety initiative that protects patients and health care personnel.

  4. Nursing students’ experiences of professional patient care encounters in a hospital unit

    DEFF Research Database (Denmark)

    Kaldal, Maiken Holm; Kristiansen, Jette; Uhrenfeldt, Lisbeth

    2015-01-01

    experiences of professional patient care encounters where students engage with patients and provide nursing care within the basic principles of nursing care relating to the patients’ physiological and psychological needs. Studies that reflect nursing students’ comprehension of or attitudes towards nursing......REVIEW QUESTION / OBJECTIVE The objective of this systematic review is to identify, appraise and synthesize the best available evidence on nursing students’ experiences of professional patient care encounters in a hospital unit. More specifically the research questions are: How do nursing students...... describe their experiences of professional patient care in a hospital unit? What kinds of experiences do nursing students have in professional patient care encounters? INCLUSION CRITERIA Types of participants This review will consider studies that include undergraduate and postgraduate nursing students...

  5. Burn unit care of Stevens Johnson syndrome/toxic epidermal necrolysis: A survey.

    Science.gov (United States)

    Le, Hong-Gam; Saeed, Hajirah; Mantagos, Iason S; Mitchell, Caroline M; Goverman, Jeremy; Chodosh, James

    2016-06-01

    Stevens-Johnson syndrome/toxic epidermal necrolysis (SJS/TEN) is a systemic disease that can be associated with debilitating acute and chronic complications across multiple organ systems. As patients with acute SJS/TEN are often treated in a burn intensive care unit (BICU), we surveyed burn centers across the United States to determine their approach to the care of these patients. The goal of our study was to identify best practices and possible variations in the care of patients with acute SJS/TEN. We demonstrate that the method of diagnosis, use of systemic therapies, and involvement of subspecialists varied significantly between burn centers. Beyond supportive care provided to every patient, our data highlights a lack of standardization in the acute care of patients with SJS/TEN. A comprehensive guideline for the care of patients with acute SJS/TEN is indicated. PMID:26810444

  6. Predictors of postoperative pulmonary complications after liver resection: Results from a tertiary care intensive care unit

    Directory of Open Access Journals (Sweden)

    Anirban Hom Choudhuri

    2014-01-01

    Full Text Available Background: Postoperative pulmonary complication (PPC is a serious complication after liver surgery and is a major cause of mortality and morbidity in the intensive care unit (ICU. Therefore, the early identification of risk factors of PPCs may help to reduce the adverse outcomes. Objective: The aim of this retrospective study was to determine the predictors of PPCs in patients undergoing hepatic resection. Design: Retrospective, observational. Methods: The patients admitted after hepatic resection in the gastrosurgical ICU of our institute between October 2009 and June 2013 was identified. The ICU charts were retrieved from the database to identify patients who developed PPCs. A comparison of risk factors was made between the patients who developed PPC (PPC group against the patients who did not (no-PPC group. Results: Of 117 patients with hepatic resection, 28 patients developed PPCs. Among these, pneumonia accounted for 12 (42.8% followed by atelectasis in 8 (28.5% and pleural effusion in 3 (10.7%. Among the patients developing PPCs, 16 patients were over a 70-year-old (57.1%, 21 patients were smokers (75% and 8 patients (28.5% had chronic obstructive pulmonary disease (COPD. The requirement for blood transfusion and duration of mechanical ventilation were greater in the patients developing PPC (2000 ± 340 vs. 1000 ± 210 ml; 10 ± 4.5 vs. 3 ± 1.3 days. Conclusion: Old age, chronic smoking, COPD, increased blood product transfusion, increased duration of mechanical ventilation and increased length of ICU stay increased the relative risk of PPC, presence of diabetes and occurrence of surgical complications (leak, dehiscence, etc. were independent predictive variables for the development of PPC.

  7. Quality of life and persisting symptoms in intensive care unit survivors: implications for care after discharge

    Directory of Open Access Journals (Sweden)

    Dorsett Joanna

    2009-08-01

    Full Text Available Abstract Background We assessed the quality of life of ICU survivors using SF-36 at 4 months after ICU discharge and investigated any correlation of PCS and MCS with age, illness severity and hospital or ICU length of stay. We examined the relationship between these variables, persisting physical and psychological symptoms and the perceived benefit of individual patients of follow-up. Findings For one year, adult patients admitted for multiple organ or advanced respiratory support for greater than 48 hours to a 16-bedded teaching hospital general intensive care unit were identified. Those surviving to discharge were sent a questionnaire at 4 months following ICU discharge assessing quality of life and persisting symptoms. Demographic, length of stay and illness severity data were recorded. Higher or lower scores were divided at the median value. A two-tailed Students t-test assuming equal variances was used for normally-distributed data and Mann-Whitney tests for non-parametric data. 87 of 175 questionnaires were returned (50%, but only 65 had sufficient data giving a final response rate of 37%. Elderly patients had increased MCS as compared with younger patients. The PCS was inversely related to hospital LOS. There was a significant correlation between the presence of psychological and physical symptoms and desire for follow-up. Conclusion Younger age and prolonged hospital stay are associated with lower mental or physical quality of life and may be targets for rehabilitation. Patients with persisting symptoms at 4 months view follow-up as beneficial and a simple screening questionnaire may identify those likely to attend outpatient services.

  8. The Creation of a Biocontainment Unit at a Tertiary Care Hospital. The Johns Hopkins Medicine Experience.

    Science.gov (United States)

    Garibaldi, Brian T; Kelen, Gabor D; Brower, Roy G; Bova, Gregory; Ernst, Neysa; Reimers, Mallory; Langlotz, Ronald; Gimburg, Anatoly; Iati, Michael; Smith, Christopher; MacConnell, Sally; James, Hailey; Lewin, John J; Trexler, Polly; Black, Meredith A; Lynch, Chelsea; Clarke, William; Marzinke, Mark A; Sokoll, Lori J; Carroll, Karen C; Parish, Nicole M; Dionne, Kim; Biddison, Elizabeth L D; Gwon, Howard S; Sauer, Lauren; Hill, Peter; Newton, Scott M; Garrett, Margaret R; Miller, Redonda G; Perl, Trish M; Maragakis, Lisa L

    2016-05-01

    In response to the 2014-2015 Ebola virus disease outbreak in West Africa, Johns Hopkins Medicine created a biocontainment unit to care for patients infected with Ebola virus and other high-consequence pathogens. The unit team examined published literature and guidelines, visited two existing U.S. biocontainment units, and contacted national and international experts to inform the design of the physical structure and patient care activities of the unit. The resulting four-bed unit allows for unidirectional flow of providers and materials and has ample space for donning and doffing personal protective equipment. The air-handling system allows treatment of diseases spread by contact, droplet, or airborne routes of transmission. An onsite laboratory and an autoclave waste management system minimize the transport of infectious materials out of the unit. The unit is staffed by self-selected nurses, providers, and support staff with pediatric and adult capabilities. A telecommunications system allows other providers and family members to interact with patients and staff remotely. A full-time nurse educator is responsible for staff training, including quarterly exercises and competency assessment in the donning and doffing of personal protective equipment. The creation of the Johns Hopkins Biocontainment Unit required the highest level of multidisciplinary collaboration. When not used for clinical care and training, the unit will be a site for research and innovation in highly infectious diseases. The lessons learned from the design process can inform a new research agenda focused on the care of patients in a biocontainment environment. PMID:27057583

  9. Evaluation of the european heart failure self-care behaviour scale in a united kingdom population

    NARCIS (Netherlands)

    Shuldham, Caroline; Theaker, Chris; Jaarsma, Tiny; Cowie, Martin R.

    2007-01-01

    Title. Evaluation of the European Heart Failure Self-care Behaviour Scale in a United Kingdom population Aim. This paper is a report of a study to test the internal consistency, reliability and validity of the 12-item European Heart Failure Self-care Behaviour Scale in an English-speaking sample in

  10. Physical Therapy Observation and Assessment in the Neonatal Intensive Care Unit

    Science.gov (United States)

    Byrne, Eilish; Campbell, Suzann K.

    2013-01-01

    This article presents the elements of the Observation and Assessment section of the Infant Care Path for Physical Therapy in the Neonatal Intensive Care Unit (NICU). The types of physical therapy assessments presented in this path are evidence-based and the suggested timing of these assessments is primarily based on practice knowledge from expert…

  11. Health Risk Behaviors in Family Caregivers During Patients’ Stay in Intensive Care Units: A Pilot Analysis

    Science.gov (United States)

    Choi, JiYeon; Hoffman, Leslie A.; Schulz, Richard; Ren, Dianxu; Donahoe, Michael P.; Given, Barbara; Sherwood, Paula R.

    2014-01-01

    Background Studies of family caregivers of the critically ill have mainly focused on the psychological impact of the patients’ stay in the intensive care unit and related stress. Despite known associations between stress and physical health, limited attention has been paid to the need to promote and maintain physical health in these caregivers. Objective To explore how family caregivers’ health risk behaviors are associated with patients’ preexisting care needs and the caregivers’ depressive symptoms and burden. Methods During the intensive-care-unit stay of critically ill patients (who required mechanical ventilation for ≥4 days), 50 family caregivers were surveyed to determine the caregivers’ depressive symptoms, burden, and health risk behaviors. Data were also collected on patients’ care needs before admission to the intensive care unit. Results One or more health risk behaviors were reported by 94% of family caregivers. More than 90% of caregivers reported depressive symptoms above the score indicating risk for clinical depression. A high level of burden was reported by 36% of caregivers. More health risk behaviors were associated with higher scores of depressive symptoms and burden (P<.001 for both). Caregivers’ responses did not differ according to patients’ preexisting care needs. Conclusion Health risk behaviors of family caregivers are associated with greater perceptions of burden and/or depressive symptoms but not with patients’ care needs before admission to the intensive care unit. PMID:23283087

  12. Recovery at the post anaesthetic care unit after breast cancer surgery

    DEFF Research Database (Denmark)

    Gärtner, Rune; Callesen, Torben; Kroman, Niels Thorndahl;

    2010-01-01

    Extant literature shows that women having undergone breast cancer surgery have substantial problems at the post-anaesthesia care unit (PACU). Based on nursing reports and elements of the discharge scoring system recommended by The Danish Society of Anaesthesiology and Intensive Care Medicine, the...

  13. Scoring system for the selection of high-risk patients in the intensive care unit

    NARCIS (Netherlands)

    Iapichino, G; Mistraletti, G; Corbella, D; Bassi, G; Borotto, E; Miranda, DR; Morabito, A

    2006-01-01

    Objective. Patients admitted to the intensive care unit greatly differ in severity and intensity of care. We devised a system for selecting high-risk patients that reduces bias by excluding low-risk patients and patients with an early death irrespective of the treatment. Design: A posteriori analysi

  14. Patients with diabetes in the intensive care unit; not served by treatment, yet protected?

    NARCIS (Netherlands)

    S.E. Siegelaar; J.H. Devries; J.B. Hoekstra

    2010-01-01

    Diabetes is associated with severe complications and decreased life expectancy. However, in the previous issue of Critical Care, Vincent and colleagues report no difference in mortality between patients with insulin-treated diabetes and patients without diabetes in the intensive care unit ( ICU), de

  15. Consensus guidelines on analgesia and sedation in dying intensive care unit patients

    Directory of Open Access Journals (Sweden)

    Lemieux-Charles Louise

    2002-08-01

    Full Text Available Abstract Background Intensivists must provide enough analgesia and sedation to ensure dying patients receive good palliative care. However, if it is perceived that too much is given, they risk prosecution for committing euthanasia. The goal of this study is to develop consensus guidelines on analgesia and sedation in dying intensive care unit patients that help distinguish palliative care from euthanasia. Methods Using the Delphi technique, panelists rated levels of agreement with statements describing how analgesics and sedatives should be given to dying ICU patients and how palliative care should be distinguished from euthanasia. Participants were drawn from 3 panels: 1 Canadian Academic Adult Intensive Care Fellowship program directors and Intensive Care division chiefs (N = 9; 2 Deputy chief provincial coroners (N = 5; 3 Validation panel of Intensivists attending the Canadian Critical Care Trials Group meeting (N = 12. Results After three Delphi rounds, consensus was achieved on 16 statements encompassing the role of palliative care in the intensive care unit, the management of pain and suffering, current areas of controversy, and ways of improving palliative care in the ICU. Conclusion Consensus guidelines were developed to guide the administration of analgesics and sedatives to dying ICU patients and to help distinguish palliative care from euthanasia.

  16. Bench-to-bedside review: Dealing with increased intensive care unit staff turnover: a leadership challenge

    OpenAIRE

    Laporta, Denny P; Burns, Judy; Doig, Chip J

    2005-01-01

    Critical care leaders frequently must face challenging situations requiring specific leadership and management skills for which they are, not uncommonly, poorly prepared. Such a fictitious scenario was discussed at a Canadian interdisciplinary critical care leadership meeting, whereby increasing intensive care unit (ICU) staff turnover had led to problems with staff recruitment. Participants discussed and proposed solutions to the scenario in a structured format. The results of the discussion...

  17. Development of the trauma emergency care system based on the three links theory

    Institute of Scientific and Technical Information of China (English)

    JIANG Guan-yu; SHEN Wei-feng; GAN Jian-xin

    2005-01-01

    The three links theory applied in trauma emergency care system refers to an integrated system with the three important components of trauma emergency care system, viz. prehospital trauma services, hospital trauma services and critical care services. The development of the trauma emergency care system should be guided by the three links theory so as to set up a practical and highly efficient system: a prompt operating and monitoring transportation system, a smooth and real-time information system, a rational and sustainable system of regulations and contingency plans, and a system for cultivating all-round trauma physicians.

  18. Parkinson’s disease permanent care unit: managing the chronic-palliative interface

    Directory of Open Access Journals (Sweden)

    Lökk J

    2011-04-01

    Full Text Available Johan LökkDepartment of Neurobiology, Caring Sciences, and Society, Karolinska Institutet; Geriatric Department, Karolinska University Hospital Huddinge, Stockholm, SwedenBackground: Parkinson’s disease (PD eventually leads to severe functional decline and dependence. Specialized care units for PD patients in need of permanent care are lacking.Methods: Patients with severe PD are referred to the PD permanent care unit harboring 30 patients with specialized medical and health care provided by trained staff. Patients need to have intensive medical and care needs, and be no longer able to stay at home or at an ordinary institution. A written and continuously reviewed care plan is made for each patient at admission, with the overriding aim to preserve quality of life and optimize functionality.Results: After five years, the PD permanent care unit has cared for 70 patients (36 men and 34 women with a mean age of 76.6 years and a mean duration of Parkinsonism of 11.8 years. Hoehn and Yahr severity of disease was 3.7, cognition was 25.3 (Mini-Mental State Examination, and the mean daily levodopa dose was 739 mg. The yearly fatality rate was seven, and the mean duration of stay was 26.9 months. Only five patients moved out from the unit.Conclusion: A specially designed and staffed care unit for Parkinsonism patients seems to fill a need for patients and caregivers, as well as for social and health care authorities. This model is sensitive to the changing needs and capacities of patients, ensuring that appropriate services are available in a timely manner. There was a rather short duration of patient stay and remaining life span after admission to the unit. Despite the chronic/palliative state of patients at the PD permanent care unit, there are many therapeutic options, with the overriding objective being to allow the patients to end their days in a professional and comfortable environment.Keywords: Parkinsonism, palliative care, end-stage disease

  19. Patients’ perceptions of the meaning of good care in surgical care: a grounded theory study

    OpenAIRE

    Mako, Tünde; Svanäng, Pernilla; Bjerså, Kristofer

    2016-01-01

    Background Patients in surgical care have reported a fear of being discharged prior to sufficient recovery and a lack of control of their situation. Establishing the patient-nurse relationship is essential in the context of the care. The Swedish National Board of Health and Welfare has established indicators for good care for comparison, evaluation and improvement of the quality of the health care system. These indicators are knowledge-based, appropriate, safe, effective and equal health care...

  20. Self-care practice of ostomy patients: contributions of the Orem’s theory

    Directory of Open Access Journals (Sweden)

    Luciana Catunda Gomes Menezes

    2013-05-01

    Full Text Available This study aimed to identify the conditioning factors to self-care practice of ostomy patients, and verify knowledge and practices on stoma care. Descriptive and qualitative study, referencing the Orem’s Self-Care Theory, carried out at the Ostomy Association of Fortaleza-CE, Brazil, in June and July 2007. We identified as the main conditioning factors for self-care: male, aged over 51 years, low education, from the capital city/metropolitan area, married, and with low family income. From the participants’ statements, emerged three categories: Learning to take care of stoma: education-support system; Stoma Care: knowledge and practices; and Difficulties found in the practice of self-care. It was concluded that ostomy patients require a multidimensional and individualized nursing care, which enables them to perform self-care effectively.

  1. Insurance coverage for male infertility care in the United States

    OpenAIRE

    James M Dupree

    2016-01-01

    Infertility is a common condition experienced by many men and women, and treatments are expensive. The World Health Organization and American Society of Reproductive Medicine define infertility as a disease, yet private companies infrequently offer insurance coverage for infertility treatments. This is despite the clear role that healthcare insurance plays in ensuring access to care and minimizing the financial burden of expensive services. In this review, we assess the current knowledge of h...

  2. Family members' lived experience in the intensive care unit: a phemenological study.

    LENUS (Irish Health Repository)

    McKiernan, Margaret

    2012-01-31

    AIM: To describe the lived experience of family members of patients in the intensive care unit. BACKGROUND: Admission of a critically ill relative to an intensive care unit causes anxiety and stress to family members. Nursing care is initially focused on maintaining the physiological stability of the patient and less on the needs and concerns of family members. Understanding how families make sense of this experience may help nurses focus on the delivery of family centred care. METHODOLOGY: A phenomenological method was used to describe the lived experiences of family members of patients in an intensive care unit. In-depth interviews were conducted with six family members and analysed using qualitative thematic analysis. RESULTS: Four main themes emerged from the data: the need to know, making sense of it all, being there with them and caring and support. Family members needed honest information about the patient\\'s progress and outcome to make the situation more bearable for them. Making sense of the situation was a continuous process which involved tracking and evaluating care given. Being with their relative sustained their family bond and was a way to demonstrate love and support. Caring reassurance provided by the nurses enabled a sense of security. Support was needed by family members to assist them in coping. CONCLUSION: The research provided an insight into how family members viewed the impact of the admission and how they subsequently found ways of dealing with the situation. RELEVANCE TO CLINICAL PRACTICE: Using a holistic approach to nursing assessment and care delivery in intensive care necessitates that nurses interact with and care for family members of patients. Development of a philosophy of family centred care is necessary, with formal assessment of families to take place soon after admission and an appropriate plan of care drawn up at this time.

  3. Examining Health Care Costs: Opportunities to Provide Value in the Intensive Care Unit.

    Science.gov (United States)

    Chang, Beverly; Lorenzo, Javier; Macario, Alex

    2015-12-01

    As health care costs threaten the economic stability of American society, increasing pressures to focus on value-based health care have led to the development of protocols for fast-track cardiac surgery and for delirium management. Critical care services can be led by anesthesiologists with the goal of improving ICU outcomes and at the same time decreasing the rising cost of ICU medicine.

  4. Re-designing Orem's Self-care Theory for Patients with Chronic Hepatitis

    Science.gov (United States)

    Hasanpour-Dehkordi, Ali; Mohammadi, Nooredin; Nikbakht-Nasrabadi, Alireza

    2016-01-01

    Background: Hepatitis is an inflammatory disease which has many adverse effects on patients’ life because of its chronic nature. Since Orem's theory of self-care is a grounded theory, the concepts and applications of this theory in patients with chronic hepatitis who have special needs may lead to some challenges. The purpose of this study was to explore self-care in patients with chronic hepatitis. Methods/Design: A directed content analysis was used in this qualitative study. Participants were recruited from a metropolitan area. Data were collected through semi-structured interviews. The verbatim transcripts of the participants’ interviews were analyzed according to directed content analysis. Results: In this study, four themes, suggested by Orem, were drawn from the data according to directed content analysis. The codes generated from the data were classified into concepts and then the concepts were assigned into these four themes. These themes were needs in the matrix of time and place, self-care agency, need for change in self-care and consequences of hepatitis. Conclusion: The use of Orem's self-care theory cannot meet the need for self-care in hepatitis patients because these patients have vital sexual, respect and belonging, physical, economical, and psychological-behavioral needs, and lack adequate knowledge about self-care. Consequently, the specific self-care model developed in this study helps health professionals identify self-care activities in patients with chronic hepatitis. PMID:27803560

  5. Understanding health-care access and utilization disparities among Latino children in the United States.

    OpenAIRE

    Langellier, BA; Chen, J; Vargas-Bustamante, A; Inkelas, M; Ortega, AN

    2016-01-01

    It is important to understand the source of health-care disparities between Latinos and other children in the United States. We examine parent-reported health-care access and utilization among Latino, White, and Black children (≤17 years old) in the United States in the 2006-2011 National Health Interview Survey. Using Blinder-Oaxaca decomposition, we portion health-care disparities into two parts (1) those attributable to differences in the levels of sociodemographic characteristics (e.g., i...

  6. SUM (Service Unit Management): An Organizational Approach To Improved Patient Care.

    Science.gov (United States)

    Jelinek, Richard C.; And Others

    To evaluate the effectiveness of Service Unit Management (SUM) in reducing costs, improving quality of care, saving professional nursing time, increasing personnel satisfaction, and setting a stage for further improvements, a national questionnaire survey identified the characteristics of SUM units, and compared the performance of a total of 55…

  7. Nurse care assesment at the end of life in intensive critical units

    Directory of Open Access Journals (Sweden)

    Mª Cristina Pascual Fernández

    2013-11-01

    Full Text Available To die nowadays is not the critical instant of our existence in occidental societies. Technological and scientific advances in health sciences have not been developed equally company and humanization in care. Nurses play an important and responsible role at end of life care, to provide patients and their families comfort cares in dying process. The main objective was to describe and analyze the professionals’ cares in Intensive Care Unit at the end of life process. An observational study was developed and 472 surveys to critical care nurses of six high complexity hospitals of Madrid Community were made. The questionnaire on the evaluation from the cares to the children that die in Pediatrics Intensive Care was applied. We have obtained that nurses said that most of the families remained with their patient in the moment of the death and needed support and empathy from the staff. As a conclusion we could say that the cares to the patients in Intensive Care Unit should be improved.

  8. Young Children's Self-care and Independence Tasks: Applying Self-efficacy Theory.

    Science.gov (United States)

    Hildebrand, Verna

    1988-01-01

    Discusses the theory of self-efficacy, the ways in which young children learn self-care and self-efficacy, and methods parents and other caregivers can use to encourage self-efficacy in young children. (RJC)

  9. The Crisis in Emergency and Trauma Care in California and the United States

    Directory of Open Access Journals (Sweden)

    Mansuri, Oveys

    2006-12-01

    Full Text Available A crisis affecting every geographic region and every socioeconomic segment of the United States is threatening the future viability of emergency and trauma care in America. As the financial and social burden of providing trauma care has fallen on individual states, hospitals and physicians, record numbers of emergency departments and trauma centers have been forced to close. The ultimate cost of these closures falls upon patients who will receive inadequate emergency and trauma care. In the fall of 2004 King Drew Medical Center Trauma Services, the second largest trauma center in Los Angeles County closed. Continuing on this path may threaten the emergency and trauma care in the United States, touted as one of the finest in the world. This article provides a general overview of the trauma center crisis in California and reviews the history of the problem and its future implications in California as well as the United States.

  10. Perceptions on psychiatric nursing care at a general hospital inpatient unit

    Directory of Open Access Journals (Sweden)

    Renata Marques de Oliveira

    2016-06-01

    Full Text Available The objective was to investigate the perception of nurses, nursing assistants and patients about nursing care at a general hospital psychiatric unit. Exploratory study with 16/20 nursing professionals and 27/84 patients from the psychiatric inpatient unit of a general hospital. Interviews were based on guiding questions about the nursing care in said unit. Thematic content analysis was adopted. The subjects acknowledge that nursing promotes the recovery of patients, that it is essential during hospitalization, and defend that working in psychiatry requires a taste and profile for it. The patients value warmth, attention, serenity, good mood, patience, concern, presence, promptness, respect and responsibility. The professionals value affection, dedication, effort, patience, security and serenity. Professionals and patients wonder if changes in nursing care during hospitalization stimulate independence/autonomy for discharge or reflect carelessness. In conclusion, nursing care is essential during psychiatric hospitalization, but it requires that professionals like it and have the right profile.

  11. Glucose control in the intensive care unit: a roller coaster ride or a swinging pendulum?

    Science.gov (United States)

    Comi, Richard J

    2009-06-01

    Many studies of tight control of blood glucose in critically ill patients are associated with poor outcomes. However, randomized studies of tight glucose control in patients admitted to coronary care or surgical intensive care units showed a reduction in mortality rates; supported by recommendations from professional organizations, many intensive care units implemented protocols for tight glucose control. More recent studies in medical intensive care units did not confirm the benefits of tight control, however, and the most recent study suggests that tight control increases mortality rates. Furthermore, tight control significantly increases episodes of hypoglycemia. The sum of the recent literature suggests that a degree of glucose control lies between the extremes of the adverse outcomes related to poor glucose control and those related to overly aggressive glucose control. PMID:19487715

  12. X-ray diagnosis of pneumothorax in intensive care units

    International Nuclear Information System (INIS)

    Pneumothorax is the most severe manifestation of pulmonary barotrauma which occurs in mechanical ventilation. Diagnosis of pneumothorax in intensive care radiology is of particular difficulty. Chest radiographs in supine position show a variety of signs which may be helpful but are not conclusive. There are different techniques for verification of ventrally located pneumothorax. 450 tangential radiographs of the hemithorax in question are most conclusive for demonstration of extrapulmonary air located inside the pleural cavity. This 450 technique is easy to carry out without changing the patients position. (orig.)

  13. Intraocular infections in the neonatal intensive care unit

    OpenAIRE

    Sisk RA; Berrocal AM; Aziz HA; Flynn HW Jr; Murray TG; Dubovy SR; Hess D; Johnson RA; Hartley K; Diaz-Barbosa M

    2012-01-01

    Hassan A Aziz1, Audina M Berrocal1,2, Robert A Sisk1, Kristin Hartley1, Magaly Diaz-Barbosa2, Rose A Johnson2, Ditte Hess1, Sander R Dubovy1, Timothy G Murray1, Harry W Flynn Jr11Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, 2Jackson Memorial Hospital, Miami, FL, USABackground: The purpose of this study was to report on the incidence and treatment outcomes of endogenous endophthalmitis among newborns in the neonatal intensive care uni...

  14. Radiation exposure of nurses in a coronary care unit

    International Nuclear Information System (INIS)

    In response to increasing awareness of radiation as a possible occupational hazard, nursing personnel staffing a hospital CCU were monitored over a 3-year period to determine occupational exposure. Portable x-ray machines, fluoroscopic units, and patients injected with radiopharmaceuticals were all potential radiation sources on such a unit. Whole-body TLD badges, exchanged monthly, indicated no cumulative exposures over 80 mR during the entire study period. The minimal exposures reported do not justify regular use of dosimeters. Adherence to standard protective measures precludes most exposure to machine-produced radiation. Close, prolonged contact with a patient after an RVG study that utilizes /sup 99m/Tc may account for some exposure. The data indicate that radiation is not a significant occupational hazard for CCU nurses at this hospital; similar minimal exposures would be expected of other nonoccupationally exposed nursing personnel in like environments

  15. Retrenchment in health care organizations: theory and practice.

    Science.gov (United States)

    Fottler, M D; Smith, H L; Muller, H J

    1986-01-01

    This paper analyzes retrenchment in health care organizations in terms of prescriptions in the literature and the actual responses of health care executives to retrenchment. Case studies of five organizations indicate that the range of coping strategies is much more limited than the range of possibilities suggested in the literature. Constraints within the culture of the organization are suggested as an explanation for this disparity.

  16. Acute Surgical Unit: a new model of care.

    Science.gov (United States)

    Cox, Michael R; Cook, Lyn; Dobson, Jennifer; Lambrakis, Paul; Ganesh, Shanthan; Cregan, Patrick

    2010-06-01

    The traditional on-call system for the management of acute general surgical admissions is inefficient and outdated. A new model, Acute Surgical Unit (ASU), was developed at Nepean Hospital in 2006. The ASU is a consultant-driven, independent unit that manages all acute general surgical admissions. The team has the same make up 7 days a week and functions the same every day, including weekends and public holidays. The consultant does a 24-h period of on-call, from 7 pm to 7 pm. They are on remote call from 7 pm to 7 am and are in the hospital from 7 am to 7 pm with their sole responsibility being to the ASU. The ASU has a day team with two registrars, two residents and a nurse practitioner. All patients are admitted and stay in the ASU until discharge or transfer to other units. Handover of the patients at the end of each day is facilitated by a comprehensive ASU database. The implementation of the ASU at Nepean Hospital has improved the timing of assessment by the surgical unit. There has been significant improvement in the timing of operative management, with an increased number and proportion of cases being done during daylight hours, with an associated reduction in the proportion of cases performed afterhours. There is greater trainee supervision with regard to patient assessment, management and operative procedures. There has been an improvement in the consultants' work conditions. The ASU provides an excellent training opportunity for surgical trainees, residents and interns in the assessment and management of acute surgical conditions. PMID:20618194

  17. Patient Safety in Critical Care Unit: Development of a Nursing Quality Indicator System.

    Science.gov (United States)

    Lima, Camila S P; Barbosa, Sayonara F F

    2015-01-01

    This is a methodological study and technological production that aims to describe the development of a computerized system of nursing care quality indicators for the Intensive Care Unit. The study population consisted of a systems analyst and fifteen critical care nurses. For the development of the system we adopted some of the best practices of the Unified Process methodology using the Unified Modeling Language and the programming language Java Enterprise Edition 7. The system consists of an access menu with the following functions: Home (presents general information), New Record (records the indicator), Record (record search), Census (add information and indicators of the patient), Report (generates report of the indicators) and Annex (accesses the Braden Scale). This information system allows for measurement of the quality of nursing care and to evaluate patient safety in intensive care unit by monitoring quality indicators in nursing. PMID:26262049

  18. Applying Orem's theory to the long-term care of adolescent transplant recipients.

    Science.gov (United States)

    Norris, M K

    1991-02-01

    The nursing theory of Dorothea Orem is applied to the care of the adolescent transplant recipient in the long-term setting of outpatient services. The theory of self-care is used as a framework to organize and direct nursing services to this select population. The following article discusses the framework that significantly contributes to maximizing the potential and quality of life for each recipient and assures the quality and utility of professional nursing services. PMID:2003754

  19. Health care policy reform: a microanalytic model for comparing hospitals in the United States and Germany.

    Science.gov (United States)

    Parsons, R J; Woller, G M; Neubauer, G; Rothaemel, F T; Zelle, B

    1999-01-01

    Microcomparison, or single-component analysis, of health care systems offers a potentially better basis for reform than traditional macrocomparison analysis of aggregate elements. Using macroanalysis, available evidence shows that Germany provides cheaper but more effective hospital care than the United States. To find the causes for this outcome, we developed a microanalytic model of hospital administrators' perceptions, financial ratios, medical outcomes, and pharmaceutical costs. However, only data on pharmaceutical costs were available, and these were similar in both countries. Our significant outcome was development of a microcomparative model that gives world medical care providers new criteria for analyzing and improving cost to care ratios.

  20. Stressors in the relatives of patients admitted to an intensive care unit

    Science.gov (United States)

    Barth, Angélica Adam; Weigel, Bruna Dorfey; Dummer, Claus Dieter; Machado, Kelly Campara; Tisott, Taís Montagner

    2016-01-01

    Objective To identify and stratify the main stressors for the relatives of patients admitted to the adult intensive care unit of a teaching hospital. Methods Cross-sectional descriptive study conducted with relatives of patients admitted to an intensive care unit from April to October 2014. The following materials were used: a questionnaire containing identification information and demographic data of the relatives, clinical data of the patients, and 25 stressors adapted from the Intensive Care Unit Environmental Stressor Scale. The degree of stress caused by each factor was determined on a scale of values from 1 to 4. The stressors were ranked based on the average score obtained. Results The main cause of admission to the intensive care unit was clinical in 36 (52.2%) cases. The main stressors were the patient being in a state of coma (3.15 ± 1.23), the patient being unable to speak (3.15 ± 1.20), and the reason for admission (3.00 ± 1.27). After removing the 27 (39.1%) coma patients from the analysis, the main stressors for the relatives were the reason for admission (2.75 ± 1.354), seeing the patient in the intensive care unit (2.51 ± 1.227), and the patient being unable to speak (2.50 ± 1.269). Conclusion Difficulties in communication and in the relationship with the patient admitted to the intensive care unit were identified as the main stressors by their relatives, with the state of coma being predominant. By contrast, the environment, work routines, and relationship between the relatives and intensive care unit team had the least impact as stressors.

  1. Evaluation of satisfaction with care in a midwifery unit and an obstetric unit: a randomized controlled trial of low-risk women

    OpenAIRE

    Bernitz, Stine; Øian, Pål; Sandvik, Leiv; Blix, Ellen

    2016-01-01

    Background Satisfaction with birth care is part of quality assessment of care. The aim of this study was to investigate possible differences in satisfaction with intrapartum care among low-risk women, randomized to a midwifery unit or to an obstetric unit within the same hospital. Methods Randomized controlled trial conducted at the Department of Obstetrics and Gynecology, Østfold Hospital Trust, Norway. A total of 485 women with no expressed preference for level of birth care, assessed to be...

  2. "Where Withstanding is Difficult, and Deserting Even More": Head Nurses’ Phenomenological Description of Intensive Care Units

    Directory of Open Access Journals (Sweden)

    Roghieh Nazari

    2016-01-01

    Full Text Available Introduction: The intensive care unit is one of the specialized units in hospitals where head nurses are responsible for both motivating the personnel and providing high quality care. Understanding of the lived experiences of head nurses could help develop new assumptions of the ICU. The present study was therefore conducted to describe the lived experiences of head nurses working in ICU. Methods: In this phenomenological study, data were collected through unstructured in-depth interviews with 5 ICU head nurses in Northern Iran and then analyzed using 7 steps Colaizzi’s method. Results: Despite the "distressing atmosphere of the ICU", the "difficulty of managing the ICU" and the "difficulty of communication in the ICU", which encourages the "desire to leave the unit" among ICU head nurses, the "desire to stay in the unit" is stronger and head nurses are highly motivated to stay in the unit because the unit "develops a feeling of being extraordinary", "creates an interest in providing complicated care to special patients", "facilitates the spiritual bond", "develops a professional dynamism" and "creates an awareness about the nature of intensive care" among them. Conclusion: According to the result, ICU head nurses are still inclined to work in the unit and achieve success in spite of the problems that persist in working in the ICU. As the individuals’ motivation can be the backbone of organizations, and given that individuals with a high enthusiasm for success are productive, hospital managers can take advantage of this strength in choosing their head nurses.

  3. The activities of hospital nursing unit managers and quality of patient care in South African hospitals: a paradox?

    OpenAIRE

    Armstrong, Susan J; Laetitia C. Rispel; Loveday Penn-Kekana

    2015-01-01

    Background: Improving the quality of health care is central to the proposed health care reforms in South Africa. Nursing unit managers play a key role in coordinating patient care activities and in ensuring quality care in hospitals. Objective: This paper examines whether the activities of nursing unit managers facilitate the provision of quality patient care in South African hospitals. Methods: During 2011, a cross-sectional, descriptive study was conducted in nine randomly selected hospital...

  4. The activities of hospital nursing unit managers and quality of patient care in South African hospitals: a paradox?

    OpenAIRE

    Armstrong, Susan J; Laetitia C. Rispel; Penn-Kekana, Loveday

    2015-01-01

    Background: Improving the quality of health care is central to the proposed health care reforms in South Africa. Nursing unit managers play a key role in coordinating patient care activities and in ensuring quality care in hospitals.Objective: This paper examines whether the activities of nursing unit managers facilitate the provision of quality patient care in South African hospitals.Methods: During 2011, a cross-sectional, descriptive study was conducted in nine randomly selected hospitals ...

  5. Mortality profile across our Intensive Care Units: A 5-year database report from a Singapore restructured hospital.

    Science.gov (United States)

    Siddiqui, Shahla

    2015-12-01

    Intensive care remains an area of high acuity and high mortality across the globe. With a rapidly aging population, the disease burden requiring intensive care is growing. The cost of critical care also is rising with new technology becoming available rapidly. We present the all-cause mortality results of 5 years database established in a restructured, large public hospital in Singapore, looking at all three types of Intensive Care Units present in our hospital. These include medical, surgical, and coronary care units.

  6. Nurse-led implementation of a ventilator-associated pneumonia care bundle in a children's critical care unit.

    Science.gov (United States)

    Hill, Charlotte

    2016-05-01

    Ventilator-associated pneumonia (VAP) is the leading cause of death with hospital-acquired infections, and preventing it is one of the Saving Lives initiatives ( Department of Health 2007 ). This article discusses the implementation of a purpose-designed VAP care bundle in a children's intensive care unit and examines the unique role of nurses in the management of the change process. A nurse-led VAP education, implementation and surveillance programme was set up. Nurse education was paramount, as nursing staff acceptance and involvement was a key feature. A multi-method training strategy was implemented, providing staff with multiple training opportunities and introducing VAP project education as a routine part of staff induction. Bundle compliance was monitored regularly and graphs of the results produced quarterly; feedback proved to be useful in keeping staff informed and engaged in VAP reduction. Comparison of VAP incidence before and after introduction of the care bundle showed a reduction after its implementation. With a co-ordinated, multidisciplinary approach, VAP care bundles can result in significant and sustained reductions in VAP rates in the paediatric intensive care unit. Effective co-ordination and leadership is crucial to successful implementation of the VAP bundle, and nurses are well placed to undertake this role. PMID:27156419

  7. Developing a mental health care plan in a low resource setting: the theory of change approach.

    OpenAIRE

    Hailemariam, M; Fekadu, A.; Selamu, M; Alem, A.; Medhin, G; Giorgis, TW; DeSilva, M.; Breuer, E

    2015-01-01

    Background Scaling up mental healthcare through integration into primary care remains the main strategy to address the extensive unmet mental health need in low-income countries. For integrated care to achieve its goal, a clear understanding of the organisational processes that can promote and hinder the integration and delivery of mental health care is essential. Theory of Change (ToC), a method employed in the planning, implementation and evaluation of complex community initiatives, is an i...

  8. From theory to practice: identifying authentic opinion leaders to improve care.

    Science.gov (United States)

    Collins, B A; Hawks, J W; Davis, R

    2000-07-01

    Diffusion of Innovations and Opinion Leader theories can be translated into practical applications to improve health care delivery and financial performance by applying them to influence referral patterns and decrease variations in care. Health care organizations can rapidly spread "better practices" to their practicing physicians by understanding the social and communication networks that are naturally developed by those practitioners. Physicians view this diffusion process as promoting autonomy, and as a legitimate approach to adoption of information needed in daily practice. PMID:18540342

  9. Infection Prevention and Control for Ebola in Health Care Settings - West Africa and United States.

    Science.gov (United States)

    Hageman, Jeffrey C; Hazim, Carmen; Wilson, Katie; Malpiedi, Paul; Gupta, Neil; Bennett, Sarah; Kolwaite, Amy; Tumpey, Abbigail; Brinsley-Rainisch, Kristin; Christensen, Bryan; Gould, Carolyn; Fisher, Angela; Jhung, Michael; Hamilton, Douglas; Moran, Kerri; Delaney, Lisa; Dowell, Chad; Bell, Michael; Srinivasan, Arjun; Schaefer, Melissa; Fagan, Ryan; Adrien, Nedghie; Chea, Nora; Park, Benjamin J

    2016-01-01

    The 2014-2016 Ebola virus disease (Ebola) epidemic in West Africa underscores the need for health care infection prevention and control (IPC) practices to be implemented properly and consistently to interrupt transmission of pathogens in health care settings to patients and health care workers. Training and assessing IPC practices in general health care facilities not designated as Ebola treatment units or centers became a priority for CDC as the number of Ebola virus transmissions among health care workers in West Africa began to affect the West African health care system and increasingly more persons became infected. CDC and partners developed policies, procedures, and training materials tailored to the affected countries. Safety training courses were also provided to U.S. health care workers intending to work with Ebola patients in West Africa. As the Ebola epidemic continued in West Africa, the possibility that patients with Ebola could be identified and treated in the United States became more realistic. In response, CDC, other federal components (e.g., Office of the Assistant Secretary for Preparedness and Response) and public health partners focused on health care worker training and preparedness for U.S. health care facilities. CDC used the input from these partners to develop guidelines on IPC for hospitalized patients with known or suspected Ebola, which was updated based on feedback from partners who provided care for Ebola patients in the United States. Strengthening and sustaining IPC helps health care systems be better prepared to prevent and respond to current and future infectious disease threats.The activities summarized in this report would not have been possible without collaboration with many U.S. and international partners (http://www.cdc.gov/vhf/ebola/outbreaks/2014-west-africa/partners.html). PMID:27390018

  10. Design of the environment of care for safety of patients and personnel: does form follow function or vice versa in the intensive care unit?

    Science.gov (United States)

    Bartley, Judene; Streifel, Andrew J

    2010-08-01

    We review the context of the environment of care in the intensive care unit setting in relation to patient safety and quality, specifically addressing healthcare-associated infection issues and solutions involving interdisciplinary teams. Issues addressed include current and future architectural design and layout trends, construction trends affecting intensive care units, and prevention of construction-associated healthcare-associated infections related to airborne and waterborne risks and design solutions. Specific elements include single-occupancy, acuity-scalable intensive care unit rooms; environmental aspects of hand hygiene, such as water risks, sink design/location, human waste management, surface selection (floor covering, countertops, furniture, and equipment) and cleaning, antimicrobial-treated or similar materials, ultraviolet germicidal irradiation, specialized rooms (airborne infection isolation and protective environments), and water system design and strategies for safe use of potable water and mitigation of water intrusion. Effective design and operational use of the intensive care unit environment of care must engage critical care personnel from initial planning and design through occupancy of the new/renovated intensive care unit as part of the infection control risk assessment team. The interdisciplinary infection control risk assessment team can address key environment of care design features to enhance the safety of intensive care unit patients, personnel, and visitors. This perspective will ensure the environment of care supports human factors and behavioral aspects of the interaction between the environment of care and its occupants. PMID:20647797

  11. Vulnerabilities of children admitted to a pediatric inpatient care unit

    Directory of Open Access Journals (Sweden)

    Larissa Natacha de Oliveira

    2014-12-01

    Full Text Available OBJECTIVE: To identify the vulnerabilities of children admitted to a pediatric inpatient unit of a university hospital.METHODS: Cross-sectional, descriptive study from April to September 2013 with36 children aged 30 days to 12 years old, admitted to medical-surgical pediatric inpatient units of a university hospital and their caregivers. Data concerning sociocultural, socioeconomic and clinical context of children and their families were collected by interview with the child caregiver and from patients, records, and analyzed by descriptive statistics.RESULTS: Of the total sample, 97.1% (n=132 of children had at least one type of vulnerability, the majority related to the caregiver's level of education, followed by caregiver's financial situation, health history of the child, caregiver's family situation, use of alcohol, tobacco, and illicit drugs by the caregiver, family's living conditions, caregiver's schooling, and bonding between the caregiver and the child. Only 2.9% (n=4 of the children did not show any criteria to be classified in a category of vulnerability.CONCLUSIONS: Most children were classified has having a social vulnerability. It is imperative to create networks of support between the hospital and the primary healthcare service to promote healthcare practices directed to the needs of the child and family.

  12. Theory of Aircraft Flight. Aerospace Education II. Instructional Unit I.

    Science.gov (United States)

    Elmer, James D.

    This publication provides guidelines for teachers using the Aerospace Education II series publication entitled "Theory of Aircraft Flight." The organization of the guide for each chapter is according to objectives (traditional and behavioral), suggested outline, orientation, suggested key points, suggestions for teaching, instructional aids,…

  13. Using Action Research Methodology to Unite Theory and Practice

    Science.gov (United States)

    Deemer, Sandra A.

    2009-01-01

    The author describes an action research project given to masters-level preservice teachers in her educational psychology classes to help them connect the theories they are learning with educational problems they have observed or experienced. Students' responses on a six-item survey indicated that they valued the better understanding of how…

  14. Experiences in end-of-life care in the Intensive Care Unit: A survey of resident physicians

    Science.gov (United States)

    Mohamed, Zubair Umer; Muhammed, Fazil; Singh, Charu; Sudhakar, Abish

    2016-01-01

    Background and Aims: The practice of intensive care includes withholding and withdrawal of care, when appropriate, and the goals of care change around this time to comfort and palliation. We decided to survey the attitudes, training, and skills of intensive care residents in relation to end-of-life (EoL) care. All residents at our institute who has worked for at least a month in an adult Intensive Care Unit were invited to participate. Materials and Methods: After Institutional Ethics Committee approval, a Likert-scale questionnaire, divided into five composite measures of EoL skills including training and attitude, was handed over to individual residents and completed data were anonymized. Frequency and descriptive analysis was performed for the demographic variables. Central tendency, variability, and reliability were examined for the five composite measures. Scale internal consistency was checked by Cronbach's coefficient alpha. Multivariate forward conditional regression analysis was conducted to examine the association of demographic data or EoL experience to composite measures. Results: Of the 170 eligible residents, we received 120 (70.5%) responses. Conclusions: Internal medicine residents have more experience in caring for dying patients and conducting EoL discussions. Even though majority of participants reported that they are comfortable with the concept of EoL care, this does not always reflect the actual practice in the hospital. There is a need for further training in skills around EoL care. As this is a self-assessment survey, the specific measures of attitudes and skills in EoL are poorly reflected, indicating a need for further research.

  15. [Equivalent continuous noise level in neonatal intensive care unit associated to burnout syndrome].

    Science.gov (United States)

    Garrido Galindo, A P; Camargo Caicedo, Y; Vélez-Pereira, A M

    2015-01-01

    Noise levels in neonatal intensive care units allow the appearance of symptoms associated with burnout such as stress, irritability, fatigue and emotional instability on health care personnel. The aim of this study was to evaluate the equivalent continuous noise levels in the neonatal intensive care unit and compare the results with noise levels associated with the occurrence of burnout syndrome on the care team. Continuous sampling was conducted for 20 days using a type I sound level meter on the unit. The maximum, the ninetieth percentile and the equivalent continuous noise level (Leq) values were recorded. Noise level is reported in the range of 51.4-77.6 decibels A (dBA) with an average of 64 dBA, 100.6 dBA maximum, and average background noise from 57.9 dBA. Noise levels exceed the standards suggested for neonatal intensive care units, are close to maximum values referred for noise exposure in the occupational standards and to noise levels associated with the onset of burnout; thus allowing to infer the probability of occurrence of high levels of noise present in the unit on the development of burnout in caregivers. PMID:26187519

  16. International care models for chronic kidney disease: methods and economics--United States.

    Science.gov (United States)

    Crooks, Peter

    2004-01-01

    In the United States, there is a major chronic kidney disease (CKD) problem with over 8 million adults having stage 3 or 4 CKD. There is good medical evidence that many of these patients can benefit from focused interventions. And while there are strong theoretical reasons to believe these interventions are cost-effective, there are little published data to back up this assertion. However, despite the lack of financial data proving cost-effectiveness and against the background of a disorganized health care system in the US, some models of CKD care are being employed. At the present time, the most comprehensive models of care in the US are emerging in vertically integrated health care programs. Other models of care are developing in the setting of managed care health plans that employ CKD disease management programs, either developed internally or in partnership with renal disease management companies.

  17. Urinary density measurement and analysis methods in neonatal unit care

    Directory of Open Access Journals (Sweden)

    Maria Vera Lúcia Moreira Leitão Cardoso

    2013-09-01

    Full Text Available The objective was to assess urine collection methods through cotton in contact with genitalia and urinary collector to measure urinary density in newborns. This is a quantitative intervention study carried out in a neonatal unit of Fortaleza-CE, Brazil, in 2010. The sample consisted of 61 newborns randomly chosen to compose the study group. Most neonates were full term (31/50.8% males (33/54%. Data on urinary density measurement through the methods of cotton and collector presented statistically significant differences (p<0.05. The analysis of interquartile ranges between subgroups resulted in statistical differences between urinary collector/reagent strip (1005 and cotton/reagent strip (1010, however there was no difference between urinary collector/ refractometer (1008 and cotton/ refractometer. Therefore, further research should be conducted with larger sampling using methods investigated in this study and whenever possible, comparing urine density values to laboratory tests.

  18. Care of severe head injury patients in the Sarawak General Hospital: intensive care unit versus general ward.

    Science.gov (United States)

    Sim, S K; Lim, S L; Lee, H K; Liew, D; Wong, A

    2011-06-01

    Intensive care for severe head injury patients is very important in the prevention and treatment of secondary brain injury. However, in a resources constraint environment and limited availability of Intensive Care Unit (ICU) beds in the hospitals, not all severe head injury patients will receive ICU care. This prospective study is aimed to evaluate the outcome of severe head injured patients who received ICU and general ward care in Sarawak General Hospital (SGH) over a 6-month period. A total of thirty five severe head injury patients were admitted. Twenty three patients (65.7%) were ventilated in general ward whereas twelve patients (34.3%) were ventilated in ICU. Overall one month mortality in this study was 25.7%. Patients who received ICU care had a lower one month mortality than those who received general ward care (16.7% vs 30.4%), although it was not statistically different. Multivariate analysis revealed only GCS on admission (OR 0.731; 95% CI 0.460 to 0.877; P=0.042) as the independent predictive factor for one month mortality in this study.

  19. Management of Acute Pancreatitis in Critical Care Unit

    Directory of Open Access Journals (Sweden)

    Güniz Meyancı Köksal

    2010-12-01

    Full Text Available Pancreatitis is characterized by an inflammation occuring due to digestion of pancreatic self tissues and other organs after activation of digestive enzymes which are stable under normal conditions . For all the pancreatitis cases, the mortality rate is <%15. In the acute pancreatitis cases, the monitorization of the inspiration system, cardiovascular system and the metabolic status are needed. There is no primary therapy for the pancreatitis. All the therapy protocols are support therapy. The basic support therapy methods are: Liquid replacement, respiration support, pain management, pancreas secretion inhibition, metabolic support, intra-abdominal monitoring and decompression, nutrition, antibiotherapy, immunomodulation, coagulation mechanism monitoring. In the acute pancreatitis, the causes of early deaths are pancreatic shock and acute pulmonary thrombohemorrhage, within the first 7 days the causes of the 75% deaths are pulmonary shock and congestion and after 7 days the causes of the 77% are pancreas abscess, MOF (multiple organ failure, purulent peritonitis and erosive hemorrhage. (Journal of the Turkish Society of Intensive Care 2010; 8: 85-9

  20. The Self-Care Deficit Nursing Theory as a curriculum conceptual framework in baccalaureate education.

    Science.gov (United States)

    Berbiglia, Violeta A

    2011-04-01

    Although Dorothea Orem's Self-Care Deficit Nursing Theory has been used for curricula framework for years, it was not until 2001 that Orem identified the nursing practice sciences and the foundational nursing sciences and specified the appropriate content for the two sciences. The broad purpose of this paper is to reinforce the importance of utilizing nursing theories as curricular conceptual frameworks. The specific purpose is to delineate the appropriate content for baccalaureate programs that adopt a Self-Care Deficit Nursing Theory conceptual framework for their curriculum. PMID:21471038

  1. Ethics and incentives: an evaluation and development of stakeholder theory in the health care industry.

    Science.gov (United States)

    Elms, Heather; Berman, Shawn; Wicks, Andrew C

    2002-10-01

    This paper utilizes a qualitative case study of the health care industry and a recent legal case to demonstrate that stakeholder theory's focus on ethics, without recognition of the effects of incentives, severely limits the theory's ability to provide managerial direction and explain managerial behavior. While ethics provide a basis for stakeholder prioritization, incentives influence whether managerial action is consistent with that prioritization. Our health care examples highlight this and other limitations of stakeholder theory and demonstrate the explanatory and directive power added by the inclusion of the interactive effects of ethics and incentives in stakeholder ordering.

  2. Health care mergers and acquisitions: implications of robbers cave realistic conflict theory and prisoner's dilemma game theory.

    Science.gov (United States)

    Creasy, Todd; Kinard, Jerry

    2013-01-01

    Many health care mergers and acquisitions have proven highly successful because of the geographic proximity of the institutions, coalignment strategies, complementary services, and improved financial performance. Other health care mergers and acquisitions, however, have been dismal failures. This article seeks to explain a primary cause of less successful mergers or acquisitions through the prism of a multiscale, iterative prisoner's dilemma that occurs between department managers. Aspects of "Coping Theory," "Resource (Conservation) Theory," and "Social Comparison Theory" are used to analyze the experience of employees charged with making mergers or acquisitions successful. Lastly, this article suggests possible culture clash remedies drawn from the realistic conflict experiment conducted by Muzafer Sherif near Robbers Cave State Park in Oklahoma.

  3. [Care provided by nursing students in a neonatal intensive care unit from the mother's point of view].

    Science.gov (United States)

    Pacheco, S T; do Valle, E R; Simões, S M

    2001-01-01

    The objective of the present study is to investigate the perspective of mothers regarding the care given by academics of nursing to their newborn in a neonatal intensive therapy unit. This is a qualitative research based on a phenomenological approach which has as its philosophical framework the thought of Martin Heidegger expressed in his book Being and Time. The data used in the investigation were interviews given by ten mothers who had their newborns in a neonatal intensive therapy unit of a university hospital in the city of Rio de Janeiro. The interpretation of the data collected revealed that mothers viewed the nursing academics as solicitous beings regarding the care given to their newborns. They also acknowledged that these students were engaged in the assistance given and concerned with what was being done and to whom it was being done. PMID:12098862

  4. Cost-benefit analysis: patient care at neurological intensive care unit.

    Science.gov (United States)

    Kopacević, Lenka; Strapac, Marija; Mihelcić, Vesna Bozan

    2013-09-01

    Modern quality definition relies on patient centeredness and on patient needs for particular services, continuous control of the service provided, complete service quality management, and setting quality indicators as the health service endpoints. The health service provided to the patient has certain costs. Thus, one can ask the following: "To what extent does the increasing cost of patient care with changes in elimination improve the quality of health care and what costs are justifiable?" As stroke is the third leading cause of morbidity and mortality in Europe and worldwide, attention has been increasingly focused on stroke prevention and providing quality care for stroke patients. One of the most common medical/nursing problems in these patients is change in elimination, which additionally affects their mental health.

  5. Chicken pox outbreak in the Intensive Care Unit of a tertiary care hospital: Lessons learnt the hard way

    Directory of Open Access Journals (Sweden)

    Sarit Sharma

    2015-01-01

    Full Text Available Varicella-zoster virus (VZV causes 2 clinically and epidemiologically distinct forms of diseases. Chickenpox (varicella is the disease that results from primary infection with the VZV. Herpes zoster (HZ results from the reactivation of VZV latently infecting the dorsal root ganglia. We are reporting an outbreak of varicella infection among the health care workers (HCWs in the Intensive Care Unit (ICU of a tertiary care hospital. We found transmission of varicella among eight HCWs of pulmonary ICU. They had a history of contact with a patient having HZ infection. Investigation of the outbreak was conducted as per guidelines. Better dissemination of information on disease transmission, isolation of infected patients inside the hospital, and adequate protection (including vaccination for susceptible employees are important to prevent such outbreaks.

  6. Chicken pox outbreak in the Intensive Care Unit of a tertiary care hospital: Lessons learnt the hard way.

    Science.gov (United States)

    Sarit, Sharma; Shruti, Sharma; Deepinder, Chhina; Chhina, R S

    2015-12-01

    Varicella-zoster virus (VZV) causes 2 clinically and epidemiologically distinct forms of diseases. Chickenpox (varicella) is the disease that results from primary infection with the VZV. Herpes zoster (HZ) results from the reactivation of VZV latently infecting the dorsal root ganglia. We are reporting an outbreak of varicella infection among the health care workers (HCWs) in the Intensive Care Unit (ICU) of a tertiary care hospital. We found transmission of varicella among eight HCWs of pulmonary ICU. They had a history of contact with a patient having HZ infection. Investigation of the outbreak was conducted as per guidelines. Better dissemination of information on disease transmission, isolation of infected patients inside the hospital, and adequate protection (including vaccination) for susceptible employees are important to prevent such outbreaks. PMID:26816447

  7. Nosocomial infection in a Danish Neonatal Intensive Care Unit: a prospective study

    DEFF Research Database (Denmark)

    Olsen, Anne L; Reinholdt, Jes; Jensen, Anders Mørup;

    2009-01-01

    AIM: The aim of this study was to estimate the incidence and identify independent risk factors for nosocomial infections in a Danish Neonatal Intensive Care Unit and to compare these findings with international results. METHODS: The study was performed prospectively from January 1, 2005 to December...... 31, 2005 in the Neonatal Intensive Care Unit at Rigshospitalet, Copenhagen. Specific criteria for blood stream infection and respiratory tract infection adapted for neonates in our ward were worked out. RESULTS: Six hundred and eighty-three patients were included. The overall incidence of nosocomial...... and respiratory tract infection, and central venous catheter and parenteral nutrition risk factors for first time blood stream infection. CONCLUSION: This first prospective study of nosocomial infection in a Danish Neonatal Intensive Care Unit found an overall incidence of 8.8/1000 hospital days, which is low...

  8. Prediction of chronic critical illness in a general intensive care unit

    Directory of Open Access Journals (Sweden)

    Sérgio H. Loss

    2013-06-01

    Full Text Available OBJECTIVE: To assess the incidence, costs, and mortality associated with chronic critical illness (CCI, and to identify clinical predictors of CCI in a general intensive care unit. METHODS: This was a prospective observational cohort study. All patients receiving supportive treatment for over 20 days were considered chronically critically ill and eligible for the study. After applying the exclusion criteria, 453 patients were analyzed. RESULTS: There was an 11% incidence of CCI. Total length of hospital stay, costs, and mortality were significantly higher among patients with CCI. Mechanical ventilation, sepsis, Glasgow score < 15, inadequate calorie intake, and higher body mass index were independent predictors for cci in the multivariate logistic regression model. CONCLUSIONS: CCI affects a distinctive population in intensive care units with higher mortality, costs, and prolonged hospitalization. Factors identifiable at the time of admission or during the first week in the intensive care unit can be used to predict CCI.

  9. 10 CFR 455.141 - Grant awards for units of local government, public care institutions, and coordinating agencies.

    Science.gov (United States)

    2010-01-01

    ... 10 Energy 3 2010-01-01 2010-01-01 false Grant awards for units of local government, public care... CONSERVATION GRANT PROGRAMS FOR SCHOOLS AND HOSPITALS AND BUILDINGS OWNED BY UNITS OF LOCAL GOVERNMENT AND PUBLIC CARE INSTITUTIONS Grant Awards § 455.141 Grant awards for units of local government, public...

  10. Speaking about dying in the intensive care unit, and its implications for multidisciplinary end-of-life care.

    Science.gov (United States)

    Iedema, Rick; Sorensen, Ros; Braithwaite, Jeffrey; Turnbull, Elizabeth

    2004-01-01

    This article addresses how professionals working in an intensive care unit in Australia speak about dying, with particular reference to the contradictions and complexities that characterize their work in this setting. The article reflects on the incommensurabilities in these clinicians' talk, and the consequences of this for how different professionals work together and care for extremely ill patients. Examples are drawn from talk recorded during ward rounds and focus groups. The article argues that intensive care units are settings where being reflexive about one's work and assumptions is especially difficult because it involves negotiating decisions and taking moral responsibility for decisions affecting very sick patients. These decisions and responsibilities put into sharp relief the 'wicked problems and tragic choices' of end-of-life existence and of intensive care in specific. This article shows some of the complex ways in which specific clinicians' discourse absorbs and manifests these tensions and responsibilities. The article concludes that these kinds of complexities are unlikely to be resolved with reference to formal knowledge or in-principle conviction, and that a new interactive basis needs to be found where clinicians can rehearse alternative ways of speaking with which to approach each other, the dying, and their families.

  11. Negotiating the equivocality of palliative care: a grounded theory of team communicative processes in inpatient medicine.

    Science.gov (United States)

    Ledford, Christy J W; Canzona, Mollie Rose; Cafferty, Lauren A; Kalish, Virginia B

    2016-01-01

    In the majority of U.S. hospitals, inpatient medicine teams make palliative care decisions in the absence of a formalized palliative system. Using a grounded theory approach, interviews with inpatient team members were systematically analyzed to uncover how participants conceptualize palliative care and how they regard the communicative structures that underlie its delivery. During analysis, Weick's model of organizing emerged as a framework that fit the data. The 39 participant inpatient team members discussed palliative care as primarily a communicative process. Themes describing the meaning of palliative care emerged around the concepts of receiver of care, timeline of care, and location of care. The emerging model included four stages in the communicative processes of inpatient palliative care: (a) interpret the need, (b) initiate the conversation, (c) integrate the processes, and (d) identify what works. In contrast to stable, focused palliative care teams or hospice care teams, which have prescribed patient populations and processes, the inpatient medicine team faces the equivocality of providing palliative care within a broader practice. This research offers a four-phase model to show how these inpatient teams communicate within this context. Implications for the provision of palliative care are discussed.

  12. Grammatical Theory in the United States from Bloomfield to Chomsky. Cambridge Studies in Linguistics: 67.

    Science.gov (United States)

    Matthews, P. H.

    A survey of the history of linguistic theory concerning grammar in the United States traces the development of theory since 1910. It begins with a general historical review of American linguistics. The subsequent three chapters focus on grammar. The first of these deals with morphology, beginning with Leonard Bloomfield's ideas in both his early…

  13. Organisational Leadership and Chaos Theory: Let's Be Careful

    Science.gov (United States)

    Galbraith, Peter

    2004-01-01

    This article addresses issues associated with applications of ideas from "chaos theory" to educational administration and leadership as found in the literature. Implications are considered in relation to claims concerning the behaviour of non-linear dynamic systems, and to the nature of the interpretations and recommendations that are made. To aid…

  14. Healthcare Providers’ Perceptions of Breastfeeding Peer Counselors in the Neonatal Intensive Care Unit

    OpenAIRE

    Rossman, Beverly; Engstrom, Janet L.; Meier, Paula P.

    2012-01-01

    In this qualitative descriptive study we examined the perceptions of 17 neonatal intensive care unit (NICU) healthcare providers (nurses, neonatologists, lactation consultants, and dietitians) about the role of breastfeeding peer counselors who were mothers of former NICU infants and who provided primary lactation care in the NICU. Findings revealed that the healthcare providers respected the peer counselors’ lactation expertise and identified three critical elements that contributed to the e...

  15. Are We Being Informed Correctly During the Patient Transfer to the Intensive Care Units?

    OpenAIRE

    Münire Babayiğit; Zehra Baykal Tutal; Necla Dereli; Handan Güleç; Mustafa Alparslan Babayiğit; Eyüp Horasanlı

    2016-01-01

    Objective: We aimed to demonstrate to what extent do the right information in patients’ inter-hospital transfers due to the intensive care indications Material and Method: In this study, 38 patients who applied to our general intensive care unit (ICU) from the other hospitals were included. The demographic data of patients, declarations before ICU admission and diagnosis after admission, the reason and accuracy of the transfer, the overall stay time and the treatments in ICU were recorded....

  16. Educational Needs of Nurses in Intensive Care Unit for Poisoned Patients

    OpenAIRE

    Dadpour B; Soltani Gh; Peivandi Yazdi A; Zirak N; AR Sedaghat; Sabzevari AR; Eftekharzadeh Mashhadi S; Ariayee N; Amini Sh

    2013-01-01

    Objectives: Poisoned patients are at risk of impaired ventilation in many situations. The purpose of this descriptive study was to investigate the impact of educational workshops on nurses' knowledge, confidence, and attitude in taking care of poisoned patients. Materials and Methods: This descriptive study was performed on 60 nursing staff in the intensive care unit (ICU) for poisoned patients in Imam Reza (p) hospital, Mashhad, Iran. Data was gathered by a researcher-designed questionnaire....

  17. How to compare adequacy of algorithms to control blood glucose in the intensive care unit?

    OpenAIRE

    Van den Berghe , Greet

    2004-01-01

    Vogelzang et al. retrospectively assessed a derivative marker of blood glucose control over time in the intensive care unit (ICU), "the hyperglycemic index" (HGI), in relation to outcome. The HGI predicted mortality better than other indices of blood glucose control that do not take the duration of hyperglycemia into account. This provided further support to the concept of maintaining normoglycemia with insulin throughout intensive care in order to improve outcome. The HGI was also proposed a...

  18. Early Rehabilitation in the Intensive Care Unit: Preventing Physical and Mental Health Impairments

    OpenAIRE

    Parker, Ann; Sricharoenchai, Thiti; Needham, Dale M.

    2013-01-01

    Survivors of critical illness often experience new or worsening impairments in physical, cognitive and/or mental health, referred to as post-intensive care syndrome (PICS). Such impairments can be long-lasting and negatively impact survivors’ quality of life. Early rehabilitation in the intensive care unit (ICU), while patients remain on life-support therapies, may reduce the complications associated with PICS. This article addresses evidence-based rehabilitation interventions to reduce the p...

  19. Dental Care Use Among Pregnant Women in the United States Reported in 1999 and 2002

    OpenAIRE

    Peggy Timothé, DDS, MPH; Paul I. Eke, PhD, MPH, PhD; Scott M. Presson, DDS, MPH; Dolores M. Malvitz, DrPH

    2004-01-01

    Introduction The purpose of this study was to determine national and state-specific estimates of dental care use among adult pregnant women in the United States using data from two 12-month periods. The study also determined person-level characteristics that may predict a lack of dental care use within this subgroup. Methods Responses were analyzed from 4619 pregnant women aged 18 to 44 years who participated in the 1999 and 2002 state-based Behavioral Risk Factor Surveillance System. De...

  20. Patients with diabetes in the intensive care unit; not served by treatment, yet protected?

    OpenAIRE

    Siegelaar, S.E.; DeVries, J. H.; Hoekstra, J.B.

    2010-01-01

    Diabetes is associated with severe complications and decreased life expectancy. However, in the previous issue of Critical Care, Vincent and colleagues report no difference in mortality between patients with insulin-treated diabetes and patients without diabetes in the intensive care unit ( ICU), despite larger severity of illness in the diabetes group at admission. This study contributes to the growing evidence that diabetes in itself is not a risk factor for ICU mortality, although the mech...

  1. Terminal care in older patients in hospital: development of a quality indicator set and its first application in a retrospective comparison of patients treated in acute geriatric unit and a palliative care unit of a Belgian university hospital

    OpenAIRE

    Cools, Annelies; Vaneechoutte, Delphine; Van Den Noortgate, Nele; VERSLUYS, KAREN; De Laat, Martine; Petrovic, Mirko; Piers, Ruth

    2015-01-01

    Background: Care at the end-of-life of geriatric inpatients is of increasing importance. Nevertheless, limited research has been conducted on this subject so far. Objectives: To compose a set of quality indicators (QIs) which measure the quality of terminal care for geriatric inpatients and to compare the quality of end-of-life care between the Acute Geriatric Unit (AGU) and the Palliative Care Unit (PCU). Design: Retrospective case study. Setting: Belgian university hospital. Par...

  2. Microbiological pattern of arterial catheters in the intensive care unit

    Directory of Open Access Journals (Sweden)

    Patel Bharat

    2010-10-01

    Full Text Available Abstract Background Intravascular catheter related infection (CRI is one of the most serious nosocomial infections. Diagnostic criteria include a positive culture from the catheter tip along with blood, yet in many patients with signs of infection, current culture techniques fail to identify pathogens on catheter segments. We hypothesised that a molecular examination of the bacterial community on short term arterial catheters (ACs would improve our understanding of the variety of organisms that are present in this niche environment and would help develop new methods for the diagnosis of CRI. Results The whole bacterial community presenting on all ACs was evaluated by molecular methods, i.e., a strategy of whole community DNA extraction, PCR amplification followed by cloning and 16S rDNA sequence analysis. Ten ACs were removed from patients suspected of CRI and 430 clones from 5 "colonised" and 5 "uncolonised" (semi-quantitative method AC libraries were selected for sequencing and subsequent analysis. A total of 79 operational taxonomic units (OTUs were identified at the level of 97% similarity belonging to six bacterial divisions. An average of 20 OTUs were present in each AC, irrespective of colonisation status. Conventional culture failed to reveal the majority of these bacteria. Conclusions There was no significant difference in the bacterial diversity between the 'uncolonised' and 'colonised' ACs. This suggests that vascular devices cultured conventionally and reported as non infective may at times potentially be a significant source of sepsis in critically ill patients. Alternative methods may be required for the accurate diagnosis of CRI in critically ill patients.

  3. The Slavic Translation Lexicography Theory and Practice: on the Material of the Stable Word Units

    Directory of Open Access Journals (Sweden)

    Алла [Alla] Лучик [Luchyk

    2015-12-01

    Full Text Available The Slavic Translation Lexicography Theory and Practice: on the Material of the Stable Word UnitsThe paper deals with the idea of the need for the dictionaries of stable units in each of the Slavic language. The register of the lexicographical works must include the word equivalents, phraseological units terminological units. For a new type of the dictionary the principles its arrangement are established. It is proved that such work will open new horizons for the further theoretical observations on the properties of the language system as well as its practical mastering. The dictionaries of the stable units will be of particular importance to the field of Slavic translation.

  4. The prevalence of vitamin D deficiency in intensive care unit and its influence on prognosis

    Institute of Scientific and Technical Information of China (English)

    胡杰妤

    2013-01-01

    Objective To investigate the prevalence of vitamin D deficiency in medical intensive care unit (ICU) and its relationship with severity of disease and prognosis.Methods A prospective study was performed to evaluate vitamin D status in 216 patients admitted to the medical intensive care unit.The incidence of hypovitaminosis D was observed.Acute Physiology and Chronic Health EvaluationⅡ (APACHEⅡ) score,days kept in ICU and on ventilator,main laboratory findings,and mortality rate were compared among patients with different serum 25-hydroxyvi-

  5. Sri Lanka's Health Unit Program: A Model of "Selective" Primary Health Care

    Directory of Open Access Journals (Sweden)

    Soma Hewa

    2011-12-01

    Full Text Available This paper argues that the health unit program developed in Sri Lanka in the early twentieth century was an earlier model of selective primary health care promoted by the Rockefeller Foundation in the 1980s in opposition to comprehensive primary health care advocated by the Alma-Ata Declaration of the World Health Organization. A key strategy of the health unit program was to identify the most common and serious infectious diseases in each health unit area and control them through improved sanitation, health education, immunization and treatment with the help of local communities. The health unit program was later introduced to other countries in South and Southeast Asia as part of the Rockefeller Foundation's global campaign to promote public health.

  6. Preventing intensive care unit delirium: a patient-centered approach to reducing sleep disruption.

    Science.gov (United States)

    Stuck, Amy; Clark, Mary Jo; Connelly, Cynthia D

    2011-01-01

    Delirium in the intensive care unit is a disorder with multifactorial causes and is associated with poor outcomes. Sleep-wake disturbance is a common experience for patients with delirium. Care processes that disrupt sleep can lead to sleep deprivation, contributing to delirium. Patient-centered care is a concept that considers what is best for each individual. How can clinicians use a patient-centered approach to alter processes to decrease patient disruptions and improve sleep and rest? Could timing of blood draws and soothing music work to promote sleep? PMID:21983504

  7. Delivery of surgical care in a district general hospital without high dependency unit facilities

    OpenAIRE

    Coggins, R

    2000-01-01

    BACKGROUND—Many hospitals lack the facilities for high dependency care, and patients requiring this level of care are nursed on the surgical ward. The aim of this study was to assess the extent of this problem in a district general hospital, looking at the impact of providing high dependency unit (HDU) care at ward level.
METHODS—A 28 bed surgical ward was studied for 39 consecutive days. Patients were assessed as being either appropriately placed (routine) or inappropriately placed (HDU). Nu...

  8. Ethical issues recognized by critical care nurses in the intensive care units of a tertiary hospital during two separate periods.

    Science.gov (United States)

    Park, Dong Won; Moon, Jae Young; Ku, Eun Yong; Kim, Sun Jong; Koo, Young-Mo; Kim, Ock-Joo; Lee, Soon Haeng; Jo, Min-Woo; Lim, Chae-Man; Armstrong, John David; Koh, Younsuck

    2015-04-01

    This research aimed to investigate the changes in ethical issues in everyday clinical practice recognized by critical care nurses during two observation periods. We conducted a retrospective analysis of data obtained by prospective questionnaire surveys of nurses in the intensive care units (ICU) of a tertiary university-affiliated hospital in Seoul, Korea. Data were collected prospectively during two different periods, February 2002-January 2003 (Period 1) and August 2011-July 2012 (Period 2). Significantly fewer cases with ethical issues were reported in Period 2 than in Period 1 (89 cases [2.1%] of 4,291 ICU admissions vs. 51 [0.5%] of 9,302 ICU admissions, respectively; P ethical issues in both Periods occurred in MICU. The major source of ethical issues in Periods 1 and 2 was behavior-related. Among behaviorrelated issues, inappropriate healthcare professional behavior was predominant in both periods and mainly involved resident physicians. Ethical issue numbers regarding end-oflife (EOL) care significantly decreased in the proportion with respect to ethical issues during Period 2 (P = 0.044). In conclusion, the decreased incidence of cases with identified ethical issues in Period 2 might be associated with ethical enhancement related with EOL and improvements in the ICU care environment of the studied hospital. However, behaviorrelated issues involving resident physicians represent a considerable proportion of ethical issues encountered by critical care nurses. A systemic approach to solve behavior-related issues of resident physicians seems to be required to enhance an ethical environment in the studied ICU.

  9. Successful introduction of a daily checklist to enhance compliance with accepted standards of care in the medical intensive care unit.

    Science.gov (United States)

    Nama, A; Sviri, S; Abutbul, A; Stav, I; van Heerden, P V

    2016-07-01

    We introduced a simple checklist to act as an aid to memory for our junior medical staff to ensure that every patient in the intensive care unit (ICU) received every appropriate element of a bundle of care every day. The checklist was developed in consultation with our junior doctors and was designed to be completed every morning for every patient by the junior doctor reviewing the patient. The completed checklist was then checked again by the attending intensivist on the main daily ward round to ensure all the appropriate elements of the checklist had been applied to the patient. It was also noted each day which of the elements of the checklist had been forgotten and was therefore prompted to be completed by use of the checklist. Of the 75 patients surveyed there were 99 occasions, in 48 patients, when the checklist detected a forgotten element of the bundle of care (i.e. in 64% of patients). There was a decrease in the incidence of missed elements of the bundle of care the longer the patient stayed in the ICU. Types of missed elements varied with the duration of the ICU stay. We found that the introduction of a simple checklist, developed in collaboration with the junior medical staff who would be using the checklist every day in the ICU, resulted in the detection and correction of missed elements of a bundle of care we had previously introduced in the ICU.

  10. Special Care Units and Traditional Care in Dementia: Relationship with Behavior, Cognition, Functional Status and Quality of Life - A Review

    Directory of Open Access Journals (Sweden)

    Jeroen S. Kok

    2013-10-01

    Full Text Available Background: Special care facilities for patients with dementia gain increasing attention. However, an overview of studies examining the differences between care facilities with respect to their effects on behavior, cognition, functional status and quality of life is lacking. Results: Our literature search resulted in 32 studies published until October 2012. Overall, patients with dementia who lived at special care units (SCUs showed a significantly more challenging behavior, more agitation/aggression, more depression and anxiety, more cases of global cognitive impairment and a better psychosocial functioning. There was a tendency towards a better functional status in specialized care facilities, and a better quality of life was found in favor of the SCU group compared to the traditional nursing home (n-SCU group. Longitudinal studies showed an increased number of neuropsychiatric cases, more patients displaying deteriorating behavior and resistance to care as well as less decline in activities of daily living (ADL in the SCU group compared to the n-SCU group. Patients in small-scale, homelike SCUs showed more agitation and less ADL decline compared to SCU patients. Conclusion: This review shows that the patient characteristics in SCU and n-SCU settings and, to a minor extent, in SCU and small-scale, homelike SCU settings are different. Over time, there are differences between n-SCU, SCU and small-scale, homelike SCU facilities for some variables.

  11. Can we learn anything from health care in the United States?

    Science.gov (United States)

    Anstey, Matthew H R; Elshaug, Adam G; Russell, Lesley M; Wells, Susan

    2014-05-19

    Some aspects of health care in the United States would be beneficial to Australia and New Zealand, but others should be avoided. Positive aspects, which should be emulated, include: •health care reform that is focused on the continuum of care and patient-centred care •trials of new models to organise, deliver and pay for health care services, where quality of care is rewarded over quantity of services •an integral view of, and strong support for, health services research as a means of evaluating reforms aimed at improving patient outcomes and systems-level efficiencies •physician engagement in reforms--for example, participating in the Choosing Wisely initiative, and trialling and implementing new payment models that are not fee-for-service. Negative aspects, which should be avoided, include: •increasingly fragmented provider and financing structures (funding provided by state and federal governments, private insurance and out-of-pocket costs) that cause frustration in terms of access and care coordination and increase administrative waste •an overemphasis on technological solutions, with insufficient acknowledgment of the importance of addressing value in health care •a focus on hospital and doctor-based health care rather than environmental and social inputs into health.

  12. Parental rejection of homosexuals in a family primary health care unit

    OpenAIRE

    Donovan Casas Patiño; Alejandra Rodríguez Torres; Camila Pereira Abagaro

    2014-01-01

    Objective: To know the frequency of parental rejection in homosexual patients in a family primary health care unit. Methods: A descriptive study carried out by the application of the Family Rejection instrument by Lozano-Díaz (2010) to 39 parents of homosexual patients assigned to the Family Medicine Unit no 195 in Chalco, Mexico. The non-probabilistic convenience sample was obtained in family medicine consultations and appointments with the parents of patients recognized as homosexuals were ...

  13. Importance of asymptomatic shedding of Clostridium difficile in environmental contamination of a neonatal intensive care unit.

    Science.gov (United States)

    Faden, Howard S; Dryja, Diane

    2015-08-01

    A survey of C. difficle in a neonatal intensive care unit (NICU) was conducted. Approximately 25% of infants in the NICU were colonized with Clostridium difficle. Environmental surface cultures were obtained from the NICU and compared with cultures taken from infant, adolescent, and hematology/oncology units. From 150 surface cultures, C difficle was recovered exclusively from the NICU. Of the 16 different types of surfaces cultured, diaper scales and the surrounding area were contaminated most often at 50%.

  14. Unit managers' role in improving nursing teamwork in a mental health care facility / Mariska Elizabeth Oosthuizen–Van Tonder

    OpenAIRE

    Oosthuizen–Van Tonder, Mariska Elizabeth

    2014-01-01

    The nursing team in a mental health care facility is a known dynamic at every hospital, rehabilitation centre and out-patient unit which enables these units to be functional. Currently nursing teams function in a challenged environment in mental health care facilities. The National Department of Health in South Africa states that one of the priority areas in the core standards of health care is to improve values and attitudes of health care professionals. One of the ways to accomplish this is...

  15. End-of-life care in the intensive care unit: Report from the Task Force of World Federation of Societies of Intensive and Critical Care Medicine.

    Science.gov (United States)

    Myburgh, John; Abillama, Fayez; Chiumello, Davide; Dobb, Geoff; Jacobe, Stephen; Kleinpell, Ruth; Koh, Younsuk; Martin, Claudio; Michalsen, Andej; Pelosi, Paolo; Torra, Lluis Blanch; Vincent, Jean-Louis; Yeager, Susan; Zimmerman, Janice

    2016-08-01

    End-of-life care in the intensive care unit (ICU) was identified as an objective in a series of Task Forces developed by the World Federation of Societies of Intensive and Critical Care Medicine Council in 2014. The objective was to develop a generic statement about current knowledge and to identify challenges relevant to the global community that may inform regional and local initiatives. An updated summary of published statements on end-of-life care in the ICU from national Societies is presented, highlighting commonalities and differences within and between international regions. The complexity of end-of-life care in the ICU, particularly relating to withholding and withdrawing life-sustaining treatment while ensuring the alleviation of suffering, within different ethical and cultural environments is recognized. Although no single statement can therefore be regarded as a criterion standard applicable to all countries and societies, the World Federation of Societies of Intensive and Critical Care Medicine endorses and encourages the role of Member Societies to lead the debate regarding end-of-life care in the ICU within each country and to take a leading role in developing national guidelines and recommendations within each country. PMID:27288625

  16. Multinational corporations and health care in the United States and Latin America: strategies, actions, and effects.

    Science.gov (United States)

    Jasso-Aguilar, Rebeca; Waitzkin, Howard; Landwehr, Angela

    2004-01-01

    In this article we analyze the corporate dominance of health care in the United States and the dynamics that have motivated the international expansion of multinational health care corporations, especially to Latin America. We identify the strategies, actions, and effects of multinational corporations in health care delivery and public health policies. Our methods have included systematic bibliographical research and in-depth interviews in the United States, Mexico, and Brazil. Influenced by public policy makers in the United States, such organizations as the World Bank, International Monetary Fund, and World Trade Organization have advocated policies that encourage reduction and privatization of health care and public health services previously provided in the public sector. Multinational managed care organizations have entered managed care markets in several Latin American countries at the same time as they were withdrawing from managed care activities in Medicaid and Medicare within the United States. Corporate strategies have culminated in a marked expansion of corporations' access to social security and related public sector funds for the support of privatized health services. International financial institutions and multinational corporations have influenced reforms that, while favorable to corporate interests, have worsened access to needed services and have strained the remaining public sector institutions. A theoretical approach to these problems emphasizes the falling rate of profit as an economic motivation of corporate actions, silent reform, and the subordination of polity to economy. Praxis to address these problems involves opposition to policies that enhance corporate interests while reducing public sector services, as well as alternative models that emphasize a strengthened public sector

  17. Large discrepancy between prehospital visitation to mobile emergency care unit and discharge diagnosis

    DEFF Research Database (Denmark)

    Holler, Christine Puck; Wichmann, Sine; Nielsen, Søren Loumann;

    2012-01-01

    to deliver optimal care in the form of percutaneous transluminal coronary angioplasty. In theory, all patients with chest pain could have STEMI. The aim of this study was to study which of the patients suspected of having acute cardiac disease based on the 112 calls and met by the MECU were given a cardiac...

  18. Investigating the European perspective of neonatal point-of-care echocardiography in the neonatal intensive care unit-a pilot study

    NARCIS (Netherlands)

    Roehr, C. C.; te Pas, A. B.; Dold, Simone K.; Breindahl, M.; Blennow, M.; Ruediger, M.; Gupta, Samir

    2013-01-01

    Point-of-care functional neonatal echocardiography (fnECHO) is increasingly used to assess haemodynamic status or patency of the ductus arteriosus (PDA). In Australasia, 90 % of neonatal intensive care units (NICUs) practice point-of-care fnECHO. The Australian Society of Ultrasound Medicine offers

  19. Using activity-based costing and theory of constraints to guide continuous improvement in managed care.

    Science.gov (United States)

    Roybal, H; Baxendale, S J; Gupta, M

    1999-01-01

    Activity-based costing and the theory of constraints have been applied successfully in many manufacturing organizations. Recently, those concepts have been applied in service organizations. This article describes the application of activity-based costing and the theory of constraints in a managed care mental health and substance abuse organization. One of the unique aspects of this particular application was the integration of activity-based costing and the theory of constraints to guide process improvement efforts. This article describes the activity-based costing model and the application of the theory of constraint's focusing steps with an emphasis on unused capacities of activities in the organization.

  20. Using activity-based costing and theory of constraints to guide continuous improvement in managed care.

    Science.gov (United States)

    Roybal, H; Baxendale, S J; Gupta, M

    1999-01-01

    Activity-based costing and the theory of constraints have been applied successfully in many manufacturing organizations. Recently, those concepts have been applied in service organizations. This article describes the application of activity-based costing and the theory of constraints in a managed care mental health and substance abuse organization. One of the unique aspects of this particular application was the integration of activity-based costing and the theory of constraints to guide process improvement efforts. This article describes the activity-based costing model and the application of the theory of constraint's focusing steps with an emphasis on unused capacities of activities in the organization. PMID:10350791

  1. Communication of bed allocation decisions in a critical care unit and accountability for reasonableness

    Directory of Open Access Journals (Sweden)

    Swota Alissa H

    2005-10-01

    Full Text Available Abstract Background Communication may affect perceptions of fair process for intensive care unit bed allocation decisions through its impact on the publicity condition of accountability for reasonableness. Methods We performed a qualitative case study to describe participant perceptions of the communication of bed allocation decisions in an 18-bed university affiliated, medical-surgical critical care unit at Sunnybrook and Women's College Health Sciences Centre. Interviewed participants were 3 critical care physicians, 4 clinical fellows in critical care, 4 resource nurses, 4 "end-users" (physicians who commonly referred patients to the unit, and 3 members of the administrative staff. Median bed occupancy during the study period (Jan-April 2003 was 18/18; daily admissions and discharges (median were 3. We evaluated our description using the ethical framework "accountability for reasonableness" (A4R to identify opportunities for improvement. Results The critical care physician, resource nurse, critical care fellow and end-users (trauma team leader, surgeons, neurosurgeons, anesthesiologists functioned independently in unofficial "parallel tracks" of bed allocation decision-making; this conflicted with the official designation of the critical care physician as the sole authority. Communication between key decision-makers was indirect and could exclude those affected by the decisions; notably, family members. Participants perceived a lack of publicity for bed allocation rationales. Conclusion The publicity condition should be improved for critical care bed allocation decisions. Decision-making in the "parallel tracks" we describe might be unavoidable within usual constraints of time, urgency and demand. Formal guidelines for direct communication between key participants in such circumstances would help to improve the fairness of these decisions.

  2. Interprofessional rhetoric and operational realities: an ethnographic study of rounds in four intensive care units.

    Science.gov (United States)

    Paradis, Elise; Leslie, Myles; Gropper, Michael A

    2016-10-01

    Morning interprofessional rounds (MIRs) are used in critical care medicine to improve team-based care and patient outcomes. Given existing evidence of conflict between and dissatisfaction among rounds participants, this study sought to better understand how the operational realities of care delivery in the intensive care unit (ICU) impact the success of MIRs. We conducted a year-long comparative ethnographic study of interprofessional collaboration and patient and family involvement in four ICUs in tertiary academic hospitals in two American cities. The study included 576 h of observation of team interactions, 47 shadowing sessions and 40 clinician interviews. In line with best practices in ethnographic research, data collection and analysis were done iteratively using the constant comparative method. Member check was conducted regularly throughout the project. MIRs were implemented on all units with the explicit goals of improving team-based and patient-centered care. Operational conditions on the units, despite interprofessional commitment and engagement, appeared to thwart ICU teams from achieving these goals. Specifically, time constraints, struggles over space, and conflicts between MIRs' educational and care-plan-development functions all prevented teams from achieving collaboration and patient-involvement. Moreover, physicians' de facto control of rounds often meant that they resembled medical rounds (their historical predecessors), and sidelined other providers' contributions. This study suggests that the MIRs model, as presently practiced, might not be well suited to the provision of team-based, patient-centered care. In the interest of interprofessional collaboration, of the optimization of clinicians' time, of high-quality medical education and of patient-centered care, further research on interprofessional rounds models is needed. PMID:26704051

  3. Interprofessional rhetoric and operational realities: an ethnographic study of rounds in four intensive care units.

    Science.gov (United States)

    Paradis, Elise; Leslie, Myles; Gropper, Michael A

    2016-10-01

    Morning interprofessional rounds (MIRs) are used in critical care medicine to improve team-based care and patient outcomes. Given existing evidence of conflict between and dissatisfaction among rounds participants, this study sought to better understand how the operational realities of care delivery in the intensive care unit (ICU) impact the success of MIRs. We conducted a year-long comparative ethnographic study of interprofessional collaboration and patient and family involvement in four ICUs in tertiary academic hospitals in two American cities. The study included 576 h of observation of team interactions, 47 shadowing sessions and 40 clinician interviews. In line with best practices in ethnographic research, data collection and analysis were done iteratively using the constant comparative method. Member check was conducted regularly throughout the project. MIRs were implemented on all units with the explicit goals of improving team-based and patient-centered care. Operational conditions on the units, despite interprofessional commitment and engagement, appeared to thwart ICU teams from achieving these goals. Specifically, time constraints, struggles over space, and conflicts between MIRs' educational and care-plan-development functions all prevented teams from achieving collaboration and patient-involvement. Moreover, physicians' de facto control of rounds often meant that they resembled medical rounds (their historical predecessors), and sidelined other providers' contributions. This study suggests that the MIRs model, as presently practiced, might not be well suited to the provision of team-based, patient-centered care. In the interest of interprofessional collaboration, of the optimization of clinicians' time, of high-quality medical education and of patient-centered care, further research on interprofessional rounds models is needed.

  4. Physical and Visual Accessibilities in Intensive Care Units: A Comparative Study of Open-Plan and Racetrack Units.

    Science.gov (United States)

    Rashid, Mahbub; Khan, Nayma; Jones, Belinda

    2016-01-01

    This study compared physical and visual accessibilities and their associations with staff perception and interaction behaviors in 2 intensive care units (ICUs) with open-plan and racetrack layouts. For the study, physical and visual accessibilities were measured using the spatial analysis techniques of Space Syntax. Data on staff perception were collected from 81 clinicians using a questionnaire survey. The locations of 2233 interactions, and the location and length of another 339 interactions in these units were collected using systematic field observation techniques. According to the study, physical and visual accessibilities were different in the 2 ICUs, and clinicians' primary workspaces were physically and visually more accessible in the open-plan ICU. Physical and visual accessibilities affected how well clinicians' knew their peers and where their peers were located in these units. Physical and visual accessibilities also affected clinicians' perception of interaction and communication and of teamwork and collaboration in these units. Additionally, physical and visual accessibilities showed significant positive associations with interaction behaviors in these units, with the open-plan ICU showing stronger associations. However, physical accessibilities were less important than visual accessibilities in relation to interaction behaviors in these ICUs. The implications of these findings for ICU design are discussed. PMID:27575795

  5. Is German long-term care insurance a model for the United States?

    Science.gov (United States)

    Schunk, M V; Estes, C L

    2001-01-01

    German long-term care insurance, implemented in 1995, significantly extends the coverage of care-related risks. Given the similarities of German and U.S. institutional features, the German social insurance approach has been put forward as a possible model for long-term care in the United States. Using a political economy framework, the authors conducted a policy analysis that compares the main shortfalls of long-term care (LTC) provision in the United States and Germany, examines the responses provided by LTC insurance in Germany, and relates them to broader trends and proposals for change in welfare policy in both countries. German LTC insurance includes a high degree of consumer direction and compensation and protection for informal caregivers; it supports the extension of community-based services. Its shortfalls include the continued split between health and LTC insurance. In both countries, decentralization and institutional and financial fragmentation are some of the characteristics responsible for the failure to promote egalitarian social policy and substantially expand social protection to family- and care-related risks. The German LTC program is a good model for the United States. With a social insurance approach to LTC, costs are spread across the largest possible risk pool. Major goals that can be reached with such a program include establishment of universal entitlements to LTC benefits, consumer choice, and equitability and uniformity. PMID:11562009

  6. Integrating Preexposure Prophylaxis for Human Immunodeficiency Virus Prevention Into Women's Health Care in the United States.

    Science.gov (United States)

    Seidman, Dominika; Weber, Shannon

    2016-07-01

    Women comprise one in five new human immunodeficiency virus (HIV) diagnoses in the United States. Trials and implementation projects demonstrate preexposure prophylaxis for HIV prevention is effective in women. Preexposure prophylaxis is a method of preventing HIV acquisition by having an HIV-negative individual take antiretroviral medication before exposure. The U.S. Food and Drug Administration approved daily oral tenofovir disoproxil fumarate coformulated with emtricitabine as preexposure prophylaxis for HIV prevention in 2012. Preexposure prophylaxis is highly dependent on adherence for effectiveness. The Centers for Disease Control and Prevention recommends offering preexposure prophylaxis to individuals at significant risk of infection and estimates 468,000 women in the United States are eligible for preexposure prophylaxis. Although variable individual and structural forces affect each woman's medication adherence, and therefore the effectiveness of preexposure prophylaxis, women's health care providers are uniquely positioned to screen, counsel about, and offer preexposure prophylaxis. Shared decision-making provides a framework for these clinical encounters, allowing patients and clinicians to make health care decisions together based on scientific evidence and patient experiences. By incorporating fertility desires and contraceptive needs, health care providers effectively integrate sexual and reproductive health care. Including preexposure prophylaxis in women's health services requires health care provider training and attention to lessons learned from family planning and HIV prevention. Nevertheless, obstetrician-gynecologists have an opportunity to play a critical role in reducing sexual transmission of HIV in the United States by integrating preexposure prophylaxis education and provision into their practices. PMID:27275793

  7. Frequency and Outcome of Meningitis in Pediatric Intensive Care Unit of Pakistan.

    Science.gov (United States)

    Jawaid, Amna; Bano, Surriya; Haque, Anwar Ul; Arif, Khubaib

    2016-08-01

    Meningitis is a leading cause of morbidity and mortality worldwide in intensive care settings. The aim of this study was to assess the frequency and outcome in children with meningitis through a retrospective chart review done in pediatric intensive care unit of a tertiary care hospital from January 2000 to December 2014. During these 14 years, 64 patients were admitted with meningitis in pediatric intensive care unit. Out of 64, 36 were diagnosed with pyogenic meningitis, 18 patients with viral meningitis, and 10 with tuberculous meningitis. Most complications were observed in the initial 48 hours. Most common presentation was altered level of consciouness in 50 (78.1%), seizure in 38 (59.4%), and shock in 23 (35.9%) patients. Ventilatory support was required in 30 (46.9%) patients and inotropic support in 26 (40.6%). During stay in pediatric intensive care unit, there was 7.8% mortality. Although meningitis was an infrequent cause of hospitalization at the study centre, but it was an important infectious cause of mortality and morbidity in pediatric age group and associated with high neurological sequelae. PMID:27539773

  8. [Quality of care in the family healthcare units in the city of Recife: user perception].

    Science.gov (United States)

    Santiago, Renata Florêncio; Mendes, Antonio da Cruz Gouveia; Miranda, Gabriella Morais Duarte; Duarte, Petra Oliveira; Furtado, Betise Mery Alencar Sousa Macau; Souza, Wayner Vieira de

    2013-01-01

    This study seeks to assess user perception regarding the quality of care in Family Health Units in Recife. It is a descriptive cross-sectional study adopting a quantitative approach. The survey was conducted in Recife and 939 users were interviewed, being predominantly young adults, female, married, housewives with low levels of education. They have strong links with the units, taking it as a benchmark for their care. The results show care in accordance with scheduled demand and users manifest marked satisfaction with the work of the professionals and less satisfaction with the conditions offered at the units. The younger and more educated the users are, the less satisfied they are with the conditions offered. There is considerable dissatisfaction with delays in attendance, in accessibility and the lack of educational and community activities, the latter two dimensions being related to the core principles of this strategy. The marked satisfaction with clinical care, confidentiality and right to information, which are dimensions related to user-professional relationship are fundamental to the quality of care. This evaluation focused on each aspect of the service provided and makes an important contribution with the critical appraisal reported by users. PMID:23338494

  9. Evaluation of vitamin D level in patients from neurosurgical intensive care unit

    Institute of Scientific and Technical Information of China (English)

    Ho Jun Yi; Je Hoon Jeong; Eun-Sun Jin; Il Young Shin; Hyung Sik Hwang; Seung-Myung Moon

    2013-01-01

    Vitamin D plays an important role in maintaining normal bone metabolism. Recent studies have suggested that vitamin D influences many other physiological processes, including muscle function, cardiovascular homeostasis, nerve function, and immune response. Furthermore, accumulated evidence suggests that vitamin D also mediates the immune system response to infection. Critical neurosurgical patients have higher infection and mortality rates. To correlate vitamin D deficiency to the immunological status of neurosurgical intensive care unit patients, we detected serum vitamin D level in 15 patients with clinically suspected infection and 10 patients with confirmed infection. Serum level of 25-hydroxyvitamin D, the primary circulating form of vitamin D, was significantly decreased in patients with suspected or confirmed infection after a 2-week neurosurgical intensive care unit hospitalization, while serum level of 1,25-dihydroxyvitamin D, the active form of vitamin D, was significantly decreased in patients after a 4-week neurosurgical intensive care unit hospitalization. These findings suggest that vitamin D deficiency is linked to the immunological status of neurosurgical intensive care unit patients and vitamin D supplementation can improve patient's immunological status.

  10. Computers in hospital management and improvements in patients care--new trends in the United States.

    Science.gov (United States)

    Pierskalla, W P; Woods, D

    1988-12-01

    This article discusses the current state of informations systems in hospital management. Decision Support Systems (DSS) for the management, administrative and patient care units of the hospital are described. These DSS's include market planning, nurse scheduling and blood screening systems. Trends for future uses of information systems in the hospital environment are addressed.

  11. Heel blood sampling in European neonatal intensive care units: compliance with pain management guidelines

    DEFF Research Database (Denmark)

    Losacco, Valentina; Cuttini, Marina; Greisen, Gorm;

    2011-01-01

    Objective To describe the use of heel blood sampling and non-pharmacological analgesia in a large representative sample of neonatal intensive care units (NICUs) in eight European countries, and compare their self-reported practices with evidence-based recommendations. Methods Information on use...... with published guidelines is needed for clinical and ethical reasons....

  12. 77 FR 65581 - Novartis Pharmaceuticals Corporation, Primary Care Business Unit (Sales) Division, East Operating...

    Science.gov (United States)

    2012-10-29

    ... Register on January 24, 2012 (77 FR 3501). At the request of a worker, the Department reviewed the... Employment and Training Administration Novartis Pharmaceuticals Corporation, Primary Care Business Unit... Healthcare, and Pro Unlimited, East Hanover, NJ and Off-Site Workers of Novartis Pharmaceuticals...

  13. Crew resource management training in the intensive care unit: a multisite controlled before-after study.

    NARCIS (Netherlands)

    Kemper, P.F.; Bruijne, M. de; Dyck, C. van; So, R.L.; Tangkau, P.; Wagner, C.

    2016-01-01

    Introduction There is a growing awareness today that adverse events in the intensive care unit (ICU) are more often caused by problems related to non-technical skills than by a lack of technical, or clinical, expertise. Team training, such as crew resource management (CRM), aims to improve these non

  14. Examining the Needs of Bereaved Parents in the Pediatric Intensive Care Unit: A Qualitative Study

    Science.gov (United States)

    Meert, Kathleen L.; Briller, Sherylyn H.; Myers Schim, Stephanie; Thurston, Celia; Kabel, Allison

    2009-01-01

    The pediatric intensive care unit (PICU) is a high-tech setting aimed at restoring health to critically ill children. When childhood death occurs in the PICU, it constitutes a special context for parent bereavement. The purpose of this interdisciplinary qualitative research was to gain a deeper understanding of parents' needs around the time of…

  15. Initial fluid resuscitation of patients with septic shock in the intensive care unit

    DEFF Research Database (Denmark)

    Carlsen, Sarah; Perner, A

    2011-01-01

    Fluid is the mainstay of resuscitation of patients with septic shock, but the optimal composition and volume are unknown. Our aim was to evaluate the current initial fluid resuscitation practice in patients with septic shock in the intensive care unit (ICU) and patient characteristics and outcome...... associated with fluid volume....

  16. The perception of partnership between parents of premature infants and nurses in neonatal intensive care units

    DEFF Research Database (Denmark)

    Brødsgaard, Anne; Larsen, Palle; Weis, Janne;

    2016-01-01

    REVIEW QUESTION/OBJECTIVE: The objective of this review is to identify how parents of premature infants in neonatal intensive care units (NICUs) and nurses perceive their partnership.The review questions are: how do parents of premature infants and nurses perceive their partnership during...

  17. Primary immunodeficiency investigation in patients during and after hospitalization in a pediatric Intensive Care Unit

    Directory of Open Access Journals (Sweden)

    Erica Suavinho

    2014-03-01

    Full Text Available Objective: To analyze whether the patients with severe infections, admitted in the Pediatric Intensive Care Unit of the Hospital de Clínicas of the Universidade Federal de Uberlândia, underwent the active screening for primary immunodeficiencies (PID. Methods: Retrospective study that assessed the data records of patients with any severe infections admitted in the Pediatric Intensive Care Unit, covering a period from January 2011 to January 2012, in order to confirm if they performed an initial investigation for PID with blood count and immunoglobulin dosage. Results: In the studied period, 53 children were hospitalized with severe infections in the Pediatric Intensive Care Unit, and only in seven (13.2% the initial investigation of PID was performed. Among these patients, 3/7 (42.8% showed quantitative alterations in immunoglobulin G (IgG levels, 1/7 (14.3% had the diagnosis of cyclic neutropenia, and 1/7 (14.3% presented thrombocytopenia and a final diagnosis of Wiskott-Aldrich syndrome. Therefore, the PID diagnosis was confirmed in 5/7 (71.4% of the patients. Conclusions: The investigation of PID in patients with severe infections has not been routinely performed in the Pediatric Intensive Care Unit. Our findings suggest the necessity of performing PID investigation in this group of patients.

  18. Perceptions of "Nursing" and "Nursing Care" in the United States by Dutch Nursing Students.

    Science.gov (United States)

    Haloburdo, Esther P.; Thompson, Mary Ann

    2001-01-01

    In the opinions of 11 Dutch nursing students on a study tour of the United States, the U.S. emphasizes technical aspects of nursing and medical over nursing care, lacks team nursing and collegiality, and has a litigious environment. These negative images have implications for the use of U.S. nursing as a benchmark for global education and…

  19. Prevention of acute kidney injury and protection of renal function in the intensive care unit

    NARCIS (Netherlands)

    Joannidis, Michael; Druml, Wilfred; Forni, Lui G.; Groeneveld, A. B. Johan; Honore, Patrick; Oudemans-van Straaten, Heleen M.; Ronco, Claudio; Schetz, Marie R. C.; Woittiez, Arend Jan

    2010-01-01

    Acute renal failure on the intensive care unit is associated with significant mortality and morbidity. To determine recommendations for the prevention of acute kidney injury (AKI), focusing on the role of potential preventative maneuvers including volume expansion, diuretics, use of inotropes, vasop

  20. Should euthanasia be legal? : An international survey of neonatal intensive care units staff

    NARCIS (Netherlands)

    Cuttini, M.; Casotto, V.; Kaminski, M.; Beaufort, I.D. de; Berbik, I.; Hansen, G.; Kollee, L.A.A.; Kucinskas, A.; Lenoir, S.; Levin, A.V.; Orzalesi, M.; Persson, J.; Rebagliato, M.; Reid, M.; Saracci, R.

    2004-01-01

    OBJECTIVE: To present the views of a representative sample of neonatal doctors and nurses in 10 European countries on the moral acceptability of active euthanasia and its legal regulation. DESIGN: A total of 142 neonatal intensive care units were recruited by census (in the Netherlands, Sweden, Hung

  1. Health through the global functionality stimulation of the elderly in a continuing care unit

    OpenAIRE

    Marques, Patrícia; Oliveira, Irene

    2011-01-01

    Work performed under the Stage Specialization in Medical-Surgical Nursing in Integrated Continuing Care Unit (ICCU), in order to describe the health gains achieved with a program to stimulate the overall functionality, adapted to the degree of physical dependence patients and the psychological profile.

  2. Risk indicators for hearing loss in infants treated in different Neonatal Intensive Care Units

    NARCIS (Netherlands)

    van Dommelen, P.; Mohangoo, A. D.; Verkerk, P. H.; van der Ploeg, C. P. B.; van Straaten, H. L. M.

    2010-01-01

    Aim: To assess which infants' characteristics and specialized procedures are risk indicators for unilateral or bilateral hearing loss (HL) and to evaluate whether these risk indicators are associated with variation in prevalence of HL between Neonatal Intensive Care Units (NICUs). Methods: For 2002-

  3. Colistin resistance in gram-negative bacteria during prophylactic topical colistin use in intensive care units

    NARCIS (Netherlands)

    Oostdijk, Evelien A. N.; Smits, Loek; de Smet, Anne Marie G. A.; Leverstein-van Hall, Maurine A.; Kesecioglu, Jozef; Bonten, Marc J. M.

    2013-01-01

    Topical use of colistin as part of selective digestive decontamination (SDD) and selective oropharyngeal decontamination (SOD) has been associated with improved patient outcome in intensive care units (ICU), yet little is known about the risks of colistin resistance. We quantified effects of selecti

  4. Coagulase-negative staphylococcal skin carriage among neonatal intensive care unit personnel: From population to infection

    NARCIS (Netherlands)

    V. Hira (Vishal); M. Sluijter (Marcel); W.H.F. Goessens (Wil); A. Ott (Alewijn); R. de Groot (Ronald); P.W.M. Hermans (Peter); R.F. Kornelisse (René)

    2010-01-01

    textabstractCoagulase-negative staphylococci (CoNS) are a major cause of sepsis in neonatal intensive care units (NICU) worldwide. Infecting strains of these commensal bacteria may originate from NICU personnel. Therefore, we studied the characteristics of CoNS isolates from NICU personnel and compa

  5. First outbreak with MRSA in a danish neonatal intensive care unit

    DEFF Research Database (Denmark)

    Ramsing, Benedicte Grenness Utke; Arpi, Magnus; Andersen, Erik Arthur;

    2013-01-01

    The purpose of the study was to describe demographic and clinical characteristics and outbreak handling of a large methicillin-resistant Staphylococcus aureus (MRSA) outbreak in a neonatal intensive care unit (NICU) in Denmark June 25(th)-August 8(th) 2008, and to identify risk factors for MRSA...

  6. Coagulase-negative staphylococcal skin carriage among neonatal intensive care unit personnel: from population to infection.

    NARCIS (Netherlands)

    Hira, V.; Sluijter, M.; Goessens, W.H.F.; Ott, A.; Groot, R. de; Hermans, P.W.M.; Kornelisse, R.F.

    2010-01-01

    Coagulase-negative staphylococci (CoNS) are a major cause of sepsis in neonatal intensive care units (NICU) worldwide. Infecting strains of these commensal bacteria may originate from NICU personnel. Therefore, we studied the characteristics of CoNS isolates from NICU personnel and compared them to

  7. The low therapeutic efficacy of postoperative chest radiographs for surgical intensive care unit patients

    NARCIS (Netherlands)

    A. Kröner; E. van Iperen; J. Horn; J.M. Binnekade; P.E. Spronk; J. Stoker; M.J. Schultz

    2011-01-01

    Background. The clinical value of postoperative chest radiographs (CXRs) for surgical intensive care unit (ICU) patients is largely unknown. In the present study, we determined the diagnostic and therapeutic efficacy of postoperative CXRs for different surgical subgroups and related their efficacy t

  8. Access to Care for Methadone Maintenance Patients in the United States

    Science.gov (United States)

    Hettema, Jennifer E.; Sorensen, James L.

    2009-01-01

    This policy commentary addresses a significant access to care issue that faces methadone maintenance patients seeking residential treatment in the United States. Methadone maintenance therapy (MMT) has demonstrated strong efficacy in the outpatient treatment of opiate dependence. However, many opiate dependent patients are also in need of more…

  9. Factors Affecting Code Status in a University Hospital Intensive Care Unit

    Science.gov (United States)

    Van Scoy, Lauren Jodi; Sherman, Michael

    2013-01-01

    The authors collected data on diagnosis, hospital course, and end-of-life preparedness in patients who died in the intensive care unit (ICU) with "full code" status (defined as receiving cardiopulmonary resuscitation), compared with those who didn't. Differences were analyzed using binary and stepwise logistic regression. They found…

  10. I Brazilian guidelines for respiratory physiotherapy in pediatric and neonatal intensive care units.

    Science.gov (United States)

    Johnston, Cíntia; Zanetti, Nathalia Mendonça; Comaru, Talitha; Ribeiro, Simone Nascimento Dos Santos; Andrade, Lívia Barboza de; Santos, Suzi Laine Longo Dos

    2012-06-01

    Developing guidelines for the role of the physiotherapist in neonatal and pediatric intensive care units is essential because these professionals are responsible for the rehabilitation of critically ill patients. Rehabilitation includes the evaluation and prevention of functional kinetic alterations, application of treatment interventions (respiratory and/or motor physiotherapy), control and application of medical gases, care of mechanical ventilation, weaning and extubation, tracheal gas insufflation, inflation/deflation of the endotracheal cuff protocol, and surfactant application, aiming to allow patients to have a full recovery and return to their functional activities. In this article, we present guidelines that are intended to guide the physiotherapist in some of the prevention/treatment interventions in respiratory therapy (airway clearance, lung expansion, position in bed, airway suction, drug inhalation, and cough assist), which help in the rehabilitation process of newborns and children in intensive care units during mechanical ventilation and up to 12 hours following extubation. PMID:23917758

  11. A process for instituting best practice in the intensive care unit

    Directory of Open Access Journals (Sweden)

    George Elisabeth

    2008-01-01

    Full Text Available Goals of health care are patient safety and quality patient outcomes. Evidence based practice (EBP is viewed as a tool to achieve these goals. Health care providers strive to base practice on evidence, but the literature identifies numerous challenges to implementing and sustaining EBP in nursing. An initial focus is developing an organizational culture that supports the process for nursing and EBP. An innovative strategy to promote a culture of EBP was implemented in a tertiary center with 152 critical care beds and numerous specialty units with diverse patient populations. A multi-disciplinary committee was developed with the goal to use evidence to improve the care in the critical care population. EBP projects were identified from a literature review. This innovative approach resulted in improved patient outcomes and also provided a method to educate staff on EBP. The committee members have become advocates for EBP and serve as innovators for change to incorporate evidence into decision making for patient care on their units.

  12. Psychiatric disorders in children attending a Nigerian primary care unit: functional impairment and risk factors

    Directory of Open Access Journals (Sweden)

    Tunde-Ayinmode Mosunmola

    2012-07-01

    Full Text Available Abstract Background There is dearth of data on the level of functional impairment and risk factors for psychiatric morbidity in children attending primary care services in developing countries like Nigeria. The risk factors for psychiatric morbidity and functional impairment in children attending the primary care unit of a teaching hospital in Ilorin, Nigeria was therefore investigated to obtain data that could be used in improving service provision by primary care physicians. Methods A cross-sectional two-stage design was employed for the study. The first stage involved administration of the Child Behavior Questionnaire (CBQ to 350 children while the children’s version of the schedule for affective disorders and schizophrenia was used for the second stage involving 157 children, all high scorers on CBQ (score of ≥ 7 and 30% of low scorers (score  In addition, the Children Global Assessment Scale was used to assess the functional status of the children (score of ≤ 70 indicates functional impairment while the mothers’ mental health status was assessed with the 12-item version of the General Health Questionnaire, a score of 3 or more on this instrument indicate presence of mental morbidity. Results It was observed that 11.4% of the children had diagnosable psychiatric disorders and 7.1% were functionally impaired; and those with psychiatric disorders were more functionally impaired than those without. Thus, significant negative correlation was noted between CBQ scores and CGAS (r = 0.53; p  Conclusions Child psychiatric disorders are prevalent in the primary care unit studied. Many of the risk factors identified in the study population are modifiable. Collaborative efforts between psychiatrists and primary care physicians could therefore help to reduce level of risk and functional impairment and psychiatric morbidity among children attending the primary care unit studied. It could also help improve referral rates of

  13. The experience of registered nurses nursing in the general audit intensive care unit

    Directory of Open Access Journals (Sweden)

    E. Pope

    1998-09-01

    Full Text Available In this article a phenomenological qualitative research study is discussed. More attention will be given to the methodology of the research. The objectives of the study are two-fold: firstly to explore and describe the experience of registered nurses nursing in the adult intensive care unit (this is the first phase of the research and to describe guidelines based on the information obtained in the first phase to support the nurses in the form of a support programme in the second phase. The units of research are the registered nurses in the intensive care unit. The characteristics of the unit of research led to the emergence of a qualitative phenomenological research design of an explorative, descriptive and contextual nature. In the discussion of research methodology attention will be given to phase one: data gathering (ethical considerations and informed consent; purposive selection, phenomenological interviews and field notes; data analysis (Tesch’s method of data analysis, methods to ensure trustworthiness, organisation of raw data and integration of findings supported by literature. Five themes were identified through the data analysis: impaired communication with management; discrimination: white on black racism; lack of fair, competitive remuneration and disregard for professional worth; non-conducive physical environment, and stressful working environment. Phase two: Guidelines were described to support the registered nurses in the intensive care unit based on the information obtained in phase one of the research.

  14. Interprofessional Implementation of a Pain/Sedation Guideline on a Trauma Intensive Care Unit.

    Science.gov (United States)

    Sacco, Tara L; LaRiccia, Brenton

    2016-01-01

    Trauma patients experience pain and agitation during their hospitalization. Many complications have been noted both in the absence of symptom management and the in presence of oversedation/narcotization. To combat noted untoward effects of pain and sedation management, an interprofessional team convened to develop a pain and sedation guideline for use in a trauma intensive care unit. Guideline development began with a comprehensive review of the literature. With the input of unit stakeholders, a nurse-driven analgosedation guideline was implemented for a 6-month trial. During this time, unit champions were integral to successful trial execution. Outcome measurement included patient and unit outcomes, nursing satisfaction, and a pre- and postimplementation patient comparison. Following implementation, unit length of stay decreased by 4.16% and there was a 17.81% decrease in average time on the ventilator following the initiation of weaning. Patient reports of nurse sensitivity and responsiveness to pain increased from 93.7 to 94.9. Nurses reported satisfaction with the practice change and improvements in care. In comparing pre- and postimplementation patient data, there was a significant decrease in mean analgesic treatment duration and an increase in the use of antipsychotics for delirium management. Following the trial period, this guideline was permanently adopted across the adult critical care service. The development of a nurse-driven analgosedation guideline was noted to be both feasible and successful. PMID:27163223

  15. Attitudes and normative beliefs of nursing students as predictors of intended care behaviors with AIDS patients: a test of the Ajzen-Fishbein theory of reasoned action.

    Science.gov (United States)

    Goldenberg, D; Laschinger, H

    1991-03-01

    Few investigators have studied nurses' or nursing students' responses to caring for AIDS patients. The purpose of this exploratory study was to test the Ajzen-Fishbein (1980) Theory of Reasoned Action in a student nurse population about AIDS patient care. This theory offers an approach to explaining individuals' intentions to engage in certain behaviors as determined by two components: attitudes toward the behavior and subjective norms. Forty-six second-year baccalaureate nursing students completed a questionnaire developed according to guidelines described by Ajzen and Fishbein (alpha reliability range was .69-.85) prior to and following an instructional unit on caring for AIDS patients. Consistent with the theory, students' attitudes and subjective norms were found to be significant predictors of intentions to care for AIDS patients in their clinical experience (R2 = .29, F[1, 43] = 6.63, p less than .003). In addition, qualitative data resembled those in previous reports of fear of contagion among health professionals. The effects of the instructional unit about caring for AIDS patients resulted in significant changes in both attitudes and subjective norms.

  16. Possibilities and limits of Joyce Travelbee's theory for the construction of a family care methodology

    Directory of Open Access Journals (Sweden)

    Maria Angélica Pagliarini Waidman

    2006-08-01

    Full Text Available This is a theoretical, reflexive study that has as its aim to present Joyce Travelbee's theory and to analyze its limitations and potentialities, with the purpose of building a family care methodology. To do so, I made an explanation of the theory including the author's concepts, beliefs and principles. I have also performed a review of several authors that used this theories in their scientific studies and I finally present a reflection begining with the theory analysis, its expliciting its possibilities and its limits and how it can be used as a base for the development of a care methodology for families that have members with mental disorders, aiming at taking these people from the mental institutions and reinserting them in their families and community.

  17. Dignity in health-care: a critical exploration using feminism and theories of recognition.

    Science.gov (United States)

    Aranda, Kay; Jones, Andrea

    2010-09-01

    Growing concerns over undignified health-care has meant the concept of dignity is currently much discussed in the British National Health Service. This has led to a number of policies attempting to reinstate dignity as a core ethical value governing nursing practice and health-care provision. Yet these initiatives continue to draw upon a concept of dignity which remains reliant upon a depoliticised, ahistorical and decontexualised subject. In this paper, we argue the need to revise the dignity debate through the lens of feminism and theories of recognition. Postmodern feminist theories provide major challenges to what remain dominant liberal approaches as they pay attention to the contingent, reflexive, and affective aspects of care work. Theories of recognition provide a further critical resource for understanding how moral obligations and responsibilities towards others and our public and private responses to difference arise. This re-situates dignity as a highly contested and politicised concept involving complex moral deliberations and diverse political claims of recognition. The dignity debate is thus moved beyond simplistic rational injunctions to care, or to care more, and towards critical discussions of complex politicised, moral practices infused with power that involve the recognition of difference in health-care. PMID:20712663

  18. Dignity in health-care: a critical exploration using feminism and theories of recognition.

    Science.gov (United States)

    Aranda, Kay; Jones, Andrea

    2010-09-01

    Growing concerns over undignified health-care has meant the concept of dignity is currently much discussed in the British National Health Service. This has led to a number of policies attempting to reinstate dignity as a core ethical value governing nursing practice and health-care provision. Yet these initiatives continue to draw upon a concept of dignity which remains reliant upon a depoliticised, ahistorical and decontexualised subject. In this paper, we argue the need to revise the dignity debate through the lens of feminism and theories of recognition. Postmodern feminist theories provide major challenges to what remain dominant liberal approaches as they pay attention to the contingent, reflexive, and affective aspects of care work. Theories of recognition provide a further critical resource for understanding how moral obligations and responsibilities towards others and our public and private responses to difference arise. This re-situates dignity as a highly contested and politicised concept involving complex moral deliberations and diverse political claims of recognition. The dignity debate is thus moved beyond simplistic rational injunctions to care, or to care more, and towards critical discussions of complex politicised, moral practices infused with power that involve the recognition of difference in health-care.

  19. The Development and Evaluation of Delirium Assessment and Nursing Care Decision-Making Assistant Mobile Application for Intensive Care Unit.

    Science.gov (United States)

    Yang, Fangyu; Ji, Meihua; Ding, Shu; Wu, Ying; Chang, Polun; Lin, Chiawei; Yang, Xin

    2016-01-01

    Delirium is a common complication among patients in ICU settings. Although it has been repeatedly confirmed that Confusion Assessment Model for Intensive Care Unit (CAM-ICU), one of the most commonly used ICU delirium assessment tool, is highly accurate in validation studies, it's sensitivity and specificity is relatively low during routine practice among bedside nurses. The aim of this study is to develop a mobile application (app) to detect delirium and to test its reliability and validity both by research nurses and among ICU bedside nurses. The app was programmed with Java and installed on a mobile device with Android system. After completion of reliability and validity testing, the app will be integrated into the existing Hospital Information System in order to automatically retrieve essential information for risk factor identification and formulation of care plan accordingly to prevent or manage ICU delirium.

  20. Leadership-organizational culture relationship in nursing units of acute care hospitals.

    Science.gov (United States)

    Casida, Jesus; Pinto-Zipp, Genevieve

    2008-01-01

    The phenomena of leadership and organizational culture (OC) has been defined as the driving forces in the success or failure of an organization. Today, nurse managers must demonstrate leadership behaviors or styles that are appropriate for the constantly changing, complex, and turbulent health care delivery system. In this study, researchers explored the relationship between nurse managers' leadership styles and OC of nursing units within an acute care hospital that had achieved excellent organizational performance as demonstrated by a consistent increase in patient satisfaction ratings. The data from this study support that transformational and transactional contingent reward leaderships as nurse manager leadership styles that are associated with nursing unit OC that have the ability to balance the dynamics of flexibility and stability within their nursing units and are essential for maintaining organizational effectiveness. It is essential for first-line nursing leaders to acquire knowledge and skills on organizational cultural competence. PMID:18389837

  1. Difficulties in access and estimates of public beds in intensive care units in the state of Rio de Janeiro

    Science.gov (United States)

    Goldwasser, Rosane Sonia; Lobo, Maria Stella de Castro; de Arruda, Edilson Fernandes; Angelo, Simone Aldrey; Silva, José Roberto Lapa e; de Salles, André Assis; David, Cid Marcos

    2016-01-01

    ABSTRACT OBJECTIVE To estimate the required number of public beds for adults in intensive care units in the state of Rio de Janeiro to meet the existing demand and compare results with recommendations by the Brazilian Ministry of Health. METHODS The study uses a hybrid model combining time series and queuing theory to predict the demand and estimate the number of required beds. Four patient flow scenarios were considered according to bed requests, percentage of abandonments and average length of stay in intensive care unit beds. The results were plotted against Ministry of Health parameters. Data were obtained from the State Regulation Center from 2010 to 2011. RESULTS There were 33,101 medical requests for 268 regulated intensive care unit beds in Rio de Janeiro. With an average length of stay in regulated ICUs of 11.3 days, there would be a need for 595 active beds to ensure system stability and 628 beds to ensure a maximum waiting time of six hours. Deducting current abandonment rates due to clinical improvement (25.8%), these figures fall to 441 and 417. With an average length of stay of 6.5 days, the number of required beds would be 342 and 366, respectively; deducting abandonment rates, 254 and 275. The Brazilian Ministry of Health establishes a parameter of 118 to 353 beds. Although the number of regulated beds is within the recommended range, an increase in beds of 122.0% is required to guarantee system stability and of 134.0% for a maximum waiting time of six hours. CONCLUSIONS Adequate bed estimation must consider reasons for limited timely access and patient flow management in a scenario that associates prioritization of requests with the lowest average length of stay. PMID:27191155

  2. Profile of Congenital Surgical Anomalies in Neonates Admitted to Tertiary Care Neonatal Intensive Care Unit of Saurashtra Region

    Directory of Open Access Journals (Sweden)

    Zalak Shah

    2016-06-01

    Full Text Available Background: Congenital surgical anomaly is a major indication for admission of a neonate to an intensive care unit. Profile of surgical conditions is variable by system affecting the neonate and outcomes of the individual conditions depending upon treatment and post surgical facilities. This study was undertaken to highlight the surgical conditions, their burden and their prognosis encountered in our newborn care unit. Methodology: This study is a cross sectional study. All information was collected from the case records of all neonates admitted in newborn care unit of our centre between 1st April, 2011 and 31st October, 2014 with congenital surgical conditions and the following information extracted: surgical condition, age, sex, maturity, birth weight, its treatment and outcome, and other associated features were studied. Result: A total of 9213 neonates were admitted in the study period, of which 328 neonates (3.6% had surgical conditions. Surgery was performed in 225 neonates. Commonest congenital surgical condition was of gastrointestinal tract (GIT. Commonest GIT anomalies were tracheo-oesophageal fistula (28.6%, intestinal obstruction (23.7%, anorectal malformation (17.9%, and omphalocoele (7%. The overall mortality in neonates with congenital surgical condition in this study was 51.2%. Significantly, more deaths occurred in preterm than in term neonates (P = 0.00003 and low birth weight babies more than normal weight (p=0.0002. Conclusion: High mortality is found in neonates suffering from surgical conditions. Commonest anomaly includes conditions of Gastrointestinal tract. Prematurity and low birth weight is a significant factor associated with high mortality. [Natl J Med Res 2016; 6(2.000: 168-170

  3. Clinical microbiology in the intensive care unit: Strategic and operational characteristics

    Directory of Open Access Journals (Sweden)

    Bhattacharya S

    2010-01-01

    Full Text Available Infection is a major cause of morbidity and mortality among patients admitted in intensive care units (ICUs. The application of the principles and the practice of Clinical Microbiology for ICU patients can significantly improve clinical outcome. The present article is aimed at summarising the strategic and operational characteristics of this unique field where medical microbiology attempts to venture into the domain of direct clinical care of critically ill patients. The close and strategic partnership between clinical microbiologists and intensive care specialists, which is essential for this model of patient care have been emphasized. The article includes discussions on a variety of common clinical-microbiological problems faced in the ICUs such as ventilator-associated pneumonia, blood stream infections, skin and soft tissue infection, UTI, infection control, besides antibiotic management.

  4. Mead Johnson Critical Care Symposium for the Practising Surgeon. 4. Abdominal crisis in the intensive care unit.

    Science.gov (United States)

    Gregor, P; Prodger, J D

    1988-09-01

    Abdominal crises are common in critically ill patients who are admitted to the intensive care unit for problems unrelated to the abdomen. General surgeons may be asked to assess these patients for such reasons as pain, distension, possible sepsis, radiologic or laboratory abnormalities. Since many of the diagnostic signs and symptoms of acute abdomen are blunted or absent in critically ill patients who may be comatose or have been given analgesics or steroids, frequent thorough physical examination and close cooperation with the service admitting the patient are necessary to ensure early diagnosis and aggressive treatment of the abdominal crisis. PMID:3046730

  5. Dental Care Use Among Pregnant Women in the United States Reported in 1999 and 2002

    Directory of Open Access Journals (Sweden)

    Peggy Timothé, DDS, MPH

    2005-01-01

    Full Text Available Introduction The purpose of this study was to determine national and state-specific estimates of dental care use among adult pregnant women in the United States using data from two 12-month periods. The study also determined person-level characteristics that may predict a lack of dental care use within this subgroup. Methods Responses were analyzed from 4619 pregnant women aged 18 to 44 years who participated in the 1999 and 2002 state-based Behavioral Risk Factor Surveillance System. Dental care use was defined as having a dental visit or a dental cleaning in the 12 months preceding the interview. State-specific estimates were adjusted to the 2000 U.S. population distribution. Multivariable regression analysis was used to evaluate person-level characteristics that may predict not obtaining dental care during this period. Results Overall, 70% of pregnant women in 1999 and 2002 had received dental care in the previous 12 months. Age-adjusted estimates ranged from 36% (Nevada to 89% (Vermont to 91% (Puerto Rico. In 19 states, 75% or more of pregnant women had obtained dental care in the previous 12 months (age-adjusted figure. Most pregnant women with dental care were non-Hispanic white and married, and they had a greater than high school education. Income and smoking status were significant predictors for not using dental care. Conclusion In several states, more than 70% of pregnant women reported a dental visit or dental cleaning during the previous 12 months. Relative to the general population, pregnant women are as likely to receive dental care, but certain subgroups need to do much better. However, these estimates may be biased toward a population with a higher socioeconomic status and may not represent dental care use among pregnant women in the general U.S. population.

  6. Existence of an information unit as a postulate of quantum theory.

    Science.gov (United States)

    Masanes, Lluís; Müller, Markus P; Augusiak, Remigiusz; Pérez-García, David

    2013-10-01

    Does information play a significant role in the foundations of physics? Information is the abstraction that allows us to refer to the states of systems when we choose to ignore the systems themselves. This is only possible in very particular frameworks, like in classical or quantum theory, or more generally, whenever there exists an information unit such that the state of any system can be reversibly encoded in a sufficient number of such units. In this work, we show how the abstract formalism of quantum theory can be deduced solely from the existence of an information unit with suitable properties, together with two further natural assumptions: the continuity and reversibility of dynamics, and the possibility of characterizing the state of a composite system by local measurements. This constitutes a set of postulates for quantum theory with a simple and direct physical meaning, like the ones of special relativity or thermodynamics, and it articulates a strong connection between physics and information.

  7. Existence of an information unit as a postulate of quantum theory.

    Science.gov (United States)

    Masanes, Lluís; Müller, Markus P; Augusiak, Remigiusz; Pérez-García, David

    2013-10-01

    Does information play a significant role in the foundations of physics? Information is the abstraction that allows us to refer to the states of systems when we choose to ignore the systems themselves. This is only possible in very particular frameworks, like in classical or quantum theory, or more generally, whenever there exists an information unit such that the state of any system can be reversibly encoded in a sufficient number of such units. In this work, we show how the abstract formalism of quantum theory can be deduced solely from the existence of an information unit with suitable properties, together with two further natural assumptions: the continuity and reversibility of dynamics, and the possibility of characterizing the state of a composite system by local measurements. This constitutes a set of postulates for quantum theory with a simple and direct physical meaning, like the ones of special relativity or thermodynamics, and it articulates a strong connection between physics and information. PMID:24062431

  8. Relocating care: negotiating nursing skillmix in a mental health unit for older adults.

    Science.gov (United States)

    Henderson, Julie; Curren, David; Walter, Bonnie; Toffoli, Luisa; O'Kane, Debra

    2011-03-01

    Mental health care in Australia in the last 20 years has moved from stand-alone psychiatric hospitals to general hospitals and the community. This paper reports an action research project exploring the experiences of nurses on an acute mental health unit for older adults staffed with a skillmix of mental health and general nurses, which recently transitioned from a psychiatric to a general hospital. The new service provides comprehensive health care, including the management of physical co-morbidity and a recovery orientation. Recovery acknowledges the role and rights of consumers and carers in planning and management of care, choice and individual strengths (Shepherd). The new ward received additional resources to establish the model of care, including a broader skillmix. The paper explores the dynamics of development of a new model of care and of bringing together staff with different professional orientations, cultures and priorities. Focus groups and interviews were conducted with 18 staff. Analysis resulted in three themes relating to the impact of competing goals and foci of care upon professional boundaries; competing organisational cultures and the impact of service change upon work practices. The findings are explored in relation to ideas about health care delivery associated with neoliberalism. PMID:21281396

  9. A visit to the intensive cares unit: a family-centered culture change to facilitate pediatric visitation in an adult intensive care unit.

    Science.gov (United States)

    Hanley, Julie Boyer; Piazza, Julie

    2012-01-01

    To guide family adjustment, an effort was made to facilitate pediatric visitation in an adult intensive care unit (ICU). Goals were to improve customer satisfaction and to raise staff comfort level with child visitation. After implementing an open visitation policy, concerns around pediatric visitation in the ICU remained. Fears centered on risks to both patient and child. Literature was reviewed before a book was written entitled A Visit to the ICU. It contained information about what a child visiting the ICU would see, hear, and feel when visiting a loved one. The book provided reassurance for caregivers and children, informing them about what to expect when visiting. The goal of the book was to provide caregivers with a framework for age-appropriate education. Staff education was provided on developmental stages, including a child's understandings of illness and death. Nursing interventions were reviewed and resources provided. A survey demonstrated that the book increased staff comfort level with children visiting the unit, was a positive tool for patients and families, and eased fears among children while helping to facilitate coping mechanisms. The article will describe the practice change of pediatric visitation in an ICU and how it could be applied to other critical care settings. PMID:22157497

  10. Healthcare associated infections in Paediatric Intensive Care Unit of a tertiary care hospital in India: Hospital stay & extra costs

    Science.gov (United States)

    Sodhi, Jitender; Satpathy, Sidhartha; Sharma, D.K.; Lodha, Rakesh; Kapil, Arti; Wadhwa, Nitya; Gupta, Shakti Kumar

    2016-01-01

    Background & objectives: Healthcare associated infections (HAIs) increase the length of stay in the hospital and consequently costs as reported from studies done in developed countries. The current study was undertaken to evaluate the impact of HAIs on length of stay and costs of health care in children admitted to Paediatric Intensive Care Unit (PICU) of a tertiary care hospital in north India. Methods: This prospective study was done in the seven bedded PICU of a large multi-specialty tertiary care hospital in New Delhi, India. A total of 20 children with HAI (cases) and 35 children without HAI (controls), admitted to the PICU during the study period (January 2012 to June 2012), were matched for gender, age, and average severity of illness score. Each patient's length of stay was obtained prospectively. Costs of healthcare were estimated according to traditional and time driven activity based costing methods approach. Results: The median extra length of PICU stay for children with HAI (cases), compared with children with no HAI (controls), was seven days (IQR 3-16). The mean total costs of patients with and without HAI were 2,04,787 (US$ 3,413) and 56,587 (US$ 943), respectively and the mean difference in the total cost between cases and controls was 1,48,200 (95% CI 55,716 to 2,40,685, Pcosts for PICU patients, especially costs due to prolongation of hospital stay, and suggests the need to develop effective strategies for prevention of HAI to reduce costs of health care. PMID:27377508

  11. A comparative cost analysis of polytrauma and neurosurgery Intensive Care Units at an apex trauma care facility in India

    Science.gov (United States)

    Kumar, Parmeshwar; Jithesh, V.; Gupta, Shakti Kumar

    2016-01-01

    Context: Although Intensive Care Units (ICUs) only account for 10% of the hospital beds, they consume nearly 22% of the hospital resources. Few definitive costing studies have been conducted in Indian settings that would help determine appropriate resource allocation. Aim: The aim of this study was to evaluate and compare the cost of intensive care delivery between multispecialty and neurosurgery ICUs at an apex trauma care facility in India. Materials and Methods: The study was conducted in a polytrauma and neurosurgery ICU at a 203-bedded Level IV trauma care facility in New Delhi, India, from May 1, 2012 to June 30, 2012. The study was cross-sectional, retrospective, and record-based. Traditional costing was used to arrive at the cost for both direct and indirect cost estimates. The cost centers included in the study were building cost, equipment cost, human resources, materials and supplies, clinical and nonclinical support services, engineering maintenance cost, and biomedical waste management. Statistical Analysis: Statistical analysis was performed by Fisher's two tailed t-test. Results: Total cost/bed/day for the multispecialty ICU was Rs. 14,976.9/- and for the neurosurgery ICU, it was Rs. 14,306.7/-, workforce constituting nearly half of the expenditure in both ICUs. The cost center wise and overall difference in the cost among the ICUs were statistically significant. Conclusions: Quantification of expenditure in running an ICU in a trauma center would assist health-care decision makers in better allocation of resources. Although multispecialty ICUs are more cost-effective, other factors will also play a role in defining the kind of ICU that needs to be designed.

  12. Evaluation of an interprofessional practice placement in a UK in-patient palliative care unit.

    Science.gov (United States)

    Dando, Nicholas; d'Avray, Lynda; Colman, Jane; Hoy, Andrew; Todd, Jennifer

    2012-03-01

    This paper reports on undergraduate students' evaluation of a new hospice-based interprofessional practice placement (IPP) that took place in the voluntary sector from 2008 to 2009. Ward-based interprofessional training has been successfully demonstrated in a range of clinical environments. However, the multidisciplinary setting within a hospice in-patient unit offered a new opportunity for interprofessional learning. The development and delivery of the IPP initiative is described, whereby multidisciplinary groups of 12 students provided hands-on care for a selected group of patients, under the supervision of trained health care professionals. The placement was positively evaluated and students reported an increased understanding of both their own role and that of other professionals in the team. The evaluation also suggests that additional learning opportunities were provided by the in-patient palliative care unit. The results of this evaluation suggest that the in-patient unit of a hospice caring for patients with life-limiting illness provides a suitable environment to demonstrate and learn about interprofessional practice.

  13. Survey of Oxygen Delivery Practices in UK Paediatric Intensive Care Units

    Science.gov (United States)

    Peters, Mark J.

    2016-01-01

    Purpose. Administration of supplemental oxygen is common in paediatric intensive care. We explored the current practice of oxygen administration using a case vignette in paediatric intensive care units (PICU) in the united kingdom. Methods. We conducted an online survey of Paediatric Intensive Care Society members in the UK. The survey outlined a clinical scenario followed by questions on oxygenation targets for 5 common diagnoses seen in critically ill children. Results. Fifty-three paediatric intensive care unit members from 10 institutions completed the survey. In a child with moderate ventilatory requirements, 21 respondents (42%) did not follow arterial partial pressure of oxygen (PaO2) targets. In acute respiratory distress syndrome, cardiac arrest, and sepsis, there was a trend to aim for lower PaO2 as the fraction of inspired oxygen (FiO2) increased. Conversely, in traumatic brain injury and pulmonary hypertension, respondents aimed for normal PaO2 even as the FiO2 increased. Conclusions. In this sample of clinicians PaO2 targets were not commonly used. Clinicians target lower PaO2 as FiO2 increases in acute respiratory distress syndrome, cardiac arrest, and sepsis whilst targeting normal range irrespective of FiO2 in traumatic brain injury and pulmonary hypertension.

  14. Survey of Oxygen Delivery Practices in UK Paediatric Intensive Care Units

    Directory of Open Access Journals (Sweden)

    Sainath Raman

    2016-01-01

    Full Text Available Purpose. Administration of supplemental oxygen is common in paediatric intensive care. We explored the current practice of oxygen administration using a case vignette in paediatric intensive care units (PICU in the united kingdom. Methods. We conducted an online survey of Paediatric Intensive Care Society members in the UK. The survey outlined a clinical scenario followed by questions on oxygenation targets for 5 common diagnoses seen in critically ill children. Results. Fifty-three paediatric intensive care unit members from 10 institutions completed the survey. In a child with moderate ventilatory requirements, 21 respondents (42% did not follow arterial partial pressure of oxygen (PaO2 targets. In acute respiratory distress syndrome, cardiac arrest, and sepsis, there was a trend to aim for lower PaO2 as the fraction of inspired oxygen (FiO2 increased. Conversely, in traumatic brain injury and pulmonary hypertension, respondents aimed for normal PaO2 even as the FiO2 increased. Conclusions. In this sample of clinicians PaO2 targets were not commonly used. Clinicians target lower PaO2 as FiO2 increases in acute respiratory distress syndrome, cardiac arrest, and sepsis whilst targeting normal range irrespective of FiO2 in traumatic brain injury and pulmonary hypertension.

  15. Terminalidade e cuidados paliativos na unidade de terapia intensiva End of life and palliative care in intensive care unit

    Directory of Open Access Journals (Sweden)

    Rachel Duarte Moritz

    2008-12-01

    pacientes são submetidos a grande estresse e tensão sendo desejável que lhes sejam disponíveis programas de educação continuados sobre cuidados paliativos.The objective of this review was to evaluate current knowledge regarding terminal illness and palliative care in the intensive care unit, to identify the major challenges involved and propose a research agenda on these issues The Brazilian Critical Care Association organized a specific forum on terminally ill patients, to which were invited experienced and skilled professionals on critical care. These professionals were divided in three groups: communication in the intensive care unit, the decision making process when faced with a terminally ill patient and palliative actions and care in the intensive care unit. Data and bibliographic references were stored in a restricted website. During a twelve hour meeting and following a modified Delphi methodology, the groups prepared the final document. Consensual definition regarding terminality was reached. Good communication was considered the cornerstone to define the best treatment for a terminally ill patient. Accordingly some communication barriers were described that should be avoided as well as some approaches that should be pursued. Criteria for palliative care and palliative action in the intensive care unit were defined. Acceptance of death as a natural event as well as respect for the patient's autonomy and the nonmaleficence principles were stressed. A recommendation was made to withdraw the futile treatment that prolongs the dying process and to elected analgesia and measures that alleviate suffering in terminally ill patients. To deliver palliative care to terminally ill patients and their relatives some principles and guides should be followed, respecting individual necessities and beliefs. The intensive care unit staff involved with the treatment of terminally ill patients is subject to stress and tension. Availability of a continuous education program on

  16. Dying in Palliative Care Units and in Hospital: A Comparison of the Quality of Life of Terminal Cancer Patients.

    Science.gov (United States)

    Viney, Linda L.; And Others

    1994-01-01

    Compared quality of life of terminal cancer patients (n=182) in two palliative care units with that of those in general hospital. Patients in specialized palliative care units were found to differ from those dying in hospital, showing less indirectly expressed anger but more positive feelings. They also reported more anxiety about death but less…

  17. What can Europe learn from the managed care backlash in the United States?

    Science.gov (United States)

    Duijmelinck, Daniëlle; van de Ven, Wynand

    2016-05-01

    Germany, the Netherlands, and Switzerland have taken steps toward regulated competition on the health insurance market to enhance efficiency and consumer responsiveness. The rationale of giving the consumer a periodic choice of health insurer is that individual risk-bearing insurers are stimulated to effectively purchase and manage the care on behalf of their enrollees. For Europe this is largely a terra incognita, while the United States have at least fifty years of relevant experience. Twenty years ago the United States were confronted with a substantial backlash against managed care. Based on the US experience we come to the following lessons for Europe. First, the greatest backlash against managed care can be expected from the healthcare providers. Second, consumers are willing to give up to some extent their free choice of healthcare provider in return for a lower premium. Third, insurers should (be allowed to) offer consumers a choice between an insurance product with free choice of provider and lower-priced products with restricted reimbursement for non-contracted providers. Fourth, insurers should use input from consumers, provide them in a timely manner with relevant information about the (non-) contracted providers, and reassure consumers that in-network providers offer good quality care. Fifth, the development of national guidelines and quality indicators, with input from the medical profession, can increase the acceptance of managed care. PMID:27055353

  18. Diarrhoea control: the experience of a health team in a primary care unit, Algeria.

    Science.gov (United States)

    Belhocine, Z; Mahiout, B; Laraba, A; Grangaud, J P

    1985-01-01

    This article reports the experiences of a primary health care unit located in Algeria's Zeralda district in the control of diarrhea. Curative and preventive care is provided to the adult and child populations of the district by a medical and paramedical team. The overall goal of the diarrheal control program, initiated in 1980, is to combat mortality from diarrhea in children under 2 years of age. Intermediate goals include improvement of care provided to infants with diarrhea, early hospitalization of cases of diarrhea, improvement of contacts between the primary care unit and the hospital, and prevention of diarrhea. Children in the target group are located through use of a register of children living in the district, and their families are sent cards containing information on diarrhea and its control. Children are followed from the 1st day of consultation for diarrhea until the 30th day after the episode. Record keeping and careful follow-up are stressed. In 1983, 335 children 18 months of age or younger (47% of the target population) consulted health structures in Zeralda for diarrhea. About 1/3 of children fail to return for follow-up visits. This is attributed both to long waits in the clinic and the fact that children are usually cured by the time of this visit. The number of children hospitalized for acute dehydration has declined from 33 in 1980 to 18 in 1983; the number of deaths from dehydration declined from 16 to 8 in this same period.

  19. Psychosocial factors and mental work load: a reality perceived by nurses in intensive care units1

    Science.gov (United States)

    Ceballos-Vásquez, Paula; Rolo-González, Gladys; Hérnandez-Fernaud, Estefanía; Díaz-Cabrera, Dolores; Paravic-Klijn, Tatiana; Burgos-Moreno, Mónica

    2015-01-01

    OBJECTIVE: To analyse the perception of psychosocial factors and mental workload of nurses who work in intensive care units. It is hypothesised that nurses in these units could perceive psychosocial risks, manifesting in a high mental work load. The psychosocial dimension related to the position's cognitive demands is hypothesised to mostly explain mental work load. METHOD: Quantitative study, with a descriptive, cross-sectional, and comparative design. A total of 91% of the intensive care unit populations of three Chilean hospitals was surveyed, corresponding to 111 nurses. The instruments utilised included (A) a biosociodemographic history questionnaire; (b) the SUSESO-ISTAS 21 questionnaire; and (c) the Mental Work Load Subjective Scale (ESCAM, in Spanish). RESULTS: In total, 64% and 57% of participants perceived high levels of exposure to the psychosocial risks Psychosocial demands and Double shift, respectively. In addition, a medium-high level of overall mental load was observed. Positive and significant correlations between some of the SUSESO-ISTAS 21 and ESCAM dimensions were obtained. Using a regression analysis, it was determined that three dimensions of the psychosocial risk questionnaire helped to explain 38% of the overall mental load. CONCLUSION: Intensive care unit nurses felt that inadequate psychosocial factors and mental work overload existed in several of the tested dimensions. PMID:26039303

  20. [Nursing interventions on the physical environment of Neonatal Intensive Care Units].

    Science.gov (United States)

    Miquel Capó Rn, I

    2016-01-01

    The objectives of this study are to analyse nursing interventions regarding noise and lighting that influence neurodevelopment of the preterm infant in the Neonatal Intensive Care Unit. A review of the literature was performed using the databases: Cuiden Plus, PubMed, IBECS and Cochrane Library Plus. The inclusion and exclusion criteria were established in accordance with the objectives and limits used in each database. Of the 35 articles used, most were descriptive quantitative studies based on the measurement of sound pressure levels and lighting in the Neonatal Intensive Care Units. The countries included in this study are Brazil and the United States, and the variables analysed were the recording the times of light and noise. Based on the high levels of light and noise recorded in the Neonatal Intensive Care Units, nursing interventions that should be carried out to reduce them are described. The evidence indicates that after the implementation of these interventions, the high levels of both environmental stimuli are reduced significantly. Despite the extensive literature published on this problem, the levels of light and noise continue to exceed the recommended limits. Therefore, nurses need to increase and enhance their efforts in this environment, in order to positively influence neurodevelopment of premature newborn.

  1. Patient perception of pain care in hospitals in the United States

    Directory of Open Access Journals (Sweden)

    Anita Gupta

    2009-11-01

    Full Text Available Anita Gupta1, Sarah Daigle2, Jeffrey Mojica3, Robert W Hurley41Pain Management Division, Department of Anesthesiology, University of Pennsylvania School of Medicine, Philadelphia, PA, USA; 2Department of Anesthesiology and Critical Care, 3Department of Anesthesiology and Critical Care, Division of Pain Medicine, University of Pennsylvania, Philadelphia, PA, USA; 4Medical Director of the Johns Hopkins Pain Treatment Center, Division of Pain Medicine, Deparment of Anesthesiology and Critical Care Medicine, Johns Hopkins School of Medicine, Baltimore, MD, USAStudy objective: Assessment of patients’ perception of pain control in hospitals in the United States.Background: Limited data are available regarding the quality of pain care in the hospitalized patient. This is particularly valid for data that allow for comparison of pain outcomes from one hospital to another. Such data are critical for numerous reasons, including allowing patients and policy-makers to make data-driven decisions, and to guide hospitals in their efforts to improve pain care. The Hospital Quality Alliance was recently created by federal policy makers and private organizations in conjunction with the Centers for Medicare and Medicare Services to conduct patient surveys to evaluate their experience including pain control during their hospitalization.Methods: In March 2008, the results of the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS survey was released for review for health care providers and researchers. This survey includes a battery of questions for patients upon discharge from the hospital including pain-related questions and patient satisfaction that provide valuable data regarding pain care nationwide. This study will review the results from the pain questions from this available data set and evaluate the performance of these hospitals in pain care in relationship to patient satisfaction. Furthermore, this analysis will be providing valuable

  2. Mortality after discharge from the intensive care unit during the early weekend period

    DEFF Research Database (Denmark)

    Obel, N.; Schierbeck, J.; Pedersen, L.;

    2007-01-01

    BACKGROUND: As a result of a shortage of intensive care capacity, patients may be discharged prematurely early during weekends which may lead to an increased mortality and risk of readmission to intensive care units (ICU). We examined whether discharge from the ICU during the first part......-Meier analysis and Cox's proportional-hazards regression to compute survival curves and risk ratio estimates. RESULTS: There were 228 patients in the weekend group and 555 patients in the non-weekend group. Crude and adjusted 28-day risk ratio of the combined endpoint was 1.50 [95% confidence interval (CI): 1...

  3. Continued transmission of Pseudomonas aeruginosa from a wash hand basin tap in a critical care unit.

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    Garvey, M I; Bradley, C W; Tracey, J; Oppenheim, B

    2016-09-01

    Pseudomonas aeruginosa is an important nosocomial pathogen, colonizing hospital water supplies including taps and sinks. We report a cluster of P. aeruginosa acquisitions during a period of five months from tap water to patients occupying the same burns single room in a critical care unit. Pseudomonas aeruginosa cultured from clinical isolates from four different patients was indistinguishable from water strains by pulsed-field gel electrophoresis. Water outlets in critical care may be a source of P. aeruginosa despite following the national guidance, and updated guidance and improved control measures are needed to reduce the risks of transmission to patients. PMID:27249962

  4. Acute kidney injury on admission to the intensive care unit: where to go from here?

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    Ostermann, Marlies

    2008-01-01

    Acute kidney injury (AKI) is a common problem, especially in critically ill patients. In Critical Care, Kolhe and colleagues report that 6.3% of 276,731 patients in 170 intensive care units (ICUs) in the UK had evidence of severe AKI within the first 24 hours of admission to ICU. ICU and hospital mortality as well as length of stay in hospital were significantly increased. In light of this serious burden on individuals and the health system in general, the following commentary discusses the current state of knowledge of AKI in ICU and calls for more attention to preventive strategies.

  5. Cardiovascular risk rate in hypertensive patients attended in primary health care units: the influence of pharmaceutical care

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    Paulo Yuri Milen Firmino

    2015-09-01

    Full Text Available Cardiovascular complications are relevant due to their frequency and severity on the hypertension scenario. Studies refer Pharmaceutical Care (PC as capable of decreasing cardiovascular risk rate (%CVR on hypertensive patients. This study aimed to investigate, through a randomized clinical assay, the influence of PC service on the %CVR of hypertensive patients assisted in a health primary care unit from Fortaleza-Ceará. Two study groups were formed: i. Intervention Group (IG, which received orientation about taking medicines, actions aiming to prevent/solve medicine interactions and adverse effects and non-pharmacological interventions for 9 months and, ii. Control Group (CG, which received traditional assistance of the unit and was monitored during the same period. It was observed a statistically significant reduction on %CVR (10.76 to 7.86; p=0.04 and systolic blood pressure levels (SBP (137.69 to 131.54; p<0.01 in the IG, while, in the CG, there was no significant alteration. 151 Drug Related Problem (DRP were identified and it was realized 124 pharmaceutical interventions, with 89.2% of them resulting on solution/prevention of the problem. Our findings indicated that the inclusion of the PC service in the hypertensive health assistance was more effective at the %CVR and the SBP reduction in comparison to the traditional assistance offered.

  6. A New Model of Delirium Care in the Acute Geriatric Setting: Geriatric Monitoring Unit

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    Chong Mei

    2011-08-01

    Full Text Available Abstract Background Delirium is a common and serious condition, which affects many of our older hospitalised patients. It is an indicator of severe underlying illness and requires early diagnosis and prompt treatment, associated with poor survival, functional outcomes with increased risk of institutionalisation following the delirium episode in the acute care setting. We describe a new model of delirium care in the acute care setting, titled Geriatric Monitoring Unit (GMU where the important concepts of delirium prevention and management are integrated. We hypothesize that patients with delirium admitted to the GMU would have better clinical outcomes with less need for physical and psychotropic restraints compared to usual care. Methods/Design GMU models after the Delirium Room with adoption of core interventions from Hospital Elder Life Program and use of evening bright light therapy to consolidate circadian rhythm and improve sleep in the elderly patients. The novelty of this approach lies in the amalgamation of these interventions in a multi-faceted approach in acute delirium management. GMU development thus consists of key considerations for room design and resource planning, program specific interventions and daily core interventions. Assessments undertaken include baseline demographics, comorbidity scoring, duration and severity of delirium, cognitive, functional measures at baseline, 6 months and 12 months later. Additionally we also analysed the pre and post-GMU implementation knowledge and attitude on delirium care among staff members in the geriatric wards (nurses, doctors and undertook satisfaction surveys for caregivers of patients treated in GMU. Discussion This study protocol describes the conceptualization and implementation of a specialized unit for delirium management. We hypothesize that such a model of care will not only result in better clinical outcomes for the elderly patient with delirium compared to usual geriatric care

  7. Hemodynamic Assessment and Monitoring in the Intensive Care Unit: an Overview

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    Adam C. Adler

    2014-08-01

    Full Text Available The goal of hemodynamic monitoring in intensive care is to assess the adequacy of perfusion, specifically with regard to maintaining sufficient perfusion pressures and oxygen delivery. Precise volume management of peri-operative and critical care patients is crucial as under or over resuscitation is associated with adverse outcomes. Hemodynamic monitoring allows care to be individualized based on specific patient response to therapy and can provide early warning of impending perfusion deficits or instability. Physiologic monitoring aids determination of appropriate therapy. Methods for obtaining accurate and continuous measurements in the critically ill patient have evolved from surgical and anesthetic techniques dating back more than a century. These techniques transitioned from the operating room to early intensive care units as necessitated by the polio epidemics of the 1950s. The advantages of cohorting critically ill patients led to specialized intensive care and later cardiac care units. Telemetry developed to monitor astronauts and miniaturization of electronics made possible by substituting transistors for vacuum tubes helped create the first generation of intensive care monitors in the 1960s. Transcutaneous oxygen sensors, end-tidal measurement of carbon dioxide, and pulse oximetry took monitoring to a new level by the 1980s. Monitors became more sophisticated and capable of calculating derived variables such as oxygen delivery and consumption as computer processing became routine. These data sets were useful to clinicians using fluids and vasoactive agents primarily to manipulate oxygen delivery in hemodynamically unstable patients. Recently, simply monitoring vascular pressures has given way to dynamic monitoring where physiologic changes with respiration can be used to derive additional parameters such as pulse pressure variation (PPV and stroke volume variation (SVV. Today’s clinician has a wealth of information available at the

  8. Establishing an acute care nursing bed unit size: employing a decision matrix framework.

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    Ritchey, Terry; Pati, Debajyoti

    2008-01-01

    Determining the number of patient rooms for an acute care (medical-surgical) patient unit is a challenge for both healthcare architects and hospital administrators when renovating or designing a new patient tower or wing. Discussions on unit bed size and its impact on hospital operations in healthcare design literature are isolated, and clearly there is opportunity for more extensive research. Finding the optimal solution for unit bed size involves many factors, including the dynamics of the site and existing structures. This opinion paper was developed using a "balanced scorecard" concept to provide decision makers a framework for assessing and choosing a customized solution during the early planning and conceptual design phases. The context of a healthcare balanced scorecard with the quadrants of quality, finance, provider outcomes, and patient outcomes is used to compare the impact of these variables on unit bed size. PMID:22973617

  9. Voluntary peer review as innovative tool for quality improvement in the intensive care unit – a retrospective descriptive cohort study in German intensive care units

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    Kumpf, Oliver

    2014-12-01

    Full Text Available [english] Introduction: Quality improvement and safety in intensive care are rapidly evolving topics. However, there is no gold standard for assessing quality improvement in intensive care medicine yet. In 2007 a pilot project in German intensive care units (ICUs started using voluntary peer reviews as an innovative tool for quality assessment and improvement. We describe the method of voluntary peer review and assessed its feasibility by evaluating anonymized peer review reports and analysed the thematic clusters highlighted in these reports.Methods: Retrospective data analysis from 22 anonymous reports of peer reviews. All ICUs – representing over 300 patient beds – had undergone voluntary peer review. Data were retrieved from reports of peers of the review teams and representatives of visited ICUs. Data were analysed with regard to number of topics addressed and results of assessment questionnaires. Reports of strengths, weaknesses, opportunities and threats (SWOT reports of these ICUs are presented. Results: External assessment of structure, process and outcome indicators revealed high percentages of adherence to predefined quality goals. In the SWOT reports 11 main thematic clusters were identified representative for common ICUs. 58.1% of mentioned topics covered personnel issues, team and communication issues as well as organisation and treatment standards. The most mentioned weaknesses were observed in the issues documentation/reporting, hygiene and ethics. We identified several unique patterns regarding quality in the ICU of which long-term personnel problems und lack of good reporting methods were most interestingConclusion: Voluntary peer review could be established as a feasible and valuable tool for quality improvement. Peer reports addressed common areas of interest in intensive care medicine in more detail compared to other methods like measurement of quality indicators.

  10. Voluntary peer review as innovative tool for quality improvement in the intensive care unit – a retrospective descriptive cohort study in German intensive care units

    Science.gov (United States)

    Kumpf, Oliver; Bloos, Frank; Bause, Hanswerner; Brinkmann, Alexander; Deja, Maria; Marx, Gernot; Kaltwasser, Arnold; Dubb, Rolf; Muhl, Elke; Greim, Clemens-A.; Weiler, Norbert; Chop, Ines; Jonitz, Günther; Schaefer, Henning; Felsenstein, Matthias; Liebeskind, Ursula; Leffmann, Carsten; Jungbluth, Annemarie; Waydhas, Christian; Pronovost, Peter; Spies, Claudia; Braun, Jan-Peter

    2014-01-01

    Introduction: Quality improvement and safety in intensive care are rapidly evolving topics. However, there is no gold standard for assessing quality improvement in intensive care medicine yet. In 2007 a pilot project in German intensive care units (ICUs) started using voluntary peer reviews as an innovative tool for quality assessment and improvement. We describe the method of voluntary peer review and assessed its feasibility by evaluating anonymized peer review reports and analysed the thematic clusters highlighted in these reports. Methods: Retrospective data analysis from 22 anonymous reports of peer reviews. All ICUs – representing over 300 patient beds – had undergone voluntary peer review. Data were retrieved from reports of peers of the review teams and representatives of visited ICUs. Data were analysed with regard to number of topics addressed and results of assessment questionnaires. Reports of strengths, weaknesses, opportunities and threats (SWOT reports) of these ICUs are presented. Results: External assessment of structure, process and outcome indicators revealed high percentages of adherence to predefined quality goals. In the SWOT reports 11 main thematic clusters were identified representative for common ICUs. 58.1% of mentioned topics covered personnel issues, team and communication issues as well as organisation and treatment standards. The most mentioned weaknesses were observed in the issues documentation/reporting, hygiene and ethics. We identified several unique patterns regarding quality in the ICU of which long-term personnel problems und lack of good reporting methods were most interesting Conclusion: Voluntary peer review could be established as a feasible and valuable tool for quality improvement. Peer reports addressed common areas of interest in intensive care medicine in more detail compared to other methods like measurement of quality indicators. PMID:25587245

  11. Ethical Issues in Surgical Critical Care: The Complexity of Interpersonal Relationships in the Surgical Intensive Care Unit.

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    Sur, Malini D; Angelos, Peter

    2016-08-01

    A major challenge in the era of shared medical decision making is the navigation of complex relationships between the physicians, patients, and surrogates who guide treatment plans for critically ill patients. This review of ethical issues in adult surgical critical care explores factors influencing interactions among the characters most prominently involved in health care decisions in the surgical intensive care unit: the patient, the surrogate, the surgeon, and the intensivist. Ethical tensions in the surgeon-patient relationship in the elective setting may arise from the preoperative surgical covenant and the development of surgical complications. Unlike that of the surgeon, the intensivist's relationship with the individual patient must be balanced with the need to serve other acutely ill patients. Due to their unique perspectives, surgeons and intensivists may disagree about decisions to pursue life-sustaining therapies for critically ill postoperative patients. Finally, although surrogates are asked to make decisions for patients on the basis of the substituted judgment or best interest standards, these models may underestimate the nuances of postoperative surrogate decision making. Strategies to minimize conflicts regarding treatment decisions are centered on early, honest, and consistent communication between all parties.

  12. A laminar flow unit for the care of critically ill newborn infants

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    Perez JM

    2013-10-01

    Full Text Available Jose MR Perez,1 Sergio G Golombek,2 Carlos Fajardo,3 Augusto Sola41Stella Maris Hospital, International Neurodevelopment Neonatal Center (CINN, Sao Paulo, Brazil; 2M Fareri Children’s Hospital, Westchester Medical Center, New York Medical College, Valhalla, NY, USA; 3University of Calgary, Calgary, Canada; 4St Jude Hospital, Fullerton, California, CA, USAIntroduction: Medical and nursing care of newborns is predicated on the delicate control and balance of several vital parameters. Closed incubators and open radiant warmers are the most widely used devices for the care of neonates in intensive care; however, several well-known limitations of these devises have not been resolved. The use of laminar flow is widely used in many fields of medicine, and may have applications in neonatal care.Objective: To describe the neonatal laminar flow unit, a new equipment we designed for care of ill newborns.Methods: The idea, design, and development of this device was completed in Sao Paulo, Brazil. The unit is an open mobile bed designed with the objective of maintaining the advantages of the incubator and radiant warmer, while overcoming some of their inherent shortcomings; these shortcomings include noise, magnetic fields and acrylic barriers in incubators, and lack of isolation and water loss through skin in radiant warmers. The unit has a pump that aspirates environmental air which is warmed by electrical resistance and decontaminated with High Efficiency Particulate Air Filter (HEPA filters (laminar flow. The flow is directed by an air flow directioner. The unit has an embedded humidifier to increase humidity in the infant’s microenvironment and a servo control mechanism for regulation of skin temperature.Results: The laminar flow unit is open and facilitates access of care providers and family, which is not the case in incubators. It provides warming by convection at an air velocity of 0.45 m/s, much faster than an incubator (0.1 m/s. The system

  13. Free living amoebae in water sources of critical units in a tertiary care hospital in India

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    S Khurana

    2015-01-01

    Full Text Available Background: Isolation of free-living amoebae (FLA is reported sparsely from water taps, ventilators, air conditioners, haemodialysis units and dental irrigation systems of hospitals worldwide. Their prevalence in hospital environment especially in wards having immunocompromised patients may pose a risk to this group of susceptible population as they may cause disease themselves or may carry pathogens inside them. No study from India has performed such surveillance. Objective: To evaluate extent of FLA contamination in water sources of bone marrow transplant (BMT intensive care unit (ICU, transplant ICU, haemodialysis unit and high dependency unit in a tertiary care hospital in India. Materials and Methods: A total of hundred samples including fifty each of tap water samples and swabs from mouth of taps used for drinking, bathing and hand washing purposes in these units were collected according to standard procedure. Samples were inoculated onto non-nutrient agar plates at room temperature followed by morphological confirmation. Molecular identification including polymerase chain reaction (PCR and sequencing was performed in culture positive samples. Results: Four tap water samples and ten swab samples showed growth of trophozoites and cyst formation. Morphologically, four amoebae resembled Acanthamoeba spp. which was further confirmed by PCR and sequencing showed them to be of T3 and T4 genotypes. Conclusion: The presence of these FLA in hospital water sources emphasises the urgent need of implementing effective preventive measures. Further studies are required to estimate the true prevalence of FLA in Indian hospitals by taking larger number of samples.

  14. Theories of Equity in Health Care, Implications for Developed and Developing Countries

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    AR Olyaee Manesh

    2005-10-01

    Full Text Available Objective: This abstract focuses on theoretical background for the notion of “equity in health care” and on the implications of applying these theories to the health care of developed and developing countries. Equity Principals and the Implications: There are different theories about the principle of Equity or Justice such as Altruism, Utilitarians, Marxists, Rawls’ theory and Nazick’s entitlement. Among these theories, some of them are applicable to health care such as Libertarianism and Egalitarianism. The focus of the Libertarians is on the extent to which people are free to purchase the health care that they want. The Libertarians’ principle is the main equity base for private health systems. In contrast, Egalitarians suggest that finance of the health care should be according to the ability to pay and distribution of health care should be according to the need (ill health. It seems that policy makers in most developed countries such as European countries accept the Egalitarians’ principle and application of this equity principle by their health systems has significantly reduced health inequities and inequalities in these countries. There are a limited number of studies to look at equity in the health care of developing countries. A common equity principle for these countries is “equal access for everyone” and different mechanisms are applied to attain this target. Despite the overall improvements in health care in recent years, evidence indicates that many of developing countries have failed to provide equal access to health care for all in need. The financial limitations of the governments, spending about 70% of the health care resources on hospital-based care, unequal access to hospital services in favour of urban population, income inequalities among population, and lack of consistent and up-to-date information of inequalities, make developing countries unable to monitor and prevent inequities and inequalities of health

  15. Inadequate physical activity and health care expenditures in the United States.

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    Carlson, Susan A; Fulton, Janet E; Pratt, Michael; Yang, Zhou; Adams, E Kathleen

    2015-01-01

    This study estimates the percentage of health care expenditures in the non-institutionalized United States (U.S.) adult population associated with levels of physical activity inadequate to meet current guidelines. Leisure-time physical activity data from the National Health Interview Survey (2004-2010) were merged with health care expenditure data from the Medical Expenditure Panel Survey (2006-2011). Health care expenditures for inactive (i.e., no physical activity) and insufficiently active adults (i.e., some physical activity but not enough to meet guidelines) were compared with active adults (i.e., ≥150minutes/week moderate-intensity equivalent activity) using an econometric model. Overall, 11.1% (95% CI: 7.3, 14.9) of aggregate health care expenditures were associated with inadequate physical activity (i.e., inactive and insufficiently active levels). When adults with any reported difficulty walking due to a health problem were excluded, 8.7% (95% CI: 5.2, 12.3) of aggregate health care expenditures were associated with inadequate physical activity. Increasing adults' physical activity to meet guidelines may reduce U.S. health care expenditures.

  16. Women's perceptions of access to prenatal care in the United States: a literature review.

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    Phillippi, Julia C

    2009-01-01

    Women report many barriers to accessing prenatal care. This article reviews the literature from 1990 to the present on women's perceptions of access to prenatal care within the United States. Barriers can be classified into societal, maternal, and structural dimensions. Women may not be motivated to seek care, especially for unintended pregnancies. Societal and maternal reasons cited for poor motivation include a fear of medical procedures or disclosing the pregnancy to others, depression, and a belief that prenatal care is unnecessary. Structural barriers include long wait times, the location and hours of the clinic, language and attitude of the clinic staff and provider, the cost of services, and a lack of child-friendly facilities. Knowledge of women's views of access can help in development of policies to decrease barriers. Structural barriers could be reduced through changes in clinic policy and prenatal care format, and the creation of child-friendly waiting and examination rooms. Maternal and societal barriers can be addressed through community education. A focus in future research on facilitators of access can assist in creating open pathways to perinatal care for all women.

  17. Who pays for health care in the United States? Implications for health system reform.

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    Holahan, J; Zedlewski, S

    1992-01-01

    This paper examines the distribution of health care spending and financing in the United States. We analyze the distribution of employer and employee contributions to health insurance, private nongroup health insurance purchases, out-of-pocket expenses, Medicaid benefits, uncompensated care, tax benefits due to the exemption of employer-paid health benefits, and taxes paid to finance Medicare, Medicaid, and the health benefit tax exclusion. All spending and financing burdens are distributed across the U.S. population using the Urban Institute's TRIM2 microsimulation model. We then examine the distributional effects of the U.S. health care system across income levels, family types, and regions of the country. The results show that health care spending increases with income. Spending for persons in the highest income deciles is about 60% above that of persons in the lowest decile. Nonetheless, the distribution of health care financing is regressive. When direct spending, employer contributions, tax benefits, and tax spending are all considered, the persons in the lowest income deciles devote nearly 20% of cash income to finance health care, compared with about 8% for persons in the highest income decile. We discuss how alternative health system reform approaches are likely to change the distribution of health spending and financing burdens.

  18. Predictors of low prevalence of latent tuberculosis infection among Egyptian health care workers at intensive care and bronchoscopy units

    Science.gov (United States)

    Hefzy, Enas Mamdouh; Wegdan, Ahmed Ashraf; Elhefny, Radwa Ahmed; Nasser, Samar Hassan

    2016-01-01

    Aim: Latent tuberculosis infections (LTBI) contain a significant reservoir for future epidemics. Screening of health care workers (HCWs) in a high-risk tuberculosis (TB) environment is an important strategy in TB control. The study aimed to assess the prevalence of LTBI among high risk Egyptian HCWs and to assess infection associated risk factors. Methods: Fifty-two HCWs who work at intensive care unit (ICU), bronchoscopy unit, and chest diseases department were tested for LTBI using both tuberculin skin test (TST) and Quantiferon TB Gold in-tube test (QFT). Risk factors for infection, knowledge of HCWs towards different aspects of TB infection and agreement between TST and QFT were also evaluated. Results: Prevalence of LTBI in this study was 13.5% by QFT and TST. It was 13.6% by TST alone and 10.3% by QFT alone. There was good concordance between both tests (Kappa=0.713). There was a statistically significant association between prevalence of LTBI and age of staff ≥30 yr (p=0.002), period of working experience (p=0.006) and working at the Bronchoscopy Unit (p=0.001). The total knowledge of HCWs towards different aspects of TB infection was generally good. Conclusion: Although the participants in the current study were among high risk HCWs, the prevalence of LTBI was low. Bacille Calmette-Guerin (BCG) vaccination, young age, short employment duration, good knowledge and a good infection control were the predictors of low risk of contracting TB at our hospitals. The risk of TB infection in resource-limited countries can be reduced with simple continuous educational and administrative infection control programmes. PMID:27777875

  19. Practical measurements of radiation dose in a neonatal intensive care unit

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    Smans, K.; Vanhavere, F.; Bosmans, H.

    2006-07-01

    The EURATOM directive 97/43 and the Belgian Royal Decree of July 20, 2001 impose today the application of the ALARA principle in medical practices. Priority should be given to paediatric examinations, especially for X-ray examinations undertaken in neonatal intensive care units. Within this framework, a dose study was started to assess the patient doses in one neonatal intensive care unit for the most common examinations. Direct measurement of radiation dose was done using highly sensitive thermoluminescent dosemeters (TLDs). The ESD was on average 66 {mu}Gy. Also DAP-measurements were performed. For RX-thorax an average DAP-value of 1,27 cGy.cm{sub w}as calculated. (Author)

  20. Retrospective Study of the Survival of Patients who Underwent Cardiopulmonary Resuscitation in an Intensive Care Unit

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    Moreira Daniel Martins

    2002-01-01

    Full Text Available OBJECTIVE: To evaluate clinical and evolutive characteristics of patients admitted in an intensive care unit after cardiopulmonary resuscitation, identifying prognostic survival factors.METHODS: A retrospective study of 136 patients admitted between 1995 and 1999 to an intensive care unit, evaluating clinical conditions, mechanisms and causes of cardiopulmonary arrest, and their relation to hospital mortality.RESULTS: A 76% mortality rate independent of age and sex was observed. Asystole was the most frequent mechanism of death, and seen in isolation pulmonary arrest was the least frequent. Cardiac failure, need for mechanical ventilation, cirrhosis and previous stroke were clinically significant (p<0.01 death factors.CONCLUSION: Prognostic factors supplement the doctor's decision as to whether or not a patient will benefit from cardiopulmonary resuscitation.